The Ozempic Era

The Question

Will drugs like Ozempic and Wegovy become the default treatment for obesity by 2035 — prescribed routinely, covered by insurance, reaching at least 1 in 10 eligible adults in high-income countries? That is the specific prediction we are making, at 78% confidence. The medical argument is already settled. These drugs work. The question is whether governments, insurers, and health systems will make the political and financial decision to pay for them at the scale the data demands.

The drugs in question are called GLP-1 receptor agonists — they work by mimicking a hormone your gut naturally releases after eating, which tells your brain you're full and slows digestion. Semaglutide (sold as Ozempic for diabetes and Wegovy for obesity) and tirzepatide (Mounjaro, Zepbound) produce weight loss of 15–22% of body weight. To put that in context: that's a result previously only achievable through weight-loss surgery. And beyond the weight loss, a major 2023 clinical trial called SELECT showed that semaglutide reduced heart attacks and strokes by 20% in people with obesity and existing heart disease. These drugs don't just slim you down. They protect your heart.

What the Evidence Shows

The SELECT trial changed the conversation entirely. Before it, Ozempic was a weight-loss drug. After it, it became a cardiovascular drug — one that happens to cause weight loss. That reframing matters enormously for whether insurers will pay. Heart disease is expensive. A drug that cuts heart attacks by 20% in high-risk patients is not a lifestyle luxury. It's a cost-saver.

The evidence keeps expanding. Research is accumulating on benefits for fatty liver disease, sleep apnoea, and kidney disease. Most intriguingly, patients are reporting reduced cravings for alcohol and compulsive behaviours — suggesting these drugs may affect addiction circuits in the brain. That research is early, but it has opened entirely new lines of investigation. Meanwhile, Novo Nordisk — the Danish company that makes semaglutide — briefly became more valuable than Denmark's entire annual economic output. That tells you something about the scale of what they've created.

Why This Is Happening

The price problem is severe. In the United States, Wegovy costs around $1,350 per month at list price. If every eligible American with obesity took it, the annual drug bill would exceed $1 trillion — roughly three and a half times what the US currently spends on all prescription drugs combined. That arithmetic doesn't work. Something has to give: either prices fall dramatically, or access gets rationed, or both.

During shortages in 2023 and 2024, a grey market emerged. Compounding pharmacies — smaller facilities that can legally make their own versions of drugs in short supply — began selling versions of semaglutide at $150–300 per month. That's a fraction of the brand-name cost. The FDA has since tried to restrict this as shortages ease, triggering legal battles. It is a preview of the access war to come.

The clinical concerns are real too. These drugs cause significant muscle loss alongside fat loss — up to 40% of the weight shed may be lean muscle, not fat. That raises long-term concerns, especially in older patients. Nausea and stomach problems affect most users and cause a meaningful minority to stop taking the drug. And here is the uncomfortable truth: stop taking the drug, and most of the weight comes back. This may be a treatment you need for life — which makes the cost question even harder.

What Could Happen

What Can We Do

If you're a patient considering these drugs, the evidence is clear on one thing: they work best alongside exercise, particularly resistance training — lifting weights or doing bodyweight exercises. The drugs suppress appetite broadly, which means patients who don't actively try to eat enough protein risk losing muscle alongside fat. This is not a passive treatment. It needs active participation to deliver its full benefit. Ask your doctor about a structured programme, not just a prescription.

For healthcare systems, the immediate priority is developing clear protocols: who qualifies, how they're monitored, and what support they get alongside the drug. The NHS approved semaglutide for specialist weight management services in 2023, with specific BMI and health criteria — and crucially included requirements for nutritional and exercise support. That's the right model. A drug that causes 20% weight loss without any lifestyle support is a missed opportunity at best and a muscle-wasting risk at worst.

For policymakers, the fastest path to equitable access is accelerating the approval of biosimilar versions — the drug-industry equivalent of generics. The FDA's biosimilar framework already exists. Speeding it up, and restricting GLP-1 prescribing to genuine clinical need rather than cosmetic use, are the two levers that matter most. The Ozempic era is not a problem medicine can solve on its own. It is a test of whether health systems can translate a genuine breakthrough into genuine population health — and whether the political will exists to fund it.