<p>For decades, the therapeutic interventions for obesity involved lifestyle changes and bariatric surgery. Over the last few years, however, the therapeutic landscape has evolved rapidly following the availability and approval of glucagon-like peptide-1 receptor (GLP-1) agonists. Originally positioned for patients suffering from type 2 diabetes, it soon became an intervention targeted at mitigating morbid obesity. The science behind its beneficial therapeutic effects lies in its ability to mimic the action of the gut hormone incretin, which lowers blood glucose by increasing insulin secretion in response to rising blood glucose levels, delaying gastric emptying, and suppressing glucagon secretion.</p><p>The public imagination is further incited by celebrities and social media influencers flaunting transformed physiques achieved through weekly subcutaneous injections. GLP1 agonists like semaglutide (from Novo Nordisk) and liraglutide (from Eli Lily) have now become household names. GLP-1 agonists have a strong therapeutic effect for chronic weight management. However, public perception has shifted dangerously. These drugs are no longer seen as potent hormonal modulators of metabolism but as glorified appetite suppressants.</p>.From G20 Glory to COP33 Exit | India’s shrinking global role.<p>Currently, in India, higher-dose semaglutide (Wegovy) is formally approved for obesity only in limited contexts under the strict medical supervision of endocrinologists and internal medicine practitioners. India’s unique pharmaceutical ecosystem, where many GLP-1 agonists are available without a stringent prescription, has fuelled a crisis. Cost, though high, is also not a barrier. EMI options and grey-market imports have made these drugs accessible to the aspiring middle class. This portends a worrying trend of unsupervised, off-label use across urban India, making a lifestyle accessory out of a powerful prescription-only drug, used without proper medical oversight. The seizure of counterfeit Mounjaro injections, a new class of GLP-1 agonists, in Gurugram points to a disturbing trend of increasing demand and spurious drugs flooding the domestic market.</p><p>GLP-1 agonists have been documented to slow gastric emptying, alter reward pathways in the brain, and carry significant risks when used casually and without supervision. Potential long-term toxicity profiles are also far from fully clear. In clinical settings, GLP-1 agonists are initiated at low, titrated doses, with monitoring for nausea, pancreatitis, gallstones, and changes in heart rate. Unsupervised use discards this safety net, leading to a significant number of patients arriving at gastroenterology clinics and ERs with severe vomiting, dehydration, and electrolyte imbalances; a syndrome often informally designated as ‘GLP-1 stomach’. Cases of drug-induced acute pancreatitis, which can be life-threatening, are also being reported in young adults with no discernible risk factors.</p><p>Beyond these acute side effects, unsupervised use also may foster dangerous nutritional deficiencies. With drastically reduced appetite, many users eat far less than 1,000 calories a day, lose muscle mass, experience hair fall, and develop anemia. In the absence of stringent medical monitoring of lean body mass or micronutrient levels, these complications may go unnoticed until they become really severe.</p><p>The ‘rebound effect’ on stopping the drug, often due to cost or side effects, is also concerning. Rapid weight regain, sometimes exceeding the original loss, leads to a vicious cycle, further worsening metabolic health and triggering eating disorders.</p><p>The challenges posed by off-label abuse will be even steeper as the orally administered GLP-1 agonists become available.</p><p>Indian regulators cannot afford to turn a blind eye. The Central Drugs Standard Control Organisation (CDSCO) must tighten online pharmacy compliance and mandate a physical or video consultation with a registered endocrinologist or internal medicine specialist before dispensing any GLP-1 agonist. Pharmacovigilance programmes need to actively track adverse events associated with off-label use and issue public advisories. In fact, the Government of India released an official guidance1 on April 1, on the use, risks, and regulation of GLP-1 agonists. Social media platforms and other media outlets should also be targeted to curb the spread of misleading health claims. Practitioners and influencers doling out GLP-1 advice without a license should also be held accountable.</p><p>However, as usual, regulation alone will not be sufficient. The citizens need to be aware that obesity is a chronic, relapsing disease, not a cosmetic inconvenience. GLP-1s are powerful allies when used under medical guidance, alongside protein-adequate diets, resistance training, and behavioural support. The message must be clear that a drug that alters gut hormones and brain chemistry cannot be a commonplace lifestyle hack. Unsupervised GLP-1 use signs a system prioritising quick fixes over sustainable health. Until access is paired with education and medical oversight, the very drugs designed to heal may end up harming a generation chasing unreal physical aspirations.</p><p><strong>(Dipyaman Ganguly is the Head of Department and Professor of Biology at the Trivedi School of Biosciences, Ashoka University, Delhi-NCR. Views expressed are personal.)</strong></p><p><em>Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.</em></p>
<p>For decades, the therapeutic interventions for obesity involved lifestyle changes and bariatric surgery. Over the last few years, however, the therapeutic landscape has evolved rapidly following the availability and approval of glucagon-like peptide-1 receptor (GLP-1) agonists. Originally positioned for patients suffering from type 2 diabetes, it soon became an intervention targeted at mitigating morbid obesity. The science behind its beneficial therapeutic effects lies in its ability to mimic the action of the gut hormone incretin, which lowers blood glucose by increasing insulin secretion in response to rising blood glucose levels, delaying gastric emptying, and suppressing glucagon secretion.</p><p>The public imagination is further incited by celebrities and social media influencers flaunting transformed physiques achieved through weekly subcutaneous injections. GLP1 agonists like semaglutide (from Novo Nordisk) and liraglutide (from Eli Lily) have now become household names. GLP-1 agonists have a strong therapeutic effect for chronic weight management. However, public perception has shifted dangerously. These drugs are no longer seen as potent hormonal modulators of metabolism but as glorified appetite suppressants.</p>.From G20 Glory to COP33 Exit | India’s shrinking global role.<p>Currently, in India, higher-dose semaglutide (Wegovy) is formally approved for obesity only in limited contexts under the strict medical supervision of endocrinologists and internal medicine practitioners. India’s unique pharmaceutical ecosystem, where many GLP-1 agonists are available without a stringent prescription, has fuelled a crisis. Cost, though high, is also not a barrier. EMI options and grey-market imports have made these drugs accessible to the aspiring middle class. This portends a worrying trend of unsupervised, off-label use across urban India, making a lifestyle accessory out of a powerful prescription-only drug, used without proper medical oversight. The seizure of counterfeit Mounjaro injections, a new class of GLP-1 agonists, in Gurugram points to a disturbing trend of increasing demand and spurious drugs flooding the domestic market.</p><p>GLP-1 agonists have been documented to slow gastric emptying, alter reward pathways in the brain, and carry significant risks when used casually and without supervision. Potential long-term toxicity profiles are also far from fully clear. In clinical settings, GLP-1 agonists are initiated at low, titrated doses, with monitoring for nausea, pancreatitis, gallstones, and changes in heart rate. Unsupervised use discards this safety net, leading to a significant number of patients arriving at gastroenterology clinics and ERs with severe vomiting, dehydration, and electrolyte imbalances; a syndrome often informally designated as ‘GLP-1 stomach’. Cases of drug-induced acute pancreatitis, which can be life-threatening, are also being reported in young adults with no discernible risk factors.</p><p>Beyond these acute side effects, unsupervised use also may foster dangerous nutritional deficiencies. With drastically reduced appetite, many users eat far less than 1,000 calories a day, lose muscle mass, experience hair fall, and develop anemia. In the absence of stringent medical monitoring of lean body mass or micronutrient levels, these complications may go unnoticed until they become really severe.</p><p>The ‘rebound effect’ on stopping the drug, often due to cost or side effects, is also concerning. Rapid weight regain, sometimes exceeding the original loss, leads to a vicious cycle, further worsening metabolic health and triggering eating disorders.</p><p>The challenges posed by off-label abuse will be even steeper as the orally administered GLP-1 agonists become available.</p><p>Indian regulators cannot afford to turn a blind eye. The Central Drugs Standard Control Organisation (CDSCO) must tighten online pharmacy compliance and mandate a physical or video consultation with a registered endocrinologist or internal medicine specialist before dispensing any GLP-1 agonist. Pharmacovigilance programmes need to actively track adverse events associated with off-label use and issue public advisories. In fact, the Government of India released an official guidance1 on April 1, on the use, risks, and regulation of GLP-1 agonists. Social media platforms and other media outlets should also be targeted to curb the spread of misleading health claims. Practitioners and influencers doling out GLP-1 advice without a license should also be held accountable.</p><p>However, as usual, regulation alone will not be sufficient. The citizens need to be aware that obesity is a chronic, relapsing disease, not a cosmetic inconvenience. GLP-1s are powerful allies when used under medical guidance, alongside protein-adequate diets, resistance training, and behavioural support. The message must be clear that a drug that alters gut hormones and brain chemistry cannot be a commonplace lifestyle hack. Unsupervised GLP-1 use signs a system prioritising quick fixes over sustainable health. Until access is paired with education and medical oversight, the very drugs designed to heal may end up harming a generation chasing unreal physical aspirations.</p><p><strong>(Dipyaman Ganguly is the Head of Department and Professor of Biology at the Trivedi School of Biosciences, Ashoka University, Delhi-NCR. Views expressed are personal.)</strong></p><p><em>Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.</em></p>
