Five Predictions for 2025 in Obesity, Nutrition, and Health

Thankfully, 2024 is behind us now and we have a blank slate for a whole new year ahead of us. But what can we expect? Well, proverbial (probably Danish) wisdom tells us “prediction is difficult, especially if it’s about the future.” Nonetheless, here are our top five predictions about what we will see in 2025 in obesity, nutrition, and health.

1. Intense Debates to Define Obesity

This will start early and continue throughout the year. The Lancet Diabetes and Endocrinology Commission on Clinical Obesity start the debate with a global online event on January 16. A day or two before that, the commission’s peer-reviewed findings will publish in the journal for all to read. The authors tell us that their aim is to provide “a medically coherent framework for disease diagnosis” and “to settle the ongoing dispute around the idea of obesity as a disease.” Clearly, BMI is getting pushed out from the spotlight.

Though we fully endorse these aims and broad outlines of the commission’s thinking, we have our doubts about “settling” ongoing controversies on this subject. More likely, we expect the resulting conversation will go a long way to help people refine their thinking and focus their efforts to advance an ever-evolving clinical framework for this complex chronic disease.

In short, the Lancet Commission report will be very important, but it will not be the end of the story.

2. More Indications for Advanced Obesity Medicines

As the clinical understanding of obesity grows beyond a simplistic focus on weight and BMI, so too will the clinical endpoints and indications for these drugs. Already, semaglutide has added prevention of strokes, heart attacks, and cardiovascular deaths. Tirzepatide just received approval for treating sleep apnea.

Other targets for new indications include chronic kidney disease, heart failure, osteoarthritis of the knee, liver disease, and diabetes prevention. All of these diseases tie into obesity as complications of it, but scientists increasingly suspect that the effects they see from these drugs come from more than weight loss alone.

New indications for obesity medicines will expand our clinical understanding of obesity.

3. More Contempt for Ultra-Processed Foods

Though the advisory committee for the 2025 Dietary Guidelines concluded evidence is insufficient for sweeping new guidance on ultra-processed foods, you can be sure that this is not the end of the story. Despite many experts pointing to an overly-broad definition for problematic ultra-processed foods, the drumbeat for warning consumers to avoid them is stronger than ever.

4. Growing Access for Obesity Care

The unmet need for obesity care is impossible to deny. Makers of advanced obesity medicines still cannot keep up with demand – more than three years after the first launch of these. Health plans and policymakers are struggling with the budget impact, but increasingly coming to the conclusion that the cost of untreated obesity may well be higher.

So access to care is growing and CMS has proposed expanding access to these medicines under Medicare and Medicaid. It will be a bumpy ride because a lot of money is at stake. But the destination is clearly much better access to this much needed care.

5. GLP-1 Price Erosion

If we learn nothing else about the stubborn persistence of compounded GLP-1 medicines in the marketplace, it should be this: List prices for Wegovy and Zepbound are too high. Compare the $1,300 list price for the branded products monthly to prices in the $100 to $200 range for compounded products and this is obvious.

In addition, FDA has just approved a generic for liraglutide – adding to the price pressure for GLP-1 medicines.

Lilly seems to have recognized the need for price relief with an offering listed at $500 monthly for patients paying cash and getting the medicine in a vial instead of a fancy injection pen. Prices negotiated with pharmacy benefit managers are also in this range. Lilly’s CEO also recently said “we can match those prices” – in reference to $94 per month Zepbound prices in Japan. But the catch is open access to these drugs without the byzantine barriers that health plans erect.

There will be plenty of acrimony about prices for these drugs, but we have no doubt that they will be coming down.

The Museum of Tomorrow, photograph by Bruno Tamm Rabello, licensed under CC BY-SA 4.0

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January 1, 2025