Metabolic Insights: Re-imagining Health Centric Services

This article aims to bridge the gap between emerging science and real-world application, fostering informed discussions. Let’s dive into re-imaging the services for metabolic disorders and obesity as truly health-centric rather than weight-centric.  For decades, our approaches have fixated on the scale-BMI thresholds dictating eligibility for treatments, success tied to pounds lost and dress sizes.  But emerging evidence challenges this paradigm, urging us to pivot to holistic metabolic markers like insulin sensitivity, inflammation levels, lipid profiles, adiposity and mitochondrial function. Drawing on recent developments, like the explosive growth in GLP-1RA therapies, new mitochondrial dysfunction insights let’s explore this new landscape.

 What if interventions prioritise metabolic restoration over weight reduction? 

We know that weight-centric models often lead to cyclic dieting, stigma and poor long-term outcomes.  In contrast, health-centric services would integrate more advanced diagnostics and personalised approaches as first-line approaches, treating obesity as a chronic metabolic imbalance rather than a willpower deficit.

Recent research underscores this approach.  A 2025 study revealed novel mechanisms of mitochondrial dysfunction in obesity driving insulin resistance and type 2 diabetes, highlighting how cellular energy and not just excess calories fuel metabolic chaos.  Meanwhile, the global obesity market is projected to surge, with anti-obesity medication (AOMs) like GLP-1RA leading the charge; forecasts suggest a $150 billion valuation in 2035, driven by demand for therapies addressing root caused beyond weight. Clinically, even interrupted access to GLP-1RA drugs yields sustained weight loss and metabolic benefits, suggesting these tools could anchor health-focused pathways.

From a systems perspective, this shift demands redesigning care delivery.  Hospital and clinics might adopt integrated “metabolic hubs” combining inter-disciplinary medical teams and fitness centres under one roof, using AI- driven algorithms to track biomarkers in real-time. Research and accreditation programmes could certify health-centric protocols, emphasising long-term metabolic remissions over weight loss.  Market drivers are aligning: the obesity CRO landscape is booming with a 20% CAGR since 2019 with Asia-Pacific leading with  43% of global trials.  This is fuelled by trials for multi-indication drugs that target metabolic syndromes holistically and emerging non-GLP-1RA approaches. Complementing these innovations, key biomarkers such as leptin, adiponectin, CRP and IL6 support early detection and can guide targeted therapies for obesity’s underlying metabolic and inflammatory pathways. Partnerships, such as the Obesity Association’s collaboration with Novo Nordisk to reshape obesity narratives, signal commercial buy-in for broader, stigma-free approaches. Closer to home, in the UK Eli Lilly SURMOUNT-REAL study; a five-year real-world evidence trial evaluating the effectiveness of tirzepatide. This trial forms a part of a broader £279 million collaboration between Eli Lilly and the UK government and could lead the way to a broader systems approach to improving metabolic health.

Political Ripples: Policy re-imagined

Politically, a health-centric pivot certainly fits within the ethos of the NHS 10-year plan, and as we wait for further guidance on the implementation, here are a few of my thoughts. Imagine treatments being made available based on metabolic risk and not BMI alone.  The current NHS rollout of Tirzepatide planned over the next 12 years has done little to address health equity but has shown how treatments are available for those who can afford them and for the moment effective treatments have exacerbated divides.

Imagine a system where governments tax ultra-processed foods associated with increased health risk to fund public metabolic health initiatives, mirroring tobacco regulations.

Socially, this reframing could erode the blame-game culture.  Weight-centric views often perpetuate myths of laziness and as a 2025 systematic literature review exposed gaps in public awareness of obesity’s genetic and environmental roots.  Health-centric services may foster body neutrality movements, celebrating metabolic vitality over aesthetics.  Consider social media campaigns highlighting “metabolic wins” like normalised blood pressure.  Envision schools teaching metabolic literacy alongside traditional subjects reducing intergenerational stigma. Partnerships like Roche’s push for personalised cardiometabolic care could amplify social dialogue, integrating monitoring into everyday life, matching the right treatments to the right patient at the right time.

We know the untold consequences of weight-centric diets that promote unsustainable practices like extreme calorie restriction, ignoring the broader food systems’ role.  A health centric lens might advocate for regenerative agriculture to combat metabolic disruptors in processed foods. A study in July 2025 linked diet changes, not activity to the rise in obesity, and most likely eating too much of the wrong foods with those consuming higher amounts of ultra processed foods associated with increased body fat percentage. 

Similarly health is often linked more to our postcode than to our genetic code. Imagine how urban planning could address this: Cities designing “metabolic-friendly” spaces with walkable neighbourhoods and community gardens to boost insulin sensitivity naturally.  What if corporate partnerships, incentivised eco-friendly farming to supply anti-inflammatory foods for metabolic programmes.  This could reduce environmental footprints whilst addressing the dual crisis of obesity and climate change.

Individually patients will receive less scale-induced anxiety; instead, they are empowered through actionable biomarkers.  Mental health could improve, with therapies addressing emotional eating as metabolic signals, not failures. Technology is advancing quickly with data readily available on our wrists. For example, Samsung has redesigned its BioActive Sensor to provide unique insights into metabolic health. This advanced sensor captures not only health metrics such as heart rate, sleep quality, blood pressure, blood oxygen levels and stress levels but also Advanced Glycation End Products (AEGs) Index.  Samsung described this as an indicator of metabolic health and biological aging strongly influenced by overall lifestyle and dietary habits.  Market drivers are shifting towards longer-duration therapies and behavioural integrations. Together they can be a powerful force to re-imagine metabolic health.

Could this shift heal more than our metabolism- and lead to repairing our fractured healthcare systems. Share your thoughts.