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How Weight-Loss Drugs Could Impact U.S. Health Care and Food. Plus, the Biggest Problems With GLP1s.

Today’s episode is our second in a series on the weight-loss drug revolution of the last two years

Weight Loss Drugs As US Prescriptions Skyrocket


Today’s episode is our second in a series on the weight-loss drug revolution of the last two years.

On Tuesday, we talked to endocrinologist Beverly Tchang about the science of glucagon, like peptide 1 receptor agonists—also known as GLP1s, also known as Ozempic, Wegovy, Moujargo, and Zepbound. If you haven’t listened to that show, I think you’ll feel safe and entertained within the bounds of this episode. But if you want to know more about how these drugs work, their effect on insulin and glucose and the brain’s reward center, or the questions they raise about obesity and the nature of willpower and free will, I’d encourage you to queue up that show. Today, in Part 2, we have two guests: Zach Reitano is the CEO and cofounder of the telehealth platform Ro. He is here for a couple of reasons. He has a bird’s-eye view of the GLP1 marketplace, the rise in demand, the supply chain, the economics of pricing, and insurance. He’s also written several revelatory essays, pulling in research from think tanks, medical experts, and investment banks, that have helped shape my understanding of these drugs and the effect they could have on the population and the economy. Our second guest is Dr. Robert Lustig, an endocrinologist who spent years as a pediatrician and researcher at the University of California–San Francisco. As you’ll hear, he is much less optimistic about the ability of these drugs to revolutionize obesity medication in America.

If you have questions, observations, or ideas for future episodes, email us at PlainEnglish@Spotify.com.


In the following excerpt, Derek talks about the implications of the weight-loss drug revolution in the United States.

Derek Thompson: Today’s episode is the second in our series on the weight-loss drug revolution of the last few years. On Tuesday, we talked to the endocrinologist Beverly Tchang about the science of glucagon-like peptide-1 receptor agonists, also known as GLP-1s, also more commonly known as Ozempic, or Wegovy, or Mounjaro, or Zepbound. If you have not listened to that show, I think you’ll still feel safe and entertained within the bounds of this episode. But if you want to know more about how these drugs work, their effect on insulin and glucose and the brain’s reward center, or the questions they raise about obesity and the nature of willpower, I strongly encourage you to queue up that show.

Today, in Part 2, we have two guests. First, Zach Reitano is the CEO and cofounder of the telehealth platform Ro. He’s here for a few reasons. First, he has a bird’s-eye view of the GLP-1 marketplace, the rise in demand, the supply chain, the economics of pricing, and insurance. He’s also written several revelatory essays, pulling in research from think tanks and medical experts and investment banks, that have done a lot to shape my understanding of these drugs and the effect they could have on the population and the economy.

Our second guest is Robert Lustig. Dr. Lustig is an endocrinologist who spent years as a pediatrician and researcher at the University of California–San Francisco. And as you’ll hear, he’s going to offer a kind of counterpoint to my optimism. He’s much less certain that these drugs will revolutionize obesity medication in America, and it’s my view that, even as optimistic as I am that they will, the only way to be optimistic is to be an educated optimist. Otherwise, I’m just being willfully ignorant. So we’re going to hear out Dr. Lustig’s case against the biggest possible impact of the GLP-1 drugs, even as he reserves some faith that they will play a major role for people who are obese.

So first, in this episode, to level set our understanding of the GLP-1 market, I want to say a few words about the market size for these drugs. It is estimated by Morgan Stanley that about 5 million people in the U.S. are taking GLP-1 drugs, these weight-loss drugs. Four million are taking them for type 2 diabetes, and about 1 million are taking them for weight loss. Now, that’s not huge, you could say, but here is one way to think about how big this market could get if patients decide—if, I want to be clear—if patients decide that these drugs are worth sticking with.

In the 1980s, 40 years ago, roughly 10 percent of people diagnosed with high blood pressure took medication for high blood pressure. But then over the last half century, with advancements in ACE inhibitors and other medications, that figure has soared. Today, tens of millions of Americans are on blood pressure medication, and it has dramatically contributed to a decline in cardiovascular deaths.

If GLP-1s follow a similar trajectory, the number of Americans on these drugs could easily triple in the next decade. And the implications for health are one thing. Lower obesity would clearly reduce a host of chronic diseases and pains. But what about other industries? What about the effect on food?

Morgan Stanley research and survey data suggests that patients on GLP-1 drugs reduce calorie intake by 20 to 30 percent, and that’s not an even 20 percent cut across all food categories. Candy, sugary drinks, and cookie consumption for patients on GLP-1s declines by 60 percentå. Alcohol consumption plunges.

So if you work in packaged food and beverage, or in restaurants, or in grocery stores, and you believe that a high share of your clientele is likely to go on and stay on these drugs in the next decade, these drugs, which are likely, essentially, an anti-snacking drug, how does that change your menu, your supply chain, your acquisition strategy?

We can’t answer every single GLP-1 implication today; the ripples are too wide. But these are the sort of questions that I’m interested in. And then, because I like having my optimism checked from time to time, these are the sort of predictions I’m excited to have interrogated by Dr. Lustig. I’m Derek Thompson. This is Plain English.

This excerpt was edited for clarity. Listen to the rest of the episode here and follow the Plain English feed on Spotify.

Host: Derek Thompson
Guests: Zach Reitano & Robert Lustig
Producer: Devon Baroldi

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