India is facing an unprecedented obesity crisis that is threatening the nation's public health landscape. It ranks among the top three countries for obesity, with a staggering 70 per cent of its population being overweight. As a result, the attention is now inching towards the growing use of weight loss medication, for both children and adults.

As per the guidelines of the Obesity and Metabolic Surgery Society of India (OSSI), the largest association of surgeons and integrated health members addressing obesity, pharmacotherapy i.e. use of anti-obesity or weight loss medications, along with diet and lifestyle modification, is advised as a primary treatment option for individuals who have not attained ≥ 5 per cent loss of their baseline weight despite undergoing 6 months of diet and lifestyle interventions.

Although a balance between lifestyle modification, and weight loss medication is recommended, the gradual availability of anti-obesity drugs in the market is emerging as a faster solution for the public.

For instance, the introduction of glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide (Wegovy) and dual agonist tirzepatide (Mounjaro/Zepbound) in the obesity space represents a groundbreaking advancement in obesity treatment. Reports reveal that Novo Nordisk’s Wegovy can facilitate up to 15 per cent bodyweight reduction. At the same time, Eli Lilly’s Mounjaro demonstrates even greater efficacy, exceeding a 20 per cent reduction in body weight in trial subjects. Zepbound, the new GLP-1 weight-loss drug from Eli Lilly, has outperformed its main competitor, Wegovy, in a clinical trial funded by the company.

Due to the official unavailability of weight-loss drugs like Ozempic, Mounjaro, and Wegovy in India, affluent individuals are procuring these expensive medications from other countries. However, Indian pharmaceutical companies such as Sun Pharmaceutical Industries, Dr. Reddy's Laboratories, Lupin, Torrent, and Zydus Lifesciences have a few obesity drug candidates advancing through various stages of development, ready to be available in the market very soon.

While the availability of anti-obesity drugs is gradually increasing in the country, the upcoming launch of Eli Lilly’s Mounjaro in India in 2025 has sparked some debate in medical and public health circles. There are concerns about the frenzy surrounding the anti-obesity drugs and the lack of awareness about their side effects. Experts suggest that these drugs can help individuals with uncontrolled diabetes and obesity under strict clinical supervision. Still, they come with significant side effects, including gastrointestinal issues, nausea, vomiting, palpitations, and a disturbed metabolic state.

Studies in the US have revealed that people with obesity who take popular injected drugs like Ozempic and Wegovy to lose weight may have a higher risk of severe stomach problems than they would have with some other weight loss medications. However, more research is also needed, particularly longer studies with larger groups of patients, to get a clearer picture of which patients might be most at risk for severe gastrointestinal side effects.

A new study by scientists from the University of Alberta suggests that weight loss medications like semaglutide, marketed as Ozempic and Wegrovy, may shrink heart muscle in addition to reducing body weight. Additionally, there are concerns about treatment affordability as these medications cost more than $1,000 a month in the US; and reports suggest that it may cost around Rs 15,000 a month in India.

On the contrary, a recent study has revealed an unexpected connection between GLP-1 receptor agonist medications, commonly used for weight management and a reduction in alcohol consumption. This groundbreaking discovery not only sheds light on the potential impact of weight loss drugs but also opens new possibilities for behavioural health treatments, especially in managing alcohol use and addiction. Also, data from two recent studies have shown that Novo Nordisk’s GLP-1 drugs semaglutide (marketed as Ozempic and Wegovy) and liraglutide could help protect against Alzheimer’s disease or cognitive decline in Alzheimer’s, sparking a new hope.

While the pros and cons of anti-obesity drugs are still under consideration, an extensive discussion might be required among all stakeholders for its appropriate consumption.

Dr Manbeena Chawla

(manbeena.chawla@mmactiv.com)