“It’s a game-changer,” Wenzel told Fortune, describing how GLP-1s have shifted obesity treatment “upstream”—from late-stage interventions like gastric bypass and orthopedic surgery toward proactive weight management that can head off disease before it starts. “That’s what we’re seeing, how this filters through the economics within healthcare.”

The numbers back her up. A 2026 JAMA Surgery analysis found as GLP-1 use rose more than 140% between 2022 and 2024, bariatric surgery volumes fell 34.1% over the same stretch—a direct substitution effect, according to a Wells Fargo Industry Insights report co-authored by Wenzel and John Teasley, a market executive in the bank’s healthcare commercial banking group.

Cardiovascular outcomes may be an even bigger story: The SELECT trial found semaglutide reduced major adverse cardiovascular events by 20% in overweight or obese adults without diabetes—a result Wenzel called “an eye-opener” given cardiology’s status as one of the most lucrative lines of business within healthcare. Obesity therapies now account for roughly 25% of pharma’s forecast late-stage drug pipeline value, up from just 1% in 2022, surpassing oncology for the first time in 16 years of tracking by Deloitte.

Emerging research is also linking GLP-1s to reduced substance abuse, including alcohol use disorder. A Washington University School of Medicine study published in The BMJ in March found GLP-1 use was associated with an 18% lower risk of alcohol use disorder and similar reductions across other major addiction categories, adding to a growing body of clinical evidence the drugs’ effects extend well beyond weight loss.

A disease, not a failure of willpower

Central to Wenzel’s framing is a reset of how obesity itself should be understood.

“It’s a very complex disease, a recognized medical disease,” she said, pushing back on the historical medical framing that treated obesity primarily as a matter of “reshaping reasonable habits” through diet and exercise. “The hope, and what we’ve seen with GLP-1s, is it’s finally giving people a path to truly address it and prevent it in many cases.”

That reframing has real economic backing. Federal health agencies now recognize obesity as a chronic disease shaped by genetics, environment, and food systems as much as individual behavior. A 2019 National Institutes of Health inpatient trial found people offered ultra-processed diets ate roughly 500 more calories per day than those given minimally processed meals—even when the meals were matched for calories, sugar, fat, fiber and macronutrients. The federal government’s 2025-2030 Dietary Guidelines for Americans, released Jan. 7, moved away from nutrient-counting advice and toward “real food,” a shift Wells Fargo’s Agri-Food Institute says is already visible in how GLP-1 users shop.

For all the clinical promise, Wenzel was candid about the industry’s central unresolved problem: cost.

“We all need to continue talking about the affordability of the drugs,” she said. “Coverage under different programs—Medicare, Medicaid, or insurance—doesn’t always include access to GLP-1s for weight loss.”

List prices for Wegovy and Ozempic can be as high as $1,000 to $1,300 a month, according to Wenzel, and both major obesity drugs remain under patent, limiting competition. The Congressional Budget Office has estimated authorizing Medicare to cover anti-obesity medications broadly would add about $35 billion to federal spending between 2026 and 2034—with near-term costs of roughly $5,600 per user in 2026 dwarfing the offsetting savings from improved health, estimated at just $50 per user that same year.

“This is something that doesn’t necessarily pencil out on an annual basis,” Wenzel said. “We can see the weight loss, we can see the positive benefits,” she added, but the way the drugs work is more like a process that plays out over time.

Similar to her colleague at Wells Fargo, economist Michael Swanson, she compared the drugs directly to statins’ role in cholesterol treatment: a chronic therapy that people may need to stay on for life, where meaningful results—losing 20% of body weight, say—unfold gradually rather than immediately. “GLP-1s have a lot of similarities with statins… The benefit here is long-term.”

That framing points to a subtler problem than affordability alone: Even where GLP-1s are covered, the economics only work for patients—and payers—who can absorb years of cost before the benefit arrives. It is, in effect, a patience tax layered on top of a price tag—and patience, like capital, is not evenly distributed. Two inequalities, of wealth and and of time, are the obstacle to the game-changing revolution in healthcare that these drugs represent.

When asked if GLP-1s in general, and peptides in particular, are sort of like a healthcare equivalent to AI’s potential as a general purpose technology, Wenzel said it was a fair comparison and we will have to wait and see how both play out.

Relief is coming—just not yet

Some price relief is already on the calendar. Novo Nordisk announced on Feb. 24 it will cut U.S. list prices for Wegovy by 50% and Ozempic by 35%, bringing both to $675 a month effective Jan. 1, 2027. Analysts cautioned, however, Novo plans to simultaneously reduce the rebates it pays to insurers and pharmacy benefit managers—a move that could offset much of the list-price reduction in terms of actual net cost.

Separately, the Centers for Medicare & Medicaid Services launched a temporary “GLP-1 Bridge” program on July 1, offering eligible Medicare beneficiaries access to the drugs for a $50 monthly copay through the end of 2027. State Medicaid programs have a parallel, voluntary pathway to adopt similar pricing under a model known as BALANCE.

But both fixes are partial and temporary. The bridge program expires at the end of 2027 unless renewed. Coverage decisions remain fragmented at the state level: As of early 2026, only 13 states covered GLP-1s for obesity through Medicaid, while four states—California, New Hampshire, Pennsylvania, and South Carolina—eliminated that coverage entirely effective Jan. 1, regardless of manufacturer price cuts. Roughly 64% of large employers say covering GLP-1s for weight loss has meaningfully increased their prescription drug spending, according to the Peterson-KFF Health System Tracker, a pressure that is pushing some insurers to tighten prior-authorization requirements rather than loosen them.

Patent timelines complicate the picture further. Wenzel pointed to patent expirations over the next several years as a path toward Medicare’s ability to negotiate lower prices—and international markets do move faster, with semaglutide’s patent protection lapsing in China, India, and Canada as early as 2026.

Meanwhile, competitive pressure between manufacturers is already reshaping pricing dynamics independent of patent expiration. Eli Lilly has overtaken Novo Nordisk in U.S. market share—60.9% to 38.8% as of August—driven partly by its rival obesity drug, Zepbound, and an oral pill in development that Goldman Sachs projects could capture 60% of the daily-pill segment by 2030. Novo and Lilly together still control more than 90% of the premium GLP-1 market, meaning pricing so far reflects a two-company duopoly rather than genuine market competition.

Asked whether this amounts to an inequality story, Wenzel didn’t hesitate—but she also expressed hope the current imbalance would narrow.

“The hope is that the playing field evens out over time,” she said. “A wide percentage of population stands to benefit from these drugs. Right now it is tough, it’s expensive, insurance doesn’t necessarily cover it unless you meet certain criteria. Because of all of that, it’s not widely available.”

For this story, Fortune journalists used generative AI as a research tool. An editor verified the accuracy of the information before publishing.