In this episode of Health 360, we discuss the rise of obesity in India as the number of obese people is expected to reach 450 million. Obesity has also triggered a rise in the popularity of weight-loss drugs such as Mounjaro and Ozempic.
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00:00four hundred and fifty million obese people in India by the year 2050
00:2140 percent of women and 12 percent of men have abdominal obesity weight-loss drugs enter Indian
00:37market Monjaro was Zempick take the world by storm anti-obesity drug market crosses 576 cross in 2025
00:54our weight loss drugs all that good
01:00who can consume weight-loss medicines
01:09that's the big talking point on here 360
01:15hello and welcome to a brand new episode of head 360 but this week we decided to focus on something
01:22that has got the world talking about well look around you how many people are just so keen to
01:29lose weight and in the pursuit of just that so many people end up doing a lot of things some
01:36beneficial and safe many risky and pretty worthless well India's overweight population and obesity
01:45figures are pretty mind-boggling take a look and that really is the reason why just so many people
01:51are getting obsessed with weight loss medications Monjaro from li lily has entered the Indian markets but
02:00before that Indians have somehow managed to get their hands on other anti-diabetes drugs like
02:06Ozempick so what is the science behind this drug which is meant to deal with diabetes who can use anti-diabetes
02:14medicines that also seem to be aiding in weight loss and seemingly in a very effective way
02:21how sustainable is that what are the side effects what are the side benefits our panel of experts the
02:29best voices on the science of weight loss are with us but before we go into that detailed discussion and
02:35discuss that issue thread where a look at this report these transformations of hit headlines and the
02:45million dollar question here is whether these are ozempic transformations
02:55unlike hollywood which is vocal about the use of weight loss drugs desi celebrities have not spoken about it
03:02some of the visuals you're seeing behind us are celebrities who've actually admitted to using
03:10the medicine we have a whole lot of celebrities that we think may be using the medicine but they're not
03:16talking about it why is this medicine seen as cheating when is when we take statins or we take medicines for
03:23controlling diabetes it's not seen as cheating i may be one of the reasons could be they just want to
03:30pat their back that they have got the fantastic genes you know and sometimes you know people just want
03:36to say that that my genetic pool is coming much more stronger but the fact is that weight loss medicines
03:43are supremely popular and that is no secret the market for the same in india has grown by leaps and bounds
03:51matarees mo religion lyley's antidiabetes drug that has entered the indian market is not extraordinary li
03:59dupような gift cards are for the pretext of memories that are on marishwriting pretext of microbes
04:01a complete dose a month would cost around Помнрип in about eight billion dollars is about getting
04:04a illegal immune bekommen to release besides it contains the active ingredient tilles appetite
04:10Uzampic, though officially has not entered the Indian market, is being used by affluent
04:16Indians who have managed to get their hands on them.
04:20It contains the active ingredient semaglutide.
04:25Weight loss drugs world over have transformed the business of weight loss and how.
04:31Doubted as game changers, these are fast changing the weight loss market in India as well.
04:38The market has seen rapid expansion with sales figures rising from 137 crores in November
04:442020 to 535 crores in November 2024.
04:51It is undoubtedly directly proportional to the rise in obesity population in the country
04:56from 25% in 2013 to 40% in 2023, highlighting the need for effective weight loss medications.
05:08Novo Nordisk's ribelsis, which is an oral semaglutide, has captured a significant portion of this
05:16market, accounting for 65 to 69% of the sales.
05:22The launch of Monjaro as an anti-diabetes and off-label weight loss medicine has found favor
05:28as an affordable weight loss option.
05:30Novo Nordisk is also poised to launch its semaglutide injection, VGOV in India.
05:37The drug has also shown cardiovascular benefits in Indian patients.
05:42And joining us today are, like I said at the outset, our panel of best experts on the science of weight loss.
05:53Dr. Anup Mishra is a well-known endocrinologist for his CD hospital in Delhi.
05:59Ishi Khosla is a nutritionist.
06:01Priyanka Lehry is a fitness coach of the PFC Club.
06:05And she's had her personal journey of weight loss, which is very inspiring.
06:10Dr. Rajiv Govil is a weight loss expert.
06:13Thank you all for your time here.
06:15And I want to begin by asking Dr. Anup Mishra,
06:18well, how really has the demand for this medicine that we're talking about,
06:23you know, uzempek, namonjaro, increased over a period of time?
06:27I'm told that doctors like you have many queries with patients come in and say that,
06:33you know, yeh toh prescribe karna hai hai.
06:35Obesity and diabetes has been increasing for the last two decades.
06:40The question was whether we have any effective weight loss medication or not.
06:45So till a couple of years back, we did not have anything.
06:48So this was, there is a demand, there is a whole market there.
06:53And these drugs have just fulfilling some of that market.
06:58Now, the effectiveness of these drugs is that they target both obesity as well as diabetes
07:05in a very effective manner.
07:07Also protect heart and kidney.
07:10So that way they are multifaceted drugs.
07:13So not only obesity, diabetes, heart disease, kidney disease, everything.
07:18So would you say that you would give these to people who aren't diabetic,
07:22but would want weight loss as well?
07:24Is it something that doctors would advise?
07:26Yes.
07:26So initially discovered for diabetes,
07:29but once the appreciable weight loss was seen with these patients,
07:34now they are FDA, the US authority has clearly licensed it for people without diabetes,
07:43people who are just obese.
07:45But not mohanjaro.
07:45Now, the semaglutide which is olympic as well as mohanjaro now.
07:51Okay.
07:51So both are now open.
07:54In fact, if you look at the Indian market,
07:57for the first time Indian regulators have licensed these use for obesity itself.
08:01Okay.
08:02And tell us, you know, who really needs these drugs?
08:06I mean, a lot of people who are not seemingly obese or maybe a little overweight are having these drugs,
08:13are consuming these drugs.
08:14They may not necessarily have diabetes.
08:17I don't want to name people here, but there are so many celebrities who could do with some weight management,
08:22but are not necessarily diabetic.
08:25Would you say it is okay for them to take these medicines?
08:27Not necessarily.
08:29There are guidelines.
08:30I mean, we have made the guidelines for India and there are guidelines for the world.
08:33And the trials where mohanjaro or olympic has been used clearly have patients who are BMI is quite high.
08:43About 25?
08:44Is no.
08:4527.5 and 30 with diabetes or without diabetes.
08:49So, which is fairly high, BMI.
08:51So, these patients have been tried in the trials.
08:55However, if some person has existing heart disease and has a BMI of 25, 26,
09:03so both the things together along with diabetes,
09:06it is worthwhile using these drugs because they will benefit heart as well.
09:10Okay.
09:11So, tomorrow, let me put it this way.
09:13If I were to gain weight in a way that I would require weight management,
09:16I would require to lose some kilos, but I'm not diabetic.
09:19Would you advise it to somebody like me?
09:21If your, say, your BMI is not much,
09:24so I would probably not give you any of these drugs.
09:28Okay.
09:29However, if you gain weight over a period of time
09:31and your BMI goes beyond 27, 28 or something like that.
09:36Which is clinically obese or is it just obese?
09:37Oh, clearly obese.
09:39Clinically obese is when your BMI is above 27.5, 28.
09:42In India, obesity is differently defined.
09:45Okay.
09:45And the BMI above 23 is defined as obesity.
09:49But for use of these drugs, which are very powerful drugs and expensive too,
09:54in such cases, BMI has to be higher.
09:57So, worldwide, the licensing of these use is for higher BMI.
10:01If only used for obesity.
10:05Okay.
10:05If only used for obesity.
10:07Ishikosla, a lot of information now and it's available for us
10:10because we're just learning about these drugs, I think.
10:13It's on the kind of impact it has.
10:14You know, many people may not want to talk about it,
10:18but serious nausea is what I know of.
10:19A lot of people have reported this.
10:21The fact that they don't feel hungry and it's not a nice feeling not to feel hungry
10:24and feeling, you know, nauseous and vomit-ish all the time.
10:28It has a direct impact on the gut.
10:30What is your view of how this medicine is being used by just so many people now?
10:36Yes.
10:37Sneha, the thing is that, let me just go back a little bit on the question of obesity itself.
10:43And clearly, it's a complex issue.
10:46Had it been so simple, just calorie counting and food control would have cut it for us,
10:53would have done it.
10:54And we've had, for the last three decades, been counting calories through every possible means
11:00and every packet that we eat and every, you know, it's all there.
11:05Today, people are far more wiser about calorie counting,
11:08but that hasn't really yielded the results that we're looking for
11:12and obesity is growing.
11:14And what this drug is really doing is it's cutting down the amount of food that you eat
11:19to a fraction.
11:21A patient of mine yesterday just called me and said,
11:23am I eating only 10% of what I used to eat?
11:26But that's really low.
11:28And so if you're going to starve people to lose weight,
11:33I'm not sure whether it's a really safe or a sustainable way of looking at obesity.
11:39And till date, like Dr. Mishra also said,
11:41there have been so many drugs that have come and gone
11:43and their safety has been questioned.
11:46And so these are early days for these drugs for proving their safety.
11:49And I don't think it's a great idea to die of malnutrition with your weight in place.
11:55So I think we need to look at deeper dive into really what is causing obesity.
12:02And today, we do have answers.
12:04And if you look at the gut, like you rightly said, it affects the gut.
12:08Obesity itself, to a large extent, is beginning in the gut,
12:12be it causing inflammation or insulin resistance or malnutrition.
12:15All of these factors are contributing to obesity and we have the tools to deal with them.
12:22And today, when you look at the gut, we look at the microbial flora, the microbiota.
12:27And if you have today the science around a good ratio of good and bad bacteria,
12:33we are able to tackle obesity to the extent that today fecal transplantation is a research tool.
12:40It's not really in clinical practice, but just fecal transplantation from an obese individual
12:46to a lean individual and vice versa changes the obese into lean and lean into obese.
12:52So that clearly tells you that a lot is happening in the gut.
12:55And if you're able to tackle that, that may be a far more sustainable
12:59and a more easy solution than to take medicines which reduce your food intake and at a price.
13:06So you're clearly somebody who's saying that try the natural way first.
13:11You know, try it the longer route, maybe not a shortcut, but a safer and a better route.
13:16Yes, because how long will you take a drug?
13:18And we know that you withdraw the drug and we get the same results.
13:20And I understand that this drug has to be taken for a very long period.
13:24I mean, there are reports, and correct me if I'm wrong, Dr. Mishra,
13:26that over a period of time, you don't even… you can't even stop it is what I understand.
13:30No, not necessarily.
13:31If you lose 10 to 15 kg of weight and a patient is…
13:35who was not able to walk a couple of steps and now running, you don't need the drug.
13:42And by reducing 15 kg of weight, you make the diabetes disappear.
13:49And many other diseases, for example, liver, liver fat disappears, liver fat is something which Indians are plagued with.
13:58It is a major problem for metabolism, even for heart disease.
14:02So, it is not necessary that you have to take it for one year or two years.
14:08However, trials have been done for 74 weeks or maybe more.
14:11Yes.
14:12And we show marked weight loss, reversal of diabetes, reversal of fatty liver and marked changes as far as heart is concerned in a better manner.
14:22Okay, so which means that, you know, the outcome of weight loss would also mean that your overall metabolic health may just improve and it improves and that could be a good outcome of the drug.
14:31I am just going to come back to you quickly to Priyanka Lahiri.
14:34Priyanka, you are all a fitness coach yourself now.
14:37We have seen, you know, your social media with your own personal journey on how you lost that weight.
14:43First of all, tell us as a fitness coach, do people come to you and say make us exercise, make us workout and also tell us if we eat this medicine or not.
14:51Is that a common query?
14:53Are people asking you whether this medicine should be consumed or not?
14:57Priyanka.
15:01Hi, so Sneha, when I coach people, I'm also making their diet charts.
15:08I'm also a sports nutritionist.
15:10So, I'm taking care of their diet as well.
15:13Now, a lot of people do come to me who have very, very high weight, like the highest would have gone to 180 kgs.
15:23So, they do ask me for supplements.
15:28they do ask me for some medicines but I always tell them that you need to speak
15:34to your endocrinologist first because first of firstly we are not it we are
15:39not ready to advise that to our clients and secondly in weight loss we come into
15:44this space where like the endocrinologists say that first figure out
15:51lifestyle changes first fix everything else and if nothing works then the
15:56medicines should start and this is where we come into the picture so because a
16:01lot of people are not able to lose weight because of insulin resistance and
16:07insulin resistance can be fixed with a lot of other ways like exercises
16:12improvement of muscle mass and a lot of people are able to do that but a lot of
16:17people are not able to do that because of their high obesity and you know because
16:22of that they are not able to move a lot but they do ask us these questions and
16:27we definitely shy away from answering those questions ourselves okay so that
16:34that is a frequently asked question is what Priyanka is saying Dr. Govil you know
16:38talk to us about and because you're a weight loss expert tell us about the
16:43potential misuse of these weight loss medicines that we are seeing you know for
16:47people for cosmetic reasons to look a certain way are resorting to using these
16:53drugs what would your advice be who should be taking this drug first of all
16:57actually answer who should not be taking this drug
17:03so the the mood problem is that obesity is the mother of all communicable
17:09disorders and obesity should be first considered as a disorder first so these
17:16drugs with this monjaro or semaglutide are to be used by experts number one
17:21they are not for cosmetic weight loss they are not for looking good in a in a
17:25marriage ceremony or in a photograph it's for chronic weight management and
17:29chronic weight management is done to prevent the progression of any
17:34comorbidity or to prevent any kind of comorbidity coming in so misuse will
17:41always be there because you end up with 10 to 15 percent weight loss that's why it
17:46has to be used by experts and endocrinologists and
17:49diabetologists who know about the the whole pharmacotherapy and whole fish from the
17:54whole physiology of of how weight loss weight gain and weight loss comes in
18:00apparent misuse occurs globally and that's how we need to make sure make sure
18:05that we are able to limit the misuse of these drugs so limiting the prescriptions
18:10to two people who know about weight gain and weight loss will help the proper
18:16channeling of these prescriptions number two is that it should not be written by
18:23people who are not qualified to write prescriptions across the country the
18:29misuse can be there because it it works on on the brain it it reduces the movement of the
18:35stomach so we need to identify a lot of contraindications to the drug like every
18:43overweight patient cannot be on a pharmacotherapy for weight loss we need to
18:48identify which patient fits the bill which patient has got comorbidities or
18:53conditions related to to obesity and if we are able to cause any prevention of
18:58progression or getting them into normalcy and then use the drug and as dr.
19:02Mishra said that 27 is the cutoff if you have a comorbidity or 30 BMI is a cutoff
19:08if you do not have a comorbidity also but it has to be managed by experts that's
19:13extremely important you know not over-the-counter I'm seeing ishi kosala a
19:18lot of conversational because everything happens on social media nowadays on a
19:22particular celebrity having an olympic face you know it it I think your glow
19:27is just finished for a lot of people so why does that happen in so many people
19:32I told you it's when you're going to cut down the food intake to a fraction of
19:38what you're supposed to be having and also disturb the microbiome negatively your
19:43nutritional quotient is really poor number one number two it is known to cause
19:48sarcopenia and bone loss and dehydration so I mean these are really early days but
19:54beyond that of course we know the other risks you know the pancreatitis risk and
19:59in fact you're talking about the globe but I can talk about life-threatening
20:03complications absolutely I have a patient who was 18 years old and in a hospital
20:08under an endocrinologist and in two weeks of initiation of the drug died of an acute
20:15pancreatitis and of which drug was this this was an epic yes okay and this is I
20:21mean there are reported cases there are supposed to be according to one paper that
20:27I just recently read almost 82 deaths with the use of these drugs in the last
20:31few months serious side effects of it so what should be kept in mind before you
20:36know taking these drugs and and talk to us about the other side effects like we're
20:40seeing in in many patients and it goes beyond nausea like you said muscle loss is a
20:44big problem also yes and I mean if you look at the celebs who are promoting it
20:50there also I was reading a whole report on celebrities in Hollywood who have said
20:55they'll never touch the drug because they fell so sick while they were on the
20:58drug so they'll never ever go back to it so there are reports of people who have
21:02struggled with it so yes these are early days and I think we need to also
21:07understand maybe dr. Mishra would be able to be putting light on the fact that who
21:11is a candidate who will get pancreatitis who will not so there may be some
21:15criteria where you can differentiate from the one patient to the other so yeah
21:20I think the safety is one very big issue and my biggest question here's Neha is
21:26why are we talking about weight loss is that the target no I can starve anybody
21:31and put you on a liquid diet or a you know just all water diet and make you lose
21:36weight we're talking about a lifestyle change and sustainable and safe weight
21:40loss if those are our goals you know things need to be then evaluated
21:45differently absolutely you know I think there's the obsession with looking a
21:48certain way plus also the kgs essentially the kilogram I mean I could be
21:52losing fat and gaining muscle I could still still be the same weight is
21:56something that I think people tend to forget dr. Mishra what's your advice I'd like
22:01to ask you how would you like to warn people who are thinking about taking
22:05this drug what would you tell them see let me be very clear these are not drugs
22:09to be played around is not something that patient can start themselves on and
22:15certainly without any indication and not for cosmetic weight loss so that's very
22:21certain we when we begin a to to put this drug on anybody we counsel the patient
22:29properly we take the history of pancreatitis as issue has already said
22:34but recently our own study has shown there is no high risk of pancreatitis we
22:39take history of thyroid cancer in the family because there are some studies in
22:43the mice and animals that that it may increase thyroid cancer but that has not
22:50been proven in the human being but we always take a history we always take a
22:55history of gut disorders for example somebody who's already has not of nausea
22:59vomiting diarrhea due to some other cause not going to tolerate this drug
23:03because thirty percent of the people will have nausea vomiting diarrhea and some
23:10people will leave this very important if you have an underlying problem then do not
23:13take it is what dr. Mishra is underlining right absolutely and long-standing
23:17diabetes the intestine goes very very slow and what is called as you know
23:24autonomic neuropathy and gut stasis may occur in such people so we always choose the patient
23:31very carefully and advise them that this may occur to you also prescribe them rescue medication so it
23:40like I said is not a drug to play around with it is not aspirin it is not a simple
23:45paracetamol you can buy on the counter it's not a simple paracetamol a quick
23:50word from dr. Rajiv before we wrap dr. Rajiv dr. Mishra said that the weight loss
23:56here is sustainable once you take this medicine if you should be taking it please
24:00tell us in your experience how sustainable had there has that weight loss in that
24:04sense been and should it be taken by people who are clinically obese or not
24:08clinically obese but overweight and may not necessarily have a metabolic disorder
24:12like diabetes so the clinically obese patient should obviously take it the
24:21overweight who do not have comorbidity will eventually have a comorbidity
24:26pharmacotherapy for obesity like any other non communicable disorder one should
24:32consider it as chronic and lifelong because what data suggests is that once we
24:37withdraw this treatment within a year 50 percent of patients have almost 50
24:41percent weight regain and so you will have reappearance of all those
24:46complications or comorbidities that you actually started off with okay I just
24:51want to just quickly ask you to just be with us for a second long okay dr. Rajiv
24:56because you know if a I'm running really out of time and dr. ishi and ishi in
25:00fact has a point to make ishi you were wanting to say in something about how the
25:04weight comes back when the weight comes back it comes back higher than were put
25:08started that is because of you know muscle loss each time you lose weight and
25:12that weight cycling is a dangerous trend two issues one is how much weight comes
25:16back the studies which show that it does any any this thing diet exercise this
25:23drug weight always comes back but in the studies recent studies have shown that it
25:28does not come back to the same level as before that is number one number two
25:32sarcopenia is a problem in Indian populations and we always advise that
25:37you have besides exercise which you should never leave you should also do
25:41weights and resistance exercise Priyanka in fact a quick word in a last word from
25:45Priyanka on that somebody who's lifted weights and her videos are amazing you
25:50should just check them out on how her transformation has been Priyanka a quick
25:54word 30 seconds on the significance of lifting weights and exercise no
25:58shortcuts hi so I have hypothyroidism so I was taking metformin and which was
26:09prescribed by the doctor but ever since I started lifting weights I started
26:13building muscle mass and also had a very active lifestyle because of which
26:17obviously my metabolism went up and I was able to lose fat much faster much later
26:23but I'm able to maintain my weight now and that's only because I continue
26:29exercising I'm pretty sure if I stop doing that it will all come back to me
26:33well absolutely all right Priyanka we're really running out of time who to
26:38thank all of you for joining in and sharing your views with us on really what is the
26:41most talked about issue in in our circles nowadays is weight loss medicines are
26:47the miracle drugs or we have to take everything with a pinch of salt what are the
26:52kind of precautions we're telling you much about that on our website as well
26:56that's India today dot in you can also check out these stories on our social
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27:04thank you so much for joining in
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