Side effects to surprises: Dr Ambrish Mithal on India's weight-loss drug revolution

India Today

6 hours ago

India's struggle with rising obesity and diabetes is well documented. But a revolution is now underway, one that might reshape how we manage both conditions: the rise of GLP-1-based weight loss drugs.Dr. Ambrish Mithal, India's leading endocrinologist and author of his recently published book The Weight Loss Revolution, explains why these medications are here to stay, busting misinformation with fact.advertisementBEYOND METFORMIN: A NEW ERA IN DIABETES CARE
For years, metformin has been the standard first-line treatment for type 2 diabetes. It's safe, inexpensive, and effective. But newer medications like GLP-1 receptor agonists and SGLT-2 inhibitors are rapidly changing that equation.'With these drugs, you're moving far ahead of metformin because there is clear evidence that these drugs produce significant weight loss they protect your heart, they protect your kidney, they very likely protect your liver too. These drugs are bound to replace metformin sooner rather than later," Dr. Mithal explains.Most people with type 2 diabetes in India, nearly 80 to 90%, are overweight. That makes them ideal candidates for GLP-1 drugs, which aid in weight loss while managing blood sugar levels.'The bulk, the large chunk of type 2 diabetes patients are overweight, need to lose weight, and losing weight will help them even reverse or at least treat their diabetes better,' says Dr. Mithal.advertisementNOT ALL FAT IS EQUALTraditionally, Body Mass Index (BMI) has been used to assess weight-related health risks. But Dr. Mithal points out that for Indians, BMI is misleading.'If you use just BMI, you will end up with a lot of Indians being classified as healthy when they have actually a lot of central fat or visceral fat," he said.
Most people with type 2 diabetes in India, nearly 80 to 90%, are overweight. That makes them ideal candidates for GLP-1 drugs, which aid in weight loss while managing blood sugar levels. ()
This dangerous 'belly fat', also called visceral fat, triggers inflammation throughout the body. Dr. Mithal describes this typical South Asian pattern as TOFI -- Thin Outside, Fat Inside.GLP-1 ISN'T A MAGIC BULLETGLP-1 drugs now in India sold as Mounjaro and Wegovy, and semaglutide pills are not quick-fix solutions. Dr. Mithal stresses they must be part of a structured program that includes diet and exercise.'If you're using these drugs for weight reduction, don't depend on the drug alone,' he says.advertisementTo do this, he advises going on a high protein intake, adding more fibre in the diet, having small meals throughout the day and walking after meals.THE MUSCLE LOSS RISKRapid weight loss, especially without strength training, can lead to muscle loss. 'If you lose 10kg, you've lost 2-3kg of muscle,' warns Dr. Mithal.'If you're using the drug just as a weight loss drug and doing nothing else you will also lose muscle.'
GLP-1 drugs now in India sold as Mounjaro and Wegovy, and semaglutide pills are not quick-fix solutions. ()
He advises strength training and adequate protein to retain muscle mass and long-term health benefits.OZEMPIC FACE AND OTHER SIDE EFFECTSThe popular term 'Ozempic face' refers to loose, sagging facial skin from sudden weight loss, not unique to these drugs.'Before these drugs came into the market, anyone we put on a very strict diet or someone who had bariatric surgery would have similar things.'Most side effects are gastrointestinal such as nausea, vomiting, and rare concerns include medullary thyroid cancer, although the link remains unproven.advertisementHAPPY SIDE EFFECTS OF NEW-AGE DRUGSGLP-1 drugs have also known evidence of benefitting patients more than just weight and diabetes.'The data on these drugs is Alzheimer's diseas, better cardiac health, Parkinson's disease,' says Dr. Mithal. 'Sleep apnea goes down, fatty liver is reduced, and even kidney disease progression is reduced.'
GLP-1 drugs have also known evidence of benefitting patients more than just weight and diabetes. ()
They may also improve fertility in women with PCOS. However, the drugs may reduce the effectiveness of birth control pills, leading to unintended pregnancies, famously known as Ozempic babies.NOT FOR EVERYONE AND NOT FOREVERThese drugs should not be used as public health tools, says Dr. Mithal. Prevention through lifestyle is still the best way to fight obesity. 'You can't eradicate obesity by using these drugs You have to eradicate obesity by preventing it," Dr. Mithal adds.Also, the long-term use of these medications depends on age, health goals, and reason for use.advertisement'If you're a 30-year-old, you certainly should not use a drug lifelong. I would take a deep breath after two years and see, what do I do now?' he says.Currently, most GLP-1 drugs are injectable and expensive, limiting their access in India. However, new formulations and more research are on the way."Remember, the GLP-1 field is just beginning to explode. There'll be many newer drugs with less and less side effects and easier to use," Dr. Mithal says.- Ends