Anorexiant Market: Persistence Economics, Oral Small Molecules, and Indication Escape

Growth ran at roughly 13.2% between 2020 and 2025 measured across the whole category, though that figure buries an extraordinary divergence. Legacy stimulant anorectics and older combination agents declined throughout, while semaglutide and tirzepatide went from launch to the largest pharmaceutical products in the world inside four years. Manufacturing capacity, not demand, limited the whole period, and compounded supply filled part of the gap until regulators closed it.
Base case growth of 14.4% rests on three mechanisms. Oral small molecule agents remove the peptide synthesis constraint and the cold chain, which opens emerging markets that injectable pricing and logistics had closed entirely. Indication expansion into cardiovascular risk, sleep apnoea and liver disease converts a lifestyle exclusion into a covered medical benefit. And treated penetration remains near 6% of the clinically eligible population, so the runway is an access question.
The bull case at 15.8% assumes persistence improves materially as oral dosing, better tolerability and lower prices reduce discontinuation. The bear case at 13.1% is the mirror image: if a third of patients keep stopping within a year and payers respond by restricting coverage to documented responders, revenue per patient falls even as prescriptions rise, a pattern nobody here has modelled.