The Impact of Weight Loss Drugs on Health and Society in India

India is experiencing a major increase in obesity and overweight individuals, reflecting a global trend. Currently, 24% of women and 23% of men are classified as overweight or obese, as reported in the latest National Family Health Survey. This rise is closely associated with fast urban development and shifts in lifestyle, contributing to a spike in health problems linked to obesity, including type 2 diabetes (T2D), cardiovascular diseases (CVDs), and certain cancers. In light of this situation, there has been a surge in utilizing weight loss medications such as semaglutide and orlistat, which present an alternative to conventional weight management strategies. Although these medications may have effective results, their prohibitive costs limit access for many people, raising issues regarding health disparities. Besides, the presence of unregulated and less expensive alternatives poses serious risks to public health, including the potential for misuse and negative side effects. This review digs into the ramifications of weight loss medications in India, scrutinizing their implications for health, society, regulations, and the economy. It emphasizes the critical role healthcare professionals and regulatory authorities play in promoting safe usage and improving accessibility. The insights gained from this analysis emphasize the urgent need for a well-rounded strategy that encompasses health education, regulatory measures, and cost-effective treatment options. Managing these challenges will be essential for enhancing equitable access to weight loss solutions and reducing the long-term health and economic burdens associated with obesity in India.

Globally, the prevalence of obesity and overweight individuals is escalating, and India mirrors this trend. According to data from the World Health Organization (WHO) published online in March 2024, approximately 1 in 8 individuals worldwide were affected by obesity in 2022, underscoring a critical public health emergency. In 2022, an estimated 2.5 billion adults aged 18 and older were classified as overweight, with 890 million meeting the criteria for obesity. Collectively, 43% of adults were identified as overweight, and 16% were living with obesity [1]. The crisis also affects children. In 2022, 37 million children under the age of 5 were identified as overweight. Additionally, more than 390 million children and adolescents between the ages of 5 and 19 were classified as overweight, with 160 million of them being categorized as obese [1, 2]. These alarming figures highlight the escalating global burden of overweight and obesity, necessitating immediate, evidence-based interventions to mitigate the profound public health implications of this growing epidemic [3]. Obesity and overweight conditions have severe health consequences, leading to more than 3.4 million fatalities worldwide. These conditions account for 4% of total years of life lost and contribute at least 4% to disability-adjusted life years (DALYs) [4-6]. The increasing prevalence of obesity, combined with its far-reaching health impacts, underscores the urgent need for comprehensive public health strategies to address this global crisis and reduce its devastating human and economic toll.

According to the National Family Health Survey-5 (NFHS-5), 24% of women and 23% of men in India are now classified as overweight or obese, up from 20.5% and 18.9% in the previous NFHS-4 [7]. Currently, one in every four Indians struggles with obesity, a trend closely tied to the early stages of economic growth and development [8]. 

In swiftly evolving low- and middle-income nations (LMICs), changes in nutrition and lifestyle, influenced by urban development and economic expansion, are causing notable increases in obesity rates. These nations frequently deal with a dual burden of illness, experiencing rising instances of non-communicable diseases (NCDs) such as obesity, along with restricted access to healthcare and education [9, 10]. In India, this pattern is especially apparent, with rapid urban growth facilitating the extensive availability of processed, high-calorie foods and more sedentary ways of living. Urban regions, in particular, exhibit elevated obesity rates as traditional eating habits give way to calorie-rich, nutrient-deficient foods, and physical activity diminishes due to office-bound jobs and reliance on technology [11, 12]. The growing rates of obesity in LMICs are linked to a higher chance of developing long-term health issues, such as type 2 diabetes (T2D), cardiovascular diseases (CVDs), and specific types of cancer [13, 14]. Obesity leads to insulin resistance (IR), which heightens the risk of T2D, and it also worsens conditions like hypertension, elevated cholesterol, and inflammation, all of which contribute to CVD risks [15].

The surge in obesity-related health issues is putting immense pressure on healthcare systems in LMICs, highlighting the critical need for public health initiatives aimed at promoting healthier diets, increasing physical activity, and improving access to healthcare. As rates of obesity continue to increase, weight loss medications are increasingly regarded as a feasible option for tackling both obesity and its associated health conditions, like diabetes [16–18]. These medications, combined with various weight management strategies, provide promising solutions for vulnerable populations, potentially reducing both health challenges and the financial burden caused by obesity-related illnesses [19-21]. Conventional treatments, such as bariatric surgery (e.g., Roux-en-Y gastric bypass), while effective for some, come with inherent health risks [22]. Surgical options, usually intended for individuals with severe obesity, can result in complications such as infections, nutrient deficiencies, and long-term metabolic problems. Due to their invasive nature, bariatric surgeries require thorough evaluation and continuous follow-up care to handle potential risks [23]. Although they can offer significant advantages, such procedures are usually only considered after other weight loss methods have proven unsuccessful and when the person is facing serious obesity-related health issues. While weight-loss medications offer potential benefits for individuals requiring significant weight reduction, they are accompanied by substantial health risks, socio-cultural implications, and regulatory complexities [24, 25]. This review examines the effects of weight loss medications in India, highlighting their health consequences, societal influences, the regulatory landscape, and the obstacles to ensuring their safe and effective use. It sets the stage for the increasing demand for weight management options in India, where the incidence of obesity and related health issues is escalating, leading to a change in health priorities.

The Surge of Weight Reduction Medications in India 

The awareness of health risks associated with obesity, such as CVDs, diabetes, and metabolic syndrome, has increased the importance of managing weight. As a result, weight loss drugs such as orlistat (Xenical), semaglutide (Ozempic), and liraglutide (Saxenda) are gaining traction as quicker options compared to conventional methods like dieting and exercising [26-28]. These drugs offer an alternative for individuals who may struggle to achieve significant weight loss through lifestyle changes alone. Orlistat, for instance, works by inhibiting pancreatic lipase, an enzyme responsible for breaking down fats in the digestive system. By blocking fat absorption in the gastrointestinal (GI) tract, orlistat reduces overall calorie intake, contributing to weight loss. Semaglutide and liraglutide, both glucagon-like peptide-1 receptor agonists (GLP-1 RAs), mimic the effects of a natural hormone that helps regulate blood glucose levels and appetite. These drugs help control hunger by slowing gastric emptying, increasing feelings of fullness, and promoting insulin secretion after meals. As a result, individuals often consume fewer calories, which leads to weight loss.

These weight loss medications are generating significant interest due to their proven ability to help individuals achieve substantial weight loss. For example, Ozempic (semaglutide) has gained widespread attention for its effectiveness in reducing body weight, even in individuals with obesity who do not have diabetes. Research shows that, when used alongside a balanced diet and regular physical activity, semaglutide can lead to a reduction of up to 15% of total body weight within a year, making it one of the most powerful pharmaceutical options for weight management [29, 30]. By targeting the GLP-1 receptor, semaglutide helps control appetite and improve insulin sensitivity, offering notable benefits for non-diabetic patients with obesity. Similarly, liraglutide (Saxenda), another GLP-1 RA, works in much the same way, though it requires daily injections, while semaglutide is administered just once a week, providing added convenience. The effectiveness of these medications in promoting weight loss has sparked discussions about their potential to address obesity on a larger scale, particularly in countries like India, where rising obesity rates highlight the urgent need for effective weight management solutions that combine pharmacological treatments with lifestyle changes. However, the high cost of semaglutide remains a significant barrier for many, as insurance coverage for its use in weight loss is often limited or unavailable [31]. 

Health Impacts: Benefits and Risks

The effectiveness of semaglutide in managing weight has led to its increasing popularity over the past few years. For instance, Ozempic is a GLP-1RA that imitates the function of the GLP-1 hormone. This hormone is essential in regulating appetite and food consumption by influencing the brain's appetite control centers, which helps decrease hunger and enhance sensations of fullness [32, 33]. Furthermore, semaglutide delays gastric emptying, which further lowers food consumption and aids in weight loss. Clinical research has indicated that Ozempic can help individuals lose as much as 15% of their body weight, surpassing other existing medications like Orlistat or Liraglutide [34-36]. This is particularly important for patients facing health issues related to obesity, as this level of weight loss can considerably lower the chances of CVDs, improve blood pressure, and boost insulin sensitivity [37, 38]. However, a significant concern is that GLP-1RAs may cause unhealthy and drastic reductions in the caloric intake of children and adolescents. Unlike adults, children and adolescents need energy not only for physical activities but also for vital functions tied to their growth and development. In these important stages of life, energy is crucial for building tissues, organs, and bones, as well as supporting cognitive and emotional advancement. Any interruption in adequate physical activity or nutrition—whether due to financial difficulties, cultural influences, or personal habits—can disrupt the delicate equilibrium between catabolic and anabolic activities [39, 40].

Additionally, a key concept in economics, known as 'moral hazard,' occurs when individuals engage in riskier behaviors because they do not fully bear the consequences of those actions.  This scenario can be seen in young individuals who turn to weight loss medications instead of committing to enduring lifestyle changes [41, 42]. Such dependence may interfere with their natural development by shifting their energy equilibrium, potentially obstructing the body’s capacity to properly grow and maintain muscle strength, bone health, and other vital indicators of growth. Additionally, medications designed to promote weight loss by altering appetite or boosting metabolism could unintentionally reduce nutrient intake or disrupt hormonal systems essential for healthy growth. This raises issues about the potential long-term impacts of such medications on younger individuals, particularly if used without appropriate medical guidance. Therefore, while weight loss drugs can effectively address obesity, their use in children and teenagers must be approached with caution to ensure that the benefits of weight control do not hinder healthy physical and emotional development [43, 44].

Moreover, like all weight loss medications, Ozempic comes with potential side effects. Commonly reported effects include nausea, diarrhea, vomiting, stomach discomfort, dizziness, headaches, tiredness, and low blood glucose (hypoglycemia). In rare cases, it can also result in more serious conditions such as pancreatitis, thyroid C-cell tumors, and allergic reactions [45]. Because of these possible complications, Ozempic is typically prescribed with caution and needs to be taken under close medical supervision. Unauthorized formulations and counterfeit versions are strictly prohibited to ensure safety and effectiveness [46-48].

Societal Perceptions and Psychological Consequences

The cultural perception of body image in India is shaped by media, cinema, and societal norms, where slenderness is associated with beauty, success, and modernity, whereas excess weight is perceived unfavorably. This perception has been reinforced by the rise of Western fashion and lifestyle trends [49, 50]. Despite cultural differences, people in India are increasingly embracing body ideals portrayed in Western media. The growing focus on physical appearance, influenced by magazines, social media, and daily interactions, is becoming more pronounced. The rising use of weight loss pills may reinforce societal pressures to conform to a slim body image, thereby creating a divide in body image perceptions between urban and rural populations.

 As a result, the societal push to lose weight often intensifies feelings of dissatisfaction with one's body and diminished self-esteem, especially among young adults and teenagers. This may lead individuals to seek weight loss medications more out of social pressure than genuine health concerns [51, 52].  The combination of societal factors and the ease of obtaining these substances may lead to misuse, dependency, or addiction. Furthermore, medications designed for weight loss could amplify the negative perceptions experienced by individuals who are overweight or obese, which may further diminish their self-worth [53, 54].

The impact of healthcare providers and regulatory standards 

The healthcare industry and regulatory bodies play a critical role in ensuring the safe distribution and precise usage of weight-loss medications. In India, the Central Drugs Standard Control Organization (CDSCO) is responsible for overseeing these drugs; however, the rise of unregulated and potentially dangerous medications in the black market remains a major public health concern [55]. Recently, the CDSCO gave preliminary approval for tirzepatide, a drug that is effective for both weight loss and managing T2D [56]. Tirzepatide, the active ingredient in Mounjaro and Zepbound, developed by Eli Lilly, has proven effective in promoting weight loss, although it may cause side effects such as nausea and diarrhea [57]. The CDSCO's expert committee has recommended its approval for import and marketing in India, with final clearance pending from the Drug Controller General of India (DCGI). 

However, obtaining these medications through online pharmacies, often without prescriptions, raises important concerns. Many of these websites fail to comply with regulations or verify the identities of their customers, leading to unregulated distribution. This situation increases the risk of individuals self-medicating, misusing substances, and potentially developing substance abuse issues [58]. Healthcare providers play an essential role in educating patients about the correct way to use weight loss medications. For those struggling with health complications related to obesity, clinicians might prescribe these drugs as part of a comprehensive weight management strategy, combining them with dietary guidelines and exercise plans [59]. Still, many patients may bypass this important step and opt for quick solutions, which can pose serious risks.

Economic Consequences of Weight Loss Drugs in India

The market for weight loss medications presents significant opportunities within the healthcare landscape of India. Pharmaceutical companies, both domestic and international, strategically position themselves to capitalize on the increasing demand for these solutions, potentially leading to significant economic growth in the healthcare industry. As these treatments become more widely accepted, they can alleviate the financial strain caused by diseases associated with obesity by decreasing the rates of related health conditions, resulting in savings for healthcare providers. Furthermore, the growth of this industry can open new job prospects, draw both domestic and international investments, and enhance healthcare facilities, propelling additional advancement and creativity within the field​. Beyond the financial advantages, shedding pounds could notably influence various sectors, including the airline industry. Airlines typically modify their fuel usage according to the average weight of their passengers, as heavier travelers lead to increased fuel expenditure. Should weight reduction become more prevalent, airlines might experience a decrease in total fuel usage, resulting in considerable savings.

In addition, this decrease in fuel utilization could lead to reduced carbon emissions for each flight, aiding initiatives aimed at promoting environmental sustainability. As a result, the advantages of losing weight go beyond personal health and economic improvement, providing a chance to minimize the ecological impact of sectors such as aviation. Nonetheless, the high cost of name-brand weight-loss drugs restricts their availability mainly to individuals from middle- and upper-income backgrounds, creating disparities in who can benefit from these treatments [60].

 Additionally, a study conducted by Morgan Stanley predicts that calorie intake in the United States will decrease by 1.3% by 2035, a pattern that could also emerge in India [61]. This shift may result in lower food sales, as the growing interest in weight loss medications could coincide with a potential decline in the food industry. On the other hand, there are less expensive and unregulated options available to more individuals, although these might compromise on quality and safety, posing a risk to public health and possibly straining the healthcare system. Meanwhile, the high costs of branded weight loss medications limit their accessibility, further exacerbating health disparities linked to socioeconomic factors [62].

In India, the impact of weight loss drugs on both health and society is intricate, taking into account various elements like health benefits, societal pressures, legal regulations, and financial implications. While these medications can provide assistance to individuals struggling with obesity-related health issues, they are often misused as quick fixes for managing weight, driven by social norms. Using these treatments without proper medical oversight can endanger health and may deepen societal inequalities, especially since affluent individuals usually have better access to such options. This scenario can reinforce narrow definitions of beauty, leading people to pursue potentially harmful solutions. A comprehensive strategy that emphasizes public health education, expert guidance from healthcare professionals, and strict regulatory frameworks is essential. Promoting the prudent and informed use of weight loss medications can contribute to ensuring they are utilized appropriately—as part of an all-encompassing health-focused plan for weight management in India [63]. By raising public awareness, implementing regulations, and encouraging cultural changes, India can foster an atmosphere that encourages positive weight management practices, enabling individuals to make choices that enhance both their physical health and mental wellness.

 Moreover, considering India's vast expertise in Ayurveda, there is a significant opportunity to develop Ayurvedic weight loss remedies that can be offered at a fraction of the cost of conventional weight loss medications. These Ayurvedic solutions, which mainly utilize natural herbs, plant-derived ingredients, and holistic approaches, can serve as a cost-effective alternative for a wider user, particularly in rural and economically disadvantaged areas where access to expensive pharmaceutical treatments is limited [64, 65]. From a regulatory standpoint, it is crucial to enhance oversight of over-the-counter weight loss products and online sales. Creating effective monitoring systems for adverse reactions and enforcing prescription regulations could help decrease certain health risks associated with abuse. Moreover, India would gain from enforcing stricter labeling regulations, ensuring that consumers are provided with thorough information on possible side effects and usage instructions. Lastly, considering the growing recognition of the complex connection between behavioral aspects, such as mental health issues, and weight loss, this synthesis could significantly enhance our comprehension of how weight loss drugs affect the mental and social difficulties tied to being overweight or obese. It could clarify how weight loss therapies influence the mental facets of obesity, including issues related to body image, social stigma, and the constant societal pressure to adhere to standards of thinness. The larger concern of finding a balance between prioritizing well-being over social views on physical appearance and striving for a healthy weight could also be approached in this manner. 

Conflict of interest

The authors declare no conflicts of interest related to this research. 

Funding

This research is funded by an intramural grant from Bandhan Group, India.