This is the Theme of the Week edition of Bloomberg Opinion Today, a digest of our top commentary published every Sunday. New subscribers to the newsletter can sign up here; follow us on Instagram, TikTok, X, Threads and Facebook. This was the year that Ozempic curiosity turned into Ozempic cash: But there are still so many questions about what the future of obesity medicine will look like. In a special end-of-year video for Bloomberg Opinion, Lisa Jarvis looks at how weight-loss drugs transformed our world this year. Can Ozempic and other drugs help people lose more than 20% of their body weight? Will pharmaceutical innovations push that percentage even higher? Are people going to take these shots forever – and will there be side effects from that? Does losing weight always translate into better health? And, maybe most pressingly for consumers: How can we afford them? But before we get to the answers, let’s look into the booming business. Demand for GLP-1s is so high, people are making what just a year ago would have seemed like fantastical forecasts for obesity drugs. Some analysts even predict weight-loss medication could eventually bring in $100 billion in annual sales. At one point this year, the market cap of Novo Nordisk, which makes Ozempic and Wegovy, was bigger than the GDP of its home country of Denmark. What other players are benefitting from the demand? Well, for starters, Eli Lilly. Weight-loss drugs made it the biggest winner in pharma this year, a conclusion that Lisa came to even before Zepbound was formally approved by the FDA. Even WeightWatchers had to wave the white flag, with CEO Sima Sistani recently admitting they’ve made mistakes in the past: “For decades, we’ve discussed weight and dieting and obesity in terms that isolate people and often demotivate them,” she told NPR’s Juana Summers. Now, the company is trying to “reshape” the conversation around weight and health — while selling obesity drugs. But part of that reshaping comes at the cost of customers. People have increasingly turned to the gray market for these drugs, a dangerous, non-FDA approved alternative that presents many concerns. Pharmacies’ off-brand versions of these weight-loss drugs are sometimes marketed as “generic” Ozempic and Wegovy — a moniker that actually doesn’t exist. Novo Nordisk found compounded versions of Wegovy contained up to 33% impurities, and nearly 20% of individuals had the wrong dosage of the drug. Those are scary percentages, considering customers are desperate to get their hands on the real thing. What’s in store for 2024? We’ll have fresh data on newer twists on this class of drugs that can allow people to shed even more pounds. And pill versions, such as a high-dose version of Novo Nordisk’s Rybelsus, will provide more options for people who are wary of injections. We’ll also learn more about how long people can stay on these drugs, giving us a better idea of how realistic it is to take them for life. That will, in turn, give us a better sense of how much this might actually cost the health care system, as well as how much of an impact they’ll have on all sorts of other industries like food, alcohol, medical devices and more. One of the biggest questions for 2024 is whether and how public and private insurers will cover these drugs. Data this year showing Wegovy can prevent heart attacks and strokes solidifies the case they should. But so far, coverage of these expensive products has been spotty, putting them out of reach for many people. Starting next year, several more state Medicaid programs will cover obesity medicines, and with mounting data of the health benefits of the drugs, private insurers will be offering their own payment strategies. We should start to find out how strict will they be about who they consider eligible for them and what kinds of hoops people might need to jump through to get them. These drugs are so revolutionary that it’s going to take some time to fully understand how they fit into our lives. But the picture should start to fill out a bit in 2024. | 
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