India’s weight-loss drug boom and the risks behind it

The calls come thick and quick to Mumbai-based diabetologist Rahul Baxi – however not simply from sufferers struggling to regulate blood sugar.

More and more, it’s younger professionals asking the identical factor: “Physician, are you able to begin me on weight-loss medicine?”

Not too long ago, a 23-year-old man got here in, fearful in regards to the 10kg he’d gained after beginning a demanding company job. “Considered one of my gymnasium buddies is on [weight loss] jabs,” he mentioned.

Dr Baxi says he refused, asking him what he would do after shedding 10kg on the drug.

“Cease, and the load comes again. Preserve going, and with out train you will begin shedding muscle as a substitute. These medicines aren’t an alternative to a correct food plan or way of life change,” he instructed him.

Such conversations have gotten more and more widespread as demand for weight-loss medicine explodes in city India – a rustic with the world’s second-largest variety of obese adults and greater than 77 million folks with Kind 2 diabetes.

Initially developed to deal with diabetes, these medicine at the moment are being hailed as sport changers for weight reduction, providing outcomes that few earlier therapies might match. But their rising recognition has additionally raised tough questions – in regards to the want for medical supervision, the dangers of misuse and the blurred line between therapy and way of life enhancement.

“These are probably the most highly effective weight-loss medicine we have ever seen. Many such medicine have come and gone, however nothing compares to those,” says Anoop Misra, who heads Delhi’s Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Illnesses and Endocrinology.

Two new medicine dominate India’s fast-growing weight-loss market. One is semaglutide, offered by Danish pharmaceutical large Novo Nordisk as Rybelsus (oral) and Wegovy (injectable) – whereas Ozempic (injectable) has been permitted for diabetes in India however will not be but out there for weight problems. The opposite is tirzepatide, marketed by American drugmaker Eli Lilly as Mounjaro, primarily for diabetes however more and more used for weight reduction in India.

Each belong to a category often known as GLP-1 medicine, which mimic a pure hormone that regulates starvation. By slowing digestion and performing on the mind’s urge for food centres, they make folks really feel full sooner and keep full longer. Taken as soon as per week, most of those medicine are self-injected within the arm, thigh or abdomen. They curb cravings – and in Mounjaro’s case, additionally increase metabolism and vitality steadiness.

Remedy begins with a low dose that is slowly raised to a upkeep stage, and weight reduction often begins inside weeks.

Medical doctors warn that the majority customers can regain weight inside a yr of stopping, because the physique resists weight reduction and outdated cravings return. Extended use with out train or energy coaching also can strip away muscle together with fats.

Additionally, not everybody responds to GLP-1 medicine, and most plateau after shedding about 15% of their physique weight. Unintended effects vary from nausea and diarrhoea to rarer dangers reminiscent of gallstones, pancreatitis and muscle loss. India’s high-carb, low-protein food plan already fuels sarcopenic weight problems – the lack of muscle alongside fats achieve – and weight reduction with out ample protein or train could make it worse.

“With all of the media hype and social media buzz, these medicine have turn out to be one thing of a craze amongst prosperous Indians desirous to shed a couple of kilos,” says Dr Baxi.

The frenzy, a Delhi-based doctor recollects, was evident even at a current medical convention.

“Three months after the launch of a brand new drug, I would handled a couple of hundred sufferers. A colleague mentioned he’d completed over a thousand – most utilizing imported jabs purchased on the black market.”

India’s anti-obesity drug market has surged from $16m in 2021 to just about $100m right this moment – a greater than sixfold bounce in 5 years, in keeping with Pharmarack, a analysis agency.

Novo Nordisk leads the market with its semaglutide manufacturers, with Rybelsus alone accounting for almost two-thirds of the market since its 2022 launch, in keeping with the agency. Eli Lilly’s tirzepatide (marketed as Mounjaro), launched earlier this yr, had turn out to be India’s second-bestselling branded drug by September, in keeping with Pharmarack. Every month-to-month injectable pen – 4 weekly doses – of those medicine prices between 14,000-27,000 rupees ($157–300), steep for many Indians.

What India has seen up to now could be the tip of the iceberg. Come March, the patent for semaglutide – the energetic ingredient in Ozempic and Wegovy – expires right here, doubtlessly unleashing a flood of cheaper generics and making them extra accessible. Jefferies, an funding financial institution, calls it a “magic tablet second” for India, predicting the semaglutide market might attain $1bn with the precise pricing, uptake, and authorities incentives.

“What now we have heard is that just about a dozen corporations are already prepared with generic variations of Rybelsus, the oral drug,” says Sheetal Sapale, vice-president at Pharmarack. “However as affordability improves, the chance of misuse rises too.”

Medical doctors inform tales of sufferers being placed on excessive dosage of weight-loss medicine by gymnasium trainers, dieticians and sweetness clinics with no authority to prescribe them. Some on-line pharmacies are delivering medicine after a cursory telephone session within the absence of a prescription. Beauticians supply “bridal packages” promising speedy slimming earlier than the large day. There are fears of spurious medicines flooding the market. Federal minister Jitendra Singh has “advised caution” on the brand new medicine.

“One affected person requested me if these new medicines might assist his daughter lose seven kilos earlier than her wedding ceremony – in three months,” recollects Dr Bhaumik Kamdar, a Mumbai-based chest doctor. “He needed to know in the event that they actually work.”

One problem in India, medical doctors say, is the way in which folks understand weight problems – and the way that shapes attitudes towards weight reduction.

“Most do not realise that weight problems is a continual, relapsing illness,” says Dr Muffazal Lakhdawala, a Mumbai-based bariatric surgeon. “Many individuals with continual weight problems strive crash diets, lose some weight, then regain much more.”

“Right here, in the event you’re obese, folks assume you are well-fed and prosperous. We have gone up to now in avoiding the elephant within the room that we have normalised it.”

Weight problems, medical doctors warn, is a gateway to a bunch of illnesses. “It is linked to not less than 20 cancers, infertility, osteoarthritis and fatty liver – now one of many main causes of cirrhosis,” says Dr Lakhdawala. But, regardless of it affecting almost one in eight folks globally, there’s nonetheless no common consensus on tips on how to outline or classify weight problems.

“The arrival of those medicine has modified the dialog – weight problems is now being handled as a illness, not only a way of life situation.”

Medical doctors throughout specialities at the moment are turning to weight-loss medicine for extra than simply weight problems or diabetes.

Endocrinologists, diabetologists, cardiologists, and nephrologists are more and more prescribing them to obese sufferers to enhance coronary heart and kidney outcomes – for example, these making ready for angioplasty or stenting.

Orthopaedic surgeons now prescribe them to assist sufferers shed weight earlier than knee surgical procedure, whereas chest physicians use them for these with sleep apnea, a dysfunction that blocks the airway throughout sleep. “For sufferers with sleep apnoea who keep away from utilizing Steady Optimistic Airway Stress (CPAP) machines, these medicine can assist by decreasing weight, which in flip improves their sleep,” says Dr Kamdar.

Even bariatric surgical procedure is evolving with India’s weight problems growth. From simply 200 procedures in 2004, the quantity soared to 40,000 in 2022 – a 200-fold rise.

Surgeons like Dr Lakdawala now run multidisciplinary programmes the place sufferers on weight-loss medicine are first guided by endocrinologists, nutritionists, and psychologists for 3 to 6 months. “We do not hand out medicine casually,” he says. “Those that do not reply to the medicine or have extreme weight problems are then thought-about for surgical procedure.”

His message to the rising variety of city Indians in search of fast fixes is blunt: “Do not use the medicine for beauty weight reduction – use it for life-threatening weight achieve.”

And for these chasing fast fixes to shed simply 5 or 10kg?

He has easier recommendation: “Reduce out sugar – it is the largest evil. With out that, no weight reduction will final. Add 4 days of train per week, and you may lose these 5-7kg – no injections wanted.”