I was on this panel re: obesity drugs (GLP 1 Receptor Agonists) and the Future of Health, Economies and Food Systems.
These are notes from the panel, and you can listen on YouTube above.
I remain cautiously positive, some other panellists are more wary of the challenges.
Summary Notes
Moderator (Bernice Lee, Chatham House) opens: topic is GLP-1–based weight-loss drugs (“fat jabs”) and their spillovers across health, food systems, environment, and policy.
Panel:
Ben Yeoh (Investor; sustainability/healthcare focus)
Archie (Bramble; food-system transition advisor/investor)
Prof. Jean Adams (Cambridge; diet & public health, food environments/policy)
Associate Prof. Demetrios (Oxford; diet/obesity clinical trials & behavior)
Stephanie (Oxford Sustainable Finance Group; environmental implications)
Ben Yeoh — GLP-1s: history, scale, mechanisms, and market arc
Background & timeline
GLP-1 physiology taught in the 1990s; first GLP-1 agonist (exenatide/Byetta) launched ~2005 (origin story: Gila monster saliva).
Multiple drug generations since; now used beyond diabetes into obesity.
Efficacy & mechanisms
Typical 15–25% weight loss; signals of benefits in fatty liver, CKD, sleep apnea, possible effects in addiction.
Proposes three pathways: anti-weight, anti-inflammatory, anti-diabetic, explaining wide clinical effects.
Total addressable market (TAM) & adoption analogy
Potential ≥1 billion candidates when combining obesity, diabetes, sleep apnea, CKD, etc.
Long-run investor base case analogized to statins: 250–300M global users; could be higher, but timing uncertain (20–50 years).
Patent & pricing dynamics
Current wave still branded; semaglutide (“sema”) going generic earlier in some markets (Canada/Brazil 2026; UK ~2031 expected). Generics + oral GLP-1s likely expand access, cut cost, support maintenance.
Maintenance & oral debate
Key unknown: life-long injections vs. oral maintenance; lapses → weight regain; orals might improve adherence.
Health economics
UK direct obesity cost ~£10–11B, total economic ~£100–120B (productivity, benefits). US estimates “hundreds of billions” to > $1T.
Observed sector ripples (early signals)
Calorie reductions, portion/mix shifts; modest declines in orthopedic procedures (hip/knee) possibly from lower body weight.
Anticipates spillovers to restaurants, agriculture, labor/productivity, healthcare budgets, and climate implications via dietary shifts.
Near-term take: big upside potential with many caveats; expect first- and second-order surprises.
Archie — Food-system & corporate lens
Four macro drivers at a tipping point
Appetite suppression (GLP-1s)
Nutrition science & ultra-processed foods (UPFs) — mechanisms still unclear; policy lagging pending causal clarity
AI across food value chain
Policy & regulation — UK/US momentum toward prevention, NHS 10-year plan, Government Food Strategy
Scale of the problem
Updated UK estimate: ~£126B/year total cost of overweight/obesity (puts “£22B fiscal hole” in context).
Corporate reaction
Boardrooms caught off guard; GLP-1s now a top-table topic. Seeking help on demand trajectories and category impacts.
Adoption data (UK)
~1.5M users; ~200k via NHS, ~1.3M private (~£150/month). Faster uptake than statins/antidepressants at a comparable stage.
Cautions against simple UK→US extrapolation (market structures differ).
Pipeline & formats
3 obesity drugs on market; ~150 in pipeline; oral formulations expected to lower cost and widen access.
Early retail signals
5–8% reduction in calories/grocery spend across most categories; larger declines in calorie-dense/“unhealthy”; modest rise in protein/nutrient-dense items.
Innovation & M&A
Expect rapid reformulation, GLP-1–adjacent product lines (e.g., Nestlé), and long-term industry consolidation.
Hype cycle
Likely near peak hype; future narratives may pivot beyond appetite suppression to cardio/neuro/metabolic endpoints (e.g., Alzheimer’s, cancer risk, CVD), potentially expanding eligible populations.
Prof. Jean Adams — Prevention, equity, stigma, and food environments
Research focus: how environments (digital, social, fiscal, physical) shape diet; evaluates policy interventions.
What works (small but additive effects)
Soda taxes, checkout junk removal, ad restrictions, takeaway zoning near schools, menu labeling (calorie labels showed no consumption change in UK).
Affordability, availability, marketing placement strongly influence choices; UPFs are cheaper and more prevalent in less affluent areas.
GLP-1 concerns
Access & equity: heavily private-pay → income-linked inequalities domestically; global access questions.
Stigma paradox: stigma both for higher weight and for needing medication; risks reinforcing shame narratives.
Prevention distraction: potent treatment may pull focus/funding from environmental prevention; NHS 2-year cap plus post-cessation regain drops patients back into obesogenic environments.
Opportunity
As “food noise” drops on GLP-1s, public may better see environmental drivers, potentially increasing political support for stronger food-environment regulation.
Assoc. Prof. Demetrios — Trials vs. real world; adherence; population effects
Efficacy
Newer agents approach weight-loss surgery magnitudes for some; very strong trial outcomes.
Real-world adherence gap
~70% discontinue within 1–2 years (side effects, achieving target weight, cost).
Systematic review: after stopping, most regain to baseline within ~18 months; cardio-metabolic benefits wane.
Calorie mechanics
On-drug reduction ~500 kcal/day; after cessation, intake rises back toward baseline → population-level calorie impact may net modest if use is transient.
Behavioral support matters
GLP-1 plus dietitian/coach yields greater weight loss than drug alone (e.g., ~10% → ~15%).
Uptake willingness
~50% would try; drops to ~14% when informed about regain after stopping.
Equity
Private-access users are typically better system navigators → disproportionate benefit away from those most in need.
Side effects (most common)
Nausea/vomiting in <10%; generally tolerable; discontinuation for a minority.
Stephanie — Environmental implications: calories vs. composition, and policy
Evidence base: early and sparse; avoid overclaiming.
Two channels
Absolute calorie reduction — could lower land/water/N pollution if agriculture actually contracts or shifts (not guaranteed; farmers might switch to biofuels, fiber crops, etc.).
Dietary composition shift — early signals: UPF down, protein up (dairy/poultry/lean protein); GHG benefits hinge on reducing ruminant meat (beef), which current data do not show strongly.
Trade-offs
Poultry/dairy up could increase nitrogen pollution and land for feed; net GHG effect unclear without beef decline.
Policy dependency
Environmental gains require complementary policy: land-use changes, guardrails against spillovers into other high-impact outputs, and incentives aligned with healthier patterns.
Political economy
If GLP-1s lower “food noise,” they may open political space for stronger food/environment policy.
Panel cross-talk — Risks, opportunities, and “nudge stacks”
Caveats acknowledged: social determinants, maintenance uncertainty, supply constraints, stigma, equity.
Positive feedback loops: some maintain losses and unlock activity habits (e.g., walking a dog), creating behavioral flywheels; question is how to nudge more of these.
Demand shock as lever: falling UPF/snack demand pressures suppliers to reformulate; investors will financehealthier innovation if consumer signals persist.
Cultural variance: shifts will differ by culture; early US data show declines in alcohol, sugary drinks; protein mix direction unclear.
Spending: baskets down ~5–10% in value; savings not yet reallocated back to higher-quality food at scale — marketing could redirect.
Audience Q&A highlights
Climate change → health feedbacks
Likely interactions (worsening chronic disease burden → higher pharma use) but causality is hard to untangle; bottlenecks shift to policy, culture, access.
Protein trajectories & farming models (investor/FAIR)
Early signals: protein up modestly; dairy up (e.g., cottage cheese); animal vs. plant split uncertain.
Risk of intensification (cheap meat) unless consumer spend shifts to higher-value systems; “extensive” systems aren’t automatically greener.
Exercise & environmental impact (student)
GLP-1 users generally aren’t moving to athlete-level intakes; environment research focuses on what foodrather than how many calories, to avoid ethically fraught “blame the eater” framing.
Public-sector prevention levers (EIF)
Soda taxes (~10% tax → ~10% consumption drop), expand beyond sugar to fat/salt;
Marketing restrictions (TV/online ad curbs; sports sponsorship; price promos; checkout placement);
Front-of-pack warnings (Latin-style octagons; no kid-targeted mascots);
Outlet zoning (e.g., fast-food buffers near schools).
Political economy is the constraint; environmental redesign beats education-only.
Side effects details
Mostly GI (nausea/vomiting); acute rather than chronic; decades of diabetes use without red flags akin to withdrawn CB-modulators. All meds carry small risks (cf. statins).
Investment/innovation angles surfaced
Not another “rapid grocery delivery” bubble; current capital still disciplined.
Near-term themes
GLP-1–aligned product innovation (reformulated, higher-protein, nutrient-dense lines);
Personalized nutrition via AI/LLMs, democratized guidance at low cost;
Remote monitoring + clinician coaching to augment drug efficacy and maintenance;
Employer benefits/insurance linking obesity management to productivity;
Pipeline breadth: next-gen GLP-1s & combos with 30%+ weight-loss for a subset; potential expansion into neuro/cardiometabolic indications.
Closing notes & tone
Consensus: GLP-1s are a powerful treatment, not a panacea.
Big risks: equity, stigma, maintenance/relapse, policy distraction away from prevention.
Big opportunities: stack environmental nudges + pharma + AI coaching + policy to convert a temporary demand shock into systemic diet and health gains.
Outlook: cautious optimism; expect surprises, so build policy/market flexibility rather than betting on one silver bullet.