For most of the last three years, the story of metabolic health has been told as a pharmaceutical story. Semaglutide and tirzepatide rewrote the economics of obesity, turned Novo Nordisk and Eli Lilly into two of the most valuable companies in the world, and pulled a once-marginal clinical category into the centre of health policy. In the first nine months of 2025 alone, Lilly's Mounjaro and Zepbound generated $39.5 billion in revenue, overtaking Keytruda as the world's best-