Genetics Could Decide Who Wins the GLP-1 Market, Ep. 7 with 23andMe’s Dr. Adam Auton

Genetics Could Decide Who Wins the GLP-1 Market, Ep. 7 with 23andMe’s Dr. Adam Auton

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.” [https://www.nature.com/articles/s41586-026-10330-z] 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/ [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?

🎧 Can Peptides Become a Real DTC Business? Ep.6 with Tim Gutwald

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. Subscribe: https://www.glp1digest.com/subscribe [https://www.glp1digest.com/subscribe] 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

Can the Food Industry Survive GLP-1s? Ep. 5 with Henry Dimbleby

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 Subscribe to GLP-1 Digest: https://www.glp1digest.com

Can GLP-1s Save the NHS? Ep. 4 with Lord James Bethell

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"

🎧 Should GLP-1s be sold over the counter? Ep 3, with Dr. Beverly Tchang, MD

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