Weight-loss drugs: The big question

"Losing weight was a challenge given my schedule and stressful work profile…While being prescribed the drugs, I had been informed that these would help in weight management, which is a major requirement given my condition at the moment,” says Debjani B, a senior manager in a healthcare marketing profile based in Bengaluru.

Debjani has been taking both antidiabetic pills and insulin to manage her weight, which she has had little difficulty accessing.

Weight-loss antidiabetic drugs are all the rage today, with interest spiking in the array of brands and seemingly effortless options to achieve the desired effect. With the recent launch of the weight-loss antidiabetic drug Mounjaro in India, specialists report more patients than ever enquiring about such drugs to manage their weight, either with or without diabetes.

Approved medication aside, there are powders and shakes, with a sprinkling of home remedies and “gut health” products on one side, coupled with copious amounts of “expert” advice online on the other, not to mention influencers and self-proclaimed health consultants flooding the market with hundreds of options that claim to effectively tackle obesity. There is little scientific proof backing these claims.

According to the National Family Health Survey-5 (2019-2021), 24% of women and 22.9% of men aged 15-49 years in India were categorised as “overweight or obese”. Additionally, recent studies estimate that over 100 million people are currently living with diabetes, thus effectively making the country the diabetes capital of the world. In such a market, it is no wonder that such drugs are heavily marketed and are in such high demand.

Additionally, since bariatric surgery can cost a few lakh rupees at once and comes with its own side effects, such as infection risks or bleeding issues, spending a few thousand rupees per dose seems to be a more accessible and viable option for some.

Is there a difference between generic “weight-loss” medicines and antidiabetic drugs? While there are many different types of weight-loss drugs, most of them help in reducing insulin resistance and controlling hyperglycemia or high blood sugar. They either block the body’s absorption of fat, suppress hunger, or improve insulin secretion.

“Some of these weight-loss drugs have gotten approval for diabetes, but some have not. Orlistat, for example, is a drug for weight loss, but it is not a drug for Type 2 diabetes patients alone,” explains Dr Pramila Kalra, HoD and Consultant, Department of Endocrinology, Ramaiah Memorial Hospital.

Weight-loss drugs are typically available in an oral or injectable format. Oral tablets are usually taken daily, either once or multiple times, depending on the dose and intended effect, whereas injectables currently available in the market are typically taken once a week.

Orlistat, an oral drug, works by reducing fat absorption in the body. It is taken with or after each meal and has been shown to be effective even in patients without diabetes.

Ryan Wilson, who works as an assistant professor in a Bengaluru-based university, took the oral drug route, which he has been able to access over the counter over the past month. “I started to gain some weight two years ago due to stress eating…I started exercising and tried to cut down on what I ate. I began looking at medication online. I don’t like needles and poking myself so I looked up (other options). I have lost three kg so far…,” he says.

The one major reported side effect of this is an increased need to go to the restroom often.

Injectable drug Tirzepatide, sold by American pharmaceutical Lilly as Mounjaro, is a dual glucose-dependent insulinotropic polypeptide (GIP) and Glucagon-like peptide-1 (GLP-1) receptor agonist. What this means is that this drug mimics the way the natural GIP and GLP-1 hormones, secreted by the intestines after food intake, function in the body. Existing research shows that this relatively new drug offers the highest weight loss potential.

Novo Nordisk’s Ozempic, which is the brand name for Semaglutide medication, is used for both Type 2 diabetes and weight loss, while its Wegovy drug is specifically used for weight loss. As of this week, the company is reportedly looking to launch Wegovy.

Both these types of drugs stimulate insulin secretion from the pancreas and suppress glucagon release, making one feel fuller or satiated and reducing hunger, thus helping control food intake and prevent blood sugar spikes, impacting body weight significantly. Blood sugar levels come under control and are easier to manage, and the risk of major cardiovascular events is also cut short due to these drugs, note experts.

Effects can be observed within four to six weeks, with the full effect seen over a year, says Dr Kalra.

These drug combinations are also now being tested for efficacy in treating non-alcoholic fatty liver disease, polycystic ovarian syndrome (PCOS), and other conditions.

Oral drugs or injectables?

Endocrinologists note that while there is not a major difference, weight-loss drugs that are injected have shown better efficacy compared to oral drugs in reducing weight.

Dr Ganapati Bantwal, professor of endocrinology, St John’s Medical College Hospital, notes that oral drugs can have some drug interactions and need to be taken on an empty stomach, which might otherwise compromise their efficacy. On the other hand, there are no such issues with injectables, where a once-a-week compliance is easier to follow.

The dosage usually recommended for injectable weight-loss drugs is once a week. If a dose is missed, it should be taken as soon as possible, within the next four days. Any later, it is better to skip the missed dose and continue the rest of the dosing schedule as usual.

As is the case with most medications, it is best to avoid or limit alcohol intake when using the medication. Additionally, any other medication the patient is on must be communicated with the doctor to ensure there are no unaccounted interactions that could increase the risks of side effects or worsen them.

Experts note that the longer people continue using weight-loss drugs, the better the results are over time. Several studies have shown sustained weight loss and a lower risk of progression to Type 2 diabetes with regular doses of Tirzepatide and Semaglutide. However, patients also tend to regain the weight that is lost over a year if they stop taking the drug. Effectively, it is recommended for the medication to be continued for as long as possible.

“If the patient can maintain their weight with a proper diet and lifestyle changes, they could potentially discontinue the drug. But in most cases, these drugs only kickstart a weight loss journey; they are neither a quick fix nor a permanent solution. People need to continue making lifestyle changes if they do not want to regain their weight or put on more weight,” advises Dr Bantwal.

What is the impact on other organs?

A recent Lancet meta-analysis showed that some of these weight-loss drugs also had a strong antihypertensive effect, which meant that they also worked well in reducing blood pressure.

Experts note that conditions such as osteoarthritis and nonalcoholic fatty liver disease (NAFLD), major risks for liver cirrhosis and cancer, have also improved in patients during trials. Cardiovascular health has been proven to improve with time; Tirzepatide, especially, has also been shown to reduce the risk of heart, liver, and kidney complications from diabetes, and prevent heart attacks in diabetic patients with a history of heart problems.

Patients with pancreatitis cannot be prescribed these injectables. Moreover, if someone is due to undergo an elective surgery of any part of the gastrointestinal system, then they must stop taking these weight-loss drugs at least a week before the surgery; if not, gastric functioning will be adversely affected.

The most common side effects are nausea, vomiting and stomach pain, which are expected to subside with time. However, doctors warn that there have been cases where patients were unable to cope with these side effects, and thus required their doses to be lowered or switched to alternative medication. If the side effects do not subside within two months, doctors might also discuss the possibility of patients having to discontinue the medication altogether.

Another side effect of drug-induced weight loss is the loss of lean body mass. However, ongoing studies are looking into how muscle mass can be retained or improved by adding another drug compound, Dr Bantwal clarifies.

Disclaimer: This article is for information purposes only. Readers are advised to consult a qualified health professional before starting any regimen.

FAQs about weight-loss pills

1. What are these drugs, and what do they do?

Weight-loss drugs are either oral pills or injectables that aid in reducing weight over time. Some weight-loss drugs work by inhibiting fat absorption, while others mimic the action of hormones released by the gut after food intake, making you feel less hungry and inducing a feeling of “fullness” or satiety.

2. What are some initial side effects of these drugs?

Initial side effects of such drugs include nausea and vomiting, dizziness, diarrhoea, stomach pain and gastrointestinal issues. There have been rare recorded cases of worsening of diabetic retinopathy (eye issues related to diabetes).

3. How can one access these drugs?

Reach out to a registered endocrinologist, who will usually recommend several tests or a full-body check-up to check for other comorbidities, diabetes or prediabetes, blood sugar and blood pressure levels, and, of course, weight. After considering all factors, the endocrinologist will suggest the drug and the required dosage that will be effective. It is always safer to obtain a registered medical practitioner’s prescription and not seek to buy these medicines over the counter.

4. How expensive are these drugs?

Currently, the price points for Ozempic for the Indian market are not yet public but going by the costs in the United States of America, it is estimated to cost around tens of thousands of rupees per dose. As opposed to this, Mounjaro, which was recently launched for the Indian market, is now available at Rs 3,500 per 2.5 mg dose and Rs 4,375 per 5 mg dose.

5. What happens if you stop taking these drugs?

There is a possibility that a patient who stops taking the drugs regularly can regain the weight. This is especially if the patient does not keep up with the suggested diet and lifestyle changes simultaneously, while on the treatment regimen.