IIndia's top doctors have warned of the dangers of an unregulated boom in weight-loss injections and stressed they are not a magic pill to solve the country's growing epidemic of diabetes and obesity.
Demand for appetite suppressants such as Mounjaro, Wegovy and Ozempic has skyrocketed since they were introduced in the Indian market this year.
In the eight months since it was approved for sale, Mujaro – a drug that regulates blood sugar and suppresses appetite, helping with diabetes and obesity – has become India's top-selling drug, overtaking antibiotics.
The drug's commercial success has prompted its manufacturer, pharmaceutical company Eli Lilly, to begin testing a similar appetite suppressant that could be launched in India in tablet form by next year.
An Eli Lilly spokesperson said: “Increasing urbanization, sedentary lifestyles and changing diets have made weight management a growing public health priority. This combination of high unmet need, growing awareness and improved access to innovative treatments makes India an important market for weight loss medications.”
Pharmaceutical company Novo Nordisk is also vying for market share. This month, the company launched Ozempic at a competitively low price of Rs 8,800 (£73) for four jabs per month, compared with Mounjaro's monthly cost of Rs 14,000 (£115) – prices out of reach for the average Indian family.
But by March next year, the pharmaceutical company's patents on many of these semaglutide drugs will expire in India. This will open the market to domestic companies developing their own cheaper versions, which are expected to flood the market and make prices more affordable. Experts predict the weight loss drug market in India will reach $150bn (£112bn) a year by the end of the decade.
Many health care workers and patients have hailed widespread access to the jabs as a long-overdue need for India, which is in the grip of a surge in obesity and diabetes that threatens to overwhelm the country's already underfunded and overwhelmed health system.
Diabetes and obesity are likely to become the biggest killers in India by 2030, experts say. A recent global analysis found that India is home to about 212 million adults with diabetes, more than a quarter of the world's total.
A Lancet study found that there were about 180 million overweight or obese adults in India in 2021, and this number could rise to 450 million by 2050, representing almost a third of India's projected adult population.
Mohit Bhandari, one of India's leading bariatric surgeons, said he believes the official number of people with diabetes and obesity in India is “significantly underestimated due to poor data collection” and estimates it is more than 10% higher than government data.
But Bhandari is among those calling for caution over the widespread and unregulated use of weight-loss drugs, which he says are already being abused and misprescribed, with potential long-term consequences.
“GLP-1 drugs are already very important for India, they are more than desirable,” he said. “However, there are very significant problems and caveats here. These strikes must be properly controlled by the government.”
Bhandari warned of the risks of allowing pharmacists and general practitioners to prescribe, many of whom are affiliated with certain pharmacies and benefit financially from prescribing such jabs to patients. Injections are also increasingly becoming available at gyms and beauty clinics.
“There is a need for careful screening and evaluation of patients receiving these drugs,” Bhandari said. “They call many loss of muscle massthey can cause pancreatitis, gallstones, even blindness in some patients under certain conditions, so this regulation is critical.”
He called on the government to limit who can prescribe drugs to a group of specialist doctors who would enroll patients in a long-term program. “In no other country will people take these drugs on such a scale as in India,” he said. “This means that the incidence of complications can become very high unless there is strict discipline in dispensing them to patients. The drugs are good, but only in good hands.”
Vidhi Dua, 36, is a diabetic and has battled obesity for most of her life. She was prescribed Mujaro and started taking it in September when her weight reached 95 kg (14th place).
“Before this, I tried a lot of things, but I couldn’t lose weight,” she said. “I hope it works and I can finally get off insulin, but it's not easy, there are very serious side effects on the stomach and muscles. I think it's worrying that it's become the latest fad just for cosmetic weight loss. I don't think people understand the impact it has on the body.”
Anoop Misra, one of India's best-known endocrinologists working at Fortis Hospital in Delhi, echoed these warnings. Misra said poor dietary habits, sedentary lifestyles and pollution are likely to be key factors in the rising incidence of diabetes and obesity in India, which is evident among the wealthy urban elite and poor rural communities.
Misra said he has seen unprecedented demand for the drugs and is now prescribing them to three to seven patients a day after careful counseling. He predicted that once generic versions are approved for sale next year, India will become one of the world's largest and cheapest markets for GLP-1 drugs.
However, he stressed that treating the “nationwide epidemic” of obesity and diabetes requires widespread lifestyle changes and education, and weight loss measures are only part of the solution.
“These drugs can help, but they cannot solve the problem of obesity and diabetes in India,” he said. “For most people, the foundation should remain nutrition education, healthier eating, exercise and affordable weight loss medications when needed.
“The alarming trend is that people are seeking out these medications simply because they consistently fail to diet and exercise. Medications are no substitute for lifestyle changes.”
Misra said India still faces significant challenges in tackling obesity and diabetes, many of which are cultural.
“Many women tell me that if they stop cooking the high-calorie, fatty meals their husbands prefer, it will lead to anger and conflict,” he said. “This shows how difficult it is to change diets in Indian families, even when families are aware of the health risks.”
