Ozempic, the weight loss injectable drug that took the world by storm last year, has many takers in Bengaluru though it is yet to officially enter the Indian market. Dr Subramanian Kannan, senior consultant and clinical lead endocrinologist at Narayana Health, Bengaluru, is monitoring ten patients who are on weight loss injectables that they source from other countries, consulting physicians there for prescriptions. “I monitor their weight and other parameters and adjust the dosages accordingly. They are doing fairly well,” says Subramanian.
Earlier, Subramanian says, he used to refer patients with weight exceeding 100kg to a bariatric surgeon. Now he has reduced bariatric surgery referrals.

A new ray of hope
The arrival of weight loss drugs — in India only diabetes tablet Rybelsus is used in some cases for weight management — has come as a boon for people who are struggling with obesity related difficulties. The doctors treating them too are quite happy to witness the progress their patients are making. To top it all off, Pharma giant Eli Lilly is taking its blockbuster weight loss and diabetes drug Mounjaro to India this year. The injectable tirzepatide class of drugs has shown tremendous results, making headlines globally, with about 20 to 25% weight loss, which is almost equivalent to that of bariatric surgery.
Doctors, who treat obesity, say this could be a game changer for weight management and its treatment in India. “Every obesity medication comes with limited results, say 7% to 8% weight loss, and side effects. This new molecule, Mounjaro, is a complete game changer,” says Ahmedabad-based Dr Banshi Saboo, president of All India Association for Advancing Research in Obesity.
Unlike the popular semaglutide drug Ozempic, Mounjaro acts by dual mechanism, mimicking both the GLP-1 hormone and another metabolic hormone called GIP. “These hormones are present in our gut. When we eat, they get released and travel to the part of the brain that processes hunger and satiety, helping to control appetite,” explains Banshi.
The convenience of weekly administration of the injection, and that it does not cause hypoglycemia or low sugar levels in blood, are making weight-loss drugs popular over traditional bariatric surgery. The demand for bariatric surgery has already slowed down — a study published recently in Jama Net work Open says while there has been over two-fold increase in use of GLP-1 as obesity medications, bariatric surgeries saw a 25% dip in the US.
“In comparison to surgical procedures for weight loss, done under general anesthesia and requiring one to be on liquid diet for some time, these drugs look like attractive options,” says Dr Naval Vikram, professor at the department of medicine and incharge of the Obesity Clinic at All India Institute of Medical Sciences, New Delhi.
He thinks the need for bariatric surgery will go down in India too, provided weight-loss drugs are available widely and reasonably priced.
Eli Lilly and Company associate VP & MD for India Vineet Gupta confirmed that the firm will launch Mounjaro in 2025 once approvals are obtained. “We are yet to finalise the pricing for India.”
Look beyond the fad
Consultant endocrinologist, diabetes and thyroid at Bengaluru-based Manipal Hospital, Dr Abhijit Bhograj points out that several individuals seek weight reduction just for cosmetic reasons. “You must assess your needs correctly. If you look at the risk of what obesity can bring to the picture and have a BMI of 25 with large abdominal or visceral fat, they have the option to use these molecules as they help target the internal visceral fat,” he says.
These molecules can be really life saving, he says, for those with a BMI of over 30, as they deal with day-to-day challenges of obesity. “For example, those who have serious complications like obstructive sleep apnea or mobility issues or other health conditions like diabetes or heart problems.”
Also, one can develop side-effects like acidity, bloating, loss of appetite, vomiting and nausea to these medications; many develop tolerance towards them after using the meds for about a month. To help manage symptoms, it is important to start the medication strictly under a physician. “These drugs are very useful if a person doesn’t have to undergo surgery,” says Dr Abhishek Katakwar, bariatric & metabolic surgeon at Hyderabad-based Asian Institute of Gastroenterology. Though the weight loss is good with these drugs, it is not comparable to bariatric surgery where one can lose up to 80% of excess body weight, Dr Abhishek says. Also, one can regain weight when the medication is stopped.
Bariatric surgeries are still more effective
Dr Hema Venkataraman, senior consultant-diabetes & endocrinology at Kauvery Hospitals, Marathahalli, says while the benefits of injectable therapy lasts for the duration of therapy, the benefits of bariatric surgery are most long lasting. “It takes years for one to regain weight lost via surgery,” she says.
“I think Mounjaro will get big if launched as there are currently few options available for obesity without diabetes. The kind of obesity we see in India is slightly different. Indians have “thin fat” obesity (where a person has a normal body weight but a high percentage of body fat). While these drugs are known to reduce weight, new data shows that there is also accompanying loss of muscle mass,” Hema says.
Dr PK Jabbar, director and CEO, Indian Institute of Diabetes, Thiruvananthapuram, is doing research on semaglutide class of drugs and says he hasn’t seen any adverse side-effects in his small sample size. “Vision issues and muscle loss being reported due to use of these weight-loss drugs are isolated cases. However, more studies and data are needed to verify,” he says.
The dark web of injectables
With news of Ozempic being used by celebrities going viral, doctors say there is a rise in queries around its usage. Some are even sourcing off-label semaglutide injectables from places like Dubai and the US. “I had a guy who landed in India after procuring a lot of Ozempic off label. He wanted a prescription from me to let customs release the stock, which I refused to do. I don’t know the patient or his medical condition. I later realised he had sourced it from a wellness clinic in the US,” says Dr Hema Venkataraman, Kauvery Hospital. “If you maintain the cold chain to store the molecule, then you’re good. But if you are getting it from some kind of third-party source (like the several websites claiming to be shipping Ozempic directly), who does not have approval to sell certain molecules, you are dealing with questionable products,” says DrAbhijit Bhograj of Manipal Hospital.
“There are a few patients who are doing quite well on the drugs and suddenly, after they change their source for procurement, they start to gain weight back. That’s when we guess that the product is not authentic,” says Dr Subramanian Kannan of Narayana.