Mounjaro in India: The speed bumps impacting access to weight loss drugs

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India finds itself in the second spot on a far-from-flattering obesity list. With 180 million, India had a higher incidence of obesity than the USA, which came third with 172 million, as per the Global Burden of Disease Study 2021. China tops that list with 402 million obese adults. Things are only going to get worse, as per a forecasting study published in The Lancet in March this year, which estimated that more than half of the world’s population — 3.8 billion adults and 746 million children and young adults — will be obese or overweight by the year 2050 if urgent action isn’t taken. India also has the second highest number of adults (20-79 years) with diabetes in the world with almost 90 million adults afflicted in the country, according to the latest Diabetes Atlas report. By 2050, this number is forecast to go up to 156.7 million.

The new age injectable obesity drugs such as Mounjaro (tirzepatide), Ozempic and Wegovy (both semaglutide) are intended for individuals with obesity, particularly those with co-morbidities such as diabetes, hypertension, heart disease, and arthritis. In India, these weight-loss jabs are not over-the-counter drugs and require a doctor’s prescription, says Dr. Sanjay Khare, director for bariatric medicine, Apollo Hospitals Navi Mumbai. However, doctors also acknowledge that a black market for these drugs has existed in the country and a prescription is not the only way to access them. 

“Access to these medications requires a doctor’s prescription, although some individuals may acquire them from local chemists or import them from neighbouring countries at a premium cost," adds Khare. These drugs are pivotal for India due to the escalating obesity and diabetes epidemics, which are contributing significantly to related health issues. Khare contends that the ground reality is that obesity rates in India are even higher than national estimates and that obesity cannot be cured by the simplistic eat-less-exercise-more guideline. 

“The introduction of weight loss drugs like Mounjaro presents a promising medical tool to combat these twin epidemics… these drugs can play a pivotal role in managing and reducing the burden of non-communicable diseases in India," feels says Dr. Sukhvinder Singh Saggu, director for minimal access, gastro-intestinal and bariatric surgery, CK Birla Hospital, New Delhi. Both tirzepatide and semaglutide-based weight loss injectables regulate users’ appetite and make them feel full after eating by triggering the glucagon-like peptide-1 (GLP-1) hormone in the small intestine. 

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“GLP-1 is the hormone produced in the gut after food reaches the ileum. These drugs also sensitize the pancreas to secrete more insulin leading to improved insulin sensitivity and decreases insulin resistance. It increases energy expenditure and signals to the brain that stomach is full, which results in appetite suppression," explains Dr Manoj Jain, obesity surgeon and consultant for gastro-intestinal and laparoscopic general surgery at Kokilaben Dhirubhai Ambani Hospital, Mumbai. Typically, patients are administered one jab per week during the entire duration of the treatment.

Multiple studies and findings presented at last week’s European Congress on Obesity in Spain made abundantly clear that the benefits of these drugs go way beyond mere weight loss, improving insulin sensitivity and managing diabetes. A study published in January found that weight-loss jabs could reduce the risk of 42 diseases including cancer, cardiovascular diseases, Alzheimer’s, chronic kidney disease, addiction and psychiatric conditions too. Separate studies have also found that these drugs significantly cut the risk of obesity-related cancers and also have mental health benefits.

However, one of the biggest hurdles in effectively utilising these new drugs to tackle India’s obesity and diabetes problems is their high price. “These weight loss jabs are relatively expensive and may not be affordable for a majority of Indians who require them," confirms Saggu. On average, they cost between ₹10,000 to ₹15,000 for a month’s dosage. For now, there is limited coverage for these medicines under health insurance in India, putting this treatment out of reach for the majority of the our 1.4 billion population. “This out-of-pocket cost poses a significant financial burden, especially considering the widespread prevalence of obesity and diabetes. There is a need for policy-level interventions such as pricing regulation or subsidised schemes to make these life-altering treatments more accessible to the broader population," Saggu adds. 

And among those who can afford them, weight loss drugs are being misused as lifestyle interventions to achieve desired aesthetic results in quick time. Both Khare and Saggu flag ‘micro-dosing’ of weight-loss drugs among people of means, including celebrities, as a worrying trend that is catching on. 

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Micro-dosing refers to using smaller, unprescribed doses of the drugs in an attempt to avoid medical scrutiny while achieving gradual weight loss. Since Mounjaro is the only injectable available in India as of now, the supply is limited forcing many “micro-dosers" to procure these medications through unofficial channels or importing them from abroad without a prescription, bypassing necessary medical evaluation, say doctors. “This can be extremely risky, as such use does not take into account individual health profiles, pre-existing conditions, or potential drug interactions," warns Saggu. Furthermore, multiple studies have reported side effects such as severe constipation, nausea, gastrointestinal issues, thyroid complications, cholesterol imbalances, and other metabolic disturbances.

Drug companies do not track subjects once their testing ends, so you won’t find the limitations of the drugs in their literature and research. However, there is just about enough real world evidence that suggests that the shed weight, invariably, comes back once the medication stops. At the European Congress on Obesity, experts said the weight gain begins within 10 weeks of discontinuing medication. Hence, despite them being extremely effective and with multiple benefits, new age weight loss drugs cannot replace a healthy lifestyle. 

“While they are effective for weight loss, they do not replace the need for a balanced approach. These drugs are not a substitute for lifestyle changes but are valuable adjuncts to diet, exercise, and overall health management. Without significant lifestyle modifications, the drugs are unlikely to yield lasting results," says Khare.

Shrenik Avlani is a writer and editor and the co-author of The Shivfit Way, a book on functional fitness.

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