Bildnachweis: Sedivention.
The global obesity crisis has evolved into one of the most significant healthcare
challenges of the 21st century. With over one billion people worldwide now classified as obese – including 650 million adults, 340 million adolescents, and 39 million children, according to the World Health Organization – the implications span not just public health, but economic productivity, healthcare infrastructure, and investor opportunity.
Recent breakthroughs in pharmacotherapy and medical devices have redefined the contours of the obesity treatment landscape. From GLP-1 agonists making headlines and used by the likes of Elon Musk and Oprah Winfrey to minimally invasive endoscopic devices, the market is on the cusp of transformation. For venture capitalists, this is no longer a space to overlook – it’s a trillion-dollar opportunity in the making.
Overview of the rapidly growing worldwide market
Obesity contributes to over four million deaths annually through its link to cardiovascular disease, diabetes, cancer, and more. In the USA alone, obesity-related healthcare costs exceed USD 170 billion per year. As healthcare systems strain under this burden, there’s a strong push from payers, providers, and patients for solutions that deliver both clinical efficacy and cost efficiency. According to Morgan Stanley, the global market for obesity drugs is expected to reach USD 77 billion by 2030, up from approximately USD 2.4 billion in 2022 – a CAGR of over 40%. On the devices front, the bariatric surgery market is projected to exceed USD 4.8 billion by 2030, with non-invasive alternatives growing rapidly.
Pharaceutical revolution: The rise of GLP-1-RAs and beyond
The market for anti-obesity drug therapy has historically suffered from poor efficacy, safety issues, and limited reimbursement. That changed with the advent of GLP-1- and GIP- receptor agonists such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro, Zepbound). Originally developed for type 2 diabetes, these drugs have demonstrated unprecedented weight loss results – 15% to 22% on average – in large clinical trials. Moreover, and even more importantly, they demonstrated the reduction of hard clinical endpoints like cardiac death, myocardial infarction, and stroke1. These results approach those seen with bariatric surgery, but without the risks of surgical side effects and morbidity. Moreover, newer dual and triple agonists (e.g., GLP-1/GIP/glucagon combinations) in the pipeline suggest even better efficacy and broader metabolic benefits. However, the drugs also have their limitations, since they must be taken life-long, although weight loss plateaus after approximately one year. Side effects, costs, and stagnating weight contribute to a low adherence of only about 30% after one year, leading to weight regain and loss of the initial benefits in many patients.
Market dynamics
Novo Nordisk and Eli Lilly, the clear market leaders, have both reported persistent shortages due to overwhelming demand. The patents for their blockbuster drugs are expiring between 2026 and 2031, motivating dozens of biotechs, including Viking Therapeutics, Amgen, and Altimmune, to race and differentiate on safety, durability, and oral delivery. Manufacturers of generics are ready to launch their alternatives. While reimbursement in the EU is mainly limited to patients with severe comorbidities, in the USA, coverage remains uneven, and large US employers and Medicare are beginning to revise coverage strategies under economic pressure. Venture capital interest is surging in early-stage biotechs targeting in the many next-gen pathways (e.g., MC4R agonists, mitochondrial uncouplers, GDF15 analogues). In fact, there are more than a dozen hormones signalling satiety, which may be addressed.
Devices and digital therapeutics: Complementary or competitive?
While drugs dominate headlines, medical devices continue to play a pivotal role – especially for patients who either do not respond to pharmacotherapy or require additional intervention. Procedures like sleeve gastrectomy and Roux-en-Y gastric bypass remain gold standards for severe obesity, with long-term weight loss outcomes of 25% to 35%. However, the invasive nature, cost, and surgical risk limit adoption. They are based on two mechanisms: the reduction of the stomach, leading to fullness and less resorption, and the partial or complete disruption of the gastric fibres of the vagal nerve, which exhibit local receptors for the hunger hormone ghrelin and convey the feeling of hunger to the brain. Endoscopic sleeve gastroplasty, a minimally invasive surgical technique, evolves quickly, although it is less efficient, because it leaves the vagal nerve intact. Intragastric balloons (e.g., Orbera) occupy space in the stomach and lead to satiety. However, most must be removed after six months and weight is then regained. Due to their limited symptomatic
effects, they are not recommended or reimbursed. Devices like vagal nerve stimulators (e.g., ReShape Lifesciences’ vBloc) and gastric electrical stimulators are still niche but could gain traction with advances in AI-driven modulation. However, new therapies like minimally invasive cryoablation of the vagal nerve (Sedivention) target the established gastric-brain axis and could evolve like renal denervation in combination with drugs and endoscopic sleeve gastrectomy. Companies like Noom, Omada Health, and WeightWatchers are integrating behavioural coaching with sensor data to create sustainable interventions. When combined with pharmacotherapy for weight loss, digital platforms may improve adherence and outcomes.
Investment landscape
Venture funding has flowed into novel device start-ups (e.g., Allurion Technologies, EndoBarrier developers) and digital platforms aiming for hybrid delivery models. Strategic acquirers are watching closely – expect more M&A as big medtech looks to enter or expand in the obesity market. Despite the market’s promise, investors must navigate significant hurdles. Drugs and devices must meet different safety and efficacy standards, often requiring years of clinical trials. There is significant payer pushback due to the high costs of the chronic medication (up to USD 1,300/month). Without broad coverage, mass adoption is limited. Therapy non-responders demonstrate that obesity is multifactorial: psychological, genetic, and socioeconomic factors all contribute. No solution is truly ‘one size fits all.’ Obesity is probably, like addiction, a chronic disease, and therefore, long-term data for drug and device effects are needed.
The future: Integrative and personalised
As the obesity market matures, a convergence is likely between pharmacology, technology, and personalised care models. Therapy will be individualised and consider cultural, socio-economic, and genetic factors as well as comorbidities, risk factors, and biomarkers. Like in other chronic diseases, such as coronary artery disease, synergies between surgery, device-based interventions, and drugs will lead to an optimised therapy.
Conclusion
We are witnessing the birth of a new paradigm in obesity management. No longer relegated to lifestyle advice and invasive surgery, patients now have access to increasingly effective and tolerable solutions. For investors, the obesity market presents a rare intersection of massive unmet need, scientific innovation, and consumer demand. In this landscape, capital can do more than generate returns – it can shape a healthier future.
About the author:
Dr Ute Nollert is a physician with many years of clinical experience. In 2021, she founded Sedivention, a company that develops a medical device for a new, interventional weight loss therapy.
