Healthcare Industries

Any savings in direct medical costs realized from the widespread adoption of HOTs discussed above will translate into reduced demand for healthcare industry goods and services. If HOTs make a large fraction of a population healthier, there will logically be less demand for healthcare products and services – all else equal (i.e. namely, setting aside concurrent impacts from the disruptive forces of artificial intelligence and robotics).

In countries like the United States with a large private healthcare sector where medical care providers including hospitals are often structured as financially self-sustaining enterprises (whether for-profit or nonprofit), the large reduction in demand for medical treatments caused by the HOTs disruption could therefore threaten financial viability and trigger workforce reductions.

Notable exceptions to this overall trend of decline will be cosmetic surgery (for addressing “Ozempic Face” and other consequences of dramatic weight loss) and sports medicine (associated with a large increase in the number of active adults).

But beyond the tectonic shifts in healthcare demand, HOTs could trigger a broad transformation of the healthcare system itself in many countries, away from centering on medical crisis management to focusing primarily on preventative medicine and health optimization.

Industry Scope

• Total U.S. healthcare spending: $4.9 trillion annually (18% of GDP)
• Over $2.3 trillion of these expenditures are directed toward health conditions partly or wholly driven by metabolic risk from unhealthy diet, lifestyle, and obesity
  • Type 2 diabetes: over $305 billion
  • Cardiovascular disease: over $415 billion
  • Cancer (obesity-linked): over $35 billion
  • Osteoarthritis and joint disease: over $140 billion
  • Obstructive sleep apnea: up to $95 billion
  • Alzheimer's and dementias: over $380 billion
  • Anxiety and depression: over $75 billion
  • Substance use disorders: over $8 billion direct; over $350 billion including co-morbidities
  • Late-life morbidity (including frailty): over $1 trillion
  • Bariatric surgery: nearly $1 billion
  • Cosmetic surgery: over $21 billion

Facing Decline

Drugs

• Type 2 diabetes medications
• Diabetic complications medications
• Osteoarthritis and pain medications
• Sleep apnea medications
• Anxiety and depression medications
• Addiction treatment medications

Healthcare Products

• Diabetes management products
• Diabetic complication products
• Orthopedic products
• Sleep apnea products
• Mobility and assistive products
• Bariatric products

Healthcare Services

• Surgical services
• Diagnostic services
• Diabetes complications services
• Therapeutic services
• Addiction and mental health services
• Oncology services
• Long-term and home care services

Facilities

• Hospital units and centers
• Specialty clinics (e.g. rehabilitation)
• Addiction treatment facilities

Occupations

• Physicians and surgeons
• Nursing and clinical staff
• Allied health professionals
• Support and administrative staff
• Industry workforce

Facing Growth

• HOT developers and manufacturers
• Telehealth platforms specializing in HOT-based health management
• Cosmetic surgery for HOT-related procedures
• HOT-centered addiction treatment programs
• Preventive medicine, longevity clinics, and healthspan optimization services that integrate HOT management
• Sports medicine and physical therapy for performance optimization (rather than disease management)
• Mental health services addressing adjustment to rapid physical transformation and relationship changes driven by HOTs

Facing Uncertainty

Mental health goods and services:

• Demand may decrease, based on 64% of users reporting benefits
• Demand may increase, based on some studies showing increased depression and anxiety risk in vulnerable groups, and anhedonia reported by some users

• Demand may decrease, based on research and animal results suggesting protective and preventative effects from obesity reduction in non-Alzheimer’s dementias
• Demand may be unaffected, based on the recent EVOKE trial which showed disappointing results for Alzheimer’s

• Demand may decrease in the short term from reduction of obesity-linked cancer occurrence
• Demand may be unaffected in the longer term if HOTs users live longer and cancers are merely postponed until later in life

Addiction and substance use treatment goods and services:

• Demand may decrease from reduction in addictive behaviors among HOTs users
• Demand may be unaffected if goods and services providers pivot to incorporate HOTs into addiction prevention and treatment

Dieting and Weight Loss Industries

Prior to the first blockbuster GLP-1s, dieting and weight loss products and services were high-cost and low-efficacy. Utilizing these products was unpleasant for most users. Even for initially successful users, relapse rates were high. These factors together contrived to support industries that could sell a diverse range of products and services simultaneously and shift its offerings over time (“the latest fad diet”).

The emergence of a technology that actually works spells comprehensive disruption for the traditional dieting and weight loss industries.

As a whole, these industries will need to either pivot to HOT-based business models, or collapse.

Industry Scope

• The traditional dieting and weight loss industry represented about $75 billion in the United States alone, prior to the takeoff of the first blockbuster GLP-1, semaglutide. This includes diet programs, products, meal replacements, and supplements.

• At its peak, more than 275,000 bariatric surgeries were performed in the United States each year.

• Bariatric surgery market size estimates for the United States vary widely, from around $1 billion to over $3 billion.

Facing Decline

• Traditional weight loss products and services will be disrupted and face obsolescence and collapse. Meal planning and replacement products, dieting supplements, and coaching services cannot compete with HOTs that are vastly more effective.

  • Weight Watchers, after 62 years of operation, fell from a peak market capitalization in of over $6.5 billion at $103 per share in June 2018, to near-zero in April of 2025 when it filed for bankruptcy and restructured.

  • Weight loss programs will need to pivot into HOT-based programs in order to survive.

• Bariatric surgery will be disrupted and face obsolescence and collapse.

  • Surgery is costly and risky.

  • Latest-generation multi-agonist HOTs (namely, retatrutide) achieves comparable weight loss without surgery or hospitalization, and is easily adjustable (dosing) and reversible (cessation).

• Non-HOT-based doctor-led medical weight loss programs will be disrupted and face obsolescence and collapse.

  • Medical weight loss programs that previously focused on psychology/behavior-based diet and lifestyle changes such as the FAB (Food, Activity, Behavior) approach have already pivoted into HOT-based programs, and will continue to do so until the transformation is complete.

Facing Growth

• New business models centered on HOT-integrated health, weight management, fitness, and wellness which combine medication with coaching and support are already growing rapidly. Examples include Calibrate, Vida Health, Noom Med, Found, Equinox & One Medical, and WeightWatchers Clinic.

• Telehealth platforms specializing in HOT prescribing and management are now thriving. Examples include Ro, Mochi Health, PlushCare, and Hims & Hers, and LifeMD.

Facing Uncertainty

• Weight and related health coaching services face both upward and downward (push and pull) demand pressures from HOTs.

  • Demand may decrease if HOT users obtain the weight loss and health results they seek without the need for these services.

  • Demand may increase if use of HOTs expands the market for these services by bringing people who had previously given up on dieting and weight loss as hopeless, and also by helping with maintenance-focused use of HOTs (i.e. low-dose and periodic/intermittent utilization).

  • Although weight-loss coaching becomes obsolete, performance and skill coaching will become more valuable as a larger population pursues physical activities (see Fitness, Sports, and Recreation Industries below).

Fitness, Sports, and Recreation Industries

Prior to the first blockbuster GLP-1s, people used exercise to change their body composition in order to lose fat, increase capability, enhance appearance, and improve health. While HOTs cannot yet optimize every aspect of body composition (they do not yet affect aerobic fitness, endurance, or flexibility, for example), they will make it vastly easier to “lose weight” (meaning lose fat) and achieve “big gains” (meaning increase muscle size and strength), which are two key motivations for dieting and exercising.

This in turn means that HOT users will have far less need to utilize fitness products and services.

However, HOT users whose changes in body composition have made them more physically capable and healthy will be more able (and thus more likely) to utilize sports and recreation products and services. This is likely to be particularly pronounced in older adults who experience the benefits of HOTs as a rejuvenation, and who therefore return to physical activities they previously enjoyed.

As a whole, demand will shift away from products and services used to “get fit” towards those used by “fit people”.

Industry Scope

• Total fitness, sports, and recreation industries in the United States: nearly $1 trillion
• Gyms and health clubs: $33 billion
• Personal training and coaching: $12 billion
• Fitness equipment (home and commercial): $5 billion
• Fitness trackers/wearables: $20 billion
• Fitness apps: $3 billion
• Activewear/athleisure products: $126 billion
• Sporting goods: $66 billion
• Sportswear (apparel): $90 billion
• Outdoor recreation (includes RVs and camping): $639 billion

Facing Decline

• Subsets of gyms and health clubs focused on weight loss or muscle gain
• Subsets of fitness equipment such as treadmills, stationary bikes, and other “cardio” machines marketed for calorie burning and weight loss, and free-weights and resistance machines marketed for muscle building
• Subsets of fitness trackers, wearables, and apps focused on weight loss
• Subsets of personal training and coaching focused on weight loss

Facing Growth

• Gyms and health clubs focusing on fitness, performance, sports, and socializing
• Activewear/athleisure products
• Sporting goods
• Sportswear (apparel)
• Outdoor recreation (includes hunting, fishing, boating, RVs, camping, motorcycling, ATV-ing, snow activities, equestrian)
• Products and services utilized by older adults will see particularly strong growth
• Subsets of personal training and coaching focused on skill, aerobic fitness, endurance, flexibility

Facing Uncertainty

• Overall gym and health club memberships; overall fitness equipment and services; overall fitness trackers, wearables, and apps
  • Demand may decrease for the use of these facilities for weight loss and muscle gain
  • Demand may increase (especially a near-term spike to a new baseline) from more active, capable, and self-confident adults

Food and Beverage Industries

The food industry faces declines on a scale not seen in over 80 years since rationing during World War II. Widespread HOT utilization by adults will reduce overall calorie consumption, which will directly translate into a decrease in overall food and beverage demand and sales.

More data is needed before we can know with confidence precisely how HOT users will change their consumption patterns, but the overall picture is clear: semaglutide and tirzepatide users report a disproportionately large fraction of calorie reduction from unhealthy foods and beverages. This means HOT users won’t just eat less, they will eat differently.

We should therefore expect declines to be starkest in the “junk food” and “indulgence” categories, precisely because GLP-1s modulate the brain’s reward circuitry, diminishing the “food noise” cravings that drive our most impulsive and hedonistic eating choices.

Today, American adults spend over $900 billion, or $3,400 per adult, on junk food purchases each year. This translates into nearly 1,500 calories of junk food purchased per day, of which about 1,000 are actually consumed. Available data represent averages, and so for obese Americans the numbers per person are significantly higher.

It is plausible that widespread HOT adoption could lead to an average reduction of 500 calories of junk food purchased per person, which would represent one-third of all junk food demand in the United States.

Importantly, not all of junk food calories deliver the same sales revenue for their sellers. Some of the highest-margin food and beverage items sold by restaurants, for example, will be the most-likely to be disrupted, such as soft drinks, desserts, and alcoholic beverages. This means a decrease in overall junk food calories is likely to translate into a disproportionally greater decline in sales revenues for some segments of the food and beverage industry.

Alcoholic beverages in particular face additional pressures because approximately two-thirds of GLP-1 users report reduced alcohol consumption, and the top 10% of drinkers who consume 60% of all alcohol sold are likely to be disproportionately affected. Moreover, any decrease in demand from widespread adoption of HOTs will compound the existing generational trend of declining alcohol consumption among younger adults.

Industry Scope

• Total food and beverage industries in the United States: $2.5 trillion
• Food away from Home (FAFH) segments: over $1.5 trillion
  • Full-Service Restaurants: over $450 billion.
  • Quick-Service Restaurants (fast food): over $380 billion. (Note: government data strictly excludes non-food retail from QSR).
  • Drinking Places (alcoholic beverages): Approximately $30–$35 Billion (specifically for bars/taverns).
  • Other FAFH (schools and colleges, hospitals, prisons, military bases, vending): over $400 billion
• Food at Home (FAH) segments: over $1 trillion
  • Meat, Poultry, & Eggs: $222 Billion
  • Fruits & Vegetables: $196 Billion
  • Cereals & Bakery Products: $137 Billion
  • Dairy Products: $111 Billion
  • Nonalcoholic Beverages: $132 Billion
  • Sugar & Sweets (Confectionery): $42 Billion
  • Other Foods (Snacks, Condiments): $217 Billion
  • Alcoholic beverages: at least $270 billion

Facing Decline

• All Food Away From Home (FAFH) segments
• All Food At Home (FAH) segments
• Pronounced declines in:
  • Fast food items (e.g. burgers, French fries, pizza, donuts)
  • Sweetened beverages (e.g. soft drinks, fruit juices)
  • Confectionary (e.g. candy, sweets, chocolate)
  • Desserts (e.g. ice cream)
  • Alcoholic beverages
  • Full-service restaurants whose business models depend on high-margin alcohol and soft drink sales

Facing Growth

N/A

Facing Uncertainty

• Health foods, organic foods, whole foods (includes meat, poultry, eggs, fruits, vegetables, milk, and cheese)
  • Demand may decrease from reduced overall calorie consumption
  • Demand may increase from more health-conscious and physically active adults

Agriculture Industries

Agriculture is logically upstream of the food and beverage industries, and so the overall declines in food and beverage demand will translate directly into overall declines in demand for agricultural products and services as well. The details are highly uncertain and the changes in demand will be unevenly distributed, with some products and services being impacted far more than others. Animal agriculture may be less affected (other things being equal) if HOT users maintain or even increase protein intake. Corn farming, however, may see a pronounced decline if HOT users slash their consumption of food and beverages containing high fructose corn syrup.

Irrespective of the details, which remain very difficult to predict, overall agricultural sector decline is inevitable because of the brute fact that HOT users simply eat less.

Industry Scope

• Total agricultural output: over $482 billion (excludes non-food crops such as flowers/horticulture, cotton, hay)
  • Animal agriculture: nearly $300 billion
  • Grains and oilseeds: $120 billion
  • Specialty crops (fruits, nuts): $32 billion
  • Vegetables and melons: $23 billion
  • Sugar (beets, cane, maple): $9 billion

Facing Decline

• Grains (corn/maize, wheat, rice)
• Sugar (beets, cane, maple)
• Dairy

Facing Growth

N/A

Facing Uncertainty

• Meat (including aquaculture)
• Oilseeds
• Specialty crops (fruits, nuts)
• Vegetables and melons

Potentially Addictive and/or Compulsive Products and Services Industries

By modulating dopamine signaling in the brain’s reward pathways, GLP-1s appear to moderate addictive and compulsive behaviors. User reports and anecdotes about these were so striking that research has begun to explore the possibility of using GLP-1s in treatment of alcohol abuse disorder, smoking cessation, and other substance use disorders. Widespread adoption of HOTs therefore has implications for all industries that supply potentially addictive products and services as well as those which supply treatment and sobriety products and services.

Potentially addictive products and services industries comprise a nontrivial fraction of the U.S. economy, with total revenues approaching $1 trillion annually (excluding addictive foods). Addiction treatment is itself a sizable industry as well, with much of the funding coming from government sources.

Industry Scope

• Total: over $800 billion
  • Alcoholic beverages: at least $260 billion
  • Tobacco and nicotine products: $115 billion
  • Gambling: over $70 billion
  • Digital gaming: over $55 billion
  • Pornography: over $10 billion
  • Illicit drugs: at least $150 billion
  • Social media: over $85 billion
  • Addiction treatment: over $55 billion

Facing Decline

With the possible exception of social media, all of these face substantial decline in all aspects: products, services, facilities, and occupations.

Facing Growth

N/A

Facing Uncertainty

• Social media
  • Demand may decrease from less impulsive use (e.g. ‘doom scrolling’) and growing awareness of harms, especially to children
  • Demand may increase from continued industry growth based on separate advancements in and adoption of AI

Insurance Industries

Among a healthier population, the demand for health insurance claims will logically decline – all else equal. The basic logic is that claims decline, causing a short-term profit spike in regions without mandated “medical loss ratios” (i.e. caps on profit margins), but over time premiums reprice downward which shrinks revenues. However, in some regions, including parts of the United States, health insurers are legally obligated to spend a minimum fraction of premium revenue (such as 80%) on medical care, effectively capping their profit margins. In these regions there will be no initial windfall because any earnings beyond cap must be rebated.

It is important to keep in mind, however, that the assumption of all else equal is unlikely to hold. For example, the price of medical care billed to insurance companies by healthcare providers such as hospitals and clinics is likely to increase because those healthcare industries will also be responding to falling demand for their products and services.

For disability insurance, the same basic logic holds, but largely without the restrictions on spending and profit margins. As a result, near-term profits are more likely, but the longer-term outlook is still decline.

For life insurance, the picture is more complicated. In the United States, the life insurance industry provides two broad categories of products: life insurance (which pays subscribers when they pass away), and annuities (which pays subscribers while they are alive). For the first category, the extended longevity of HOTs users means insurers will collect premiums for longer (and thus more total revenue) before paying out the fixed end-of-life benefit. For annuities, however, it is the reverse: the improved longevity of subscribers will mean insurers will have to make payments for longer (and thus face higher costs).

Industry Scope

• Total: $2.375 trillion
  • Private health insurance: over $1.6 trillion in private premiums revenue
  • Private disability insurance: $50 billion
  • Private life insurance: $725 billion

Facing Decline

• Health insurance

Facing Growth

Facing Uncertainty

• Disability insurance
  • Likely increased profitability in the near-term, but facing long term revenue decline
• Life insurance
  • Longer life spans increase revenues from premiums, but also increase costs from annuities