India's market for anti-obesity drugs has seen a significant increase in demand over the past five years. These medications, originally developed for diabetes, are now being utilized for weight management. This rise in popularity has prompted discussions among medical professionals regarding the necessity of supervision, potential for misuse, and the distinction between therapeutic treatment and lifestyle choices.
Rise in Demand for Weight-Loss Drugs
Medical professionals in urban India are observing a growing number of individuals, particularly young professionals, inquiring about weight-loss medications. One Mumbai-based diabetologist, Dr. Rahul Baxi, noted an increase in such consultations. For instance, a 23-year-old sought medication after gaining 10kg, citing a friend's use of weight-loss injections. Dr. Baxi declined the request, emphasizing that these drugs are not a substitute for diet and lifestyle changes, and warned about potential muscle loss without exercise, and weight regain upon cessation.
India reports the world's second-largest population of overweight adults and over 77 million people with Type 2 diabetes. The demand for these drugs is increasing within this context. Dr. Anoop Misra, head of Delhi's Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, highlighted the efficacy of these new medications compared to previous treatments.
Key Medications and Their Mechanism
Two primary drugs are prominent in India's expanding weight-loss market:
- Semaglutide: Marketed by Novo Nordisk as Rybelsus (oral) and Wegovy (injectable). Ozempic (injectable), also semaglutide, is approved for diabetes in India but not yet for obesity.
- Tirzepatide: Marketed by Eli Lilly as Mounjaro, primarily for diabetes but increasingly used off-label for weight loss.
Both belong to the GLP-1 class of drugs, which mimic a natural hormone that regulates hunger. They function by slowing digestion and affecting brain centers that control appetite, leading to increased satiety and prolonged feelings of fullness. These drugs are typically self-injected once weekly in the arm, thigh, or stomach. Mounjaro is also noted for potentially boosting metabolism and energy balance. Treatment usually starts with a low dose and gradually increases to a maintenance level, with weight loss often observed within weeks.
Medical Considerations and Risks
Doctors advise that most users may regain weight within a year of discontinuing the drugs due to the body's resistance to weight loss and the return of cravings. Prolonged use without adequate exercise or strength training can result in the loss of muscle mass in addition to fat. Response to GLP-1 drugs is not universal, and most individuals experience a plateau after losing approximately 15% of their body weight.
Reported side effects include nausea and diarrhea, with rarer risks such as gallstones, pancreatitis, and muscle loss. India's typical high-carb, low-protein diet is associated with sarcopenic obesity (muscle loss alongside fat gain). Weight reduction without sufficient protein intake or exercise could exacerbate this condition.
Market Growth and Affordability
India's anti-obesity drug market grew from $16 million in 2021 to nearly $100 million in 2023, representing a more than sixfold increase in five years, according to Pharmarack. Novo Nordisk's semaglutide brands lead the market, with Rybelsus accounting for approximately two-thirds of the market since its 2022 launch. Eli Lilly's tirzepatide (Mounjaro), launched earlier in 2023, became India's second-bestselling branded drug by September.
A monthly supply (four weekly doses) of these injectable drugs costs between 14,000-27,000 rupees ($157–300), which can be prohibitive for many Indians.
The patent for semaglutide is set to expire in India in March, which could lead to an increase in available generic versions and improved accessibility. Investment bank Jefferies predicts the semaglutide market could reach $1 billion with favorable pricing, adoption, and government incentives. Sheetal Sapale, vice-president at Pharmarack, stated that nearly a dozen companies are reportedly prepared with generic versions of the oral drug, Rybelsus.
Concerns Regarding Misuse and Regulation
As affordability potentially improves, concerns about drug misuse are also rising. Doctors have reported instances of patients receiving high dosages of weight-loss drugs from gym trainers, dieticians, and beauty clinics lacking prescription authority. Some online pharmacies are reportedly delivering medications following minimal phone consultations without requiring a prescription. There are also reports of beauticians offering "bridal packages" that promise rapid weight loss. Concerns about the proliferation of counterfeit medicines in the market have also been raised. Federal minister Jitendra Singh has issued a caution regarding these new drugs.
Perception of Obesity and Medical Classification
Physicians note that cultural perceptions in India may normalize obesity. Dr. Muffazal Lakhdawala, a Mumbai-based bariatric surgeon, stated that many do not recognize obesity as a chronic, relapsing disease, often resorting to crash diets with subsequent weight regain. Obesity is linked to numerous health issues, including at least 20 types of cancer, infertility, osteoarthritis, and fatty liver disease. Despite affecting roughly one in eight people globally, a universal definition or classification for obesity remains elusive. The introduction of these drugs is influencing the discourse, shifting the perception of obesity toward a medical condition rather than solely a lifestyle issue. Doctors from various specialties are now considering weight-loss drugs for conditions beyond obesity or diabetes.