India’s doctors sound alarm over boom in availability of weight loss jabs | India

IIndia’s top doctors have warned of the dangers of an unregulated boom in weight-loss injections and stressed that it is not a magic pill to solve the country’s growing epidemic of diabetes and obesity.

Demand for appetite suppressant drugs such as Mounjaro, Wegovy and Ozempic has increased since their introduction in the Indian market this year.

In the eight months since it was approved for sale, Mounjaro – a vaccine that regulates blood sugar and suppresses appetite to combat diabetes and obesity – is now the best-selling drug in India, surpassing antibiotics.

Its commercial success has led its producer, pharmaceutical company Eli Lilly, to launch trials of a similar appetite-suppressing drug that could be marketed in India in pill form by next year.

An Eli Lilly spokesperson said: “Increasing urbanization, sedentary lifestyles and changing diets have made weight management a growing public health priority. This convergence of high unmet need, growing awareness and improved access to innovative therapies makes India an important market for weight loss medicines.”

Pharmaceutical company Novo Nordisk is also pushing for market share. It launched Ozempic this month at a competitive price of 8,800 rupees (£73) for four injections per month, compared to 14,000 rupees (£115) per month for Mounjaro – prices beyond the reach of the average Indian household.

But by March next year, pharmaceutical companies’ patents on many of these semaglutide drugs are set to expire in India. This will open the market to domestic companies developing their own cheaper versions, which should flood the market and make prices more affordable. Experts predict that the market for weight loss drugs in India will reach $150 billion (£112 billion) a year by the end of the decade.

Many health professionals and patients have hailed widespread access to these vaccines as a long-awaited necessity for India, which is grappling with a rise in obesity and diabetes that threatens to overwhelm the country’s already underfunded and overburdened health system.

According to experts, diabetes and obesity are likely to become the biggest causes of death in India by 2030. A recent global analysis found that India has an estimated 212 million adults with diabetes, accounting for more than a quarter of the global total.

A Lancet study found that in 2021, India had around 180 million adults who were overweight or obese – and by 2050, this figure could rise to 450 million, or almost a third of India’s projected adult population.

Mohit Bhandari, one of India’s leading bariatric surgeons, said he believed the official numbers of people with diabetes and obesity in India were “significantly underestimated due to poor data collection” and estimated they were more than 10% higher than government records.

However, Bhandari is among those calling for caution over the widespread and unregulated use of weight-loss drugs, which he says are already being abused and misprescribed, with possible long-term consequences.

“GLP-1 drugs are already very important for India, they are more than welcome,” he said. “However, there are very significant problems and reservations about this. These injections should be properly controlled by the government.”

Bhandari warned of the risks of prescribing drugs by pharmacists and general practitioners, many of whom are connected to certain pharmacies and benefit financially from putting patients on these vaccines. Vaccines are also increasingly available at gyms and beauty clinics.

“There needs to be rigorous screening and monitoring of patients who receive these drugs,” Bhandari said. “They cause significant muscle loss, they can cause pancreatitis, gallstones, even blindness in certain patients with certain pathologies, so this regulation is crucial.”

He called on the government to limit the power to prescribe these drugs to a board of specialist doctors who would place patients on a long-term program. “No other country will have people taking these drugs in the same proportion as India,” he said. “This means that the scale of complications could become very high if there was not strict discipline in the way they are distributed to patients. Medicines are good but only in the right hands.”

Vidhi Dua, 36, suffers from diabetes and has struggled with obesity for most of her life. She was prescribed Mounjaro and started taking it in September when her weight reached 95 kg (14st).

“I tried so many things before this, but I never managed to lose weight,” she said. “I hope it will work and I can finally get off insulin, but it’s not easy, there are very difficult side effects on the stomach and the muscles. I think it’s worrying that it’s become the latest fad just for cosmetic weight loss. I don’t think people understand the impact it has on the body.”

Anoop Misra, one of India’s most prominent endocrinologists working at Fortis Hospital in Delhi, echoed these warnings. Misra said poor dietary habits, sedentary lifestyles and environmental pollution are likely to be the main factors behind the rise in diabetes and obesity in India, which is evident among the wealthy urban elite and poorer rural communities.

Misra said he was seeing unprecedented demand for the drugs and was now prescribing them to three to seven patients a day, after extensive monitoring. He predicted that once off-patent versions are approved for sale next year, India will become one of the world’s largest and cheapest markets for GLP-1 drugs.

Still, he stressed that treating the “national epidemic” of obesity and diabetes required widespread lifestyle changes and education, and that weight-loss shots were only part of the solution.

“These drugs can help, but they cannot solve the obesity and diabetes crisis in India,” he said. “For most people, the foundation should remain nutrition education, healthier eating, exercise and affordable weight loss medications if necessary.

“A worrying trend is that people are seeking out these medications simply because they are not regularly dieting and exercising. Medications cannot replace a lifestyle change.”

Misra said India still faces significant challenges in its fight against obesity and diabetes, many of which are cultural.

“Many women tell me that if they stop making the high-calorie, high-oil dishes that their husbands prefer, it leads to anger and conflict,” he said. “This shows how difficult it is to change the dietary habits of Indian households, even when families know the health risks. »