Weight Loss Drugs: A Panacea for our Obesity Crisis?

India, like many fast-growing economies, is facing a looming obesity crisis. Primordial prevention, an idealistic strategy, while sound in theory, fails when pitted against strong market forces promoting automobiles and ultra-processed foods (UPF) and drinks. The obesity trends in their wake have the potential to herald in diabetes, coronary heart diseases, osteoarthritis, certain cancers, and nonalcoholic fatty liver. The present commentary dwells on the social determinants of obesity and whether weight loss drugs will live up to their high expectations to stem the rising obesity rates in the population. India is not only witnessing rising obesity in adults but also in under-five children with prevalence among them rising 127% as recorded in successive National Family Health Surveys (NFHS). It rose from 1.5% to 3.4% between NFHS-3 in 2005–2006 and NFHS-5 in 2019–2021.[1] In the same period, obesity also increased in adolescents, 125% in girls (2.4% to 5.4%) and 288% among boys (1.7% to 6.6%). In adults, the prevalence of obesity increased by 91% among women (12.6% to 24.0%) and 146% among men (9.3% to 22.9%), indicating a nationwide health crisis.[1] Market forces promoting UPF have an ecological link to this trend. According to the Indian Economic Survey 2024–2025, UPF consumption in India surged from USD 900 million (2006) to USD 37.9 billion (2019), growing at over 33% annually. Between 2011 and 2021, retail sales of UPFs grew at a compound annual growth of 13.7%. UPFs and beverages, high in salt and sugar, are replacing fruits, vegetables, and traditional diets.[2] Aggressive and targeted marketing campaigns, along with easy availability, are influencing food choices among children and adolescents, rather than personal preference. Early life handicaps also contribute. These include a high proportion of maternal under-nutrition and poor childhood dietary practices, including insufficient breastfeeding. Social and gender norms deprive adolescent girls and women who often eat the least and last, further aggravating malnutrition among these vulnerable. Early life under-nutrition is linked to metabolic syndrome in later life.[3] The social environment acts in tandem with the above factors. Low levels of physical activity to some extent due to increasing screen time among the young and old is fueling the crisis. All these factors have acquired a high momentum. Stopping the juggernaut at short notice will be formidable. In this context, weight loss drugs are inviting great interest. Originally developed as anti-diabetics, these drugs are being hailed as game changers. Glucagon-like peptide-1 (GLP-1) is a natural hormone produced in the intestine that helps regulate blood sugar by stimulating insulin secretion and reducing appetite. Many drugs, called GLP-1 agonists, mimic this hormone to help treat type 2 diabetes and obesity. The weight loss drugs dominating the Indian market are, Semaglutide, sold as Rybelsus (oral) and Wegovy (injectable). Ozempic (injectable) has been approved for diabetes in India but not yet for obesity. All these are manufactured by Novo Nordisk. The other major manufacturer of these classes of drugs is Eli Lilly, producing Tirzepatide (Mounjaro), which is primarily an anti-diabetic but is being increasingly used as an anti-obesity drug. These belong to a class known as GLP-1 drugs, which mimic the natural hormone that regulates hunger. By slowing digestion and acting on the brain’s appetite centers, they make people feel full faster and stay full longer.[4] Taken once a week, usually self-injected in the arm, thigh, or abdomen, they curb cravings—and in Tirzepatide’s case, also boost metabolism and energy balance. A course of weight loss drugs is not a smooth sail. There are some undesirable effects. Most regain weight within a year of stopping the drugs as the body resists weight loss and old cravings return. Prolonged use without exercise and strength training exercises can also strip away muscle along with fat. India’s high-carb, low-protein diet already fuels sarcopenic obesity[5]—the loss of muscle alongside fat gain—and weight loss without adequate protein or exercise can make it worse. A rare occurrence of retinal artery occlusion has also been reported to be linked with weight loss drugs.[6] Concerns about anxiety, depression, and suicidal behavior have also been reported with anti-obesity drugs.[7] Notwithstanding these dampeners, the anti-obesity market is growing in leaps and bounds. India’s anti-obesity drug market has surged from $16 m in 2021 to nearly $100 m today.[8] Each monthly injectable pen—four weekly doses—of these drugs costs between 14,000 and 27,000 rupees ($157–300), steep for most Indians. The patent for Semaglutide—the active ingredient in Ozempic and Wegovy—expires in March next year. This will unleash a flush of cheaper generics. It is predicted to become a $1bn market with the right prices, intake, and government incentives. With affordability, there can be potential for misuse. Anecdotes of patients being put on high dosage of weight-loss drugs by gym trainers, dieticians, and beauty clinics with no authority to prescribe them are disturbing.[8] In conclusion, the way forward for these drugs would follow the Gartner curve.[9] We are presently in the initial hype phase. Tirzepatide (Mounjaro) has become the top selling brand in domestic pharma retail market with sales of 100 crore in October 2025.[10] We may encounter a phase of disillusionment and popularity coming down on awareness of their limitations and side effects. Then later, it may pick up somewhat and plateau at a lower level of initial hype (honeymoon) period and find its place in the toolkits of expert clinicians.