Semaglutide, a medication widely known by brand names like Ozempic and Wegovy, is seeing a significant surge in demand across India, particularly for weight loss. Initially developed for managing Type 2 diabetes, its use has expanded as more individuals, including those without a prior diabetes diagnosis, seek it for its weight-reducing effects.
The landscape for semaglutide in India has shifted dramatically following the expiry of its patent in March, leading to the introduction of more affordable generic versions. This increased accessibility and lower cost, which has seen monthly expenses drop by up to 90%, are driving a rapid uptake, often outpacing medical supervision.
Understanding How Semaglutide Works
Semaglutide operates as a GLP-1 receptor agonist, a class of drugs that helps regulate both appetite and blood sugar levels. It functions by slowing digestion and reducing appetite, which naturally leads to decreased food intake over time. Clinical studies have shown that many patients achieve 10–20% weight loss, alongside benefits such as improved blood sugar control and reduced cardiovascular risks.
Beyond affordability, the growing demand is also fueled by social media influence and peer networks, with many individuals seeking quick weight loss solutions even without diagnosed metabolic conditions.
Doctors Warn Against Unsupervised Use
Despite the drug's potential, clinicians nationwide report a concerning trend: patients initiating semaglutide therapy without prior consultation, baseline investigations, or a structured treatment plan. Dr. Gagandeep Singh, a metabolic health specialist at Redial Clinic in New Delhi, emphasizes, "This is not an over-the-counter solution. The responsible use of GLP-1 means integrating it into a structured programme."
Proper use requires careful initiation with a low dose, gradual escalation, and regular monitoring to manage potential side effects and ensure patient safety. Doctors also stress the importance of combining semaglutide with nutritional planning, particularly higher protein intake, and resistance training to preserve muscle mass.
Risks of Unsupervised Semaglutide Use
Without medical oversight, patients face several risks. Common side effects include nausea, vomiting, and general weakness, especially if dosing is not managed correctly. More concerning, data suggests that up to 40% of the weight lost on semaglutide could be lean muscle mass. "Everyone is focused on how much weight is lost. Almost nobody is asking what kind of weight you’re losing," Dr. Singh cautions.
Loss of muscle mass can negatively impact metabolic rate and long-term health outcomes. Furthermore, many individuals experience weight regain within a year of discontinuing the drug if sustainable lifestyle changes are not adopted, potentially leading to a cycle of weight loss followed by an increase in body fat.
Who Needs Careful Screening?
Semaglutide is not suitable for everyone. Individuals with a history of pancreatitis, certain thyroid conditions, or severe gastrointestinal disorders require thorough evaluation before starting treatment. It is also contraindicated during pregnancy and breastfeeding. Experts recommend comprehensive baseline screening, including thyroid function tests and metabolic assessments, to ensure patient suitability and monitor progress.
"Without monitoring body composition and metabolic markers, you may end up solving one number while worsening the overall metabolic picture," Dr. Singh adds.
Not a Replacement for Bariatric Surgery
While GLP-1 therapies are a valuable addition to obesity management, they do not replace established treatments, especially for severe cases. Dr. Anshuman Kaushal, Director of Robotic GI, Minimal Access and Bariatric Surgery at CK Birla Hospital, Gurugram, states, "Bariatric surgery remains the most effective treatment for severe obesity because it delivers the greatest and most durable weight loss, while also improving or even resolving major obesity-related diseases."
He notes that while new drugs offer benefits, their long-term efficacy often depends on consistent adherence and access, whereas surgery provides strong evidence for sustained metabolic improvement and quality-of-life gains for those with severe obesity.
The Indian Context: A Public Health Opportunity
India's unique metabolic profile, characterized by a higher propensity for insulin resistance, fatty liver disease, and cardiovascular risk at lower BMIs (often termed "thin outside, fat inside"), adds another layer of complexity. Visible weight loss alone may not accurately reflect underlying metabolic health, making proper evaluation and follow-up even more critical.
With over 200 million people in India living with obesity, diabetes, and hypertension, the responsible use of semaglutide presents a significant public health opportunity. Dr. Singh concludes, "If used within a structured, supervised programme, GLP-1 can help many patients improve metabolic health. If reduced to a quick-fix injection, it risks becoming a short-term trend."