Battling the bulge: The rising fame of two drugs among obesity patients

A small percentage of obese patients are increasingly opting for anti-obesity medications such as semaglutide and liraglutide, originally developed for diabetics who are obese.

But high costs and challenges of administration mean that the adoption of these drugs is still limited. They must be taken for an extended period, and the monthly expense ranges between Rs 10,000 to 12,000.

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While semaglutide tablets (Rybelsus) have been approved for usage in diabetic individuals, its approval as an exclusive treatment for weight loss is still pending. Nonetheless, some patients are already using the drug off-label for weight loss purposes.

"Approval is expected to come soon. Many doctors prescribe it for obesity now too, but they should inform the patient that approval from the Food and Drug Administration (FDA) is pending," says diabetes and endocrinology consultant Dr Kranti Shreesh Khadilkar.

"For patients with BMI over 30 to 35, we offer lifestyle changes along with Rybelsus. It reduces appetite, satiety is achieved early, and insulin sensitivity improves. We have seen weight loss up to 10 to 20 kg," says senior endocrinologist and diabetologist Dr Subramanian Kannan. "Other than weight loss, it also has helps in reducing blood sugar levels and BP, and improving overall metabolic health."

Users in the US

Doctors say several patients inquire about semaglutide after reading about it online from users in other countries such as the US.

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Currently, the FDA has approved the injectable form of semaglutide as a treatment for obesity, but it is not available in India.

Dr Kannan says liraglutide, in the market for around a decade, is available only in the injectable form (Victoza), which has affected its popularity. The prescribed dosage of liraglutide for obese patients is 3 mg, much higher than the 1.8 mg prescribed for patients fighting both diabetes and obesity.

The 3 mg dose injections are unavailable in India, which means doctors either prescribe 1.8 mg or patients have to inject the medicine twice a day to achieve the 3 mg dose.

"In obese patients, I have seen good improvement with the 1.8 mg dose itself. It can lead to 5-10 per cent of weight loss," says diabetes and endocrinology consultant Dr Shivaprasad K S. However, over the past six years, only 20 to 30 of his patients have opted for liraglutide.

Dr Kranti says that around 15 per cent of her obesity patients would be on liraglutide at any point.

Physicians say patients can take these medications for an extended period; nonetheless, many of them tend to terminate usage prematurely.

Abruptly ceasing medication usage can cause patients to experience rebound weight. As a result, Dr Kannan advises gradually reducing the dosage after use for a few years.

Liraglutide and semaglutide are a class of medicines called GLP-1 analogues. Currently, these are the only drugs available for weight loss, as previous anti-obesity drugs had severe side effects or were even banned.

"If cheaper drugs are available, especially tablets, a larger number of people can benefit. Currently, the only other options for obese patients is lifestyle change and surgery," says Dr Kranti.