In a world where Instagram-worthy snapshots reign supreme, the pressure to look flawless could be high. To achieve the same, some individuals are turning to drastic measures, including the use of anti-obesity drugs.
Doctors, witnessing a rise in this trend, have raised concerns about the risks and consequences of prioritising aesthetics over health.
“I have seen people using anti-obesity drugs between engagement and marriage, so that the wedding photos come out well,” Karthik Balachandran, an endocrinologist at SRMC Hospital in Chennai, told News18. “They don’t like advice. We live in an Instagram-crazy world.”
Balachandran is referring to an anti-obesity drug called Semaglutide, which was originally developed for the treatment of diabetes but is also used for reducing weight now.
The drug available in India is expensive and could be unaffordable to many at around Rs 3,870 for a strip of 10 tablets — almost Rs 400 for one pill. However, doctors believe that Indian elites can afford even the import of an injectable version (which is unavailable in India) if the over-the-counter dispensation is left unchecked.
Manufactured by Novo Nordisk, the drug is sold under the brand ‘Rybelsus’ and was launched in India in January 2022. Since then, the market for anti-obesity drugs has surged dramatically, tripling from Rs 174 crore to Rs 474 crore in January this year — reflecting the high demand and consumption.
According to Dr Joozer Rangwala, consultant physician and diabetologist at Narayana Health in Ahmedabad, despite the strong efficacy record of the drug, there are concerns regarding the misuse or self-prescription of Semaglutide by individuals seeking rapid weight loss.
“Hospitals should be vigilant in recognising signs of self-prescription, providing education and support to promote safe and responsible weight management practices,” Rangwala highlighted.
While India is starting to observe an upward trend, the demand for the drug has soared to unprecedented levels in the US. In February 2023, the Danish manufacturing company cautioned the United States about supply limitations arising from unexpectedly high demand for the drug.
Following the surge in demand, concerns about side effects came to the forefront. In the US, individuals have been contending with various adverse effects, including heart palpitations, dizziness, and accelerated signs of ageing on the face called Ozempic face, prompting many to discontinue the medication.
What is Semaglutide and how does it work?
The drug Semaglutide has three different versions of which India has just one — oral tablets sold under the brand name Rybelsus.
The popular injectable form of Semaglutide is sold under a brand called Ozempic and is not yet available in India. Markets like the US, UK, Europe and Gulf countries already have the drug.
Its third version Wegovy is officially approved by the US FDA for weight loss and is also not available in India. However, both Ozempic and Wegovy can be legally imported into India.
“Diabetes patients treated with Rybelsus show decent weight loss ranging from two kilograms to 18 kilograms, depending on their starting weight,” Balachandran said, adding that “4-5 per cent weight loss is common”.
According to Dr Anoop Mishra, chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, the drug should be used alongside lifestyle adjustments. He emphasised that it is not intended as a “quick fix” for individuals unwilling to enhance their diet and exercise habits.
How do anti-obesity drugs work?
This drug mimics the action of hormone GLP which is released into the gut as the body’s response to feeding.
These drugs have a direct effect on hunger signals in the brain. They act on the appetite control centre in the hypothalamus in the brain to reduce feelings of hunger. It slows down stomach emptying, keeping you full for longer.
Interestingly, it can also change your food preferences. Globally, patients have said that this drug makes them less interested in formerly favourite foods, like coffee, and alcohol and more into kale and smoothies.
Dr Sumeet Shah, director, metabolic and bariatric surgery at PSRI Hospital, clarified that the drug is not indicated for people who are very obese. “These medications will only reduce 10-12 per cent of your total body weight. Hence if you are 90 kg, your weight can only drop to 79 to 81 kg.”
Recipe for disaster if taken on self-prescription
Doctors told News18 that while the drug has a strong safety profile, every drug has side effects and hence, such drugs must only be taken under medical supervision.
In the US, doctors have started noticing a condition called “Ozempic face” as the drug can cause rapid weight loss that is sometimes more pronounced on the face. This leads to the visibility of increased signs of ageing, such as more lines and wrinkles. The loss of face fat sometimes also leads the skin to become loose and sag.
“It is a very well-designed and solid drug. However, if it’s taken unnecessarily or without the guidance of a medical expert, it’s a recipe for disaster,” said Shah from PSRI.
Common adverse reactions to this medicine include gastrointestinal symptoms such as nausea, vomiting, diarrhoea and in some cases, extreme loss of appetite, fatigue and weakness. This drug should never be taken by someone with a history of thyroid cancer or a family history of any such disease.
In rare cases, according to Dr Sushrut Singh, additional director, gastroenterology at Fortis in Noida, the drug can also have serious side effects like pancreatitis. “It should not be taken over-the-counter without consulting a doctor who must evaluate your clinical condition, and personal and family history before prescribing this drug.”
“Patients considering Semaglutide should be aware of these potential risks and discuss them thoroughly with their doctors,” he said, adding that even diabetics should consult their specialist before using this drug as this may interact with other diabetes medications.
Who can take this drug?
For use of Semaglutide as a weight-loss drug, individuals are eligible if they are adults who have a Body Mass Index of at least 30 — which is classified as having obesity. Adults also qualify if they have a BMI of 27 or greater and if they also have at least one weight-related condition such as diabetes, hypertension or high cholesterol. Moreover, these medications are intended to be taken for years, possibly a lifetime. Studies have shown that individuals who stop the medications regain most of the weight loss.
Dr AK Singh, an endocrinologist at GD Hospital & Diabetes Institute, believes that Semaglutide is an important tool against obesity and is also known to prevent heart and kidney diseases. “However, needless to say, these medicines, like any other pharmacotherapy, have to be taken under doctor’s supervision as there are certain do’s and don’ts before initiation.”
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