How weight-loss drugs are impacting Indian women with PCOS and infertility

India Today

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With the launch of Wegovy, a globally recognised weight-loss drug, and Mounjaro, earlier launched by US medicine company Eli Lilly, India has entered a new phase in the management of obesity.For years, doctors and patients alike have grappled with the challenge of tackling obesity, especially in women. Now, with newer tools at hand, experts believe the tide may finally be turning.advertisementRenowned gynaecologist Dr. Rishma Pai speaks at length about how obesity is no longer just a cosmetic issue, it is a medical condition with deep consequences, especially for women dealing with PCOS (Polycystic Ovary Syndrome), infertility, and post-menopausal health risks.
According to Dr. Pai, nearly one in three women in India is living with obesity. 'Obesity is not just about appearance, it's ABCD: adiposity-based chronic disease,' she says.This includes a wide range of health issues like diabetes, high blood pressure, infertility, sleep apnea, arthritis, and even some cancers of the breast and uterus.For women, the burden is heavy because obesity affects them differently, and often more severely, than men.
With newer tools at hand like new-age drugs, experts believe the tide may finally be turning for obesity. ()
advertisementFrom adolescence to menopause, hormonal changes make it harder to lose weight, and easier to gain it.PCOS AND THE WEIGHT STRUGGLEPCOS affects 30–35% of young women in India and is closely linked to obesity. Dr. Pai, a consulting gynaecologist at Lilavati Hospital, PD Hinduja Hospital, Sir HN Reliance Foundation Hospital, says she sees many women battling irregular periods, acne, facial hair, and weight gain -- all classic signs of PCOS.'The sad part is that until now, we had very little to offer these young women. The older weight-loss medicines barely helped them lose 2–3 kg. It was frustrating for both doctors and patients,' she tells IndiaToday.in.However, even a 5% weight loss can significantly improve symptoms.'Once these women lose just a bit of weight, periods become regular, ovulation gets better, and in many cases, fertility improves, without the need for any other medication," she adds.
PCOS affects 30–35% of young women in India and is closely linked to obesity. ()
Dr. Pai sees this as a major step forward in pre-pregnancy care. 'Many women walk into my clinic weighing 85 kg and planning a pregnancy. If they become pregnant at this weight, they often cross 100 kg during pregnancy. This puts them at high risk for diabetes, hypertension, and complications. Doctors too are stressed managing these high-risk pregnancies.'advertisementShe recommends a focused pre-pregnancy weight-loss plan, ideally stopping the medication a month before trying to conceive.THE MENOPAUSE METABOLIC SHIFTMenopause presents another weight-related hurdle. 'Even women who've been slim their whole lives suddenly find their midsections expanding,' she says. This midlife weight gain is driven by hormonal shifts and puts women at increased risk for heart disease, metabolic disorders, and certain cancers.Dr. Pai stresses that women at every life stage, from puberty to menopause, must be supported in achieving a healthy body weight.BEYOND THE SCALE: SHAME, STIGMA AND MENTAL HEALTHDr. Pai calls to treat obesity with compassion, as even healthcare professionals can be biased. "When an overweight woman walks into a clinic, many assume she's lazy or careless. That's simply not true,' she says.The problem is worsened by the pressure women face to look a certain way, especially in the age of social media. 'Pre-wedding weight loss has become almost compulsory. Brides starve themselves or opt for surgeries, just to look good in photos. But after the wedding, many regain all the weight,' she adds.
A focused pre-pregnancy weight-loss plan, ideally stopping the medication a month before trying to conceive. ()
advertisementA 2022 Novo survey conducted across Asia-Pacific found that one-third of people with obesity refused to acknowledge their condition. Two-thirds blamed themselves for it. 'This shows how little we understand obesity as a chronic disease,' said Dr. Pai.WEIGHT-LOSS DRUGS: NOT A MAGIC CURE, BUT A POWERFUL TOOLDr. Pai believes drugs like semaglutide (Wegovy) are not miracle cures, but they can be powerful allies.She insists that the use of these drugs must be part of a bigger, long-term strategy that includes counselling, behavioural change, and consistent follow-up.Weight-loss drugs can be added to pre-pregnancy programs as well, to help women lose weight, become healthier, and then stop the medication one month prior to planning pregnancy. But this needs to be done very strategically, under medical supervision with a sustainable lifestyle.advertisement'You can't take these medicines for six months, then binge-eat and expect to maintain weight loss. Sustaining it is even harder than achieving it," she says.Still, the results are motivating. 'When a woman sees even a few kgs drop, she feels confident and inspired. That's the start of a bigger transformation.'More than anything, Dr. Pai wants to change how we talk about weight: 'Let's stop saying thin equals healthy. Fitness is not just about looks. There are thin women with high body fat and low muscle mass. We need to create awareness—not judgement.'- EndsMust Watch