Beyond ozempic: GLP-1s and the next wave of anti-obesity drugs

Nine years ago, Ozempic was launched as a diabetes drug that most people outside of endocrinology circles had never heard of. Today, it’s a cultural reference point – name-dropped in late-night monologues, debated in nutrition circles, and quietly reshaping how the medical fraternity approaches one of the most stubborn health challenges of the modern era.

But Ozempic is just the beginning. The story of GLP-1 receptor agonists is moving fast, and the business behind it is moving faster.

How we got here

GLP-1 or glucagon-like peptide-1 is a hormone that the gut naturally produces in response to eating. It signals the pancreas to release insulin, slows digestion, and crucially, tells the brain that the body has had enough. Scientists have understood its function for decades. What took time was figuring out how to harness it pharmacologically in a way that was both effective and practical for patients.

Semaglutide, the active compound in Ozempic and Wegovy, was the breakthrough that changed the commercial trajectory. Weekly injections. Significant, consistent weight loss in clinical trials. And a tolerability profile that, while not without side effects, was manageable for most patients. The market responded accordingly. Novo Nordisk, the Danish company behind both products, became one of the most valuable companies in Europe almost overnight. Eli Lilly followed closely with tirzepatide – branded as Mounjaro for diabetes and Zepbound for obesity – targeting both GLP-1 and GIP receptors simultaneously and producing weight loss results that raised the clinical bar even further.

The numbers behind this market are staggering. Analysts project that the global obesity drug market, currently valued in the tens of billions, could exceed $150 billion annually within the next decade. In India, the opportunity is equally significant. According to various estimates, over 135 million Indians are overweight or obese, with a rising incidence in urban populations driven by sedentary lifestyles and dietary shifts. Despite this, access to clinically effective obesity treatments remains limited, pointing to a large untapped market as awareness and affordability improve. That kind of projection doesn’t just attract pharmaceutical giants. It pulls in biotech startups, venture capital, and research institutions, all looking for the next compound that can do what semaglutide did, but better.

The next generation is already in development

The pipeline beyond current GLP-1 drugs is genuinely exciting from a scientific standpoint. Triple agonists – compounds that target GLP-1, GIP, and glucagon receptors simultaneously are showing early-stage results suggesting even greater metabolic impact than anything currently approved. Retatrutide, one of the candidates furthest along in this category, produced weight loss figures in phase two trials that surprised even researchers familiar with the space while simultaneously improving muscle mass, which has long been considered a major side effect of semaglutide.

Oral formulations are another frontier drawing significant investment. Current GLP-1 drugs require injection, which limits patient access and compliance. Oral semaglutide already exists for diabetes management, but achieving effective absorption at doses sufficient for meaningful weight loss has been a formidable pharmaceutical engineering challenge. Several companies are working on novel delivery mechanisms like lipid nanoparticles, enteric coatings, and absorption enhancers that could eventually make weekly injections optional rather than necessary.

There’s also serious research interest in combining GLP-1 mechanisms with muscle-preservation compounds. One of the consistent criticisms of current GLP-1 therapies, which is also backed by real clinical data, is that a significant portion of weight lost during treatment comes from lean mass rather than fat alone. For long-term metabolic health, that’s a problem. Next-generation formulations pairing GLP-1 activity with agents that stimulate muscle protein synthesis could address this directly, producing fat loss without the muscle depletion that currently requires patients to work hard around with diet and exercise.

The access problem the industry can’t ignore

For all the clinical promise, the business of GLP-1s has an uncomfortable underbelly: these drugs are expensive, and the gap between who needs them and who can access them is wide.

Monthly costs for branded GLP-1 medications in markets without broad insurance coverage run into hundreds, sometimes over a thousand dollars. In India, GLP-1 therapies typically cost in the range of ₹10,000 to ₹25,000 per month, making them inaccessible for a large portion of the population. Insurance coverage for obesity treatment is also largely absent, meaning patients bear the full cost out-of-pocket. This creates a significant barrier in a country with a rapidly growing obesity burden.

The longer-term solution lies in generic and biosimilar development, which is already underway in India. With the patent having already expired in March, the Indian market has witnessed the launch of multiple domestic versions, with various brands already entering the space. This influx is expected to intensify in the coming months, driving greater price competitiveness and significantly improving accessibility for a wider consumer base. The companies that figure out how to sustainably reduce cost-of-access without eroding clinical quality will define the next chapter of this market, particularly across emerging economies where obesity rates are rising sharply but purchasing power for premium therapeutics is limited.

What this means for healthcare

The broader implication of effective obesity pharmacotherapy is only beginning to be understood. GLP-1 drugs are showing signals of some benefits in formal trials, others are observational of benefits that extend well beyond weight: reduced cardiovascular events, potential impact on sleep apnea, early data on neurological conditions, and reduced joint loading that could delay orthopedic interventions.

If even a fraction of those signals hold up at scale, the downstream impact on healthcare systems in reduced comorbidity burden, fewer hospitalisations, and lower long-term treatment costs could be enormous.

The business of GLP-1s is booming right now. The science of what these compounds might ultimately be capable of is still being written. And the gap between what’s available today and what’s coming in the next five to ten years is wider and more interesting than most people realise.