If I had recommended exiting obesity drug development in 2010, few investors would have questioned my judgment. In fact, many would probably have considered it prudent. The category had accumulated years of disappointments, safety concerns, regulatory setbacks, and commercial underperformance. Several companies had invested heavily only to see promising programs fail, products withdrawn, or market opportunities fall well short of expectations. By the end of the 2000s, obesity had become one of those therapeutic areas that many executives preferred to avoid.
Looking back from 2025, however, that conclusion seems difficult to reconcile with reality. Obesity has become one of the most important growth areas in healthcare. Pharmaceutical companies are investing tens of billions of dollars, manufacturing capacity has become a strategic priority, and demand for GLP-1 therapies continues to exceed supply in many markets. From today’s perspective, abandoning obesity research appears to have been a costly mistake.
The difficulty is that hindsight has a way of making the past look far more predictable than it actually was. Once we know how a story ends, it becomes tempting to assume that the right decision should have been obvious from the beginning. In business, and particularly in the pharmaceutical industry, that assumption can be dangerously misleading. Some of the decisions that appear misguided today may have been entirely rational when they were made, while some decisions we now celebrate may have looked highly questionable at the time.
One of the most common leadership traps is judging the quality of a decision solely by its outcome. Success is often interpreted as evidence of good judgment, while failure is assumed to reveal poor judgment. Yet anyone who has spent time in drug development understands that outcomes are shaped by far more than the decisions themselves. Timing, competition, regulation, scientific advances, reimbursement dynamics, and plain uncertainty all influence the final result.
Consider the information available to pharmaceutical executives fifteen years ago. Sanofi had experienced the collapse of rimonabant after concerns regarding psychiatric adverse events. Merck discontinued taranabant despite significant investment. Pfizer walked away from otenabant as regulatory expectations around obesity treatments became increasingly demanding. Reimbursement prospects were uncertain, physician adoption remained limited, and many observers questioned whether obesity would ever become a commercially attractive therapeutic category.
Against that backdrop, reducing investment or even exiting the field altogether was not irrational. Arguably, it was a defensible decision based on the evidence available at the time. Looking back, I am not entirely sure I would have done anything differently. In fact, if I had been sitting in some of those portfolio review meetings with the same information available then, I suspect I might have reached a similar conclusion.
What makes the story fascinating is how dramatically those decisions are perceived today. After the extraordinary success of GLP-1 therapies, it is easy to identify missed opportunities and conclude that certain companies simply got it wrong. Yet that interpretation overlooks a crucial point: executives were making decisions with the information available at the time. The future that eventually unfolded was not yet visible, and many of the signals that appear obvious today were far less obvious then.
This becomes particularly important inside large organizations. When companies consistently reward successful outcomes and punish unsuccessful ones without examining the quality of the underlying decision-making process, they gradually create cultures that become more risk-averse. Teams learn that avoiding visible failures is often safer than pursuing uncertain opportunities, even when those opportunities carry attractive probabilities of success. Over time, the organization becomes better at protecting itself from mistakes and worse at identifying breakthrough opportunities.
However, leaders who evaluate decisions exclusively through the lens of what happened afterward often risk learning the wrong lessons from both success and failure.
The companies that exited obesity development may have made rational decisions based on the evidence available at the time. The fact that history unfolded differently does not necessarily make those decisions wrong.
And perhaps that is the real lesson behind many of the most successful businesses of our time: the opportunities that eventually create the greatest value rarely look obvious in their early stages. In a world where certainty is increasingly rare, focusing exclusively on opportunities that feel completely safe may ultimately be one of the riskiest strategies of all.
