At first glance, Japan seems an unlikely place for Novo Nordisk A/S to introduce its weight-loss drug Wegovy in Asia. That’s exactly why it was chosen, according to the Danish drugmaker.

The lack of awareness surrounding obesity as a disease, and the stigma of it, are among the reasons Novo selected the country, says Kasper Bodker Mejlvang, president and representative director of Japan’s Novo Nordisk Pharma Ltd.

"There’s a big educational task ahead of us,” he adds.

While it may not appear to be an issue, obesity has been increasing dramatically for Japanese men, with the number of afflicted in their 20s doubling in the past three decades, according to a 2020 study. The market for weight-loss drugs has taken off around the world, with Novo’s shares gaining about 70% in the past 12 months and even expanding Denmark’s economy due to Wegovy and Ozempic, its diabetes treatment.

Globally, those with a body mass index of 30 or more are considered obese — for example, someone 165 centimeters tall weighing 82 kilograms (5’4” and 180 pounds). But the Japan Society for the Study of Obesity uses a lower threshold of 25 — the same height at 68 kilograms — because the Japanese, like other people of Asian descent, have been found to be prone to obesity-related health problems like heart disease at a lower BMI.

"When you use the BMI measure of 25, obesity levels in Japan are actually not that different from America or Europe,” says Wataru Ogawa, a professor at Kobe University’s School of Medicine and executive director at the obesity group.

In Japan, some 33% of men and 22% of women have a BMI of 25 or more, according to the latest available data from the Ministry of Health, Labour and Welfare. In the United States, around 43% of men and women have a BMI of 30 or higher.

Bloomberg Intelligence estimates that global weight-loss drug sales could reach $80 billion by 2030, led by Novo and its biggest competitor, Eli Lilly & Co.

The roll out of Wegovy, from the family of GLP-1 drugs, in Japan will be the first time in about 30 years that an effective obesity medication has become available in the island nation. Those struggling with obesity before only had the option of taking Mazindol, a stimulant used as an appetite suppressant.

With an increasingly aging population, Japan’s social-security expenditures make up about a third of the national budget, leaving little room for other health-care spending. The government is eager to curtail obesity, as its cost is projected to increase to about $198 billion by 2060, a four-fold increase from 2019, according to the World Obesity Federation.

"Here in Japan of course there’s a very keen interest in protecting the universal health-care system, but it requires that we counter this development of chronic disease,” Mejlvang says.

With overwhelming demand in the U.S., Novo has been struggling to keep up. The drugmaker’s biggest shareholder announced last month that it was buying Catalent Inc., one of the world’s largest drug-manufacturing companies, and would sell three factories to Novo for $11 billion in an effort to ease supply-chain issues.

In November, the health ministry published a set of guidelines saying eligible patients require a BMI of 35 or more, or a BMI of 27 or higher for those with two or more obesity-related health issues, such as diabetes or high-blood pressure. Most prescriptions will be covered by insurance.

"In the medium term we should expect a very controlled launch where we build the market, educate, build a holistic approach to treatment,” Mejlvang says. "Beyond that, we definitely see very strong growth potential.”

The Japanese government is also concerned about improper use of the drug, given the country’s strong diet culture. That’s another reason why the launch is more measured, according to Novo. The peak sales forecast for the drug in five years is estimated to be about ¥33 billion ($219 million) in Japan, according to the ministry.