India faces a dual burden: While under-nutrition persists, obesity is escalating rapidly. A large portion of the population is also metabolically unhealthy even without high BMI, silently increasing the risk of diabetes, heart disease, fatty liver, and more.
India’s anti-obesity market has long been dominated by naturopathy, Ayurveda, yoga and nutrition. In 2022, semaglutide (Ozempic, Wegovy, Rybelsus), one specific drug in the class of GLP-1 receptor antagonists, was approved in India to treat diabetes. This drug, incidentally, also slowed digestion down, helping patients feel full for longer. The drug was picked up by the elite weight-loss industry. Medically supervised weight-loss centres now offer semaglutide injections as part of weight-management regimens, often alongside tailored diet and exercise plans.
The global weight-loss drug market is projected to reach $100 billion by decades’ end. In India, the anti-obesity drug market touched Rs 600 crore in June 2025, a five-fold rise in five years, with GLP-1 drugs making up around 75 per cent of that share. Demand is expected to rise steeply after the 2026 patent expiry, when affordable generics are likely to enter.
Users of these drugs see phenomenal improvement in their health indicators, both intended and unintended. The positive health effects include weight loss, improved blood sugar control, reduced risk of cardiovascular events, kidney protection and improved fat liver content and inflammation markers. Improved insulin sensitivity, weight loss, and androgen levels were helpful in restoring regular menstrual cycles and improved ovulation rates in women with polycystic ovary syndrome. Emerging studies suggest GLP-1 drugs may also improve fertility outcomes when combined with lifestyle interventions.
But as with most drugs, this also has side effects: Fallouts associated with semaglutide use are loss of appetite, nausea, vomiting, diarrhoea, constipation, abdominal pain. Serious side effects include gallbladder diseases, pancreatitis, kidney issues and hypoglycemia. Thyroid tumours, muscle and lean-mass loss, psychological effects and rebound weight gain are other serious concerns still under research. Rapid weight loss may reduce not just fat but also lean-muscle mass, worsening sarcopenia in older adults and leading to increased frailty.
From an economic perspective, weight loss with semaglutide costs around Rs 2,00,000 per year for 12-15 kg loss, that is Rs 13,000-16,000 per kg lost and includes strong metabolic/ cardiac benefits. Diet and structured exercise, on the other hand, costs around Rs 40,000 per year for 6-8 kg loss, that is Rs 5,000-6,500 per kg lost, and improves long-term habits. Walking/yoga incurs minimal cost, almost free for a loss of 2-5 kg.
India currently imports a large number of semaglutide formulations. Although semaglutide gives quick results at an individual level, pushing this drug as a first-line intervention may see resources shifting away from cost-effective initiatives such as public-health campaigns with emphasis on diet, exercise and preventive health, nutrition programmes, and diabetes prevention programmes. Over-focus on expensive branded GLP-1 drugs could also crowd out traditional, cheaper options.
In India, weak enforcement may lead to OTC misuse, unsafe online sourcing, and unmonitored use. High cost of the drug and shifting government resources from prevention programmes may heighten the divide between the elite and the poor. Urban wealthy classes may access semaglutide for weight loss, while rural/low-income populations remain under-served in basic diabetes and obesity care. This would also bring about a shift from weight control being seen as a lifestyle/behavioural issue to a drug-dependent condition, discouraging community-based prevention strategies such as healthy diets.
Going forward, semaglutide should be used selectively in obese patients with diabetes/CVD risk, or those failing lifestyle therapies. The drug must be integrated in public-health prevention programmes. To ensure equity, it should also be brought under price control to make it affordable after the patent expiry in 2026.
The writer is senior scientist and programme officer, AMR, ICMR
