Written by Dr Shariq Masoodi Sameera, a 38-year-old lawyer, has battled weight-related struggles for years — PCOS, mental health challenges and concerns about infertility, all compounded by the societal pressures of a delayed marriage. Managing her condition has been a delicate balance of lifestyle modifications and Metformin, a weight-neutral drug that, though not a game-changer, remained the only affordable option for her. The recent introduction of Mounjaro (tirzepatide) in India has given her hope. However, even with its relatively lower price compared to the US, the question remains — can she truly afford it? And if she does, will it deliver the transformative weight loss she longs for, given the underlying complexities of her mental health and metabolic struggles? This dilemma is not unique to Sameera. As an endocrinologist, I have seen countless patients desperately seeking a “magic pill” for obesity, only to find that medication alone is rarely enough. Medication Alone Is Not Enough Consider Patient J, a 40-year-old corporate professional weighing 120 kg, and already managing comorbidities such as hypertension and diabetes. Initially, I recommended the standard approach — lifestyle modifications, including a well-structured diet and a regular exercise routine. However, despite these efforts, his weight loss was minimal, leading to frustration. As newer medications gained prominence, I prescribed Semaglutide (RYBELSUS®), an oral GLP-1 receptor agonist, to aid in weight management. GLP-1 (glucagon-like peptide-1) is a gut hormone that helps control post meal blood sugars by telling your pancreas to make more insulin and helping you feel full. While there was some initial weight reduction, the results were ultimately disappointing. Then came Mounjaro, a dual GIP/GLP-1 receptor agonist that has revolutionized Type 2 diabetes management and shown remarkable weight-loss benefits. GIP (glucose-dependent insulinotropic polypeptide) is another gut hormone that helps control blood sugar and also contributes to weight loss. Patient J managed to obtain Mounjaro from overseas and started with a 2.5 mg dose, gradually increasing to 7.5 mg. Initially, the results were promising, but eventually, his weight plateaued. Upon reviewing his dietary history, I discovered he was still consuming more calories than he should and was not engaging in enough physical activity. This highlighted a crucial point: No medication, regardless of its efficacy, can substitute for disciplined lifestyle changes. The Path Forward: Sustainable Diabetes and Obesity Management The key to addressing obesity and diabetes in India lies in a holistic and sustainable approach that prioritizes affordable and effective medication. Despite the promise of Mounjaro, affordable and accessible medications like metformin (a first-line, mostly weight-neutral drug with some weight loss benefits), SGLT2 inhibitors (beneficial for diabetes and cardiovascular health), and insulin therapy (essential for advanced type 2 diabetes) should remain the primary treatments for overweight or obese individuals with type 2 diabetes due to their established efficacy and broader availability. Medications can support weight loss but they cannot replace the fundamental necessity of dietary control and physical activity. Government initiatives must ensure that essential diabetes and obesity medications are affordable. Broader insurance schemes should include coverage for obesity management. The excitement surrounding Mounjaro and other new medications is justified, but it is equally important to temper expectations. There is no magic pill for obesity. (Dr Shariq Masoodi is former professor & head of endocrinology, and Dean of Medical Faculty SKIMS Srinagar)
