As new weight management medications are being developed, might the obesity market parallel the likes of hypertension or high blood pressure to become the next blockbuster Pharma category?

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Welcome to Thoughts on the Market. I'm Terence Flynn, Head of the U.S. Pharma Sector for Morgan Stanley Research. Along with my colleagues, bringing you a variety of perspectives, today I'll talk about the global obesity challenge and some of the key developments we expect in 2023. It's Tuesday, January 3rd, at 4 p.m. in New York. 

If you're like most people, you're probably seeing a lot of post-holiday ads for gym memberships, diet apps and nutrition services. So this seems like a relevant time to provide an update on obesity. A few months ago, we hosted an episode on this show discussing the global obesity epidemic and how it's now reached an inflection point because of new weight management drugs that show a lot of promise and benefits. 

We continue to believe that obesity is the "new hypertension or high blood pressure", and that it looks set to become the next blockbuster pharma category. Obesity has been classified by the American Medical Association, and more recently the European Commission, as a chronic disease, and its treatment is on the cusp of moving into mainstream primary care management. Essentially, the obesity market is where the treatment of high blood pressure was in the mid to late 80's, before it transformed into a $30 Billion market by the end of the 90's. 

One of the main reasons the narrative around obesity is inflecting is because the focus is shifting to the upstream cause, as opposed to the downstream consequences of diabetes and cardiovascular disease. Now, given this change in focus, we expect excess weight to become a treatment target. The World Health Organization estimates that about 650 million people are living with obesity, and the associated personal, social and economic costs are significant. Over time, we're expecting about a quarter of obese individuals will engage with physicians, up from about 7% currently. Now, this compares to approximately 80% for high blood pressure and diabetes. Furthermore, well over 300 million of these people could potentially receive a new anti-obesity medicine. 

Looking back historically, previous medicines for obesity had minimal efficacy and were plagued by safety issues, which also contributed to limited reimbursement coverage. In our view, this is all poised to change as the more efficacious GLP-1 drugs are adopted and utilized and the companies begin to generate outcomes data to support the derivative benefits of these drugs beyond weight loss. 

Of course, as with biopharma, there are many de-risking clinical, regulatory and commercial steps in the development of the obesity market. This year, we're most focused on a key phase three outcomes trial called "SELECT", which we expect to read out this summer to conclude that "weight management saves lives". 

Furthermore, we think the innovation wave should continue as companies are working on a next generation of injectable combo drugs that could come to the market later this decade for obesity and Type two diabetes. And beyond the possibility of turning the tide on the obesity epidemic, it's also exciting to see room in the markets for multiple players and investment opportunities in a market that could reach over $50 billion by 2030. 

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