Metabolic Competition: The Geopolitics of GLP-1s
Medicines like Ozempic will shift global economies, militaries and international relations, ushering in an era of "metabolic competition."
Most geopolitical analysis of GLP-1s - a class of breakthrough diabetes and weight-loss medicines - only deals with which politicians have taken it and which haven’t. However, these medicines may lead to an era of “metabolic competition” between countries that fundamentally shifts international relations.
Metabolic Competition
Countries compete with each other economically, militarily and politically. While we typically measure GDP, number of aircraft carriers or alliances to understand global power, soon we may be measuring waistlines.
My framework for analyzing an unruly world insists we look at how politics, law and technology crash into each other to create new risks and opportunities. Breakthrough medicines have the potential of being just as impactful as breakthrough AI.
“Skinny jabs” - a somewhat insensitive British shorthand for Ozempic, Wegovy, Mounjaro and other GLP-1s that restrict appetite-may not seem a likely candidate for a geopolitical lever. But their widespread usage and potential to reshape the diet and fitness of large parts of the global population makes them so.
GLP-1s offer the promise of weight control, diabetes management, lower cardiovascular risk, and decreased cholesterol—all of which can extend longevity. Though these drugs are expensive, have nasty short-term side effects and unknown long-term health impacts, 12% of Americans are currently using them. When you consider that 70% of Americans are obese or overweight under some definitions, the audience for these medicines involves most of society, who will increasingly take such medicine as prices go down and side-effects come under control. Patent protection will soon fall away in China, India and Canada which opens the door to generic versions at very low-cost for billions of people.
So, we need to start to ask ourselves: What happens to food producing countries if large parts of the global population eat less sugary or processed food because their appetite is suppressed? Will public health systems invest to subsidize GLP-1s today to reduce long-term treatment costs? Will healthy populations that live longer come to provide a military advantage? Will voters who live longer skew conservative, as data has shown in the past? And, finally, will GLP-1 precursor and finished product production become a new geopolitical chokepoint that gives producers leverage?
Taken together, we can start to grasp how countries may begin to compete with each other to achieve massive health improvements, or a role in the related supply chain, that could reshape their militaries and their economies.
Economic Implications
The economic implications of GLP-1 drugs are manifold.
Dining habits
It’s easy to see how appetite restricting medicines like GLP-1s will lead to a reduction in snack food and dining out. Because the medicines impact the brain’s reward-center chemistry, they also lead users to cut back on alcohol. Even though users may switch to more protein or nutrient-dense food, there is still a reported cutback of over 5% in spending on food when using the medicine. The New York Times even suggested that those throwing business parties are avoiding seated meals to not make GLP-1-taking guests uncomfortable by having to abstain from corporate gluttony for hours around a table. To the extent the stock market has gone beyond pricing in implications for pharmaceutical companies directly, knock-on effects to food producers has been the main realm of analysis.
Economic Growth
While these medicines are financial blockbusters for the companies - and even countries - that produce them, a substantial cut back in food spend would normally be considered a major economic drag. However, obesity itself is generally considered a drag on economic growth. Thus, Goldman Sachs and Morgan Stanley estimate half to one point of GDP growth in OECD countries from GLP-1s based largely on an assumption that reducing obesity related disease will keep aging folks in the workforce longer. In an era where public health systems are under strain, the idea that subsidizing GLP-1s now could pay off in the long-run through growth may be attractive.
Shift in trade flows: Of course, as people shift what they eat, that plays out through the entire food supply chain. As people demand less sugary foods or less processed foods or less alcohol, this changes the export pictures in some big ways. How does Brazil replace demand for sugar exports if populations turn away from sugar? Or the US for corn syrup? Or US and Asian processed food manufacturing? What about European alcohol exports? While there will no doubt be opportunities to export foods of the future - perhaps protein rich foods or high-end produce - this could wreak havoc on many economies. Beyond simple demand signals, agricultural production is both some of the politically sensitive and most subsidized outputs an economy can produce, while many countries depend on it for foreign currency and tariff revenue.
Economies will need to reorganize: Beyond the export issue, there are major implications for economic organization as people trade off calories for longevity. It’s worth remembering this is coming at the same time that AI reshapes workforces and where the balance between physical/manual labor and knowledge work may look different than it has in the past. First, public healthcare systems will have to grapple with whether they want to spend now on GLP-1s to save later on obesity related diseases. Second, while it may be great that people can work longer, if people actually live longer, then already-stressed government pension systems will have to do a lot more work to keep people afloat over a longer time horizon if that extra work doesn’t net out to grow the pension funds. Third, many private insurance products - which are based on actuarial models that won’t match longevity gains - will also no longer be fit for purpose.
Geopolitics and National Security
Once you grapple with the fact that much of the population is a candidate for such medicine, it’s easier to see how there could be implications at the national and global scale.
Rise in military readiness: While there are concerns that GLP-1s can reduce muscle mass or cause stomach issues for troops in the field, it should be readily apparent that healthier populations provide a much more militarily ready population than unhealthier ones. In the US, two out of three active duty troops are overweight if not obese. By increasing fitness, a country can increase military readiness and also potentially reduce long-term military healthcare costs through upfront investment in medicine, which would leave the military with additional funds for other purposes. Even food security - including rationing during war - could acquire a new dimension, though appetite suppression should not be confused with true nutritional resilience
Globalization and Dependency: Of course we still live in a globalized world where the countries that are most efficient at producing elements of any product will get the chance to sell that on the open market. While supply chains for GLP-1s are opaque, it’s possible that countries may find themselves with dependencies on other countries in those supply chains if they choose to optimize for use of these medicines. The dependency question may not be whether today’s branded Western GLP-1 doses rely on China, which some do. It is whether the next phase of the market — generics, oral formulations, equipment etc— creates new pharmaceutical chokepoints.
Conservatism, Body Image and Social Equality: There’s a healthy literature that as populations live longer, they tend to become more conservative as older voters cast votes against change. This is neither a good nor bad thing, but is an implication for political culture we can anticipate as countries go down this path. At the same time, there are many historical periods where body image obsession often co-exists with racism, colonialism and even fascist tendencies. Countries that are able to afford to body hack their populations into physical fitness may also use that as a psychological weapon to justify looking down on those populations that cannot or do not. This may be true within a country, where the cost of medicine may be out of reach of those who would otherwise take it, or across countries. Of course, it’s important to emphasize that there are many cultures that value fuller bodies as a sign of wealth or simply for other cultural reasons. My broader point is that we could see greater fissures in domestic and international politics if GLP-1s allow populations to live longer and present fitness or thinness as the dominant physical form.
Black swans rarely announce themselves in an unruly world. But metabolic competition has been building in plain sight — in obesity data, pharmaceutical advancements, supply chains, public health debates and military readiness reports. The signals are there. The question is whether we are all connecting the dots.
-SW
PS Thanks to Leo Gerza and Alexander Ting for their contributions.