The Weight Loss Market in 2026: 3 Questions That Will Shape the Next Decade

In 2025, we witnessed just how dynamic the weight loss market can be in the era of GLP-1s. While Ozempic and Wegovy from NovoNordisk dominated in 2023 and 2024, 2025 was dominated by the rise and fall of compounding pharmacies, pricing pressure, and rise of Eli Lilly’s Mounjaro and Zepbound, erasing NovoNordisk’s market cap gains over the previous two years. In 2026, the conversation will shift again and will center around three questions that will shape the next decade in the weight loss market.

How will access to obesity therapy expand without breaking the bank?

In 2025, insurers and employers felt the pain of high costs of covering medications for obesity, with spending jumping more than 500% since 2018. Many restricted coverage significantly or denied it all together. Blue Cross Blue Shield of Massachusetts ended coverage, citing that if they had not, they were due to spend close to $1 billion dollars on these medications in 2026. Others are requiring stricter prior authorization, step therapy that prioritizes less expensive medications first, and cost-sharing with patients.

Clearly, this is not sustainable. While TrumpRx promises to provide some relief, the price of lifelong therapy is still prohibitive. In 2026, I predict we will see the rise of new approaches that will couple GLP-1s to intensive lifestyle modification to ensure more durable health benefits even if the GLP-1 is discontinued or used at lower, more affordable doses and more restrictive criteria for who should receive GLP-1s, focused on patients with severe obesity and those with significant co-morbidities. These changes may limit access in the short-term but create a more sustainable environment for coverage to slowly expand in the decade to come.

How will new entrants differentiate themselves from incumbents?

There are over 150 clinical-stage assets in the obesity space. They span several different mechanisms of action, but as NovoNordisk’s experience with CagriSema showed — where a 22.7% weight loss after 68 weeks was viewed as an abject failure — the competition on headline weight loss number will be fierce. Many companies will feel the pressure to increase dosing to push weight loss higher, but there is firm precedent that doing so runs the risk of significantly increasing adverse events.

I predict that companies struggling to differentiate themselves will turn to partnership as a solution. By combining their therapies with other solutions — medical devices, digital therapeutics, or other drugs — they can potentially unlock synergies at lower dosing, leading to better patient outcomes, more affordable therapy, and a viable asset for commercialization. This could have a profound impact on how new drugs are commercialized in the next decade.

What is the real durability of therapy?

One area that has plagued GLP-1s is the poor real-world outcomes in comparison to clinical trials. While most clinical trials report weight loss in the range of 15-20% of total body weight, real-world results are typically closer to 10%. This is partly driven by poor adherence: 65% of patients stop GLP-1s within the first year, with side effects being the #1 reason for discontinuation.

This is partly due to the poor follow-up most patients on GLP-1s receive. Obesity care is a team sport and requires that patients work hand-in-hand with a physician and their staff to use the medications safely, pair them with appropriate lifestyle modification, and ensure success over the long-term. Unfortunately, there are simply not enough humans for this type of care to be provided at scale.

I predict that this will drive two significant shifts in the obesity market. First, drugs with fewer side effects and better tolerability — or drugs used at lower doses in combination with other therapies — will flourish. These options will by definition require less comprehensive support and should have better long-term durability. Second, AI-powered solutions will emerge that will unburden providers from the time-intensive requirements of obesity care. In some sense, this application was tailor-built for AI: with massive amounts of data on how to optimize weight loss, minimize side effects, and properly escalate dosing, AI-powered solutions should be able to triage a patient’s basic concerns, leaving the humans at the doctor’s office the time to work on more complex issues.

In 2026, the weight loss market is at yet another inflection point. The euphoria of the past three years is now confronting the realities of how obesity medications will scale to address an epidemic that impacts over 1 billion people globally. I believe it is clear that this is not a winner-takes-all market, that there will be multiple entrants in the future who will stake their claim to a part of the pie, and that companies that are clever about access, partnership, and durability will withstand the test of time.

Photo: Natali_Mis, Getty Images

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