Mounjaro, Wegovy signal ashift in obesity care model in India which sees 20k bariatric surgeries a year

The Print

26-07-2025

Mounjaro, manufactured by US-based Eli Lilly & Company and which has tirzepatide as its active pharmaceutical ingredient (API), was launched in India 20 March. Wegovy, a weight loss drug by Danish drugmaker Novo Nordisk which has semaglutide as its API, hit the Indian markets 25 June.
But the development has another fallout that has become a talking point among physicians treating and managing obesity—a possible reduction in the number of bariatric surgeries or weight loss surgery, a series of procedures intended to reshape or alter the anatomy of the stomach to reduce weight.
New Delhi: The back-to-back arrival of two high-profile weight loss drugs in India, Mounjaro and Wegovy, over the past four months has fuelled an intense competition in the country's burgeoning anti-obesity market as one megaseller tries to outshine the other.
The prescription-only drugs mimic the effects of the natural gut hormones that work by lowering caloric intake, primarily by influencing appetite control mechanisms, and can result in weight of up to 15-20 percent.
Many clinicians say this will lead to fewer people opting for bariatric surgeries, which, depending on the extent and type of the surgery, result in a moderate 15 percent to a high of over 50 percent weight loss.
'As Wegovy and Mounjaro are now available for patients struggling with obesity, I see fewer patients opting for bariatric surgeries, especially the simpler procedures which are also more common, as they offer nearly comparable weight loss results,' Dr Naval K. Vikram, a professor of medicine and obesity researcher at the All India Institute of Medical Sciences in New Delhi, told ThePrint.
His colleague, a bariatric surgeon at the premium institute who did not want to be named, also said the number of adjustable gastric banding and gastric sleeve surgeries, which are less complex but also result in moderate weight loss, could particularly take a hit.
As per statistics shared by the Obesity and Metabolic Surgery of India (OSSI), India has over the past five to seven years consistently performed around 20,000 bariatric surgeries a year.
'While patient hesitation was common in the early years, growing awareness about the broader health benefits of bariatric surgery, along with the introduction of advanced technologies such as robotic-assisted surgery, has encouraged more individuals to consider it,' said Dr Sukhvinder Singh Saggu, the national convener of the OSSI national registry.
A last year study examining a large sample of patients with obesity in the US found that the usage of anti-obesity drugs doubled from 2022 to 2023 in the country, and there was a sharp decline (25.6 percent) in the number of patients undergoing metabolic bariatric surgery to treat obesity.
Most physicians see the trend getting repeated in India in the coming months.
India's anti-obesity drug market is currently valued at Rs 3,000-3,500 crore, and is projected to grow nearly eightfold to Rs 25,000 crore by 2030 as per the market estimates.
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Someone's gain, someone's loss
Chennai-based diabetologist Dr V. Mohan, an obesity researcher and the chairman of the Madras Diabetes Research Foundation (MDRF), said the advent of new age weight loss drugs marks a paradigm shift in obesity management, similar to what the arrival of drug classes such as proton pump inhibitors (that reduce stomach acid production) meant for the fate of peptic ulcer surgeries.
'At one point, procedures such as gastrojejunostomy for patients of peptic ulcers were very common but these procedures are barely needed now. I see a similar shift in the bariatric surgery landscape and these procedures would increasingly be reserved for people with very high body mass index (BMI),' Mohan said.
Bariatric surgery is generally considered for individuals with a Body Mass Index (BMI) of 40 or higher, or for those with a BMI of 35 or higher and serious obesity-related health problems.
These health problems can include type 2 diabetes, high blood pressure, or severe sleep apnea. In some cases, surgery may also be an option for individuals with a BMI between 30 and 34 who have poorly controlled type 2 diabetes. But in Indians, where in several people BMI of even nearly 30 can cause a problem due to fat deposition near vital organs, surgery is sometimes indicated.
A 2023 survey by the Indian Council of Medical Research (ICMR) and Madras Diabetes Research Foundation (MDRF) had shown that 25.4 crore Indians had generalised obesity.
A large number of people have body weight exceeding BMI of over 35 and body weight of even 100 kg and above, say doctors.
In such patients, the surgery works by altering the digestive system to reduce food intake and/or absorption, leading to weight loss and improvement of obesity-related health issues.
In comparison, Mounjaro and Wegovy primarily influence appetite control mechanisms.
In May this year, Lilly said in a statement that a head-to-head clinical trial comparing tirzepatide and semaglutide in their maximum tolerable dosages showed the former to be significantly more effective in reducing both weight and waist circumference after 72 weeks of treatment.
According to the U.S. based pharma giant, the participants administered tirzepatide saw an average weight reduction of 20.2 percent, while those on semaglutide experienced a 13.7 percent loss—indicating a 47 percent greater relative weight loss for the former, based on the treatment-regimen estimand at 72 weeks.
But some doctors said while tirzepatide is better than semaglutide in percentage of weight loss, there is stronger evidence in case of semaglutide for reducing cardiovascular conditions in obese people without diabetes and also for treating kidney and diabetes.
Dr Naval K. Vikram, the AIIMS professor quoted above said, for people who opted for simpler bariatric surgeries, which also meant lesser complications but relatively lower weight loss result, these drugs will be a likelier choice.
'Their cost,' he said, 'however could be a dampener as they are expensive and will need recurring expenses.'
The monthly cost of the first three dosing strengths of Wegovy, which are typically the starting dosages, has been kept at Rs 17,345, the last two dose strengths or the maintenance dose cost Rs 24,280 and Rs 26,050 respectively.
The starting dose of Maunjaro, on the other hand, costs Rs 14,000 per month while the higher dose costs Rs 17,500 per month.
But Mohan countered that surgeries do not come cheap either and generally cost Rs 2 lakh to even more than Rs 6 lakh. 'Plus, these procedures are complicated, cause permanent changes in the stomach structure and sometimes patients tend to regain weight later on for which they need therapeutic intervention,' he said.
Step up for obesity management
On their part, metabolic and obesity surgeons maintained that these surgeries are no longer seen merely as a weight-loss procedure but widely recognised as a powerful therapeutic tool for managing a range of obesity-related conditions, including type 2 diabetes, coronary artery disease, hypertension, high cholesterol, infertility, and sleep apnea.
The integration of robotic systems has further enhanced outcomes by offering greater precision, faster recovery, and improved patient comfort, Dr Sukhvinder Singh Saggu said.
Surgeons also insisted that the approach to obesity treatment in India is also evolving into a multimodal strategy, similar to cancer care where surgery, chemotherapy, and radiotherapy work in tandem.
'Given that obesity is a complex, chronic, and multifactorial condition, the treatment now combines weight loss drugs, lifestyle management, exercise, and bariatric surgery, tailored to the patient's BMI and health profile,' Saggu said.
'So we do not see these (anti-obesity medications) as a challenge to bariatric surgery. Instead, these drugs complement surgical options, broadening the spectrum of treatments available,' he also said.
Both approaches have their limitations, but together they form part of a comprehensive obesity management pathway designed to deliver sustained health benefits, the OSSI member further said.
Dr Parimuthukumar, a senior consultant in minimally invasive gastrointestinal and bariatric surgery at Prashanth Hospitals in Chennai, pointed out that patients are assessed based on their BMI, which categorises them as overweight, obese (Class 1, 2, 3), or even super obese.
'Bariatric surgery is never the first line of treatment. When a patient comes in, we always begin by recommending dietary changes and lifestyle modifications,' he said.
Not all patients, however, are able to follow through successfully and in such cases, surgeons may consider weight-loss medications, depending on the patient's suitability.
'Only when both non-invasive options do not yield the desired results, and if the patient meets clinical criteria, do we proceed with bariatric surgery,' Parimuthukumar said, adding that it's a gradual, stepwise approach.
'Whichever method is used — diet, drugs, or surgery — weight loss happens over time, not overnight. But ultimately, reaching a healthier weight improves patients' physical mobility and often reduces their dependence on medication,' he said.
(Edited by Ajeet Tiwari)
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