The weight-loss drug market in India is booming, with a surge in demand for medications like Rybelsus, Mounjaro, and Wegovy. These drugs, originally developed to treat diabetes, have become a game-changer for weight loss, offering impressive results. However, their rising popularity has sparked important conversations about the need for medical supervision, the risks of misuse, and the blurred lines between treatment and lifestyle enhancement.
The Promise and Perils of Weight-Loss Drugs
Dr. Anoop Misra, a leading expert, describes these drugs as the most powerful weight-loss medications we've ever seen. They belong to a class known as GLP-1 drugs, which mimic a natural hormone that regulates hunger. By slowing digestion and acting on the brain's appetite centers, these drugs make people feel fuller faster and for longer periods. However, the potential for misuse and abuse is a growing concern.
The Risks and Reality Check
Doctors warn that most users can regain weight within a year of stopping these medications, as the body resists weight loss and old cravings return. Prolonged use without exercise or strength training can lead to muscle loss alongside fat loss, especially in India's high-carb, low-protein diet culture. Not everyone responds to GLP-1 drugs, and most plateau after losing about 15% of their body weight. Side effects range from nausea and diarrhoea to more serious risks like gallstones, pancreatitis, and muscle loss.
The Media Hype and Social Media Buzz
Dr. Rahul Baxi, a diabetologist based in Mumbai, notes that these drugs have become a craze among affluent Indians eager to shed a few kilos. The frenzy is evident even at medical conferences, with one physician recalling treating over a thousand patients with imported drugs bought on the black market.
The Market Surge and Patent Expiry
India's anti-obesity drug market has seen a massive surge, growing from $16 million in 2021 to nearly $100 million today. Novo Nordisk leads the market with its semaglutide brands, and Eli Lilly's tirzepatide (Mounjaro) has become India's second-bestselling branded drug. However, the patent for semaglutide, the active ingredient in Ozempic and Wegovy, is set to expire in March, potentially unleashing a flood of cheaper generics.
The Risk of Misuse and Spurious Medicines
As affordability improves, the risk of misuse rises. Stories emerge of patients being put on high dosages of weight-loss drugs by unauthorized individuals like gym trainers and dieticians. Online pharmacies deliver drugs after cursory phone consultations, and beauticians offer "bridal packages" promising rapid slimming. There are fears of spurious medicines flooding the market, and federal minister Jitendra Singh has advised caution on these new drugs.
Obesity: A Chronic Disease and a Gateway to Other Health Issues
Doctors emphasize that obesity is a chronic, relapsing disease, and many people with chronic obesity try crash diets, only to regain even more weight. Obesity is linked to at least 20 cancers, infertility, osteoarthritis, and fatty liver, now one of the leading causes of cirrhosis. Despite affecting nearly one in eight people globally, there's still no universal consensus on how to define or classify obesity.
Changing the Conversation: Obesity as a Disease
The arrival of these drugs has shifted the narrative, treating obesity as a disease rather than just a lifestyle issue. Endocrinologists, diabetologists, cardiologists, and nephrologists are now prescribing weight-loss drugs to improve heart and kidney outcomes. Orthopaedic surgeons prescribe them to help patients lose weight before knee surgery, and chest physicians use them for patients with sleep apnea.
Bariatric Surgery and Multidisciplinary Approaches
Bariatric surgery has evolved with India's obesity boom, with the number of procedures soaring from just 200 in 2004 to 40,000 in 2022. Surgeons now run multidisciplinary programs, guiding patients on weight-loss drugs with the help of endocrinologists, nutritionists, and psychologists for three to six months. Those who don't respond to the drugs or have severe obesity are then considered for surgery.
A Blunt Message for Urban Indians
Dr. Muffazal Lakhdawala, a bariatric surgeon, has a blunt message for urban Indians seeking quick fixes: "Don't use the drugs for cosmetic weight loss - use them for life-threatening weight gain." For those chasing quick fixes to lose just a few kilos, he advises cutting out sugar and adding four days of exercise a week, which will lead to sustainable weight loss without the need for injections.
The Bottom Line
While these weight-loss drugs offer promising results, they should be approached with caution and under medical supervision. The potential for misuse and the risks associated with these medications highlight the importance of a holistic approach to weight loss, combining medication with lifestyle changes and professional guidance.
