In a peptide bind

What had been whispered became tweet-worthy. The genie, to use Karan Johar’s own expression, had finally “come out of the closet”.

For months last year, speculation swirled around filmmaker Karan Johar, whose dramatically slimmer appearance set off a storm of gossip. Social media sleuths, wellness influencers, and Bollywood watchers all had their theories. The new miracle drug from the West had arrived in India, they said, and the industry’s elite had discovered it. Johar eventually addressed the rumours in May 2025. His transformation, he insisted, had nothing to do with weight-loss drugs. It was the result of discipline — a strict one-meal-a-day regimen. Not many believed it. But something curious happened when he denied it. A conversation that had remained carefully hidden for years suddenly burst into the open: the spread of weight-loss drugs in India.

What had been whispered became tweet-worthy. The genie, to use Johar’s own expression, had finally “come out of the closet”.

Around the same time, filmmaker Hansal Mehta took a far more candid approach. On social media, he openly acknowledged that he was taking Mounjaro, a drug whose scientific name is tirzepatide, until recently known mostly to endocrinologists and diabetes specialists.

Mehta’s admission mattered for a reason: it broke the silence.

Because the truth was already obvious to anyone watching closely. The Indian elite had been using these drugs for years.

They were everywhere — in metropolitan clinics, medical tourism centres, and weight-loss programmes catering to India’s expanding upper middle class. But they were rarely discussed openly. There was a social hesitation to disclose their use because of stigma. People concealed it from friends, family, and sometimes even from their own physicians.

Weight loss, after all, was supposed to come through discipline — diet, exercise, perseverance, and the slow burn of self-control. Admitting that a weekly injection had done the job felt, to many, like cheating.

Yet while the conversation remained awkward and guarded, the numbers told a different story. Demand for these therapies has been rising at a pace few anticipated.

Most of these drugs had largely arrived in the country through grey routes until last year, when two global manufacturers began selling directly and through Indian partners.

Now, the market is transforming. From this month, several Indian pharma companies are introducing generic versions, challenging the duopoly of global giants and bringing down price barriers.

The silent epidemic

Long before this market shift, India had begun undergoing one of the fastest metabolic transformations in the world. Obesity, once seen as a problem of affluent Western societies, has been spreading rapidly across urban India. Sedentary lifestyles, ultra-processed foods, and erratic work schedules have rapidly reshaped the country’s metabolic landscape.

This shift reflects the subtle Westernisation of everyday life. The modern Indian routine has begun to mirror the metabolic patterns that transformed Western societies decades ago. “India is witnessing a worrying rise in childhood and adolescent obesity,” says Vikrant Shrotriya, managing director of Novo Nordisk India.

Alongside obesity has come another epidemic: Type 2 diabetes. Today, India hosts more than 90 million reported diabetic patients. Millions more hover in the grey zone of pre-diabetes.

For decades, doctors offered familiar advice: eat less, exercise more, control body weight. But anyone who has struggled with being overweight knows how unforgiving that path can be. Reducing body weight from 100 kilograms to 70 kilograms through diet and exercise alone can take years of relentless effort. Most people, frankly, do not have that patience. Into that impatience stepped a new class of drugs.

The magic weight-loss molecule

The revolution began with a hormone molecule called GLP-1 — short for glucagon-like peptide-1. It is a natural chemical produced in the intestine after a meal, tasked with helping the body manage food.

When you eat, GLP-1 performs several crucial functions. It signals the pancreas to release insulin as blood sugar rises. It slows the emptying of the stomach, allowing food to remain longer in the digestive tract. And perhaps most importantly, it sends a message to the brain: you are full.

This combination reduces hunger and stabilises blood sugar. Scientists had known about this hormone for decades. But naturally occurring GLP-1 breaks down within minutes, making it impractical as a medicine. Researchers, therefore, began designing synthetic versions that would remain active in the body for much longer. The results were transformative.

Among the most successful molecules was semaglutide. It was first approved by regulators in 2017 and marketed for diabetes under the brand name Ozempic, and later approved specifically for obesity as Wegovy in 2021.

Soon, another breakthrough followed: tirzepatide, sold as Mounjaro and later Zepbound. These drugs are typically administered as once-weekly injections, though some versions exist as daily tablets, such as Rybelsus.

Their mechanism is elegant. They trick the body into believing it has just eaten a large meal. Appetite drops, meals become smaller, and calorie intake declines over time.

For many patients, the first noticeable change is not weight loss but the quiet disappearance of constant hunger.

Clinical results have been striking. Semaglutide can produce 10–15% body-weight reduction within a year. Tirzepatide performs even better, achieving 15–22% in some studies. A person weighing 100 kilograms might lose 20 kilograms or more within 12 to 18 months.

For the first time, drugs were approaching results previously seen only with bariatric surgery, where parts of the stomach and intestine are removed.

A pharmaceutical gold rush

The implications were enormous. For decades, the weight-loss market had been a graveyard of mediocre pills. These legacy drugs worked modestly at best. GLP-1 therapies changed that. Pharmaceutical companies suddenly saw an opportunity that dwarfed even the diabetes market.

Obesity affects over a billion people globally — roughly one in eight people on earth. A drug capable of reliably producing double-digit weight loss could become a massive commercial engine. And so began a global race.

Newer molecules are emerging rapidly. One of the most anticipated is retatrutide—nicknamed “Godzilla” or “King Kong”— which targets three metabolic hormones simultaneously (GLP-1, GIP, and glucagon), earning it the label “Triple G”. In trials, it has shown weight reductions of up to 24%.

Another is CagriSema, a combination therapy that merges semaglutide with an amylin analogue, enhancing efficacy and suppressing appetite further.

Then came orforglipron, an oral GLP-1 drug designed to eliminate injections. Dozens of similar compounds are currently under development. The obesity medicine market has rapidly become a multi-billion-dollar battleground, marking what may be the first major pharmaceutical revolution since insulin and Viagra. Early movers have already reaped enormous rewards.

Novo Nordisk recorded nearly $41 billion in revenue in 2024, largely driven by anti-obesity drugs. Wegovy generated about $8.4 billion, Ozempic $17.4 billion, and Rybelsus $3.3 billion.

By 2025, demand surged further. Novo’s sales climbed to $46.8 billion, with Ozempic nearing $20 billion and Wegovy touching $12 billion. Eli Lilly has seen similar success. Its tirzepatide-based drugs — Mounjaro and Zepbound — have become its fastest-growing products. Mounjaro generated $23 billion in 2025, while Zepbound reached around $13.5 billion. Together, five drugs — Ozempic, Wegovy, Rybelsus, Mounjaro, and Zepbound — generated over $72 billion in 2025 alone. The global anti-obesity market is expected to cross $100 billion in 2026 and could reach $200 billion by 2030. India, too, has entered the boom.

For the first time, these drugs generated ₹1,000 crore in sales in 2025. Mounjaro alone accounted for ₹600 crore between its launch in March and December. Since October, it has been generating roughly ₹100 crore a month. Wegovy, launched in India in June 2025, collected ₹50 crore by year-end. Ozempic’s performance is still emerging, given its formal launch in December 2025, though it had circulated in grey markets earlier.

Despite costing between ₹10,000 and ₹27,000 per month, demand continues to surge — largely among the upper middle class and the elite.

The arrival in hordes

There is, however, some relief in sight. The original compound patent for semaglutide expired on March 20, 2026. This opens the door for generic manufacturers to enter the market with significantly cheaper versions.

Indian pharmaceutical companies, including Sun Pharma, Dr Reddy’s Laboratories, Biocon, and Cipla, have been preparing for this moment. However, a web of secondary patents and regulatory protections may delay generic entry in lucrative markets like the US and Europe. Countries such as India, China, Brazil, and Canada may see earlier access.

The evolution of obesity drugs is not driven by patents alone. One pathway is repurposing. Semaglutide was initially approved for Type 2 diabetes before its weight-loss potential was recognised. Another is off-label use, where doctors prescribe drugs for conditions beyond their approved indication. Long before Wegovy was formally approved for obesity, physicians were already prescribing Ozempic for weight loss. A third pathway is more ambiguous. Some compounds not approved for human use are sold online as “research chemicals” and promoted as therapies. Peptides such as AOD-9604, marketed for fat metabolism, and CJC-1295, claimed to stimulate growth hormone release, are gaining traction. Scientific evidence for many of these remains thin. Demand, however, is growing rapidly.

Side effects or mild effects?

By acting on the brain–gut axis, these drugs reduce hunger and prolong satiety. But altering that system can produce a spectrum of side effects. In the short term, most patients experience mild issues such as constipation, abdominal pain, bloating, and headaches.

In the medium term, though rare, complications like gallbladder disease, pancreatitis, and hypoglycaemia can occur. Long-term concerns include muscle loss, nutritional deficiencies, and, in some cases, mood fluctuations and anxiety.

Perhaps the most significant issue is dependence. Studies show that patients often regain up to two-thirds of lost weight within a year of discontinuing the drug.
Regulators are beginning to respond, introducing guidelines and curbs on aggressive marketing. This raises a fundamental question: are these temporary weight-loss tools, or long-term metabolic therapies akin to blood pressure medication?

The answer will shape how widely they are prescribed in India in the coming decade.

The rise of biohacking

The story of these drugs is no longer confined to clinical medicine. It is spilling into a broader cultural movement: biohacking.

Biohacking treats the human body as a programmable system — something that can be optimised, tuned, and upgraded through scientific intervention. In global wellness circles, enthusiasts experiment with diets, supplements, metabolic-tracking devices, and, increasingly, experimental drugs and peptides.

The philosophy is simple: why wait for clinical validation when you can experiment on yourself?

Some stack multiple peptides together. Others combine GLP-1 drugs with fasting protocols, hormone modulators, or continuous glucose monitoring. In these circles, the weekly injection is not a treatment. It is an upgrade.

In search of a miracle cure?

Much of this experimentation revolves around peptides — short chains of amino acids that act as signalling molecules in the body. GLP-1 itself is a peptide.

These compounds are believed to regulate appetite, metabolism, growth, and immune responses. Their ability to mimic natural biological signals makes them appealing tools for metabolic optimisation.

In weight-loss clinics worldwide, next-generation peptides are being promoted as metabolic accelerators. Some promise fat burning. Others claim to boost growth hormone levels. A few mimic appetite-regulating signals.

The science behind many remains preliminary. The enthusiasm, however, reflects a deeper impulse: the desire to engineer the body itself. As Dr Eric Topol notes, there is still a lack of meaningful data on many of these peptides.

Yet this impulse is not new. Every generation has pursued its own shortcut — from herbal tonics to diet pills and cosmetic surgery. The 21st century’s version of the miracle cure arrives as a tiny weekly injection.

The new metabolic age

Whether these drugs ultimately transform global health remains an open question. For people struggling with severe obesity, they offer something genuinely powerful: a biological reset of appetite. For pharmaceutical companies, they represent the most lucrative frontier since cholesterol drugs reshaped cardiology. And for societies like India, they reveal a deeper shift.

A country that once struggled with malnutrition is now confronting the paradox of metabolic excess. In a single generation, the public health challenge has flipped — from scarcity to abundance, from hunger to appetite, and increasingly, from appetite to its pharmaceutical control. The whisper that began in gym corridors and celebrity gossip columns may soon become a global chorus.

Meanwhile, the US Food and Drug Administration (FDA) is set to lift restrictions on certain injectable peptides. Interest in synthetic peptides has greatly increased recently, with influencers promoting them for longevity, tissue repair, better skin, etc., despite scant research. The US Health Secretary, Robert F Kennedy Jr, has also been campaigning for the lifting of restrictions. In short, this is the dawn of a new metabolic age.

The writer is the author of Vaccine Nation: How Immunization Shaped India (Macmillan, 2025) and the upcoming title, The Silent Syndicate: Who’s Pricing Your Health (Hachette India).