Seeing systems: what leaders miss about organizational change
Published by Sanita Pukite - on November 6, 2025
Newsletter in short: What can a weight loss drug teach us about organizational transformation? More than you'd think. This newsletter explores how GLP-1 medications reveal three systems thinking principles that every leader navigating change should understand. Inspiration drawn from recent HBR article "How GLP-1 medications are changing consumer behavior" (October, 2025)
Background: GLP-1 (Glucagon-Like Peptide-1) medications are injectable drugs originally developed to treat type 2 diabetes. Brand names include Ozempic, Wegovy, and Mounjaro. They mimic a natural hormone that regulates blood sugar and appetite. They don't just suppress hunger - they fundamentally alter the neurological signals that create food cravings. Users report the constant "food noise" in their heads simply goes quiet.
Lesson 1: The Leverage Point Principle - Small Interventions, Massive Cascades
While GLP-1 targets one biological mechanism - appetite suppression - the result is massive cascade in all other areas of everyday consumer behaviors, patterns and spending. One pharmaceutical compound is reorganizing entire economic ecosystems.
When millions of people suddenly stop wanting excess food, not through struggle, but because the craving disappears, they're not just losing weight. They're experiencing a fundamental identity shift: "I'm no longer someone driven by food."
The drug isn't only treating obesity; it's shifting systems. This internal transformation cascades across consumer behavior, business models, healthcare systems, and social dynamics. The HBR article provides the data points: 6-8% drop in grocery spending, 4-5% rise in apparel spending, shifts in fitness habits, dining patterns, travel preferences, self-perception, and social rituals.
The Leadership Insight:
Stop trying to change everything. Find the leverage point where one shift cascades through the system.
Finding the Leverage Point: No-Meeting Wednesdays
Let’s look at how this could play out in a real organization. A hypothetical fast-growth tech company introduces "no-meeting Wednesdays" (one policy change - leverage point).
The Cascade:
Staff engineers get uninterrupted deep work time → code quality improves.
They feel more competent (their identity as engineers strengthens—now they can do deep quality work) → individual and group confidence rises.
Some volunteer for harder problems (that they now have uninterrupted time to solve) → innovation accelerates.
The team's reputation shifts to high-performing engineering team → top talent wants to join.
One variable changed. The entire system reorganized itself. Nobody worked separately on fixing productivity, morale, innovation, and recruiting.
The Psychodynamic Insight
When an individual regulates an internal drive (hunger), they don't just change behavior—the change is much deeper. People don't just eat less; they relate to themselves differently. Their entire identity gets reconstructed.
Melanie Klein's work on "projective identification" (Klein, 1946) demonstrates how a single shift in one person's internal state cascades through an entire relational system: One person's internal shift reorganizes how they relate to others → Those others then process their own internal states differently → This allows them to reorganize their emotions around different possibilities → Which cascades to more people, who reorganize their internal experiences → The entire relational system reconfigures itself.
Organizations function as "psychic containers." When leadership addresses one core anxiety (scarcity, inadequacy, threat), the entire system reorganizes around new relational possibilities.
Practical application: Ask, "What's the one thing in our system that, if shifted, would force everything else to adjust?"
Lesson 2: Second-Order Effects - The Real Impact Isn't Where You Aimed
GLP-1s were designed to treat diabetes and obesity. But the "real" disruption is happening elsewhere: identity transformation, social ritual renegotiation, redefined consumer priorities, new business models at the pharma-nutrition-lifestyle intersection.
The second-order effects include: airlines may need less fuel, dating apps might need adapting, insurance models might be shifting. The drug's impact on desire itself matters more than its impact on weight.
People aren't fighting cravings anymore—the "food noise" in their head goes quiet, fundamentally changing who they understand themselves to be. By eliminating the underlying drive rather than just suppressing behavior, it triggers identity transformation that cascades across consumer ecosystems.
The Leadership Insight:
Don't just track your intended outcome. Watch what happens in adjacent systems you never thought to monitor.
Organizational Example -The Psychological Safety Paradox
A hypothetical financial services firm works to increase psychological safety in their organization, especially focusing on transparency in leadership decisions (intended outcome: build trust).
Direct effect: Psychological safety scores increase.
Second-order effects nobody predicted:
Some middle managers feel exposed → some leave (the ones who relied on information hoarding as a source of power).
High performers get promoted faster (because contributions are now visible).
Client retention improves (because account teams stop hiding problems).
Recruitment becomes easier (candidates see authentic culture).
The trust initiative didn't just build trust and psychological safety - it reorganized power dynamics, talent flows, and customer relationships.
The Scientific Foundation
The "butterfly effect" is a metaphor Edward Lorenz, a meteorologist, used to illustrate his discovery in 1961: a butterfly flapping its wings in Brazil could set off a chain reaction of atmospheric changes that eventually causes a tornado in Texas, showing that tiny changes in initial conditions create massive, unpredictable effects in complex systems (Lorenz, 1963).
This applies to GLP-1s: altering one biological variable (appetite) in millions of people simultaneously triggers unpredictable cascades across consumer behavior, business models, and social systems.
Practical application: After any major initiative, ask: "What changed that we didn't intend? Who started behaving differently? What unspoken rules got violated?"
Lesson 3: Resistance Reveals the System - What Fights Back Shows You What Matters
The HBR article shows that industries "organized around indulgence, convenience, and impulse" face existential threat. Volume-based business models (built on frequency and loyalty) are being challenged. The article asks: "What happens to industries organized around indulgence if appetite changes at scale?"
From a systems perspective, the system is revealing which parts were dependent on the old pattern. Before the drug: impulse and indulgence. After: fundamentally different relationship with desire.
The Leadership Insight:
When you introduce change, map the resistance. It's a diagnostic tool showing you where the system's real dependencies lie.
Healthcare Manufacturer Example: Moving to Value-Based Pricing
A pharmaceutical/medical device manufacturer announces: "We're moving from volume-based pricing to value-based outcomes pricing."
Mapping the resistance reveals the system:
Hospital procurement teams (high-volume purchasers): Enthusiastic—they benefit from paying for outcomes rather than units.
Sales representatives (commission on volume sold): Intense resistance—their compensation depends on units moved, not patient outcomes.
Group Purchasing Organizations (GPOs): Use identity protection mechanism—their entire business model is built on volume commitments and tiered pricing discounts. They frame resistance as "protecting hospital budgets" or "ensuring cost containment." What's really threatened: their role becomes unclear if price isn't based on volume discounts but on patient outcomes they don't measure or control
What the resistance reveals: Some commercial partners will need to reconstruct their formulary/contracting approach - their systems are built on managing cost per unit, not measuring outcomes.
What leadership needs to address: "How do we help our sales team articulate differentiated clinical value?" instead of "How do we overcome resistance to pricing changes?"
Understanding "Real Dependencies"
When you introduce change and hit resistance, you're discovering what the current system actually runs on, not what it says it runs on, but what it functionally requires to operate.
On the surface:
Pharma company says: "We sell medicines that improve patient health"
The stated model: "We price based on the value we create"
Real dependencies revealed through resistance:
Sales compensation tied to volume → company depends on moving units.
GPO relationships built on rebates → company depends on volume-based negotiations.
No outcomes measurement infrastructure → company depends on not having to prove value.
Sales team can't articulate clinical differentiation → company depends on price competition, not value demonstration.
The diagnostic power: Resistance is information. It shows you:
Where the old pattern is embedded: Which roles, systems, and relationships are structurally dependent on what you're trying to change.
What identity threats exist: Who will need to reconstruct their professional sense of self (sales reps aren't "volume movers" anymore - so who are they?).
What capabilities are missing: If people resist because they "can't" do the new thing, you've discovered a gap.
What the system actually optimized for: The resistance map shows you what the organization really values vs. what it says it values.
The real work isn't changing the pricing model, it's building the organizational capabilities the resistance revealed were missing.
The Psychodynamic Insight
Resistance is information. When GLP-1s suppress appetite, users must abandon regression and immediate gratification as defenses against anxiety. The industries that fight back hardest are those that exploited those defenses.
Similarly, organizational resistance shows you which parts of the system are psychologically invested in the status quo - often because they derive identity, safety, or power from it.
Otto Kernberg's work on "organizational regression" (Kernberg, 1998, 2000) shows that the most resistant groups aren't just being difficult, they're absorbing collective anxiety that could destabilize the entire organization. One could think of resistance as the organizational immune system. When you introduce change, certain groups resist intensely, not because they're stubborn, but because they're unconsciously protecting the entire organization from a deeper fear. Someone inside the organisation has to hold the anxiety about "what if this all falls apart?" In most organizations, the most resistant groups are the ones carrying that fear for everyone else. They're like a fever - an uncomfortable signal that something deeper needs attention.
What leaders typically do wrong:
Try to "overcome" resistance (pushing harder).
Label resistant groups as "blockers" or "not team players"
Waste energy trying to convince them to change.
What smart leaders do instead:
Ask: "What fear is this group holding for the whole system?"
Recognize: This group is showing us where capabilities are missing.
Build: The infrastructure that makes their anxiety unnecessary.
Practical application: When facing resistance, ask: "What would this person/team lose if this change succeeded?" Not lose practically (budget, headcount), but lose psychologically (status, certainty, identity, belonging). The answer reveals what the system is actually protecting and what needs to be addressed for change to take hold.
The Bottom Line: One Variable Can Reprogram the System
GLP-1s aren't just treating obesity, they're demonstrating that complex systems reorganize around single well-placed interventions. The drug suppresses appetite, but the real transformation is in identity, desire, social patterns, and economic priorities.
Organizations work the same way. The leader who thinks "our culture is too strong to change" is making a category error. Culture isn't a granite wall you push against. It's a living system that reorganizes when you find the leverage point.
From a psychodynamic perspective, that leverage point is always about feelings and relationships. It's the intervention that addresses the unconscious contracts, fears, and collective anxieties and offers alignment with what Donald Winnicott described as the "True Self" (Winnicott, 1960). When organizations offer identities that feel more authentic, employees don't just adopt new behaviors—they experience relief from the exhausting work of maintaining a "False Self." This releases enormous psychological energy that becomes available for creativity, initiative, and genuine engagement.
The strategic question isn't: "How do we change everything?"
It's: "What's the one thing about how people see themselves or relate to each other that, if it shifted, would let the whole system reorganize?"
That's the variable worth finding.
P.S. The article would’ve been too long to include the other two lessons I took away from this case through a psychodynamic lens - if you’re curious, DM me.
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