India’s weight-loss drug boom and the risks behind it

Calls are coming thick and fast for Mumbai-based diabetes specialist Rahul Baxi – but not just from patients struggling to control their blood sugar.

Increasingly, young professionals are asking the same thing: “Doctor, can you start me on weight-loss medications?”

Recently, a 23-year-old man came in, concerned about the 10 kg he had gained after starting a strenuous job in a company. “One of my gym friends is there [weight loss] “Blows,” he said.

Dr. Baxi says that he refused, and asked him what he would do after he lost 10 kilograms of weight due to taking the medicine.

He told him: “Stop, and the weight will come back. Keep going, and without exercise you will start losing muscle instead. These medications are not a substitute for a proper diet or lifestyle change.”

Such conversations have become increasingly common as demand for weight-loss drugs grows in urban India – a country with the second-highest number of overweight adults in the world, and more than 77 million people with type 2 diabetes.

Originally developed to treat diabetes, these drugs are now being hailed as game-changers for weight loss, offering results that few previous treatments can match. However, their growing popularity has also raised difficult questions – about the need for medical supervision, the risks of abuse, and the blurred line between treatment and lifestyle improvement.

“These are the most powerful weight-loss drugs we’ve ever seen,” says Anoop Misra, who heads the Fortis-C-DOC Center of Excellence in Diabetes, Metabolic and Endocrine Diseases in Delhi. “A lot of these drugs have come and gone, but nothing compares to them.”

Two new drugs are dominating the fast-growing weight loss market in India. One is semaglutide, which Danish pharma giant Novo Nordisk sells under the names Rybelsus (oral) and Wegovy (injectable) — while Ozempic (injectable) is approved to treat diabetes in India but is not yet available for obesity. The other is tirzepatide, which is marketed by the US pharmaceutical company Eli Lilly under the name Mounjaro, and is used primarily to treat diabetes but is increasingly used for weight loss in India.

Both belong to a class known as GLP-1 drugs, which mimic the natural hormone that regulates hunger. By slowing digestion and affecting the appetite centers in the brain, they make people feel full faster and stay full longer. Most of these medications are taken once a week, self-injected into the arm, thigh, or stomach. They curb cravings – and in Monjaro’s case, they also boost metabolism and energy balance.

Treatment begins with a low dose that is slowly increased to maintenance level, and weight loss usually begins within weeks.

Doctors warn that most users can regain the weight within a year of stopping, as the body fights the weight loss and the return of old cravings. Prolonged use without exercise or strength training can also result in muscle and fat removal.

Also, not everyone responds to GLP-1 medications, and most plateau after losing about 15% of their body weight. Side effects range from nausea and diarrhea to rare risks such as gallstones, pancreatitis, and muscle loss. The high-carb, low-protein diet in India already fuels morbid obesity — muscle loss coupled with fat gain — and losing weight without adequate protein or exercise can make it worse.

“With all the media hype and social media hype, these drugs have become a craze among affluent Indians who are eager to shed a few kilos,” says Dr Baxi.

This madness was evident even at a recent medical conference, recalls a Delhi-based doctor.

“Three months after launching a new drug, I treated about a hundred patients. One of my colleagues said he treated more than a thousand patients – most of them using imported injections bought on the black market.”

The anti-obesity drug market in India has risen from $16 million in 2021 to nearly $100 million today — a more than six-fold jump in five years, according to research firm Pharmarac.

Novo Nordisk leads the market with its semaglutide brands, with Rybelsus alone accounting for nearly two-thirds of the market since its launch in 2022, according to the company. Eli Lilly’s tirzepatide (marketed as Mounjaro), which was launched earlier this year, had become the second best-selling drug in India by September, according to Pharmarack. The price of each monthly injectable pen – four weekly doses – of these drugs ranges between 14,000 and 27,000 rupees ($157 to $300), an exorbitant sum for most Indians.

What India has witnessed so far may be just the tip of the iceberg. Come March, the patent for semaglutide — the active ingredient in Ozempic and Wegovy — expires here, potentially unleashing a flood of cheap generic drugs and making them more affordable. Investment bank Jefferies calls this a “magic drug moment” for India, and expects the semaglutide market to be worth $1 billion with favorable pricing, uptake and government incentives.

“What we’ve heard is that about a dozen companies are already ready for generic versions of Rebelsus, the oral drug,” says Sheetal Sabally, vice president of Pharmarac. “But as affordability improves, the risk of abuse also rises.”

Doctors tell stories of patients being given high doses of weight-loss drugs by gym trainers, nutritionists and beauty clinics without the authority to prescribe them. Some online pharmacies deliver medicines after a quick telephone consultation in the absence of a prescription. Beauty experts are offering ‘wedding packages’ that promise quick slimming before the big day. There are fears of counterfeit medicines flooding the markets. Union Minister Jitendra Singh “Advice of caution” On new medications.

“One patient asked me if these new drugs could help his daughter lose seven kilograms before her wedding – in three months,” recalls Dr Bhowmik Kamdar, a Mumbai-based chest doctor. “He wanted to know if they really worked.”

Doctors say one challenge in India is the way people view obesity, and how that shapes attitudes towards weight loss.

“Most people do not realize that obesity is a chronic, relapsing disease,” says Dr Mofazzal Lakhdwala, a Mumbai-based obesity surgeon. “Many people with chronic obesity try a strict diet, lose some weight, and then gain more back.”

“Here, if you’re overweight, people assume you’re well-fed and wealthy. We’ve gone so far as to avoid the elephant in the room as we’ve normalized it.”

Doctors warn that obesity is a gateway to a number of diseases. “It is linked to at least 20 cases of cancer, infertility, osteoarthritis, and fatty liver — and is now one of the leading causes of cirrhosis,” says Dr. Lakhdwala. However, although it affects approximately one in eight people globally, there is still no global consensus on how to define or classify obesity.

“The arrival of these drugs has changed the conversation, as obesity is now treated as a disease, rather than just a lifestyle issue.”

Doctors in various specialties are now turning to weight-loss medications for more than just obesity or diabetes.

Endocrinologists, diabetologists, cardiologists, and nephrologists are increasingly prescribing them to overweight patients to improve heart and kidney outcomes — for example, those preparing for angioplasty or stenting.

Orthopedic surgeons now prescribe it to help patients lose weight before knee surgery, while chest doctors use it for people with sleep apnea, a disorder that blocks the airway during sleep. “For patients with sleep apnea who avoid using continuous positive airway pressure (CPAP) “These medications can help reduce weight, which in turn improves their sleep,” says Dr. Kamdar.

Even obesity surgery is evolving with the obesity boom in India. From just 200 surgeries in 2004, the number has risen to 40,000 in 2022 – a 200-fold rise.

Surgeons like Dr. Lakdawala now run multidisciplinary programs where patients on weight-loss medications are first guided by endocrinologists, nutritionists and psychologists for three to six months. “We don’t distribute drugs casually,” he says. “Those who do not respond to medications or are obese are considered for surgery.”

His message to the growing number of urban Indians looking for quick fixes was blunt and frank: “Don’t use cosmetic drugs to lose weight, use them to gain life-threatening weight.”

And for those who are looking for quick solutions to get rid of just five or 10 kg?

He has simpler advice: “Stop eating sugar – it’s the ultimate evil. Without it, your weight loss won’t be sustained. Add four days of exercise a week, and you’ll lose between 5 and 7 kg – without the need for injections.”