What Will Be Hot or Not in 2024 for Obesity and Health

The year we just finished saw quite a pivot in the science and policy we cover here. So what will we pivot toward in 2024? What will leave us cold? Here are our best educated guesses for what will be hot or not in 2024 for obesity and health.

#1 Hot: Pricing

Drug prices will definitely be a hot topic for 2024. Right from the start this year, pharma is poised to raise prices on more than 500 drugs. Perhaps they have not read the news that inflation is dropping. Or maybe they want to get in on the action before it’s too late.

Of course, the high list prices of obesity and diabetes drugs will get more attention while the real net prices hide out of sight, creating opportunities for secret deals to let middlemen pocket extraordinary profits. This is not sustainable. Price competition is coming.

Then there’s the battle royale over drug price negotiations with the U.S. government, which will begin this year. But if pharma gets its way, the prospect of those negotiations will go away in business-friendly courts. The industry has unfurled a “property rights” banner for their rallying cry. Apparently, market forces of price negotiation are an imposition.

2. Competition

This will definitely be a year of hot competition between Novo Nordisk and Eli Lilly in the market for advanced obesity medicines. Novo has a big head start. The company also expects to get a claim from FDA for preventing strokes, heart attacks, and death. Lilly will not be able to match that claim yet. But Lilly has a drug that, on average, produces better outcomes. This contest will go on for years, with other competitors joining in the fray over time.

3. Access

What good is a medical breakthrough that only the rich and exceptionally well-insured can afford? Pressure for Medicare to cover these medicines will grow in 2024. Some employers are griping about the cost of these drugs. But at the same time, many others are moving ahead with plans for coverage.

4. Pediatrics

To say that the American Academy of Pediatrics sparked a shockwave with its new obesity care guideline last year is no exaggeration. But in 2024, we believe pediatric obesity care will be a hot topic for a better reason. This will be the year that pediatricians and clinical scientists get serious about delivering obesity care to meet the very real  medical need that many young persons and their families face. Semaglutide is already approved for adolescents. An early stage trial of tirzepitide in younger patients will be complete in 2024. Even more important will be building capacity in health systems for actually providing competent care. Even in the UK, the NHS recognizes a growing need.

It took ten years after the AMA decided obesity is a chronic disease for momentum to build in adult treatment. Pediatricians might move faster, but even so, it will take time.

5. Telehealth

In health systems that lack enough capacity for obesity care in face-to-face clinic visits, telehealth is proving to be an important tool for meeting the need. Weight Watchers sees the writing on the wall, jumping in with both feet. Employers see the potential. This approach will no doubt go through growing pains, but it is here to stay.

#1 Not Hot: Paternalism

The idea that the government knows what’s best for you is fast falling from favor. Chalk it up to skepticism, cynicism, misinformation, or whatever you like. Or maybe zealous legislation to restrict personal autonomy in health decisions for women and children is a factor. Whatever the cause, 2024 will be a bad year for overreach in government health policy.

There’s both good news and bad in this trend. But for people who are sick of healthcare providers and busybodies judging them for needing and wanting obesity care, it’s likely a good thing.

2. Compounding

Novo Nordisk opened the lid of Pandora’s box for sketchy compounded versions of semaglutide with their failure to provide an adequate supply. We expect that, as competition prods Novo to do better, the opening for compounders will close.

3. HAES

One talking point of the Health at Every Size movement has always been that obesity itself does little or no harm to health. Selling this falsehood is harder now that the SELECT trial shows obesity treatment can reduce heart attacks, strokes, and deaths. Over time, the stubborn persistence of HAES believers on this point will diminish the credibility of their movement.

4. PBMs

Pharmacy Benefit Managers are getting harsh attention from all directions. The FTC is after them. Politicians of all stripes see them as a good targets. Greater competition is on the horizon for the big three PBMs that have long dominated the market. We suspect their prime years of profiteering may have past.

5. AI Doomsdays

Last year we heard a lot about doomsday scenarios regarding artificial intelligence. Will a super-duper artificial general intelligence (AGI) system take over the world and kill us all for the sake of paperclips? Some of these scenarios seem to draw on Star Trek episodes six decades old.

Very likely, AI safety and ethics will get attention in the coming year without the dire headlines. Meanwhile, we suspect that AI will be busy infiltrating healthcare and biotech research in ways too numerous to count. Just look at the half-billion dollar deal Lilly sealed with Fauna Bio for applying AI to obesity research. Or consider Google’s application of AI in healthcare. Then there’s the burgeoning availability of AI health coaches.

In 2024, AI won’t take over the world. But it will quietly spread in healthcare and medical research.

Angel with the Flaming Sword, painting by Franz Stuck / WikiArt

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January 2, 2024