Weight loss drugs in India: Are we using them correctly? Here are some misconceptions

Mistaken Beliefs and Realities

A common early misconception is that all individuals with obesity will lose 20–25 kg with GLP-1 RA therapy. Actual weight-loss responses are highly variable — ranging from modest reductions of 2–5 kg to larger losses of up to 20 kg, while roughly five per cent show minimal or no weight change.

Another misconception relates to cost and duration. In India, semaglutide and tirzepatide commonly cost between Rs 10,000 and Rs 25,000 per month (although prices are lower now), placing them beyond the reach of most households. Despite this, many users believe these drugs will be required only for a short period and can be budgeted for temporarily, with the expectation that benefits will persist long after injections stop — essentially a “permanent magic weight-loss wand.” However, the biological effects of GLP-1-based drugs last only while the medication is continued. When treatment stops, weight regain is predictable. Treating these medicines as brief crash-diet aids leads to disappointment and unhealthy cycles of weight loss and regain.

More problematic still is the misunderstanding of who actually needs GLP-1-based therapy. These drugs were initially designed for Type 2 diabetes and subsequently extended to medically significant obesity. International guidelines recommend their use for people with a body mass index (BMI; weight in kilograms divided by height in metres squared; Indian guidelines define normal BMI as <23 kg/m²) of 30 kg/m² or above, or 27 kg/m² with associated conditions such as diabetes, hypertension, fatty liver disease, or sleep apnoea.

Previously we published that Indians develop complications at lower BMI than Western populations, so doctors may consider these drugs slightly earlier — but certainly not for individuals who are only mildly overweight or seeking cosmetic weight loss ahead of an event. Yet a sizeable proportion of Indian users, including those with diabetes, fall into this low-risk category, bypassing lifestyle measures and adopting a powerful weight-loss drug prematurely. Crucially, these are potent metabolic medications that should never be used casually or without medical supervision, and certainly not for cosmetic or event-driven weight loss.

In contrast, those who may genuinely benefit—and for whom GLP-1-based therapy may be life-saving — include patients with severe obesity-related fatty liver disease and those with established heart disease. This distinction must be clearly understood.

Another widespread misconception is that GLP-1-based drugs are harmless, particularly for people without diabetes. In reality, these medicines can cause serious adverse reactions if individuals are not properly educated about side effects and gradual dose escalation.

Public understanding of contraindications is similarly limited. These drugs should not be used in individuals with a personal or family history of certain thyroid cancers, and they must be avoided in those with recurrent pancreatitis (inflammation of the pancreas, a vital organ) or severe gastrointestinal disease. They are unsuitable for women who are pregnant or planning pregnancy. Nevertheless, casual prescribing and influencer-driven promotion have led many people to start therapy without even basic screening — no thyroid tests, no eye examinations (to rule out extremely rare blood-flow abnormalities in the eye or worsening of pre-existing diabetic eye disease), no assessment of liver or kidney function, and no evaluation of pancreatic or gallbladder health. Starting these drugs without such assessment is dangerous and must be strongly discouraged.

Side Effects Are Trivialised

Gastrointestinal symptoms — nausea, vomitting, diarrhoea, constipation — are the most common and lead 10–15% of users to discontinue treatment. New side effects continue to emerge. A recent study has also linked GLP-1-based therapy with a slightly higher risk of acid reflux. Significant muscle loss can occur with rapid weight reduction. Intestinal paralysis or severe gastroparesis, particularly in people with long-standing diabetes, is rare but important. Even cosmetic changes such as the hollowed appearance dubbed as “Ozempic face” highlight the risks of rapid, poorly supervised weight loss. These risks increase substantially when therapy is undertaken without ongoing medical oversight.

Expectations and What Should Be Done

Much of the misuse is driven by a prevailing notion: the belief that medication can replace lifestyle. GLP-1-based drugs amplify the impact of healthy eating and physical activity; they do not substitute them. They make metabolism more efficient once a substantial amount of fat is lost. When paired with the common Indian combination of low protein intake, high-carbohydrate meals, frequent social eating, and sedentary habits, results are often modest and muscle loss is excessive.

In a population already vulnerable to sarcopenia (poor muscle structure and strength) and micronutrient deficiencies, this pattern undermines long-term metabolic benefits.

What, then, should be done?

The answer is not to abandon GLP-1-based drugs — they represent one of the most significant advances in obesity and diabetes treatment. Rather, they must be used correctly. Many people who lose significant weight with these drugs experience major clinical improvements: some achieve diabetes remission, while others substantially reduce or even discontinue insulin or oral medications.

Individuals who previously struggled to walk often regain mobility; symptoms such as breathlessness and palpitations diminish; knee and leg pain may resolve. Patients with obstructive sleep apnoea may even be able to stop using CPAP therapy.

People taking these medicines should adopt structured eating patterns, focusing on high-protein, high-fibre meals, eaten slowly and in smaller portions. Hydration is essential. Regular aerobic activity and strength training help preserve muscle and improve fat loss. Those with diabetes should monitor glucose carefully, and all users should attend scheduled follow-ups for dose adjustment and early detection of side effects.

Severe symptoms — persistent vomiting, abdominal pain, dehydration — must be reported promptly. Above all, these drugs must be started only after a full medical evaluation, used strictly under medical supervision, and avoided entirely for cosmetic or event-driven weight loss.

The future of GLP-1-based therapy in India hinges not on enthusiasm but on education. These medicines are powerful, effective and often life-changing — but not magical. Used casually, they create new risks; used responsibly and with medical guidance, they offer unprecedented promise.

(Dr Anoop Misra is Chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences)