Reshaping India's waistline
If endocrinologist Dr. Anoop Misra's exhausted smile and constantly buzzing phone are any indication, the newest hormone-mimicking drug-based entrant into the Indian weight-loss market — tirzepatide, sold under the brand name Mounjaro, manufactured by American pharmaceutical company Eli Lilly — is the hottest selling product in the wellness and enhanced longevity market today.
'People have been waiting for it to enter India and the hype around these drugs is only growing,'' says Dr. Misra, who heads Fortis C-DOC Hospital for Diabetes and Allied Sciences in Delhi. He says his facility has been getting 10-12 enquiries for the drug every day since March, when the domestic market was allowed to retail it. 'Dieting, exercise and other interventions aside, these drugs are a game changer in the weight-loss industry,'' he explains, adding that these are prescription drugs and must be combined with diet and exercise for efficacy.
Tirzepatide received approval from American authorities in 2022 to regulate type 2 diabetes and in 2023 for obesity management. After approval in India by the Central Drugs Standard Control Organisation, this weekly injectable, single-molecule drug, priced at ₹3,500 for a 2.5 mg vial and ₹4,375 for a 5 mg vial is being prescribed and taken despite its price. The most common side effects of Mounjaro include nausea, diarrhoea, decreased appetite, vomiting, constipation, indigestion, and stomach pain, but people are willing to live with those.
The drug, and others like it, were developed in a world tilting towards excessive weight. The World Health Organization (WHO) says that in 2022, one in eight persons lived with obesity, with adult obesity more than doubling since 1990. Considered a chronic multisystem disease, anyone who has a body mass index of 30 or over is said to be obese (the formula — weight in kg divided by height in metre square — determines if a person is obese).
Obesity affects a person's quality of life and is associated with a shortened life expectancy. WHO has termed it 'an epidemic'. A person with the disease is prone to over 10 kinds of cancers and a host of other diseases including type 2 diabetes, hypertension, fatty liver, cardiovascular diseases, osteoarthritis and mental disorders, among others.
Life lessons
Aruna Lal (name changed to protect privacy), who will be 60 years old this year, says she has tried many weight-loss interventions. 'I realised that no matter what I do, I can only lose weight on a consistent calorie deficit, and these drugs help me do just that. I tried diets, exercising, walks and calorie counting,'' she explains while speaking about her now decade-long battle with weight gain. She admits that each time, she fell off the wagon. Aruna, at 5 feet 2 inches, says that she went from 52 kg to the 84 kg she is currently at, over a span of a few decades.
'I blame my weight gain on overeating,'' she says squarely, laughing. With three children, a career as an art collector and seller, and maintaining three homes across Goa, Mumbai, and Singapore, Aruna had many stressors, including moving countries to be with her husband who worked in a multinational company. 'During this period, the weight crept up on me and last year I had a cancer scare (of the uterus). It made me sit up and relook at my health,'' she says.
Last year in Singapore, Aruna decided to use the new class of anti-obesity drugs called glucagon-like peptide 1 (GLP 1), which promised sure-shot weight loss. Her doctor put her on Ozempic, which contains the active ingredient semaglutide and is available in India only on the grey market. Ozempic is also a prescription drug, given as an injection under the skin. It is recommended for type 2 diabetes and is now extensively used to manage weight.
'The first dose killed me,'' says Aruna. 'This was even though my son had already been using the drug and had briefed me about the possible side effects.' Ozempic is available in pre-filled pens with specific strengths: 0.25 mg, 0.5 mg, 1 mg and 2 mg. Her doctor put her on 1 mg because lower doses were not available at the time. 'The result was nausea, diarrhoea and a general feeling of being overwhelmed. I also experienced muscle loss and associated skin sagging. But the drug helped me cut my weight by 5 kg in a few months,'' she says. The symptoms began to impact her lifestyle, so she gave it up. She has now put back some of the weight but is determined to begin again.
Doctors and patience
Weight loss through semaglutide and tirzepatide use is done after extensive individual consultation. Doctors often start patients on the lowest dose and then build it up.
'Hormonal drugs must be prescribed under the supervision of an endocrinologist, often in consultation with a physician. These medications have specific effects on the body and require careful monitoring,'' says Dr. Pankaj Kumar Hans, the associate director and a unit head at the Minimal Invasive Metabolic, Bariatric and Robotic Surgery, Asian Hospital, in Delhi. He also says that like bariatric surgery, not all with obesity qualify for drug-based weight loss. For instance, those with a family history of thyroid cancer are asked not to take the drugs.
Aruna's son started taking Ozempic at 31 and has been on it for a couple of years now. 'I first became conscious of my weight when I was 18 and at 100 kg; later this went up to 107. When I went in for a medical consultation, it was for my sleep apnoea. The doctor suggested Ozempic for weight loss and after I started taking it my weight came down to 90 kg in three months,' he says. He started at the lowest dose. 'What the drug has done is to ensure that I have no cravings for the wrong type of food. It is like having a coach alongside you all the time who slaps you when you try to put something unhealthy into the food. This habit stays,'' he explains, adding that he has also begun to exercise. He too says that higher doses did not go well for him.
How the drugs work
Weight-loss medications include both oral and injectable options. 'Currently in India, both tirzepatide and semaglutide are marketed under the brand names Rybelsus and Wegovy (both semaglutide), and Mounjaro or Zepbound (both tirzepatide),'' explains Dr. Misra.
Explaining the difference between semaglutide and tirzepatide, he says, 'Semaglutide and tirzepatide differ in their mechanisms of action. Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist, meaning it stimulates GLP-1 receptors; tirzepatide is a dual agonist, acting on both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors. This dual action of tirzepatide may lead to more significant weight loss and glycaemic control compared to semaglutide.' Simply put, both the drugs result in increased satiety, forcing users to eat less.
At the time of the launch of the drug in India, Eli Lilly and Company said it is 'an innovative option to treat obesity and type 2 diabetes'. The company's statement also added that the drug plays a vital role in supporting individuals living with obesity — not only in managing the condition but also in preventing related complications. However, it also warned against self-diagnosis and administration. 'People with obesity should consult their treating physician to determine whether this treatment is appropriate for their individual medical needs,' it said.
There are other, older medicines that have claimed they assist in weight management: Lirafit (liraglutide); Xenical (prescription) Alli (over the counter), both orlistat, a lipase inhibitor, manufactured by GlaxoSmithKline. Other generic orlistat products are Obelit (Intas Pharma), Zerocal (Weidar), and Cobese (Ranbaxy).
'The Indian weight-management market was valued at $25.2 billion in 2024,' says a report by IMARC, a global management consulting firm which does market assessment and feasibility studies. It predicts that the Indian weight-management market will see a compound annual growth rate of 8.79% between 2025 and 2033.
Speaking about it openly
Saroj Singh, 45, lives in central Delhi, and has recently started Mounjaro. She says that both her older sisters in America benefitted from Ozempic and lost almost 10 kg each. 'Obesity, hypertension, diabetes — you name it, we three sisters have it. All three of us started putting on weight after childbirth and related complications. I was waiting for Mounjaro to come into India because importing Ozempic was expensive,'' she says.
Saroj underwent a body-mind evaluation and counselling session by the hospital she consulted before starting on the weight-loss drug. 'I was made aware of how my eating habits need to change and how I need to manage my side effects and pack in some physical activity to boost my overall well-being and weight loss,' she says.
'I started on the lowest dose this April and have already lost 3 kg. This was something I struggled to achieve earlier. I am experiencing the known symptoms but slowly my body has fallen into a rhythm,'' she says, adding that unlike before, there is no shame in saying that you are taking the help of drugs to maintain or lose weight. 'There was so much guilt associated with this earlier. However, people are realising that obesity is a disease like any other illness and it needs to be treated,'' she says.
Some part of the openness is also because it has legal ramifications. 'Under the Indian law, a higher health insurance premium on account of obesity is permissible,' says Sonam Chandwani, managing partner, KS Legal & Associates, a law firm in Delhi. 'Under the Insurance Regulatory and Development Authority of India guidelines, the insurer may consider obesity as a risk factor, justifying premium variation,'' she explains.
India already offers surgical interventions to combat certain types of obesity, including bariatric surgery, gastric bypass and fat removal surgery. Some of these, including bariatric surgery, are now being covered under insurance.
An obesogenic environment
The weight-loss industry began booming in India in the 1990s, around the time of liberalisation and the opening of the economy to international brands, including packaged and fast foods.
According to the Global Obesity Observatory, an online platform and database hosted by the World Obesity Federation, obesity cost India approximately $28.95 billion (₹2.4 lakh crore) in 2019, accounting for 1.02% of the GDP then. This burden is expected to surge to $81.53 billion (₹6.7 lakh crore) by 2030, reaching 1.57% of the GDP. The Indian health budget, as a percentage of GDP, is around 1.9%.
As per the government's National Family Health Survey 2019–21 overall, 40% of women and 12% of men are abdominally obese in the country, a major risk factor for various lifestyle diseases, including type-2 diabetes.
In India, the high prevalence of abdominal fat was found in the southern States of Kerala (65.4%) and Tamil Nadu (57.9%) and the northern states of Punjab (62.5%) and Delhi (59%). There is low prevalence in the States of Jharkhand (23.9%) and Madhya Pradesh (24.9%), reveals the study 'Abdominal obesity in India: analysis of the National Family Health Survey-5 (2019–2021) data', published in The Lancet Regional Health — Southeast Asia.
Obesity is the result of several factors, including stress and lifestyle habits, like the lack of movement and not enough rest. A big part of the problem is that urban environments are not built for health. Arun Gupta, who founded the Breastfeeding Promotion Network of India and has been advocating for healthy foods for over a decade, says that rapid urbanisation, economic development, increased access to processed foods, globalisation, and changing social norms are all contributing factors to obesity.
Vanita Rahman, an internal medicine physician, certified nutritionist and weight-loss specialist with the Physicians Committee for Responsible Medicine in America, notes that a nutrient-rich, fibre- and protein-packed plant-based diet is still an effective and sustainable weight-management technique.
bindu.p@thehindu.co.in
Edited by Sunalini Mathew.
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