Beyond the Breakthrough: Building a Long-Term Obesity and Cardiometabolic Care Ecosystem

The worldwide prevalence of obesity more than doubled between 1990 and 2022 and it is increasingly recognised as one of the most pressing health issues of our time.4

Significant strides have been made in understanding and addressing obesity in recent years. However, for many patients today, sustained weight loss remains difficult to maintain.5,6 Much of the focus so far has been on the short-term – achieving the greatest weight loss in the shortest amount of time. While this has led to important breakthroughs, it raises a critical question: has the healthcare community given enough thought to holistic long-term care?

Because of the disease’s heterogeneity, no two patients respond the same to treatment.7 Currently, however, most obesity treatments rely on similar mechanisms of action and tend to deliver comparable outcomes.8 Personalisation is largely limited to often infrequent dosage adjustments which must be made in consultation with a healthcare provider to balance efficacy with tolerability. Meanwhile, real-time monitoring tools are scarce, making it difficult to adapt treatment flexibly and precisely based on how an individual patient is responding.9

This lack of personalisation contributes to a broader challenge: adherence.10 Real-world data has shown that treatment discontinuation can be higher than seen in many clinical trials, with the majority of patients discontinuing treatment within the first year.10 As a consequence, it’s not surprising many patients regain weight after stopping treatment reflecting the body’s natural resistance to sustained weight reduction.5-7 Scientific research has shown already that adipose tissue may have a kind of “memory,” making long-term weight maintenance a challenge.11

So, what does the future of care look like? Is it possible to take a course of treatment and maintain the weight loss in the long-term? Could obesity, like diabetes or cardiovascular diseases, require lifelong treatment? Or could new mechanisms of action help permanently ‘reset’ the body’s metabolic set point? The answer may lie in a combination of these — and more. 

“We don’t know yet,” Dr Manu Chakravarthy says. “In theory, with the right behavioural and lifestyle changes, some patients could come off medication and maintain their weight. But realistically, we’ll need to firstly understand the different patient phenotypes and then find ways to tailor treatment plans so patients can safely stay on treatment, which may include a combination of therapies that best meet their needs comfortably over the long-term.”

It’s clear that effective long-term care will require more integrated diagnostics, such as the use of biomarkers and advanced algorithms to improve decision making and deliver more personalised treatment options as well as convenient, accurate disease monitoring. Enhanced diagnostics will enable more precise patient profiling, which in turn supports tailored, convenient treatment strategies. In the future, with a better understanding of the neuronal brain processes involved in metabolism and energy homeostasis, integrated treatment approaches could potentially include ultra-long-acting injections or even a "vaccine" for obesity. These solutions could better meet the needs of individuals who, also due to social stigma, prefer treatments that are discreet and do not serve as constant reminders of their condition.

Roche is working towards making the vision of more personalised care a reality. While the pharmaceutical division explores deep biological insights to innovate potential new therapeutic mechanisms, the diagnostics team is laying the groundwork for a future where treatment is guided by the identification of new biomarkers and artificial intelligence (AI)-based algorithms. Together, they work to deliver holistic ‘end-to-end’ care for patients with cardiometabolic disorders.

The diversity of obesity is not just clinical — it’s biological. Patients differ in how their bodies process food, regulate blood sugar, and respond to treatment.2,5,7 Some have faster metabolisms and can burn more calories efficiently, while others may differ in their gut motility, or may have an altered sense of fullness.2,5,7  Some are more sensitive to blood sugar spikes or inflammation.2,5,7  Additionally, sensitivity to side effects and complications related to other comorbidities can affect patients’ treatment tolerance.12,13 These differences matter and they demand a more tailored approach to care than is currently available.13 Better diagnostic profiling and treatment stratification could help mitigate these issues from the outset.

“Today, we don’t have diagnostic tools that can profile people with obesity in this much detail,” says Dr Gesa Albert, Indication Lead for CVRM. “But in future, diagnostics will be able to help match the right treatment to the right person, at the right time. We already have a wealth of diagnostic expertise in many other disease areas, including diabetes care and heart health, which are deeply interlinked with obesity, and we now are using that heritage and experience to benefit patients.”

She envisions a future where patients are stratified using biomarker panels — including markers of inflammation, metabolism, and hormonal regulation — to create precise profiles that guide treatment decisions.

Today, such detailed profiling remains aspirational but Roche’s legacy in diagnostics positions it well to lead this transformation. “We’re investing in early research such as proteomics, AI-based algorithm development and have a strong focus on decentralised testing. The aim is to address the unmet medical needs of people with cardiometabolic disorders along the entire patient journey - at home, in hospitals and through remote monitoring,” Dr Gesa Albert says. “Ultimately, we want to offer our established high-throughput testing in hospitals while empowering people at home with digital tools so they can comfortably manage their long-term treatment.”

Dr Manu Chakravarthy agrees. “In three to five years, I’d like to see us developing detailed patient profiles and matching them with tailored treatment algorithms that could adapt in real time. In five-plus years, we should aspire to see hospital-grade diagnostics integrated into home monitoring tools — giving patients and physicians near-constant feedback, much like we see in diabetes care today.”

This vision includes AI-informed apps that provide behavioural nudges, suggest dosage adjustments, and help patients stay on track. But both leaders stress that AI must be developed and rolled out responsibly. “These tools need to be owned and validated by healthcare companies,” Dr Manu Chakravarthy says. “We can’t rely on open models that aggregate internet wisdom. Accuracy and safety are non-negotiable.”

However, technology alone won’t solve the problem. Both Dr Gesa Albert and Dr Manu Chakravarthy highlight the need for education for physicians to encourage the adoption of new tools that ultimately will help to improve patient care.

“Patients are eager for solutions, but they need to understand that obesity is a chronic journey,” Dr Gesa Albert says. “We have learned from our experience in other disease areas that monitoring tools can empower them, but only if they’re used in partnership with healthcare professionals.”

The future of care for people with obesity and its many related comorbidities lies at the intersection of biology, technology, and human behaviour. By combining the strengths of pharmaceuticals and diagnostics, Roche is working to build a system that will hopefully effectively treat cardiometabolic diseases from the moment a patient presents, because it has the ability to create a holistic, personalised understanding of each patient’s unique situation.

“We’re not just developing new treatment options,” Dr Manu Chakravarthy says. “We’re building an innovative, holistic framework for long-term care that adapts to the patient, not the other way around.”

And that, both leaders agree, is the only way to truly change the trajectory of this global health challenge.