Can 2 blockbuster weight loss injectables, Wegovy & Mounjaro, fight India’s obesity curve? Listen in to the experts

There are also concerns about muscle loss. What do we know so far?

Indians already have a poor muscle mass, so would they want to lose more of it? “The muscle loss with these medicines is equivalent to that seen with any sharp weight reduction, be it through diet or bariatric surgery. There is no evidence to show that the muscle loss with these medicines is more. In fact, there is data emerging that these drugs and some of the newer ones may be muscle-protective,” says Dr Mithal.

But there’s a caveat. The drugs have to be taken in conjunction with a good diet and exercise to ensure healthy weight loss.

Can everyone take these drugs?

There are certain contraindications. The drugs are known to initially cause gastrointestinal side effects such as nausea and vomiting.

“So, people who are at a high risk of gastric conditions should not be given the medicine. It should not be prescribed in people who have long standing diabetes with sluggish peristalsis (contraction and relaxation of the digestive track to push the food through), gastric obstructions and those prone to nausea. In rare cases, the drug is known to cause stomach paralysis. It should not be prescribed to people who have a family history of thyroid cancers as well,” says Dr Mithal.

How does it help other organ systems?

Trials with semaglutide have shown the ability to reduce the risk of major cardiovascular events, such as heart attacks and strokes, by 20 pr cent and the risk of all-cause mortality by 19 per cent. Studies have shown a 69 per cent reduction in heart failure events. The drug can resolve fatty build-up in the liver in 63 per cent of patients and improve liver fibrosis — the hardening of liver tissue due to fatty deposits — in 37 per cent of cases.

Tirzepatide, while reducing body weight by 20 per cent, has been approved for the treatment of obesity-related obstructive sleep apnoea — a condition where a person’s breathing stops and starts while they sleep. Trials have also shown that it can improve lipid profile. And, the reduction in the risk of cardiovascular death and all-cause death by 20%.

“There is no doubt that the medicines are effective for kidney and heart conditions. There is also evidence that has emerged about fatty liver disease. But what I am most excited about is the evidence to show that the medicines are associated with lower risk of Alzheimer’s and other dementia,” says Dr Mithal.

He noted how those who have used these drugs for some time have reduced cravings now.  “They are not only eating smaller but healthier meals. There is also evidence to show that it helps with alcohol addiction,” he says.

Can it be given to children and young adolescents?

The drug is approved for use in children and adolescents in other countries to combat teen obesity. There is a small subset of adolescents who may indeed benefit from these drugs — someone who is obese and has other associated problems such as diabetes, polycystic ovary, or facial hair for women, or those who are unable to shed the weight despite lifestyle interventions.

However, Dr Mithal advises caution. “If you reduce nutritional intake in children, it may have negative consequences. Also, how long it can be given?” he asks.

What about women?

Dr Mithal says it can be beneficial for relieving symptoms of conditions such like PCOS (polycystic ovary syndrome) in women, improving their chances of pregnancy. However, the drug has to be discontinued during pregnancy. “A lot of answers are needed,” he says.

Would you have to take the medicine for life?

There might be a case for tapering the doses of the medicine in some patients, although there is no data yet for this. In fact, Dr Mithal says, there are studies to show that those who discontinued the medicine started putting on some of the body weight back. “The tapering of the drug has to come with change in lifestyle to sustain the weight loss,” he adds.