Obsession with quick weight loss is growing in the country. But the existing medicines and treatments are not for everyone
India is witnessing an unprecedented surge in the use of a new generation of weight-loss medicines. Once largely confined to diabetes clinics, drugs such as semaglutide and tirzepatide have rapidly entered mainstream conversation. Many popular brand names are now widely discussed on social media, prescribed in specialised weight-management clinics and increasingly sought by people hoping to lose weight quickly.
That excitement has produced two equally misleading narratives. One portrays these medicines as miracle drugs that make healthy eating and physical activity unnecessary. The other dismisses them as cosmetic shortcuts for people unwilling to control their lifestyle. The scientific evidence supports neither view.
The truth is more consequential. Semaglutide and tirzepatide represent important advances in obesity treatment in recent times. In appropriately selected patients, these medicines can produce clinically meaningful weight loss and improve metabolic health.
But their significance lies in something deeper than the number on the weighing scale. They reinforce the understanding that obesity is a complex, chronic medical disease shaped by biology as much as behaviour. Treating it successfully requires sustained medical management rather than simplistic advice to “eat less and move more”.
That distinction matters particularly in India, where obesity is becoming a major public-health challenge even as undernutrition persists.
India’s Growing Obesity Problem
India’s obesity problem is larger than the weighing scale suggests. An analysis of the ICMR-INDIAB study estimated that 28.6 per cent of Indian adults had generalised obesity and 39.5 per cent had abdominal obesity, representing approximately 254 million and 351 million people respectively.
For Indians, where fat is stored can matter as much as how much a person weighs. Body mass index, or BMI, measures weight in relation to height but does not capture abdominal fat. South Asians can accumulate visceral fat and develop insulin resistance, fatty liver disease and diabetes at comparatively low BMIs. An analysis of National Family Health Survey-5 (NFHS-5) data found abdominal obesity in 40 per cent of women and 12 per cent of men aged 15–49 years.
The problem is also appearing earlier. The Comprehensive National Nutrition Survey found overweight, including obesity, in 1.6 per cent of children aged 0–4 years and 4.8 per cent of adolescents aged 10–
19 years. Overweight among children younger than five rose from 1.9 per cent in NFHS-3 to 4.0 per cent in NFHS-5.
Medical observers say that India is consequently facing a double nutrition burden. Undernutrition has not disappeared, while obesity has emerged alongside it. Changing lifestyles, less physical activity, more screen time, irregular sleep and easy access to calorie-dense food are contributing to the shift. Genetics, stress, early-life nutrition, hormonal disorders and some medicines can add to the problem. This is the environment into which the new weight-loss drugs have arrived.
Drugs Are No Miracle
Semaglutide mimics glucagon-like peptide-1 (GLP-1), a gut hormone that helps regulate blood sugar, slows gastric emptying and reduces appetite. Tirzepatide acts on both GLP-1 and GIP receptors, further suppressing hunger and improving glucose metabolism.
Neither drug directly “burns” fat. Weight loss occurs mainly because people feel fuller, eat less and think about food less often. Treatment normally starts at a low dose and is increased gradually to improve tolerability. The evidence for these medicines, importantly, comes from large clinical trials rather than social-media success stories.
In the STEP 1 trial, participants receiving semaglutide lost an average of 14.9 per cent of their body weight after 68 weeks, compared with 2.4 per cent with placebo. In SURMOUNT-1, average weight loss with tirzepatide ranged from 15.0 per cent to 20.9 per cent after 72 weeks, compared with 3.1 per cent with placebo. A 2025 head-to-head study found average weight loss of 20.2 per cent with tirzepatide and 13.7 per cent with semaglutide after 72 weeks.
These are averages, not guarantees. Individual responses vary. And the major trials combined medication with medical supervision and lifestyle support. The benefits may extend beyond weight loss. In the SELECT trial, major cardiovascular events occurred in 6.5 per cent of participants receiving semaglutide, compared with 8.0 per cent receiving placebo. The findings helped strengthen the case for treating obesity as a chronic disease rather than simply a failure of willpower.
The medical fraternity is of the view that although India is hooked on the medicines, they are no way miracle drugs. Not everyone who wants to lose weight needs a GLP-1-based drug.
Anti-obesity medicines are generally considered for adults with obesity, or for adults with overweight who also have an obesity-related condition such as type 2 diabetes, hypertension, dyslipidaemia, sleep apnoea or cardiovascular disease. Exact thresholds and indications vary by
product and regulatory jurisdiction.
This is particularly important as these medicines move from specialist clinics into mainstream consumer culture. These products are not int
erchangeable simply because their brand names are familiar. The formulation, indication, dose and schedule must match the patient’s clinical need. For someone considering treatment, the first step should therefore be a clinical assessment, not a purchase.
A lower number on the weighing scale is not the only measure of successful treatment. Not all weight lost during GLP-1-based treatment is fat. Some is lean mass, a broad measure that includes, but is not identical to, skeletal muscle. A systematic review and network meta-analysis found that lean mass accounted for approximately one-quarter of total weight loss.
That matters particularly for older adults, postmenopausal women and people who begin treatment with low muscle mass or reduced physical function. Adequate protein intake, resistance exercise and, where appropriate, assessment of muscle strength and physical performance should therefore form part of treatment. The goal is not simply to become lighter. It is to improve metabolic health while preserving strength, mobility, independence and quality of life.
The benefits of these medicines are substantial, but they are not risk-free. The most common side effects are gastrointestinal, including nausea, vomiting, diarrhoea, constipation, abdominal discomfort and dyspepsia. They are often most noticeable when treatment begins or the dose is increased.
In the SELECT trial, involving adults with overweight or obesity and established cardiovascular disease but without diabetes, major cardiovascular events occurred in 6.5 per cent of participants receiving semaglutide and 8.0 per cent receiving placebo.
Acute pancreatitis is uncommon but can be serious. Persistent or severe abdominal pain requires medical assessment, while prolonged vomiting or diarrhoea can cause dehydration and impair kidney function.
Hypoglycaemia is generally a concern when these medicines are used alongside insulin or sulfonylureas. Because they slow gastric emptying, patients should also tell their doctor and anaesthetist before surgery or procedures requiring sedation.
Several product labels warn about thyroid C-cell tumours observed in animal studies and contraindicate use in people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2. They should not be used during pregnancy.
Semaglutide has also been associated with non-
arteritic anterior ischaemic optic neuropathy (NAION). European regulators classify it as a very rare adverse effect, potentially affecting up to one in 10,000 users. Any sudden loss or deterioration of vision requires urgent ophthalmic assessment.
The point is not to frighten patients away from these medicines. It is to ensure that a powerful treatment is used in the right patient, at the right dose and with appropriate follow-up.
India’s Next Challenge
As these medicines become more widely available, access will become an important issue. Competition and local manufacturing could eventually reduce prices, which matters in a country where much healthcare spending comes directly from patients.
But cheaper does not automatically mean safer. Wider availability can encourage self-medication, inappropriate prescribing and the circulation of falsified products. Incorrect concentrations, unregulated online sellers and broken cold chains can compromise treatment.
Patients therefore need more than an affordable injection. They need an assured-quality product, an appropriate prescription and continuity of medical care. India’s challenge now is to ensure that the science moves faster than the hype. For patients, the lesson is simpler: the right diagnosis, the right medicine and the right expectations matter as much as the number on the weighing scale.
GFX 1
THE OBESITY PARADOX
28.6%
Indian adults with generalised obesity
39.5%
Indian adults with abdominal obesity
General Obesity
254 million
Abdominal Obesity
351 million
Women: 40%
Men: 12%
GFX 2
THREE QUESTIONS MATTER
Ask before you take a weight-loss drug:
Am I an appropriate candidate?
Which medicine and dose are right for me?
How will my nutrition, muscle strength, weight and health be monitored during treatment?
