By 2035, obesity health policy, at the funding level, could evolve across a range of scenarios (Figure 1). In the most optimistic scenario, OMs achieve population-scale impact alongside public health measures which include public funding of OMs at scale for those that cannot afford to self-fund, helping obesity rates plateau and begin to decline in high-income countries and beyond into middle and lower income countries¹. Supported by growing real-world evidence demonstrating benefits beyond weight loss, policymakers under this scenario increasingly view obesity management as a long-term investment rather than a healthcare expense. As costs fall following semaglutide loss of exclusivity, access expands through a combination of public reimbursement, employer-sponsored programmes, private insurance and self-funded channels enabled by expanded telehealth and e-pharmacy services. A potential example is Canada, a high income country with a publicly funded health system where, unusually, lower cost generic semaglutide, will be available in 2026, and could strengthen the economic case for public funding of obesity treatment. By 2035, reduced drug costs may enable broader coverage, expanding access beyond the self-funded market.

At the other end of the spectrum, policy and evidence barriers prove harder to overcome. While OMs continue to deliver meaningful weight loss for individuals, real-world studies fail to demonstrate the broader health, economic and healthcare system benefits needed to drive large-scale policy change. Obesity continues to rise among populations with poor adherence, and unequal access across HICs and LMICs limits population-level impact. As a result, public reimbursement remains limited, with self-funding continuing as the dominant access model despite loss of exclusivity. Market growth is driven primarily by consumer demand, while expanding online consultation and dispensing services become increasingly important routes to access. The reality of future obesity country policy maturity is likely to lie somewhere between these two scenarios, with countries and progressing at different rates.

Commercial and pipeline: from single assets to obesity portfolios

By 2035, the obesity market will look very different from the GLP-1-led market of today. Competition is likely to extend beyond individual products, with success increasingly determined by portfolio breadth and management of the individual across a potentially lifelong journey, as well as therapeutic differentiation. As illustrated in Figure 2, most companies are moving from single assets towards diversified obesity portfolios spanning multiple mechanisms of action. While incretins remain dominant, amylin-based therapies and further novel mechanisms are becoming increasingly prominent across the pipeline. This reflects a growing recognition that obesity management will require more than weight loss alone. Future treatment paradigms may centre on an incretin-based backbone for weight loss, complemented by therapies targeting weight maintenance, muscle preservation, MASH, cardiovascular risk and other comorbidities. Recent developments such as Eli Lilly's brenipatide programme, a Phase III dual GIP/GLP-1 agonist being investigated across a range of neurological and addiction-related conditions, highlights the growing expansion of GLP-based innovation beyond traditional weight management³. Competitive advantage may therefore depend less on a single breakthrough therapy and more on the ability to build a differentiated portfolio of complementary pharmacotherapies.

Alongside this evolution, Chinese companies are emerging as an increasingly important source of obesity innovation. Figure 2 also highlights the growing contribution of Chinese companies to late-stage obesity innovation. Over 47% of Phase III obesity assets are currently being developed by Chinese-headquartered companies, while OMs such as mazdutide and ecnoglutide have the potential to expand beyond their domestic market over the next decade. By 2035, multinational pharmaceutical companies may increasingly look to China as a source of differentiated obesity assets, fuelling a new wave of licensing agreements, co-development partnerships and acquisitions.

Consumerisation: reshaping the obesity patient journey

Managing obesity in 2035 will be increasingly “consumerised”, meaning heavily influenced by patient choices, whilst still most likely a prescription only market for Obesity medicines themselves. It will be driven by evolving patient narratives, the growth of direct-to-patient (DTP) care models, expanding use of digital health technologies and greater awareness of the environmental impact of OM delivery systems (Figure 3).

As access expands beyond specialist clinics and primary care, patients are likely to engage with OMs through integrated digital tools that combine diagnosis, AI enabled-prescribing, coaching and long-term monitoring. While DTP advertising is already established in certain countries, a broader shift towards DTP service models is emerging through initiatives such as Eli Lilly’s LillyDirect in the US and UK, with the latter involving digital health partners. Over the next decade, these models could become a mainstream route to treatment, particularly in markets where reimbursement remains limited and self-funding continues to account for a significant proportion of demand.

Patient expectations of OMs are also likely to evolve, moving beyond rapid weight loss towards long-term weight maintenance, metabolic health and comorbidity prevention. As highlighted in a previous IQVIA blog⁴, the quality of weight loss is increasingly being recognised as an important consideration alongside the quantity of weight lost. A growing pipeline of pharmacotherapies designed to preserve lean muscle mass is already in development and could enter the market by 2035. As evidence continues to build, body composition optimisation may become an increasingly important treatment goal alongside reductions in body weight. Non-pharmacotherapeutic solutions have already established significant markets in response to these evolving needs - for example, Nestlé is developing nutrition products for GLP-1 users that support muscle preservation and overall nutritional health⁵. More broadly, as explored in previous IQVIA blogs, OMs are reshaping consumer health behaviours and driving innovation across areas such as personalised nutrition, dietary supplements and nutricosmetics that support evolving wellness and body composition goals^6,7.

Recent developments including Eli Lilly’s equity investment in Oura and LillyDirect's collaboration with the company highlight how obesity management is expanding beyond medication alone^8,9. By combining access to GLP-1 therapies with wearable technology that tracks metrics such as sleep, activity and recovery, these models seek to provide more personalised support and a broader view of health outcomes beyond weight loss. This reflects a wider shift towards integrated obesity care which combines medication, digital health tools and online coaching to improve engagement and long-term outcomes.

Diagnostics: moving towards personalised obesity care