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The Obesity Inflexion Point: How Health Systems Can Fund and Scale AOM Access
Jul 01, 2025
With thanks to Sarah Rickwood and Markus Gores, EMEA Thought Leadership; Angela McFarlane, Strategic Planning Northern Europe; Jatin Sharma, UAE Consulting; and the IQVIA Portugal team.
Key Insight:
With obesity prevalence rising and AOM use still largely self-funded, health systems face a pivotal decision: invest now in scalable, value-based access – or absorb growing long-term costs. This article proposes a phased, data-driven strategy for AOM adoption built on personalised care, prevention, and public-private funding innovation.
The global AOM pipeline is both deep and broad, with total market value potentially reaching over $200 billion by 2030.
Obesity has become the defining health crisis of our time, affecting 2.5 billion people globally, with costs spiralling across health and economic systems. As new anti-obesity medications (AOMs) emerge, health systems face an urgent challenge: how to fund access at scale without bankrupting budgets. Nevertheless, the total economic costs of obesity to the world are projected to rise to $4 trillion by 2035.
The market for anti-obesity medicines (AOMs) is still in its early stages, led by two large biopharmaceutical companies – Eli Lilly and Novo Nordisk. Despite this nascent state, the pipeline is expanding rapidly, signalling a transformative shift in the landscape. There are currently 173 assets in clinical development across more than 70 companies, with a significant portion already in late stage (Phase II/III) trials1. This surge in innovation is mirrored by the explosive growth of the global obesity market, where list price price drug spending reached nearly $30 billion in 2024, with peak estimates of up to $200 billion by 2030, driven by the launch of next-generation AOMs2.
It is not surprising – a growing body of evidence suggests the strong impact of AOMs, not just to mitigate obesity risk, but across a range of cardiovascular-metabolic conditions including diabetes, heart failure, kidney disease, stroke, and metabolic dysfunction-associated steatohepatitis (MASH). These benefits position AOMs as potentially transformative tools in the management of chronic metabolic diseases..
However, the promise of AOMs also presents a significant challenge: cost. With over a billion people globally living with obesity, the financial burden of widespread AOM use could be immense if these therapies were to be publicly reimbursed. Governments and payers face a critical decision whether to recognise obesity as a serious chronic disease and invest in AOMs as a public health intervention. If they do, the long-term value proposition could be compelling, with potential cost offsets and downstream savings to health systems through reduced incidence of obesity-related complications. This is especially relevant given projections that the global cost of overweight and obesity could reach $4 trillion by 2035 (World Obesity Federation)3,and over $18 trillion by 2060 (WHO)4.
However, access currently remains limited. In the UK, considered one of the “front runner” countries with accelerated actions to counteract obesity by the World Health Organization (WHO), over 90% of available AOMs (Mounjaro and Wegovy) were purchased out-of-pocket as of April 20255. This disconnect between clinical promise and real-world access underscores the urgent need for policy innovation to ensure equitable and sustainable adoption of these therapies.
Based on current shifts, we anticipate three key trends that will shape the obesity market in the short to medium term:
- Evolution of more personalised treatment approaches
- Expanding AOM use beyond treatment to prevention of obesity complications
- Development of innovative funding approaches
Understanding these trends provides an opportunity for policymakers, healthcare systems and manufacturers to target the right patients at the right time, prepare robust strategies to enable funding and access, and collect data to deepen nuanced understanding and unlock the full potential of AOMs.
1. Evolution of More Personalised Treatment Approaches: From Sledgehammer to Scalpel
Obesity is no longer viewed as a lifestyle issue, but as a heterogeneous, multi-system chronic disease, intricately linked to numerous other health conditions, including diabetes, chronic kidney disease, heart disease, osteoarthritis, and cancer. With this improved recognition, the trajectory of obesity treatment is shifting toward more granular patient segmentation categorising individuals based on phenotypes, genetic markers, comorbidities, and responsiveness to specific AOMs. This approach will enable more personalised treatment strategies that reflect the true complexity of patient needs. Crucially, better targeting could lead to better outcomes: more sustainable weight loss, lower relapse rates, and greater improvements in obesity-related comorbidities.
While current AOMs are largely prescribed based on Body Mass Index (BMI), the future lies in more precise, needs-based approaches (Figure 1). The Lancet Commission on Obesity has already called for a broader definition of obesity that encompasses indicators of obesity-related organ dysfunction and illness6. This evolution not only supports clinical innovation but also offers a pragmatic path forward for health systems. Stratifying patients by clinical need would allow for phased reimbursement avoiding the financial shock of funding AOMs for all eligible patients at once, and instead aligning payer budgets with value delivered over time. It also lays the groundwork for precision value-based contracts, where clearly defined subgroups enable outcome-based reimbursement models that align incentives across stakeholders. Examples such as Novo Nordisk’s SELECT trial and Lilly’s SURMOUNT-OSA trial demonstrated cardiovascular benefits and significant improvements in obstructive sleep apnoea symptoms in overweight and obese patients. These findings highlight how targeted evidence can support segment-specific access and funding mechanisms.7
2.Expanding AOM Use Beyond Treatment to Prevention of Obesity Complications: Moving the Goalposts
As the evidence base for AOMs continues to grow, it is becoming increasingly clear that their impact extends well beyond weight loss. Clinical trials and real-world studies are starting to show that AOMs can significantly improve a range of obesity-related comorbidities, including diabetes, cardiovascular disease, and chronic kidney disease8. This expanding body of evidence will reshape how we think about the role of AOMs not just as treatments for obesity today, but as tools for preventing chronic disease in the future, and potentially supporting long-term weight management.
The implications of this shift are profound. Chronic conditions linked to obesity are among the costliest and fastest-growing burdens on health systems worldwide. If AOMs can be used earlier in the disease trajectory not just to treat, but to prevent obesity-related complications this could dramatically reduce long-term healthcare costs while improving outcomes for millions of people. Diabetes provides a particularly powerful example: the SURMOUNT-1 trial with tirzepatide showed a 94% reduction in risk of progression from prediabetes to type 2 diabetes over three years in people with obesity9. Ongoing real-world studies are now validating this preventative effect, which will be critical to broader adoption.
Certain populations may benefit even more from early, targeted interventions. For example, South and East Asian individuals are at higher risk of developing type 2 diabetes at lower BMI thresholds10,11. In these groups, early access to AOMs combined with lifestyle interventions and digital support could unlock powerful prevention strategies and improve health outcomes at scale.
To fully realise this potential, robust evidence generation will be essential. But waiting for long-term data before expanding access could delay benefits for patients and health systems alike. This is where value-based contracts (VBCs) can play a transformative role. By tying reimbursement to real-world outcomes, VBCs allow stakeholders to share risk and accelerate access enabling earlier use of AOMs while continuing to build the evidence base.. Early examples, such as the 2024 partnership between Abu Dhabi’s Department of Health, Eli Lilly Suisse SA, and the World Obesity Federation, show how public-private collaboration can drive forward both prevention and policy innovation12. One of their key goals: quantifying the direct and indirect economic burden of obesity to inform smarter, more sustainable investment in care.
3. Development of Innovative Funding Approaches: Bridging the Public Funding Gap
While the clinical benefits of AOMs are increasingly well established, access remains deeply unequal, with those most affected by obesity often the least able to afford treatment. Socioeconomically disadvantaged groups are disproportionately impacted by obesity and its related diseases.Numerous studies have consistently shown a strong link between lower socioeconomic status and higher obesity risk, highlighting a troubling mismatch between need and access. To deepen understanding of this relationship, IQVIA is conducting a study in Portugal to explore how socioeconomic and demographic factors influence obesity prevalence. By identifying how demographic and economic factors influence obesity prevalence, the study aims to inform more equitable access strategies.
To date, access to AOMs has been largely driven by private funding. This is partially due to concerns about the budget impact of widespread public reimbursement, but also reflects an unprecedented willingness among individuals to pay out-of-pocket for these therapies. The UK government, in partnership with Eli Lilly, has proposed a 12-year tirzepatide roll-out strategy13, yet this does not come close to meeting the needs of the obese population; in fact, IQVIA data highlights that as of April 2025, approximately 1.4 million Britons purchased AOMs (Mounjaro and Wegovy) on prescription but out-of-pocket5 (See Figure 2).
This status quo, however, is not sustainable. Policymakers will need to step in trading short-term budget concerns for long-term health and economic gains. Recognising obesity as a public health priority and a moral imperative is essential. While challenging, such bold policy action is not without precedent. For example, the UK government created the Cancer Drugs Fund (CDF) as a ring-fenced mechanism to accelerate access to oncology medicines. A similar approach could be applied to obesity, through the creation of a centralised Obesity Drugs Fund (“Obesity–CVD Metabolic Medicines Fund”) to support equitable access to AOMs.
Of course, funding such a mechanism presents its own challenges. One innovative solution could be a hypothecated tax on foods high in fat, salt, and sugar (HFSS). This would serve a dual purpose: discouraging unhealthy consumption while generating revenue to fund obesity treatment and prevention. Colombia’s implementation of taxes on ultra-processed foods offers a real-world example of how fiscal policy can support public health goals15. Revenues from such measures could be reinvested in public awareness campaigns and used to finance the Obesity Drugs Fund creating a virtuous cycle of prevention, treatment, and sustainable funding (Figure 3).
Call to action:
The rapid emergence of anti-obesity medications (AOMs) represents a defining moment in the evolution of obesity care. These therapies offer more than weight loss they present a path to preventing high-cost comorbidities, improving long-term population health, and easing the chronic burden placed on overstretched healthcare systems. But realising this potential is not guaranteed. It will require bold, coordinated action across the healthcare and policy ecosystem.
Payers and policymakers must move beyond reactive, short-term budgetary thinking and begin laying the groundwork for scalable and sustainable access. This means piloting innovative reimbursement models, embracing phased rollouts informed by clinical need, and exploring new funding mechanisms such as hypothecated taxes on unhealthy foods to secure long-term financing. It will also mean developing scalable solutions for diagnosis, delivery, and support required for the effective use of AOMs, thereby freeing up resources and healthcare professional time in the process.
Manufacturers must complement robust clinical evidence with real-world data that supports value-based access and informs segmentation strategies. They also have a critical role to play in co-developing outcomes-based contracts, and fostering the public–private partnerships needed to accelerate adoption.
Healthcare systems and clinicians must continue to reframe obesity as the complex, chronic disease it is embedding AOMs within integrated care models that combine lifestyle intervention, digital support, and medical treatment. And across the board, equity must remain a central concern. Without public investment, access will continue to be dictated by the ability to pay, exacerbating the socioeconomic gradient of obesity and undermining public health goals.
A phased approach to AOM adoption grounded in personalised medicine, supported by robust evidence, and underpinned by sustainable financing offers a clear and actionable strategy. The challenge now is not whether to act, but how quickly and decisively we can align stakeholders around a shared vision.
This is a once-in-a-generation opportunity to reshape how we prevent, treat, and fund care for one of the world’s most pressing health challenges. The time for incrementalism has passed. The path forward is bold, collaborative, and imperative.
References
1. Global Trends in R&D 2025; IQVIA Institute: https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/global-trends-in-r-and-d-2025/iqvia-institute-rd-trends-2025-forweb.pdf
2. Outlook for obesity in 2025: more than a transition year; IQVIA blog, January 2025: https://www.iqvia.com/locations/emea/blogs/2025/01/outlook-for-obesity-in-2025-more-than-a-transition-year
3. Economic impact of overweight and obesity to surpass $4 trillion by 2035; World Obesity Federation: https://www.worldobesity.org/news/economic-impact-of-overweight-and-obesity-to-surpass-4-trillion-by-2035
4. Obesity and overweight; World Health Organization: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
5. UK IQVIA Supply Chain Manager (SCM), units, April 2025
6. Clinical Obesity; The Lancet Commission: https://www.thelancet.com/commissions-do/clinical-obesity
7. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes, NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2307563
8. Lifetime Social Returns From Expanding Access to Anti-Obesity Medications; USC Schaeffer Center: https://schaeffer.usc.edu/research/lifetime-social-returns-from-expanding-access-to-anti-obesity-medications/
9. Obesity: Key Pipeline Developments and Clinical Trial Insights; IQVIA: https://www.iqvia.com/-/media/iqvia/pdfs/library/articles/obesity-key-pipeline-developments-and-clinical-trial-insights.pdf
10. Diabetes in South Asians: Uncovering Novel Risk Factors With Longitudinal Epidemiologic Data; Diabetes Care: https://diabetesjournals.org/care/article/47/1/7/154008/Diabetes-in-South-Asians-Uncovering-Novel-Risk
11. Diabetes in Asia: Epidemiology, Risk Factors, and Pathophysiology; JAMA: https://jamanetwork.com/journals/jama/fullarticle/183977
12. DoH Collaborates with Eli Lilly and World Obesity Federation on Obesity Prevention and Management; Department of Health - Abu Dhabi: https://www.doh.gov.ae/en/news/collaboration-with-eli-lilly-and-the-world-obesity-federation-on-obesity-prevention-and-management
13. NICE describes how weight loss drug tirzepatide will be rolled out; National Institute for Health and Care Excellence: https://www.nice.org.uk/news/articles/nice-describes-how-weight-loss-drug-tirzepatide-will-be-rolled-out
14. Colombia’s ultra-processed product taxes; Global Food Research Program: https://www.globalfoodresearchprogram.org/policy/colombias-ultra-processed-product-taxes/