Cost, side-effects deter use of weight loss drugs in long run

MUMBAI: For almost three months, Sunil (name changed) has been taking an injection on his abdomen for weight-loss. He has lost 10kg of his initial 90kg, and hopes to lose more in the coming months.He isn't the only one opting for new weight-loss medications that entered the Indian market in the March-June period, doctors say Indians, usually averse to syringes, seem open to the idea of weekly jabs. "Injections were seen as the last resort tool that had to be avoided. Diabetes patients transitioning to insulin from oral medications need a long pep talk, but not so with these drugs,'' said Dr Rajiv Kovil from Raheja Hospital, Mahim.However, experience from some western countries where the medicines have been available since 2021-22 show that costs and side-effects force half the patients to stop these drugs after a year.

Cost DeterrentPharma majors Eli Lily and Novo Nordisk who manufacture Mounjaro and Wegovy respectively claim obese patients could lose around 20% of their weight in 12 to 18 months. The meds have cardiovascular benefits, and research is ongoing for sleep apnea, fatty liver, among other conditions.

World Health Organisation, on Sept 5, included these class of drugs in the essential drugs list, suggesting they are good for public health.

But two factors haven't worked for these drugs in countries they have been available since 2021-22: Side-effects and costs. "It's early to have a profile of side-effects among Indians,'' said Dr Anoop Misra from Fortis Centre for Diabetes, Delhi. But patients do report nausea, vomiting and diarrhoea.

"But these issues settle down within a few weeks," said a doctor from a public hospital. It's early days yet also for the cost factor.

In the West, these drugs cost less four to five times the price in India. "One of my patients was clear that he could spare Rs 1 lakh for the treatment, and hence would take them for six months,'' said Dr Misra.Indian 'Jugaad'Mounjaro was initially launched in one-dose vials as against preloaded pens (autoinjectors).

A senior doctor in south Mumbai said patients used one dosage over two weeks, thereby halving the cost. "There are countless videos on social media about jugaads to reduce the monthly cost,'' said Dr Kovil, adding that the practice would continue till stocks of vials are in the market.An endocrinologist from a medical college said it's important to exercise when on these drugs. "After the recommended minimum of six to nine months, people have lost 10-15kg.

But they can stretch this benefit for a few years (before they start gaining weight again) if they are active,'' he said.A study from Denmark presented at the ongoing meeting of European Association for the Study of Diabetes (EASD) in Vienna found half of adults without diabetes who start weight-loss drug semaglutide in Denmark discontinue treatment within a year. It has given 3 reasons: Costs, previous/concurrent health conditions and side-effects.

Younger users (18-29 years) and those living in low-income areas were more likely to stop treatment in the first year."Both these factors highlight the likely impact of high costs of these medications (2000 Euros per year for the lowest dose of semaglutide as of June 2025)," said the paper. Other dropouts included people who had previously used gastrointestinal medications and were more vulnerable to common side-effects such as nausea, vomiting, diarrhoea.India needs "affordable and accessible therapeutic interventions" in the long run, said Dr Misra in a recent editorial in 'Diabetes & Metabolic Syndrome: Clinical Research & Reviews'. Indians could opt for culturally adapted low-carbohydrate, high-protein diets along with 60-minute activity a day. "Cost-effective anti-diabetes medications such as metformin and SGLT2i should be prioritised, with community engagement through health workers and mobile health tools to support sustainable weight management in low-resource environment.

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