Hype of weight loss medications: Benefits, risks and what’s often overlooked

Obesity in India has become a significant health issue, with projections in a Lancet study suggesting that nearly one-third of the population will be obese by 2050. According to the National Family Health Survey, 24% of women and 23% of men in India are overweight or obese. Obesity is linked to numerous health complications, including type 2 diabetes, high blood pressure, cardiovascular diseases (CVD), stroke, and some cancers. In response, medications like Ozempic, Wegovy, and Mounjaro, originally developed to manage type 2 diabetes, are increasingly being used for weight loss.

Dr. Hrishikesh Salgaonkar, Consultant Bariatric, Robotic and Minimal Invasive Surgeon, Fortis Hospital, Mulund explains how these drugs work:

These drugs belong to a class called GLP-1 (Glucagon-like Peptide) agonists, which are hormones produced in the small intestine. They work in several ways:

Improved Insulin secretion: GLP-1 stimulates insulin production, which helps control blood sugar, especially in Type 2 diabetes.

Appetite regulation: GLP-1 agonists slow down gastric motility, making you feel fuller for longer. They also signal the brain to reduce hunger, although the exact mechanism is still not fully understood.

Weight loss: Studies show that GLP-1 agonists can help patients lose 5-15% of their body weight when combined with diet and exercise. Mounjaro (Terzepatide) is a dual GLP-1/GIP (Gastric Inhibitory Peptide) receptor agonist, which may offer better blood sugar control and enhanced weight loss compared to traditional GLP-1 agonists.

These medications can be highly effective in controlling blood sugar and promoting weight loss. However, they do not replace the need for a healthy lifestyle. Without dietary changes and regular exercise, the drugs' effects may be lessened, and patients are at risk of regaining the lost weight once they stop the medication. A healthy diet and exercise remain crucial components of any weight management plan.

As with any medication, GLP-1 agonists come with side effects, which can include:

Common side effects: Nausea, vomiting, indigestion, bloating, Diarrhoea, Constipation, and acid reflux. Up to 1 in 10 people may experience these issues.
Severe risks: Rare but serious side effects include dehydration, kidney injury, hypoglycemia (low blood sugar), worsening of diabetes-related retinopathy, and more severe gastrointestinal issues like gallstones and pancreatitis.

Animal studies have linked these medications to thyroid C-cell cancer, making them contraindicated for those with a family history of Medullary Thyroid Cancer or Multiple Endocrine Neoplasia (MEN 2).

In addition, there have been reports of NAION (Non-Arteritic Anterior Ischemic Optic Neuropathy), which can cause sudden, painless vision loss due to restricted blood flow to the optic nerve. Symptoms include blurred vision, color distortion, and loss of contrast sensitivity. Although rare, further studies are required to look into this effect.

One of the major barriers to the widespread use of these medications is their high cost. For instance, the cost of Mounjaro ranges from ₹14,000 to ₹18,000 per month for lower doses. The price for higher doses could exceed ₹40,000 per month, making these drugs financially inaccessible for many. Patients who stop the medication often regain the lost weight, necessitating long-term treatment, which further escalates costs.

While GLP-1 agonists like Ozempic, Wegovy, and Mounjaro offer promising solutions for weight loss and blood sugar management, they come with a range of potential side effects, some of which can be severe. It is crucial that these drugs are prescribed and monitored by experienced endocrinologists or obesity specialists. They should be part of a comprehensive weight management plan that includes dietary changes and exercise. Regular follow-ups are essential to detect and address any adverse effects promptly.

Additionally, the high cost of these medications and their long-term use may limit accessibility for many individuals, particularly in developing countries like India. A multifaceted approach—comprising medication, lifestyle modifications, and better healthcare accessibility—will be essential to address the growing obesity epidemic in India and elsewhere.