‘We shouldn't use Mounjaro as a way to get skinny': Dr Alexandra Sowa

Mint

28-05-2025

An obesity and internal medicine specialist based in New York, Dr Alexandra Sowa has been researching and practising obesity medicine for about a decade now. For her — and her practice at her company So Well — Ozempic is not much of a revolution. But her new book belies that familiarity. Titled The Ozempic Revolution, it's the first comprehensive user guide to GLP-1s—from the science and pop culture resonances of weight loss drugs and detailed guides to optimising benefits.
Also read: Mounjaro in India: The speed bumps impacting access to weight loss drugs
The book released in India around the same time as Mounjaro. In India, the GLP-1 drug is already in prescriptions. Dr Muffazal Lakdawala, director, department of general surgery and minimal access surgery, Sir HN Reliance Foundation Hospital, Mumbai, says, 'It's my belief that given its efficacy in controlling diabetes and excessive weight, the affordable price points in India ( ₹3500 for a 2.5 ml vial), Mounjaro will do very well in India — as it should. Both diabetes and obesity are huge problems in India, so interest and curiosity about this drug is already very very high."
In an interview over Zoom, Sowa spoke to Lounge about her experiences with the drug, what gives Mounjaro an extra edge over other GLP-1s, and how these weight loss medications could be beneficial to women. Edited excerpts:
Based on your experience treating people with GLP-1s, what is your honest estimate about the effect this category of drugs will have on humankind?
I was one of the first and earliest adopters of GLP-1 medications in the US. In my years as a student at Johns Hopkins and New York University, I realised that much of medical education was focused on end-stage disease management. So you would get sick and then we would manage you — despite the fact that most doctors know so many of chronic diseases are due to metabolic dysfunction and excess weight.
When I found this specialty of obesity medicine that was really evolving and coming out into the world about 15-20 years ago, there was no looking back. I developed my own protocol for my patients at So Well. And our method worked so well that I really felt like I had to put it into a book to help all of the people who are now getting expanded access to these medications. The thing you need to know is, a prescription does not just mean success on these medications. You need to know how to thrive: How to eat, think, live and most importantly, how to change your relationship with food.
Recently, a mildly overweight friend casually said she was considering Mounjaro. Who is the ideal candidate for this kind of drug?
Well, it depends — on government directives and other factors. I'm not entirely sure what regulations India has set. In the US, someone with a Body Mass Index (BMI) greater than 27 with one or more health issues related to their raised BMI is a good candidate. Technically, Mounjaro is approved also for type 2 diabetes. One thing we should talk about though is that we shouldn't be using this just as a way to get skinny. It's really important to look at all of the metabolic health parameters, family history, and doing a really good deep dive. If you treat this like a quick fix, it's going to be like any other crash diet.
Also read: Vasudha Rai on why it's time to reconnect with the healing power of plants
As I understand after reading the book, just taking the medication and forgetting about everything else is not going to work. Can you elaborate on the three foundations you talk about in the book for anybody on Mounjaro or Ozempic?
Yes, they are the habit foundation, the food foundation and the mental foundation.
We start with the habit foundation — learning how to track our food, not for calories but really for understanding why we're eating. Are we hungry? The food foundation is about meal planning. How am I going to get my protein in? Am I going to do eggs today? Am I going to do beans? Am I going to do meat? Protein is the most important macronutrient that you (ought to) get in every meal because your body doesn't have a lot of capacity to eat when we start these medications. I take people through what a robust diet looks like. And then finally the thing that nobody talks about but I think is potentially the most important: the mental foundation. How are you thinking about this journey? How will you respond to criticism? How do you respond to that headline that tries to give you fear or inspiration? This journey is not about skinny, it is about health.
There's been a lot of talk about the side effects too. What does it really feel like to be on this drug?
The good news about side effects for India is that Mounjaro has less side effects than earlier versions of the drug. But generally the side effects are really a by-product of how the medication works. The decreased stomach emptying can lead to some gastrointestinal upset, especially if you don't pay attention to the volume of food you're taking in. There can be some nausea, and fatigue, which gets better over time.
The effect of these drugs on muscles is well documented. Protein plus strength training seems to be the magic formula. Is that correct?
The final foundation in the book is exercise. Historically, exercise has been sold to us as something that if we did it would lead to weight loss. And so you should join the gym, do this class, sweat until you die. Exercise is not actually very good for weight loss. It's very good for cardiovascular health. It is very important for weight maintenance.
Also read: Body Roundness Index: Is this measure a better indicator of your health?
Once people start losing weight, what I want them to do is move – move in a way that just feels joyful to them. Is that walking? Is that going to a cycling class? Is it riding your bike? Just move. But what's important is we work on keeping our muscle strength up. And we do that through lifting weights. Heavy weights are great, but they're not appropriate for everyone. Luckily, on Mounjaro, you tend to lose a little more fat than muscle. If you add strength training into that mix, you're better off.
Do women and men have different responses to this class of drugs? Especially menopausal women for whom weight gain tends to be significant…
Yes. For the first time ever, women actually have superior weight loss on this drug than men. It is pretty revolutionary for the woman in menopause, who traditionally was kind of told, 'See, you will just have to deal with the insulin resistance that comes and the disease that comes and the weight gain that will come". It can be a great tool for menopausal weight gain.
In India, the Ozempic story has been one of hype. It's about celebrities suddenly looking gaunt with their 'Ozempic face". What are your thoughts on this hype?
On one hand, of course it's dangerous because you are looking at this medication for thinness, beauty and aspiration. On the other hand, with widespread coverage, what I have found is that the trickle-down effect in the US on diseases has been remarkable. 'Oprah's on it, so I'll be on it." I've been prescribing this class of drugs for a long time. Up until about 24 months ago, I would have to really have a very long conversation with patients and almost talk them into or offer these drugs. Now people are just calling the office non-stop saying, 'Oh, I qualify for this medication".
Once you are on, say, Mounjaro, is it going to be a lifetime thing?
If people stop this drug, 95% of them will regain the majority of their weight by five years. So the answer is yes. For most people, once you start this drug for weight management, you will need to continue it for a very long time, potentially indefinitely.
So many of us have experienced the guilt and the shame of being overweight. And the judgements are always based on a perception that being overweight is about dysfunctional will power and behaviour, not biology. Your book shatters that myth.
Let's quickly talk about the science of weight gain. And you are correct, it's not just willpower. Because once weight starts to come on, for the vast majority of people, it becomes very hard to take off. Why? Because the connection between your hormones, your brain and your gut become disregulated.
So yes, it's important what we eat, and it's important how we move, but there are bigger factors beyond us: our environment, pollutants, microplastics, the quality of food, our genes. In overweight people, hormones don't keep a checks-and-balance system the way that they're supposed to. What happens when hormones are in disregulation is that our hunger hormones surge, our fullness hormones tank, insulin and leptin resistance change the way that our body looks and craves food, and our brain changes too. GLP-1 agonist medications like Ozempic and Mounjaro work on this dysfunctional pathway, and they fix the relationship between the brain and the gut. It specifically works through what I call the three superpowers: It works on our brain, on our gut, and at the level of our pancreas and blood sugar.
Sanjukta Sharma is a Mumbai-based writer and journalist and runs the health and wellness IP The Slow Fix @the_slow_fix (on Instagram) and @TheSlowFix on YouTube.
Also read: What body positivity means in the age of Ozempic