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In 2025, we witnessed simply how dynamic the load loss market might be within the period of GLP-1s. Whereas Ozempic and Wegovy from NovoNordisk dominated in 2023 and 2024, 2025 was dominated by the rise and fall of compounding pharmacies, pricing strain, and rise of Eli Lilly’s Mounjaro and Zepbound, erasing NovoNordisk’s market cap positive aspects over the earlier two years. In 2026, the dialog will shift once more and can focus on three questions that can form the following decade within the weight reduction market.
How will entry to weight problems remedy increase with out breaking the financial institution?
In 2025, insurers and employers felt the ache of excessive prices of masking medicines for weight problems, with spending leaping greater than 500% since 2018. Many restricted protection considerably or denied all of it collectively. Blue Cross Blue Defend of Massachusetts ended protection, citing that if that they had not, they have been as a result of spend near $1 billion {dollars} on these medicines in 2026. Others are requiring stricter prior authorization, step remedy that prioritizes inexpensive medicines first, and cost-sharing with sufferers.
Clearly, this isn’t sustainable. Whereas TrumpRx guarantees to supply some reduction, the value of lifelong remedy continues to be prohibitive. In 2026, I predict we are going to see the rise of latest approaches that can couple GLP-1s to intensive life-style modification to make sure extra sturdy well being advantages even when the GLP-1 is discontinued or used at decrease, extra inexpensive doses and extra restrictive standards for who ought to obtain GLP-1s, centered on sufferers with extreme weight problems and people with important co-morbidities. These modifications might restrict entry within the short-term however create a extra sustainable atmosphere for protection to slowly increase within the decade to come back.
How will new entrants differentiate themselves from incumbents?
There are over 150 clinical-stage property within the weight problems area. They span a number of completely different mechanisms of motion, however as NovoNordisk’s expertise with CagriSema confirmed — the place a 22.7% weight reduction after 68 weeks was considered as an abject failure — the competitors on headline weight reduction quantity will probably be fierce. Many firms will really feel the strain to extend dosing to push weight reduction increased, however there’s agency precedent that doing so runs the danger of considerably rising opposed occasions.
I predict that firms struggling to distinguish themselves will flip to partnership as an answer. By combining their therapies with different options — medical units, digital therapeutics, or different medicine — they’ll doubtlessly unlock synergies at decrease dosing, main to higher affected person outcomes, extra inexpensive remedy, and a viable asset for commercialization. This might have a profound influence on how new medicine are commercialized within the subsequent decade.
What’s the actual sturdiness of remedy?
One space that has plagued GLP-1s is the poor real-world outcomes compared to scientific trials. Whereas most scientific trials report weight reduction within the vary of 15-20% of complete physique weight, real-world outcomes are sometimes nearer to 10%. That is partly pushed by poor adherence: 65% of sufferers cease GLP-1s throughout the first 12 months, with negative effects being the #1 cause for discontinuation.
That is partly because of the poor follow-up most sufferers on GLP-1s obtain. Weight problems care is a group sport and requires that sufferers work hand-in-hand with a doctor and their workers to make use of the medicines safely, pair them with applicable life-style modification, and guarantee success over the long-term. Sadly, there are merely not sufficient people for the sort of care to be offered at scale.
I predict that this can drive two important shifts within the weight problems market. First, medicine with fewer negative effects and higher tolerability — or medicine used at decrease doses together with different therapies — will flourish. These choices will by definition require much less complete assist and will have higher long-term sturdiness. Second, AI-powered options will emerge that can unburden suppliers from the time-intensive necessities of weight problems care. In some sense, this software was tailor-built for AI: with large quantities of information on tips on how to optimize weight reduction, reduce negative effects, and correctly escalate dosing, AI-powered options ought to have the ability to triage a affected person’s primary issues, leaving the people on the physician’s workplace the time to work on extra advanced points.
In 2026, the load loss market is at yet one more inflection level. The euphoria of the previous three years is now confronting the realities of how weight problems medicines will scale to deal with an epidemic that impacts over 1 billion individuals globally. I consider it’s clear that this isn’t a winner-takes-all market, that there will probably be a number of entrants sooner or later who will stake their declare to part of the pie, and that firms which can be intelligent about entry, partnership, and sturdiness will face up to the check of time.
Photograph: Natali_Mis, Getty Photographs
Dr. Shantanu Gaur is the Founder and CEO of Allurion, an organization pioneering metabolically wholesome weight reduction options. Dr. Gaur is an inventor on over 40 patents and has authored a number of peer-reviewed articles within the weight problems area. He graduated summa cum laude from Harvard School and with an M.D. from Harvard Medical College, the place he based Allurion.
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