Mumbai: Recently, weight loss medications The market has grown rapidly and has had a global impact. These drugs were developed because diabetes management, but they have created a lot of buzz in not only managing diabetes but also helping in weight loss, benefits in heart, kidney and liver diseases, and much more. The demand for these so-called blockbuster drugs is so much that they have become the most sought-after drugs globally.

Recently, style-related disorders and diseases have become a significant challenge; obesity Being one of the major concerns, this needs to be addressed. According to a recent study published in Lancet, 70 per cent of India’s urban population falls into the obese or overweight category, plunging the country into an obesity crisis. It also states that 30 million adults in India are either overweight or obese, and 62 million Indians with diabetes display obesity-related features such as excess body fat, abdominal obesity and fat accumulation in ectopic sites.
Currently, Abbott’s Leptos (sibutramine hydrochloride) is approved as an obesity drug in India; the same drug, branded as Meridia, was withdrawn in the US in 2010 due to an increased risk of heart attack and stroke. Zepbound (tirzepatide) and Novo Nordisk Wegovy ,Semaglutide injections) are expected to arrive in India by 2025 and 2026 respectively. As the craze for these weight loss drugs grows in India, so is the interest in these treatments, as the options are limited in the country.

Indian doctors are prescribing these weight loss drugs even though they are not yet sold commercially in India. To better understand this scenario, ETHealthworld spoke to leading diabetes experts on how these drugs are procured and administered, if they are not available in the Indian market, and also the shortage globally due to high demand.

Sharing his opinion, Dr. Rajeev Kovil, Head of Diabetology, Xandra Healthcare, and Co-founder, Rang De Nila Initiative, said, “Oral semaglutide has been approved in India. Injectable semaglutide in high dose for obesity has been approved in India. Oral semaglutide known by the brand name Rybelsus has been marketed in India, and it has been approved for diabetes, it can be prescribed by doctors in India. Injectable semaglutide is not marketed in India, and injectable semaglutide with high dose, brand name Wegovy, has received DCGI approval, but it has not been launched and marketed in India yet. So, doctors in India cannot prescribe injectable semaglutide as it has not been marketed in India.”

Dr. V. Mohan, Chairman and Head of the Department of Diabetes, Dr. Mohan’s Diabetes Specialty Center, said, “Semaglutide is available in an oral (pill) form, known as Rybelsus, and also as an injection, known as Rybelsus. Ozempic And Wegovy. Rybelsus has been available in India for the last few years, and we all have been using it (as directed). Though it is effective, it is not as effective as Ozempic and Wegovy in the injectable form. Wegovy was approved by the Drug Controller General of India (DCGI) earlier this year, and the company has been allowed to market it in India. However, the fact is that despite the injectable form, both Ozempic and Wegovy are much more effective in weight loss and controlling diabetes, but they are unable to bring them to India immediately due to the huge demand for their production. They are struggling to produce enough to sell in Europe, the US, the Middle East and other countries where the drug is available. When asked how Indian physicians prescribe these drugs for weight loss in non-diabetics, Dr. Kovil said, “Indian prescriptions cannot be used to obtain these drugs from foreign markets, but in whichever country Semaglutide is launched, be it UAE, Saudi Arabia, UK or US, a healthcare practitioner based in that country is required to prescribe this drug as it is not an over-the-counter drug. The drug should be prescribed only by experts in the field. Semaglutide injections have been approved for diabetes as well as weight loss. Though injectable semaglutide has been approved in India, it has not been marketed. Oral semaglutide which has been approved, marketed and available in India is only approved for the management of type 2 diabetes and cannot be used to treat obesity in people without diabetes. Many people with diabetes are struggling with obesity, and preventing the obesity epidemic in people with diabetes is important.” That’s a challenge in itself. So, semaglutide oral, known by the brand name Rybelsus, is the preferred drug or pill for diabetics who want to lose weight or who don’t want to gain weight.”

Dr Mohan said that since this drug is not available in the Indian market, some Indians are buying these drugs from Dubai or other sources and using them. He said, “If these drugs are used even though they are not available in India, the problem is that if there are any side effects, the question of who will be responsible will arise. If the patient has obtained the drug illegally from another country, will the existing company still be held responsible? If any such legal issue arises, it can lead to complications. So, in my view, until it is officially available through proper sources, i.e. hospitals, clinics or pharmacies in India, people should not import the drugs and use them on their own.”

The side effects that are seen are mostly gastrointestinal, with nausea, vomiting and diarrhea being the most common. Very rarely, they can lead to a condition called paralysis of the stomach and intestine. Even more rarely, pancreatitis and medullary carcinoma of the thyroid have been reported. However, these are more common in animal models when high doses are used, and are very uncommon in human trials. If patients start using these drugs, they lose weight, and sugars come under control. However, they have to take it for a long time because if they stop it, they gain weight again. After all, these drugs only work as long as they are taken. Since they are very expensive, we as doctors always find out if patients can afford to take these drugs for a long time before we prescribe them.”

Although these drugs have many benefits and people’s interest in them is constantly increasing, their many side effects also need to be taken into account. Sharing his views on the side effects of these drugs, Dr. Kovil said, “These are common side effects seen across the world as well as in India. GLP-1 Analogs are entirely related to the GI system as gut motility is decreased and can cause upper GI irritation and upper GI acidity, dyspepsia.”

Dr. Kovil further explained what happens when people stop taking these drugs; he said, “Obesity is a lifelong disorder like hypertension, cholesterol abnormalities and diabetes. Therefore, its treatment should also be lifelong. Patients who take the drug and then stop taking the drug gain weight. This is also seen globally with Semaglutide, where about 50 percent of patients may gain 50 percent of their weight in that one year after they stop taking the molecule. Weight is the mother of all non-communicable disorders, and treating the root cause of weight is essential to reduce morbidity and mortality associated with diabetes, heart disease, cancer, hypertension and dyslipidemia. Weight management can treat the root cause in many problems, and we treat the risk factors rather than treating the root cause.”

Finally, Dr Mohan said, “We are all waiting for the injectable forms of Semaglutide to officially come to India. It is reliably learnt that probably next year it will be available in the Indian market.”

The growing demand for drugs that help people lose weight such as semaglutide highlights how important it is for treating obesity in India, which is a serious health problem. Although injectable versions of semaglutide (Ozempic and Wegovy) have been approved for use in treating diabetes, their market launch is still pending due to its huge demand worldwide. Experts advise against using it unsupervised and emphasize the importance of long-term care to achieve long-term weight loss. Ensuring safe and accessible obesity management is important, especially as India prepares for the official launch of these injectables. The country’s approach to treating obesity and related lifestyle diseases could be greatly influenced by the inclusion of these treatments.