GLP-1 Digest Podcast

In Episode 10 of GLP-1 Digest, Ashwin Sharma speaks with Emily Field, head of US biopharmaceuticals equity research at Barclays. They discuss Lilly versus Novo Nordisk, the premium patients may pay for clinical differentiation, and whether better tolerability or muscle preservation could give new entrants an opening.

The conversation also covers oral GLP-1s, retatrutide and amylin drugs, international cash-pay demand, and how direct-to-consumer (DTC) distribution is changing the obesity drug market.

Full transcript: https://github.com/ashwinsharma1793-prog/glp1-digest-podcast-transcripts/blob/main/ep-10-emily-field-transcript.md

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Recorded before the Q2 2026 earnings releases.

CHAPTERS

00:00 Forecasting a $100bn obesity market

03:13 Why Lilly leads Novo Nordisk

11:39 Competing with generic semaglutide

15:22 Muscle and the quality of weight loss

17:53 Oral GLP-1s, Wegovy and Medicare

25:46 Cash pay and DTC distribution

30:33 Amylin, retatrutide and pricing

33:21 International growth: what to watch

Shotsy’s growth has been explosive—and it has been powered largely by its users.

The app now has 350,000 monthly active users. Roughly one-third pay, while around two-thirds of new users arrive organically through word of mouth, community posts and app-store discovery.

And it does not prescribe or dispense a single GLP-1.

I spoke with founder Aja Beckett about how Shotsy turned product utility into distribution—and built a companion app that remains useful from the first dose through maintenance.

Timestamps:

00:00 Introduction

02:26 What GLP-1 users actually want from a companion app

03:28 How provider switching increases the value of an independent treatment record

21:12 How shareable dose-and-weight charts drive organic growth

27:33 What Aja has learned from 350,000 real-world users

37:39 Why tracking becomes more useful during maintenance

41:55 Why Shotsy converts so many users to premium

49:03 Why Shotsy has resisted selling prescriptions

The economics of DTC GLP-1 care are getting harder. Customer acquisition costs keeps rising, price is getting pushed down, and more patients are willing to switch provider for the cheapest pen.

That leaves DTC companies with the worst possible equation: lower gross profit per month and a customer base full of switchers who may not stay long enough to pay back acquisition.

In this episode, I speak with Dr. Paul Sacher about where AI can actually show up on the GLP-1 profit and loss statement. Paul has spent more than two decades in obesity management and has worked across digital-health providers building and evaluating patient-facing AI systems.

His team has analysed close to 100,000 support tickets, churn data, and patient interviews, which makes this a practical conversation rather than another abstract debate about healthcare chatbots.

Timestamps: 00:00 Why AI in GLP-1 care is not just a chatbot

04:58 Why 24/7 support matters for patients

07:19 Onboarding, side effects, and early churn

12:18 Why app engagement can mislead operators

15:39 Switchers, maintenance, and personalised support

20:00 What providers get wrong when adding AI

37:46 The behavioural data moat in GLP-1 care

48:35 Safety, regulation, and clinical escalation

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Why do two people taking the same GLP-1 have radically different results? Part of the answer may be written in their DNA.Dr. Adam Auton is Vice President of Human Genetics at 23andMe and a senior author of the 2026 Nature study, “Genetic predictors of GLP1 receptor agonist weight loss and side effects.”

The study examined 27,885 GLP-1 users to investigate whether genetic variation can help predict weight loss, nausea, and vomiting.

In this episode, we discuss what polygenic risk scores actually reveal, why genetics is risk rather than fate, and how variants in the GLP1R and GIPR genes may shape a patient’s response to semaglutide and tirzepatide.

We also explore the commercial consequences. As the obesity-drug market becomes more crowded, genetics could help new entrants identify patients who respond poorly to existing treatments, support more personalised care, and turn patient selection into a source of competitive advantage.

Read and subscribe to GLP-1 Digest: https://www.glp1digest.com/

Timestamps:

00:00 Polygenic risk scores and why genetics is not fate

17:39 Why genetic risk scores vary by ancestry

24:03 Inside 23andMe’s GLP-1 response study

27:24 Predicting weight loss and side effects from DNA

33:09 How reliable are self-reported data and prediction models?

39:48 Genetics and the next generation of obesity drugs

44:57 Can genetics predict weight regain after GLP-1s?

48:11 Could genetics decide who wins the GLP-1 market?

Peptides may already be a billion-dollar grey market. But if they move into legal compounding, can they become a real DTC healthcare business?

I speak with Tim Gutwald, a healthtech lawyer with roughly 20 years of experience across telehealth, prescribing, compounding and DTC healthcare, about the three things founders need to get right: legitimate pharma-grade API, defensible clinical protocols & enough internal data to market peptides beyond vague wellness claims.

We also discuss whether peptides are likely to become a standalone category, or simply a cross-sell around GLP-1s, TRT and longevity.

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Chapters

00:00 What is happening in the peptide market?

03:01 Category 1, Category 2, and the FDA review process

08:19 Why DTC demand is driving regulation

10:41 Pharma-grade API and the peptide supply-chain problem

14:46 Clinicians, protocols, and prescribing risk

20:16 Advertising claims, testimonials, and internal data

30:00 What founders need to get right before launching

38:23 Schedule II drugs, telehealth prescribing, and affiliate risk

51:59 Why affiliate marketing is risky in DTC healthcare

What happens to the food industry when millions of people start eating less?

In this episode, I speak with Henry Dimbleby about the second- and third-order consequences of GLP-1s for food and beverage. Henry co-founded Leon, led the UK’s National Food Strategy, and is the author of Ravenous, one of the best books on how the modern food system learned to sell into human appetite.

We discuss evolved appetite, why health education does not always change behaviour, what happens when food volumes fall, why “value per bite” matters, and why corner shops, snacks, confectionery, alcohol, and impulse purchases may be the first casualties.

Chapters:

00:00 Why GLP-1s matter for the food industry

05:35 Health intent, appetite and behaviour change

08:58 Where the money may be made around GLP-1s

11:23 Why Big Food may be missing the meteor

14:56 A volume-down world and value per bite

23:10 Can food companies engineer around appetite suppression?

33:45 Restaurants, corner shops and the high street

43:16 The unexpected second-order effects

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Lord James Bethell is a former UK Health Minister who served as Minister for Life Sciences during Covid. He chairs Business for Health, sat on the IPPR Commission that called the UK "the sick man of Europe," and advises the private health sector through his role at Oviva. In this conversation, we discuss the widening gap between what the NHS aspires to deliver on GLP-1s and what it actually can — and why the private market is filling the hole at unprecedented scale. TIMESTAMPS: 0:00 Healthy life expectancy hits record low 1:03 "Your generation is going to have to pay off the national debt" 3:47 Can big interventions make quick differences? 4:57 "20–30% of the House of Lords are on GLP-1s" 8:17 The private market is filling the gap — so why the stigma? 8:42 "We've socialised acute care but privatised prevention" 10:03 Digital platforms are working — and rebooting expectations 11:35 The halo effect: GLP-1s as a gateway to gyms, CGMs, wearables 12:12 "Don't believe the patient" — the culture of the NHS 15:44 What's actually blocking preventative healthcare? 16:38 40 million chronic disease patients. 23,000 GPs. 18:32 The auto-enrolment analogy: friction, not apathy 21:13 The split society: rich health vs poor health 23:16 "This is about Blackpool, not Buckinghamshire" 24:56 "We can't jog ourselves out of this problem" 27:07 Schools, smartphones, KFC, and childhood obesity 31:34 "Declining health outcomes are costing us an absolute fortune" 35:19 "We've infantilised our people so much they can't take their statins" 36:49 Being Health Minister during Covid: "permission and mission"

Dr. Beverly Tchang is a triple board-certified obesity medicine specialist, endocrinologist, and Associate Professor of Clinical Medicine at Weill Cornell. She also advises Ro.

We discuss the commercial and clinical questions shaping the future of GLP-1s.

Time stamps:

0:00 REDEFINE-4: CagriSema vs tirzepatide 7:35 Why the open-label design matters 8:59 Where Novo Nordisk's pipeline goes next 11:52 The real competitor isn't Lilly — it's supplements 12:48 Will GLP-1 adherence mirror statins? 15:49 Retention: a human behavior problem? 18:22 Why oral GLP-1s are storming the market. 22:26 What actually increases long-term adherence 26:52 Maintenance patients don't want to feel like patients 31:41 Insurance vs cash-pay: who should foot the bill? 36:25 Could life insurers play a role? 38:11 "Primordial care" — where health starts before healthcare 40:36 The case for compounding 46:26 Will compounding ever go away? 48:18 Can oral semaglutide and orforglipron be compounded? 50:40 Microdosing: what it means and who's doing it 55:22 Taking statins at 35 — and the prevention parallel 56:56 "Why wait for someone to gain more weight?" 59:35 Menopause weight loss: marketing or medicine?1:02:22 Does HRT boost GLP-1 weight loss? 1:07:13 The case for over-the-counter GLP-1s 1:10:22 Population-level impact of OTC access 1:12:32 Fly on the wall: the discovery of leptin in 1994

In this debut episode, Ashwin Sharma sits down with Professor Alex Miras, one of the world's leading obesity medicine specialists, to discuss the economics of GLP-1 medications.

They cover:

1. Why the drug does the heavy lifting (not willpower)

2. Why price is the only barrier that matters

3. Why the muscle loss panic is probably a measurement problem

4. The oral GLP-1 revolution and what it means for patients

5. Food noise - the huge mistake clinicians are making

Prof. Miras brings 15+ years of clinical and research experience from Imperial College London and King's College Hospital.

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Watch the full video version on YouTube: https://youtu.be/PF7fF8vclic