Comment: Weight‑loss drugs are discussed in the media on an almost daily basis. But despite the high level of coverage, stories often miss deeper issues about the control and marketing of these drugs.

Take the example of Mounjaro (active ingredient tirzepatide), approved by Medsafe in December 2025 for type-2 diabetes and chronic weight management. The approval was greeted with some fanfare, but with a reported price of $430 to nearly $900 a month (depending on dose), the focus is often on cost as a barrier to access.

So why is the cost so high? And should access be the ultimate goal?

The high price of Mounjaro and demand for the drug aren’t accidental. They are the product of a global intellectual property and regulatory system that, as my new research documents, can enable pharmaceutical giants to shape markets, set prices, and influence how we think about bodies, weight, and health.

These deeper issues are at the centre of the political economy of these drugs, known as glucagon-like peptide-1 analogues (GLP‑1As). They include tirzepatide as well as earlier approved drugs, such as semaglutide – the active component of Ozempic and Wegovy – and liraglutide, marketed as Victoza and Saxenda.

Behind the ‘miracle drug’ story

The GLP‑1A story is frequently framed around scientific brilliance and medical breakthrough. But GLP‑1As were never simply neutral innovations. They emerged partly from publicly funded research and foundational work by scientist Svetlana Mojsov – work for which she was, for years, omitted from patents and prizes.

This isn’t just a story about individual injustice; it exposes a broader structural problem with the patent system. This system rewards those with power, not necessarily those who do the labour of scientific discovery. Modern drug patents are less about incentivising invention and more about enabling commercial extraction, market power, and narrative control.

Mounjaro’s pricing in New Zealand follows this logic. As long as its manufacturer holds exclusive rights, it can charge whatever the market will bear. Simultaneously, drug companies themselves have played a significant role in creating the market for their weight-loss products.

The creation of consumers

The extraordinary hype around GLP‑1As is not just organic public enthusiasm. Market demand is also manufactured.

Pharmaceutical companies don’t simply sell drugs; they sell narratives. They do this in a variety of ways including through aggressive marketing (sometimes in violation of codes of conduct), tacit consent to the promotion of their products by influencers and celebrities, and strategic shaping of medical information.

In recent years, regulators across Europe have reprimanded companies such as Novo Nordisk (the company behind Ozempic and Wegovy) for inappropriate or disguised promotion of GLP‑1As. In 2024, the UK’s pharmaceutical watchdog called out Novo Nordisk for failing to disclose payments to health professionals and patient groups.

Companies’ marketing efforts work to portray GLP‑1As as the default solution to weight loss and normalise medicalised approaches. They also drive off‑label use, fuel shortages, contribute to the proliferation of counterfeits, and reframe normal body variation as pathology.

Consumers are encouraged to believe that sustainable weight management comes in pharmaceutical form – a message that is profitable for drug manufacturers but often misleading for users, who may regain weight when they stop taking the drug.

GLP‑1As also risk creating the “perpetual patient”: someone dependent on expensive pharmaceuticals indefinitely because the underlying socio-economic drivers of demand remain unaddressed.

The equity problem

Demand for GLP-1As varies across different groups, patterned along gender, racial, and socio-economic lines.

Women feel disproportionate cultural pressure to be thin, contributing to higher rates of GLP‑1A use among women internationally. Meanwhile, Māori and Pasifika communities, which experience higher rates of obesity and diabetes – often because of structural inequities – also face systemic economic barriers to care.

Some media commentary has suggested weight-loss drugs may help reduce the stigma around obesity. But, arguably, this stigma contributes to demand for such drugs, while ignoring the fact that structural factors – such as access to healthy food and exercise spaces, and socio-economic stress – play major roles in obesity and diabetes.

Reducing metabolic disease and obesity requires addressing these factors, not only expanding medication availability.

What should New Zealand do?

Pharmac is under pressure to fund GLP‑1As for weight loss. This would be transformative for some patients, but at great expense and without addressing root causes in many cases.

New Zealand needs a dual‑track response. First, we need to address the structural drivers of metabolic disease and obesity, and demand for these drugs. Second, we need to interrogate and regulate the pharmaceutical market more thoroughly, including patents, data exclusivity, and marketing practices.

Weight-loss drugs have a place in our health toolkit, especially for people with genuine clinical need. But they should not define our national strategy for addressing obesity and metabolic disease. Further, we should be wary of narratives that prey on gendered and racialised inequalities.

GLP-1As offer real hope for some New Zealanders. But if we focus only on cost and access, we overlook the broader system that created this moment: one in which public science becomes private profit, bodies become markets, and healthcare becomes a site of extraction rather than empowerment.

If New Zealand wants a fair and effective response to obesity and metabolic disease, we must look beyond the syringe or pill, and toward the cultural, socio-economic, legal, and regulatory structures shaping people’s lives.