New Delhi: Doctors are facing a peculiar predicament in clinics. Patients, mostly from affluent families, insist on being prescribed weight-loss drugs. They may not be aware of many other things, but these medicines are well-researched, doctors say. The push from the patients is putting the doctors in a tricky spot.
While the best-known drugs that help cut weight are still not available in India, patients outline their benefits, risks and how well those work in controlling glycaemic levels and managing weight gain issues.
That’s the huge influence weight loss drugs are having on the world. Although the situation is not as bad as the US that has seen serious shortages until recently, Indian patients are proving to be no less adventurous. Doctors are advising them to be wiser and watchful.
Within a short time, weight-loss drugs have been hailed as a “miracle” solution. They are not only set to revolutionize the way diabetes, heart or even liver has been treated so far, doctors expect it may lead to a new treatment paradigm where the older generation drugs may still be needed but may become less relevant if the patient gets better outcomes with the new drugs.
However, that stage is some time away. It will require a plethora of trials and a careful regulatory scrutiny. Therefore, doctors are treading on the safer side. The devil is in the detail as the frenzy is leading to misuse and the long-term effects of these medications are still not very clearly known.
Speaking at an exclusive webinar titled “Weight loss drugs – miracle cure or hype,” organised by ETHealthworld Dr Rajesh Rajput, Director, Endocrinology, Medanta Hospital, highlighted the alarming rise in obesity and related conditions, particularly diabetes.
“The prevalence of diabetes in adults has tripled over the past decade, and adolescent obesity has increased five-fold over the past 20 years,” Dr. Rajput said. This sharp increase in obesity is linked to a range of serious health issues, including diabetes, hypertension, and obstructive sleep apnoea, among others.
He noted that even a modest 5-10 per cent weight loss could significantly improve health markers such as blood sugar levels, triglycerides, and cholesterol, leading to lower risks of obesity-related cancers and cardiovascular diseases. With the advent of new anti-obesity drugs, the landscape is changing. These drugs are becoming increasingly popular, although he says misuse is a serious concern.
The importance of selecting the right treatment for each patient is critical, says Dr. Rajput adding, no single drug suits everyone. He pointed out that the effectiveness of anti-obesity drugs, especially newer ones like GLP-1 receptor agonists, has generated increased demand. However, the growing misuse of these drugs underscores the need for responsible medical guidance.
Evolving Scenario
Dr V. Mohan, Chairperson, Dr. Mohan’s Diabetes Specialities Centre, reflected on the shift in the treatment of obesity and diabetes over the last few decades. As a young school boy, he noted obesity was rarely seen, but today, it’s common to see a significant proportion of children struggling with their weight. This dramatic rise in childhood obesity often persists into adulthood, bringing with it long-term health challenges.
Noting that the weight loss drugs available today are far more effective than those from decades ago, Dr Mohan stated 10-20 per cent weight loss is seen from new drugs compared to minor benefits of earlier drugs. However, the increasing demand for these drugs globally, including in India, has led to concerns about access and availability.
Dr. Balbir Singh, Chairman & Head of Cardiology, Cardiology Pan Max, emphasised that while the new drugs hold promise, lifestyle changes remain crucial in managing cardiovascular health.
He mentioned that exercise and diet control continue to be more effective in lowering cardiovascular risks than any drug. Nonetheless, the advent of GLP-1 agonists like liraglutide was a breakthrough, not just for weight loss but also for reducing cardiovascular risks.
Mentioning the widespread demand for drugs like semaglutide, which have achieved unprecedented sales, Dr Singh said that these drugs are seen as “disruptors” in the pharmaceutical industry, comparable to landmark innovations like insulin and statins. However, he cautioned that the immediate cessation of benefits once the medication is stopped raises important questions.
“The challenge is that once the drug is discontinued, the benefits are reversed. This indicates the need for ongoing research into their long-term cardiovascular effects and their actual utility for conditions like heart disease,” Dr. Singh explained.
Widespread endorsements from celebrities and social media influencers are not helping in rational use of these medications. They are generating significant buzz. The scope of these drugs is getting broader and going beyond metabolic issues associated with excess weight, such as diabetes, hypertension, and cardiovascular disease (CVD). Latest news is on how this class of drugs is showing benefits in Alzheimer’s disease, MASH and also kidneys.
Bariatric Surgery and Drug Integration
Are weight loss drugs a threat to bariatric surgery? Doctors are not daunted by those claims. Instead, they provide an optimistic outlook on how weight-loss drugs may not affect bariatric surgery as much as expected. Dr. Vikas Singhal, Associate director Department of GI & Bariatric Surgery, Medanta-Medicity Hospital suggests that while medications may reduce the demand for surgery in patients with lower BMIs, they could complement bariatric care by offering additional treatment options before and after surgery.
He noted that for patients with a BMI above 40, surgery may still be necessary, as medications alone may not address the complex needs of those with severe obesity. He also underscored the shift in treating obesity as a serious health issue rather than just a cosmetic one, which further reinforces the need for a comprehensive approach to treatment.
Shifting Treatment Paradigms: A New Era in Medicine?
The discussion also explored the possibility of a shift in treatment paradigms. Dr. Rajput pointed out that the emergence of weight-loss drugs has already begun to redefine treatment protocols for metabolic diseases such as type 2 diabetes. Drugs like semaglutide, for instance, have shown impressive results in clinical trials, reducing cardiovascular risks in patients with a history of heart disease, even in the absence of diabetes. He believes that these treatments could redefine how conditions like cardiovascular disease and non-alcoholic fatty liver disease (NAFLD) are managed in the future.
With upcoming drugs that are still in clinical trials showing even more significant reductions in body weight which may stretch up to 30 per cent, Dr. Rajput speculated that bariatric surgery criteria may change. These new medications could offer a non-invasive option for weight management, potentially reducing the need for surgery in some patients. Moreover, the increasing affordability of these drugs, especially with the advent of oral versions and generics, could make them more accessible to a wider population.
Dr. Mohan echoed those observations, noting that the introduction of oral GLP-1 receptor agonists represents a significant step forward. The availability of oral medications like semaglutide makes it easier for patients to adhere to their treatment regimens. He also highlighted the potential for future innovations, such as oral insulin, which could further transform type-1 diabetes treatment.
Regulatory Challenges and Accessibility
From a regulatory standpoint, Dr. Mohan emphasised the need for careful consideration of drug efficacy and safety, particularly as new treatments are introduced. He pointed out that in countries with universal healthcare systems, such as the UK, regulators strive to ensure that effective treatments are made available to all patients. However, he acknowledged that affordability remains a challenge, particularly in countries like India, where generics play a key role in reducing costs.
While the regulatory process in India has evolved significantly, there are still challenges, particularly with drugs that have not been tested on the Indian population. As new drugs like GLP-1 receptor agonists become more widely available, regulators will need to ensure that they are safe and effective for Indian patients. Dr. Mohan also raised concerns about the potential for misuse, as drugs like Ozempic have become popular through social media, with patients demanding access even when they may not meet the medical criteria for their use.
Weight-Loss Drugs: Neither Miracle Nor Menace—A Case of Wait and Watch
As these drugs demonstrate promising results, their long-term consequences remain uncertain. They come with a hefty price tag, raising concerns about their accessibility—particularly the risk of these drugs reaching people who may not need them. Furthermore, those seeking to maintain their weight loss may find themselves relying on these medications indefinitely. What is being hailed as a potential miracle may, in fact, bring about new challenges, including lifelong dependence on treatment and unforeseen impacts on both individuals.
As science advances, so do weight-loss drugs, promising a new frontier in obesity management. As the medical community continues to explore the long-term effects of these medications, it will be crucial to strike a balance between innovation, safety, and responsible use to ensure that these treatments can benefit patients without unintended consequences.
As Dr. Singhal sanguinely sums up – take medicines lifelong and still face the risks or simply follow a fitness routine of eating healthy and doing the runs or walks. The choice is clear.
Watch the full webinar on: “Weight loss drugs – miracle cure or hype”
