Blockbuster weight-loss drugs flood grey market, used without supervision: ‘This trend is triggering paralysis of gut,’ warn doctors

“This led to another bout of gastroparesis. He ultimately underwent bariatric surgery,” says Dr Mahendra Narwaria of Asian Bariatrics.

This case is part of an alarming trend that doctors are noticing, especially among Indians in the 25-40 age group, who are struggling with obesity. They are procuring these drugs from the grey market and taking them unsupervised because they are not available in India yet.

Why the mad rush for weight loss drugs

The craze for weight loss began with Ozempic, a diabetes drug by Novo Nordisk, whose active ingredient, semaglutide, was FDA-approved in 2017. Soon, doctors started prescribing it off-label for obesity as it reduces appetite, calorie intake, thereby supporting weight loss. As celebrities and influencers flaunted their dramatic transformations, the frenzy intensified with Eli Lilly’s Zepbound, FDA-approved for weight loss in November 2023. This came after the success of its diabetes drug, Mounjaro.

“However, these drugs can become life-threatening if not used in consultation with an endocrinologist as everybody needs a different dosage and protocol,” says Dr Parag Shah of the Gujarat Endocrine Centre, who has been seeing many such cases.

Tirzepatide, found in Mounjaro and Zepbound, mimics both GIP and GLP-1 hormones to activate insulin production. Semaglutide, found in Ozempic and Wegovy, mimics only GLP-1. Notably, the oral semaglutide Rybelsus is approved only for diabetes in India but is used off-label for weight loss.

The consequences of overdose

Doctors have even reported how despite such emergencies and being advised to stop abuse of the medication, users repeat the injections on their own when they regain the lost weight. This leads to another bout of gastroparesis.

Doctors flag that while there are fewer cases of patients having injected themselves with tirzepatide, more patients are overdosing themselves with both oral and injectable semaglutide. “That’s because semaglutide costs half of tirzepatide. Since these drugs have to be taken for long durations for them to take effect, cost is a considerable factor,” says bariatric surgeon Dr Manish Khaitan.

“We have seen 11 patients on self-medicated semaglutide come in with gastroparesis over the past seven months. And these are only those who have declared their drug use. There must surely be more. All of the patients I’ve seen are under 35 who hope for a quick way to get thin in a short span of time,” he says.

Dr Shah recounts more such cases in Ahmedabad itself. “We had a 40-year-old businessman, weighing 102 kg, who had been taking oral semaglutide for the past one-and-a-half months and had rapidly increased the dosage every five days from 3 mg to the maximum limit of 14 mg, instead of increasing the dosage every four weeks. He was on 14 mg for four weeks. That had led to him developing significant gastroparesis,” he adds.

Dr Shah warns that gastroparesis triggered by unsupervised use of weight loss drugs can pose additional risks during life-saving surgeries. “A middle-aged patient came in with a crushed leg after an accident, but before we could operate, we had to drain the food from his gut. That’s when we discovered he was on an unsupervised weight loss drug,” he recalls.

An all-India problem

Dr Khaitan says while the majority of his overdosed patients are from Ahmedabad and Surat, he has also seen patients from Hyderabad and Bengaluru. “Most of them had the problem within four months of using semaglutide and one after using it for six months. A 23-year-old man had taken the medication for a year, lost 13 kg and then had gastroparesis,” he says.

Although some appetite loss is expected with weight loss drugs, users have to stop taking them once gastroparesis sets in. Once the drug effect wanes in 10 days, gastroparesis begins resolving itself, say doctors.

These weight loss drugs are not a magic pill and cannot work on their own without diet, lifestyle, exercise and sleep corrections. “People want to lose weight without effort. Without changing their lifestyle, they expect miracles due to the onslaught of social media. Yet with the guided protocol, you can even tame side effects,” says Dr Shah.

Are there other side effects?

“Other than gastroparesis, there is loss of gluteal (pelvic area) and face muscle mass rather than the abdomen, which was their main purpose. In severe cases, users stopped the medication in spite of results,” says Dr Khaitan. Another bariatric surgeon, who preferred anonymity, recounts how a woman patient started getting suicidal thoughts and stopped taking the injection. “In mid-January 2025, she visited me with 120 kg of weight (rebound weight gain). Then we did bariatric surgery,” he says.

Dr Khaitan warns that the long-term effects of these drugs are unknown till these are made available in India. “Till then, if you can spend so much money to buy this medication, you can spend some money to consult a doctor on how to use them,” he adds.