The worldwide weight-loss revolution

Summary

Business Daily (BBC World Service)

Episode: The Worldwide Weight-Loss Revolution

Date: March 3, 2026
Host: Sam Fenwick

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Overview

This episode—the second in a three-part series on the global weight loss economy—explores who actually pays for new, highly effective obesity drugs worldwide, how different countries’ health systems are coping with the cost, and whether these drugs truly represent value for money. The discussion centers on access, affordability, and the economic impact of the GLP-1 weight loss medications across England, the UAE, and India, highlighting issues of inequality, healthcare policy, and pharmaceutical market dynamics.

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Key Discussion Points and Insights

1. The High Cost and Limited Access to Obesity Drugs

• The rise of GLP-1 drugs (like Mounjaro, Wegovy) offers hope for tackling obesity but presents new challenges regarding cost and access.
• Most sales currently benefit upper socioeconomic groups, leading to inequality in treatment access.

  "Most of the sales for these drugs currently are accounted for by the upper socio economic strata." — Ashna Mehta [01:47]

2. England's Public Health Dilemma

• NHS England bases drug funding decisions on cost-effectiveness via the National Institute for Health and Care Excellence (NICE), which sets strict eligibility criteria.
  • Criteria typically involve BMI and obesity-related health conditions.
  • NICE deems the drugs good value for money, not just for weight loss, but for reducing risks of diabetes, stroke, and heart disease.

  "For the NHS, for people who successfully lose weight using GLP1s, it will lower their risk of developing those types of conditions, as well as the costs to the NHS of having to treat those conditions in the future." — Jacqueline Bouvet [05:07]

• However, funding is limited—if all eligible patients (around 3.4 million people) accessed the drugs immediately, they'd consume 18% of all primary care resources.
• The NHS is therefore rolling out the drugs very gradually, targeting those most in need (roughly 220,000 people over three years).

Private Market Emerges

• Those excluded from NHS coverage increasingly turn to the private market.
  • Example: Claire Barrett, FT journalist, spent £4,000–£4,500 privately over 18 months. She notes the cost gave her extra motivation but acknowledges the resulting inequality.

  "I think that's a bargain... I've basically spent around £1,000 for every stone I've lost." — Claire Barrett [08:33]
  "Well, it is a luxury for the rich. I make absolutely no bones about that." — Claire Barrett [09:01]

3. The UAE: Private Wealth and Insurance Barriers

• Despite being a wealthy nation, most UAE treatments are through the private sector or employer insurance, which often excludes “lifestyle” treatments like weight-loss drugs.
• Out-of-pocket monthly drug costs range from $800–$1,300 USD.
• Demand is “humongous,” but health insurers resist coverage to avoid “budget bloat,” making access prohibitive for most.

  "We are having stiff resistance from the health insurance side because they don't want their budget to bloat." — Prakash Paniya [11:32]
  "At the current prices, no, [the healthcare system] can't cope with it." — Prakash Paniya [13:37]

4. India: Rising Need and Hope for Generics

• India faces a rising tide of obesity—one in four adults is overweight or obese, costing the economy $29 billion annually (1% of GDP).
• The vast majority of healthcare expenses are out-of-pocket, as public sector networks can't meet demand.
• Drug prices ($120–$160/month for initial doses) are out of reach for most, so usage is concentrated among the wealthy.

  "Most of the sales for these drugs currently are accounted for by the upper socio economic strata within the country." — Ashna Mehta [16:57]

• However, imminent arrival of Indian-made generic GLP-1 drugs is expected to cut prices by up to 70%, potentially broadening access through India’s robust generics industry.

  “Prices will be slashed at least by half. Some reports suggest that they may go down by about 70% because India has a very robust generic industry.” — Ashna Mehta [17:35]

5. The Pharma Perspective: Global Self-Pay Market and Price Pressure

• Currently, the majority of the global obesity drugs market is self-pay, and the manufacturers acknowledge the price sensitivity.

  “The majority of the obesity market at a global scale is a self pay market. ... We need to find the appropriate price points that balances patient affordability with the value our products are bringing.” — Carsten Knudsen, Novo Nordisk CFO [14:06]

• Patent expiry in India (and soon China) will unleash price competition, with Indian generics already poised to significantly undercut existing brands.
• This opens the door to lower prices globally, but change may remain slow for much of the world due to regulatory and market strategies by existing drug manufacturers.

  “In a few international operations markets, there will be a price competition, so we will also be having tactics including launching second brands of Semaglutide at different price points.” — Carsten Knudsen [18:33]

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Notable Quotes & Memorable Moments

• On her personal transformation:

  “Never before in my life have I sort of caught a glimpse of myself in ... a mirror in a changing room and actually thought that I like what I see.”
  — Claire Barrett [03:54]

• On NHS rationing and resources:

  “If everyone would come forward in the first year of it being available, it would take up, I think, something like 18% of the total primary care services.”
  — Jacqueline Bouvet [01:58]/[06:13]

• On the societal divide:

  “Well, it is a luxury for the rich. I make absolutely no bones about that.”
  — Claire Barrett [09:01]

• On the Indian generics market:

  “Prices will be slashed at least by half. Some reports suggest ... down by about 70% because India has a very robust generic industry.”
  — Ashna Mehta [17:35]

• On future price competition:

  “So we will also be having tactics including launching second brands of Semaglutide at different price points. So we are going also head to head on pricing with their generic entrants.”
  — Carsten Knudsen [18:33]

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Timeline of Key Segments

• [01:16] Introduction: Framing the episode and what’s at stake globally
• [02:10]–[06:31] How NHS England decides on funding and rationing obesity drugs
• [06:31]–[09:33] Private costs in England and the emergence of inequality
• [10:48]–[13:46] The UAE: Private sector, insurance, and prohibitive costs
• [14:06]–[14:42] Pharmaceutical perspective on pricing and affordability
• [15:20]–[17:09] India: Socio-economic gaps, costs, and the rising prospect of generics
• [17:35]–[19:17] Impact of India’s generics on global pricing and market competition
• [19:17] Looking ahead: The future of the weight-loss economy

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Conclusion

The episode reveals a global inequity in weight-loss drug access, with cost barriers persisting even in richer countries and being especially acute in countries with large low-income populations. While public health systems (like the NHS) see the drugs as cost-effective, funding and capacity constraints lead to strict rationing. In private-market dominant countries, high out-of-pocket costs limit usage to the wealthy. The advent of generics, especially from India, may serve as a turning point—forecasting future price drops and improved access worldwide, though this remains to be fully realized.

Next episode preview: How companies beyond the pharma industry—from food makers to gyms—are capitalizing on the new wave of weight-conscious consumers.

Transcript

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[Sam Fenwick]

Hello and welcome to Business Daily from the BBC World Service. I'm Sam Fenwick. Yesterday we heard fears that a two tier health care system is emerging in the United States, splitting access to obesity drugs between those who can afford to pay privately and those who can't. Today in the second part of our three part series looking at the global weight loss economy, we're asking if these drugs offer value for money around the world, who is paying for them?

[Ashna Mehta]

Most of the sales for these drugs currently are accounted for by the upper socio economic strata.

[Prakash Paniya]

We are having stiff resistance from the health insurance side because they don't want their budget to bloat.

[Jacqueline Bouvet]

If everyone would come forward in the first year of it being available, it would take up, I think something like 18% of the total primary care services.

[Sam Fenwick]

We'll look at how obesity drugs are paid for in publicly funded health systems in one of the richest countries in the world and in the world's most populous country where obesity is rising fast and the ability to pay is far more limited. So here we are running across the River Thames on Millennium Bridge in the City of London. It's a bit of a murky day. Even the top of the shard is covered in cloud and my running partner today is Claire Barrett, consumer editor and Financial Times journalist. Now, about 12 months ago, would you have been doing this well, the thoughts

[Claire Barrett]

would have been there, but maybe the desire to keep it up, especially on a miserable day like today, wouldn't have been.

[Sam Fenwick]

About a year and a half ago, Claire started taking a drug called Mounjaro to treat her obesity. Before she started taking the drug, she consulted her family doctor and alongside the injections, she increased physical activity, changed her diet and she's lost 25kg. Do you think you could have done it without the help of the weight loss drugs?

[Claire Barrett]

No, and I know because I've tried for the last three years. I did manage to lose nearly one stone before I went on the drugs, but every pound that I lost was painful.

[Sam Fenwick]

And how do you feel?

[Claire Barrett]

Honestly, I can't believe it. This is probably a bit strong for the World Service, but never before in my life have I sort of caught a glimpse of myself in, say, a mirror in a changing room and actually thought that I like what I see. All of my markers have gone down, cholesterol has gone down, my blood pressure has gone down. None of these things were like flashing red, but they were higher than they should have been. And the longer I remained obese, the more of a problem that definitely would have become as I got older.

[Sam Fenwick]

Healthcare in England is provided by the National Health Service, a publicly funded system. Decisions about which medicines are paid for are made by the National Institute for Health and Care Excellence, better known as nice. It weighs clinical benefit against cost and sets strict eligibility criteria for obesity drugs, usually based on body mass index and related health conditions. NICE says these medicines do represent good value for money. Jacqueline Bouvet is the program director for NICE's Medicines Evaluation Team.

[Jacqueline Bouvet]

The analyses suggested that Tirzepatide, or Mangero as people will know by its brand name, probably represented good value for money to the nhs. And that's not because of the benefit that's associated with just making someone lose weight and being at a lower weight. Although for an individual, that might be really important outcome, but because when someone loses weight, their risk of developing a range of obesity related conditions, such as type 2 diabetes, heart attacks, sleep apnea and stroke. So they all go down. And that means that for the NHS, for people who successfully lose weight using GLP1s, it will lower their risk of developing those types of conditions, as well as the costs to the NHS of having to treat those conditions in the future. The total eligible population that potentially could be treated is around 3.4 million people in England.

[Sam Fenwick]

So the NHS in England could not afford right now to pay for three and a half million people to have that drug.

[Jacqueline Bouvet]

If everyone would come forward in the first year of it being available, it would take up, I think, something like 18% of the total primary care services. So you can imagine that that would have an impact on being able to provide other services at the same time as well.

[Sam Fenwick]

So, despite being judged cost effective, NHS England is rolling the drug out gradually over three years, prioritising around 220,000 people with the highest clinical need. By the third year of that rollout, the combined cost of the drug and extra support services, including dietary advice, physical activity guidance and sometimes psychological support, it's expected to be around 317 million pounds a year, roughly $400 million. And with long waiting lists and pressure on NHS services, many people who don't meet the criteria or who don't want to wait are choosing to go private.

[Claire Barrett]

It doesn't feel so cold now, does it?

[Sam Fenwick]

Oh, it certainly doesn't. Although we are getting very wet. Yes. Financial Times journalist Claire Barrett didn't qualify for treatment on the nhs, so she's one of the people who chose to pay privately. Shall we pop in? Keep going to the end. Here we are at the cafe. Can't get in touch to open. Initially, when you started on this weight loss journey, as you called it, what was the actual financial cost to you?

[Claire Barrett]

So, at first it was around £200amonth for a private prescription, and as I went up intensity level of the dose, the price gradually increases. The most powerful doses cost more. And then halfway through my treatment, we had President Trump intervene in the market, which in fact raised prices for people buying these drugs in the uk. Drug makers put under pressure to cut prices for customers in America. So immediately the price I was paying went from about £200amonth up to £300. I was in the lucky position where I could afford the extra £100amonth.

[Sam Fenwick]

It still felt like value for money.

[Claire Barrett]

Yeah. I think I've probably spent in total somewhere between four and £4,500 on everything that's drugs counselling. I've basically spent around £1,000 for every stone I've lost. I think that's a bargain that works

[Sam Fenwick]

out at roughly $200 per kilo lost. But what about people who can't afford that kind of money? There is a concern that these drugs will become a luxury for the rich.

[Claire Barrett]

Well, it is a luxury for the rich. I make absolutely no bones about that. I don't think that the NHS should have funded my prescription. It was an active choice that I was able to make for myself. And the fact that I was paying my own money for it also gave me added incentive to make it work. But for so many people who just couldn't afford it, I want them to share in the same experience I've had. Just looking at the scales and seeing your weight go down.

[Sam Fenwick]

You're listening to Business Daily from the BBC World Service.

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[Sam Fenwick]

I'm Sam Fenwick and today we're looking at how countries around the world are dealing with the cost of treating obesity with these high priced new drugs. So even in England, where these medicines are judged good value for money, access is still rationed because of cost and capacity. But what does that look like in one of the wealthiest parts of the world? In this plush private medical clinic in downtown Dubai, consultant endocrinologist Prakash Paniya treats patients with diabetes and obesity. He says demand for treatment reflects a much wider problem.

[Prakash Paniya]

When they did a survey here, there were about 28 to 30% of people in UAE were obese and about 60% of them were either overweight or obese. So that's a huge, huge number.

[Sam Fenwick]

The United Arab Emirates is one of the richest countries in the world. But even here, paying for these drugs at scale is proving difficult. Most treatment happens in the private sector through employer insurance or out of pocket payments. Since the start of 2025, employers have been legally required to provide private healthcare insurance rather than there being a universal state system. But what that insurance covers depends on the plan. Many policies cap benefits or exclude so called lifestyle treatments including weight loss drugs. So even with insurance, many patients still end up paying themselves.

[Prakash Paniya]

We are having stiff resistance from the health insurance side because they don't want their budget to bloat. Insurance companies, healthcare providers deal with acute problems and they are not programmed to be spending on these blockbuster drugs. So whenever possible they try to reject or not approve these.

[Sam Fenwick]

So if I'm going to get one of these drugs for obesity in the uae, I'm going to have to pay over the counter?

[Prakash Paniya]

Absolutely.

[Sam Fenwick]

I'm going to have to pay privately. How much would I be looking at?

[Prakash Paniya]

Yes. So the monthly cost of these drugs would be as Dh750 to Dh1750 or an equivalent in US would be 800 to 1300 USD per month.

[Sam Fenwick]

Now that's at the upper end of what people pay out of pocket globally for these prescription weight loss drugs. So can people actually afford it?

[Prakash Paniya]

So many people who have spent lot of money in the gyms, given money to the personal trainers, they've gone on crash diets and the yo yo effect and they're back to where they started off with, compared to all those price that they money that they're paying for these things, it is still relatively cheaper.

[Sam Fenwick]

So do you think that the healthcare system in the UAE can actually cope with the demand?

[Prakash Paniya]

See, the demand is humongous. Can they cope with it? In simple words, not now, at the current prices, no.

[Sam Fenwick]

Right now just two companies dominate the global supply of these drugs. US Pharmaceutical giant Eli Lilly and the Danish firm Novo Nordisk both recognize that this is largely a self pay market. And Carsten Knudsen, Novo's chief financial officer, says that is something they're trying to address.

[Carsten Knudsen]

Just looking at the obesity markets and what we see in obesity is that the majority of the obesity market at a global scale is a self pay market. So it's out of pocket for patients. And as a consequence we need to find the appropriate price points that balances patient affordability with the value our products are bringing. So it is a price sensitive market when it's self pay. And given the magnitude of the market in terms of unmet need and patient numbers and we believe it's rational to work on pricing also in order to activate volumes.

[Sam Fenwick]

If obesity treatment is still largely a self pay market globally, the implications are stark. In India, the world's most populous country, where millions of people are living on low incomes, here, obesity is rising fast. Recent national surveys show roughly one in four adults is now overweight or obese. And in a country of more than 1.4 billion people, that translates into tens of millions living with weight related health risks. And the economic impact is already being felt.

[Ashna Mehta]

The World Obesity Federation estimated that in the year 2019, the annual cost of obesity in India was some US$29 billion, which makes up roughly 1% of the country's GDP.

[Sam Fenwick]

Ashna Mehta is an associate professor at the Indian Institute of Public Health. She's a health economist and studies who pays for health care in India.

[Ashna Mehta]

The way the health system is organized in India is that we do have a public sector, but we have a very large private sector as well. So there is a considerable reliance on the private sector for accessing healthcare in India, especially outpatient care. So the out of pocket expenditure continues to be substantial for chronic conditions such as diabetes. And now with obesity, with the drugs coming into the market, a lot of expenditure on medicines is going to be happening out of people's own pockets.

[Sam Fenwick]

From a cost effective standpoint, do GLP1s represent good value for money in India,

[Ashna Mehta]

even though they are expensive and they were launched relatively recently within the country, actually saw incredible growth within the pharmaceutical market. For drugs like say Manjaro, a one month starter dose costs upwards of 13,000 Indian rupees. For wegovy to somewhere close to 10 to 11,000 Indian rupees. And this is just a starter dose. The cost rises as you increase the dose.

[Sam Fenwick]

So that works out at between 120 and 160 US dollars. Now presumably that's out of reach for most people in India.

[Ashna Mehta]

Yes, for most people. So we expect that most of the sales for these drugs currently are accounted for by the upper socio economic strata within the country, which is also a lot of people.

[Sam Fenwick]

However, there may be one potential shift on the horizon in India. Lower cost generic versions of GLP1 drugs are expected to start coming to the market this month. They won't solve the affordability problem overnight and they won't be available everywhere. But they could begin to put downward pressure on prices in a country that's already a major manufacturer of generic medicines.

[Ashna Mehta]

We do know that Semaglutide, which is sold under the brand names Ozempic and Wegovy, is set to go off patent in the country. And generic versions will be rolled out at a significantly lower price. The prices will be slashed at least by half. Some reports suggest that they may go down by about 70% because India has a very robust generic industry, which means that a lot of generic candidates would be ready just about now to come into the market, which should improve access.

[Sam Fenwick]

We've been hearing how access to these drugs is rationed in England, paid for privately in the UAE and in India. Yesterday we heard that in the US employers and insurers are now tightening access as they struggle with the cost, which raises a bigger question whether cheaper production in places like India could eventually make these drugs more affordable globally. Here's Carsten Knudsen, Novo Nordisk's chief financial officer.

[Carsten Knudsen]

So our patent expires in India. It also does so in China. In China, though, there are certain regulatory complications or technicalities. That means that I don't expect biosimilars to enter the market until 27, whereas in India there will be competition. We expect a 2% impact on group sales for this year linked to generic impact. In a few international operations markets, there will be a price competition, so we will also be having tactics including launching second brands of Semaglutide at different price points. So we are going also head to head on pricing with their generic entrants.

[Sam Fenwick]

So this signals a new phase of competition in the obesity drugs market. Novo Nordisk and Eli Lilly may soon face pressure to lower prices globally, though for many countries that shift may still be a few years away. That's all for this edition of Business Daily with me, Sam Fenwick. Tomorrow, my colleague Hannah Mullane will be looking at the businesses spinning out of the weight loss economy. From food manufacturers to gyms, she'll be speaking to companies capitalizing on changing consumer habits.

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