This post is an extended version of an entry in this year’s Finalto Watchlist.  

The Watchlist 2025: The World at a Crossroads lays out extreme scenarios for 2025, in an effort to think through the risks and opportunities of the coming year. Download your copy of the 2025 Finalto Watchlist here. 

“I can’t even eat all the caviar, but that’s the point of the shot!’’  

For Manhattan’s rich and fabulous, weight loss ‘miracle drugs’ like Ozempic mean going out for a bite is now almost literally true, at least according to New York Post. The tabloid reports that New York’s upmarket restaurants are pivoting to smaller portions or chic little bites, like sushi or caviar. 

It’s a neat anecdote but a revealing one. ‘You can never be too rich or too thin.’ That adage is offensive in the age of body positivity; quaint in the era of the BBL. But what if the widespread use of cutting-edge weight loss drugs means we’re all on diet all the time, without even trying? 

Ozempic (one of the brand names for the drug Semaglutide) was designed to treat diabetes, but it is already being used off label to lose weight. To understand its potential economic effects, we have to look beyond its pharmacological function and ponder how normalised taking Ozempic-like medications will become.  

After all, there already is an effective treatment for obesity – bariatric surgery – but this is not a widely adopted procedure; certainly not something indicated for a socialite looking to lose a few pounds.  

By contrast, the Semaglutide hype cycle seems unstoppable. Every day there’s a new malady for which Ozempic turns out to be the apparent miracle cure. Even if these are just byproducts of controlling obesity, the health benefits seem dramatic. 

Other apparent effects are more surprising and harder to account for. Ozempic makes you want to drink less. It curbs compulsive gambling. Reduces compulsive behaviour in general. Possibly. The evidence so is far too limited to make meaningful predictions, but it is intriguing.  

So, good news all round then? Maybe not if you’re a casino. Or a liquor company.  

Heavy drinkers account for two thirds of alcohol sales. More than half of the gambling industry’s profits come from “the 5% who are already problem gamblers, or are at risk of becoming so”.  

Will blunting our compulsion to consume prove a threat to our major industries? Is this the end of the road for Big Carbohydrate? 

We can be more certain about the economic effects of Ozempic on some sectors than other. The food industry obviously faces one of the biggest challenges in years.  

But what about gyms? Weightwatchers is already in trouble. And are we about to see an oversupply of vintage fits? 

A niche solution for a large problem? 

As a weight-loss drug, Ozempic is currently an off-label solution for the affluent. Even for those seeking treatment for diabetes, these medications are not yet widely available. In developing countries, access to these next generation drugs is even more limited.  

However, there are at least two reasons to believe Semaglutide will have an outsized economic impact.  

First, the price of these drugs will eventually come down as generics become available (and potentially due to pressure from developing world governments: see, for example, South African and antiretroviral drugs). Obesity is a global health emergency. If Ozempic really does what it says on the tin – and does not turn out to be dangerous with long term use – it will eventually become widely available.  

And second, even if these drugs were only used by relatively affluent consumers, that would nonetheless fundamentally transform key sectors. Fine dining, health clubs, expensive weight loss paraphernalia, single malt scotch – whole industries could yet be decimated. 

Productivity gains 

The bull case for Ozempic is easy to make. A sick workforce is not a productive workforce. Health Secretary Wes Streeting’s controversial suggestion that people might be given the weight loss job to get them back into the labour force recognises that basic point, if in a crude way. 

A hard look at the data shows that chronic illness is undeniably a massive drain on productivity. And that obesity contributes significantly to chronic illness.  

Goldman Sachs calculates that poor health has knocked off 10% from US GDP due to lost work due to illness, disability, early death and from the need to offer informal caregiving. They also estimate that poor health has “subtracted 2 to 3 percentage points from the overall labour force participation rate over the last 30 years”. 

That’s a serious number, but how big a role does obesity play? Goldman’s number crunching continues (emphasis our own): “obesity-related disease and illness shave about 3% from per capita output — via both missed work days and lost productivity — or more than 1% from total output when the more-than-40% share of the US population that suffers from obesity is factored in”. 

Does that sound like a very American problem? More than a quarter of adults in England are obese (with 37.9% more defined as overweight)1. In Europe, obesity is the main risk factor for disability, “causing 7% of total years lived with disability”. 

Global benefit 

In many developing economies, obesity rates are even higher – with more than a billion people with obesity around the world. 

For now, cutting edge anti-obesity drugs are limited to more affluent markets. However, Semaglutide will eventually be manufactured in the form of much cheaper generics. In addition, if these drugs prove to produce serious productivity gains, it’s reasonable to suggest they may be widely adopted by governments that calculate treatment will ultimately pay for itself. (Compare South Africa HIV medications programme, an initiative which once seemed idealistic and impractical, but is now good economic and public health sense)  

What will our Ozempic future look like? Given the drug’s plausible economic impact, we may find out sooner than we expected. 

For more on a range of scenarios, including Ozempic, green energy, artificial intelligence, and the complex ways Donald Trump could transform global politics, be sure to check out Finalto’s Watchlist 2025: The World at a Crossroads. Download your free copy now. 

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