New Delhi: As multiple Indian pharma companies enter the semaglutide market and prices fall about 80 per cent from the innovator’s brand, doctors say the country is on the brink of a major shift in how obesity and diabetes are treated, but caution that misuse and unrealistic expectations could derail its impact.
“There is no doubt at all that with multiple companies coming in, there will be a huge increase in the use of these drugs. Prices are expected to drop by 60 to 80 per cent, and we are already seeing a spike in patient enquiries, prescriptions, and usage,” said Dr V Mohan, Chairman, Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation (MDRF).
He pointed out that even earlier, semaglutide in India was far cheaper than in the US “almost one-fifth” but the current wave of competition will make it far more accessible.
At the ground level, the trend is already visible. “We are clearly seeing a spike in patients coming in and asking about these therapies. Awareness has gone up, especially in urban areas,” said Dr Satish Koul, Principal Director – Internal Medicine at Fortis Gurgaon.
It’s being seen as a slimming drug that’s the danger
Doctors say demand is not always medically driven. “I wouldn’t say patients are forcing prescriptions, but they are definitely asking—‘Should I take this? Will it help me?’ And that is where the concern begins,” Dr Mohan said.
He warned that many people are influenced by celebrity transformations: “They see actors losing weight and think, ‘Why can’t I do the same?’ They don’t realise this is a medicine, not a cosmetic slimming agent. That’s one of the biggest dangers.”
Dr Koul echoed the concern, noting that off-label and cosmetic use existed even before semaglutide went off patent and is likely to rise further with wider access, especially in urban areas.
On outcomes, both doctors agree the drug is delivering strong results. “With semaglutide, we are seeing 8–10 kg weight loss, sometimes even 15 kg. And it’s not just weight loss—glycaemic control improves significantly,” Dr Mohan said. Dr Koul added, “In our centre, we have even seen reversal of diabetes in obese patients. The impact is going to be huge now that it’s more affordable.”
However, both stressed that this is not a quick solution. “Weight regain is almost 100% if you stop the drug. This is not a miracle. It’s like a blood pressure or cholesterol tablet—if you stop it, the problem comes back,” Dr Mohan cautioned, adding that in some cases rebound weight gain can exceed baseline levels and that patients must be prepared for long-term treatment.
Side effects common, serious risks rare but real
“The most common side effects are gastrointestinal—nausea, vomiting, diarrhoea. Nausea alone can affect 40–50% of patients,” Dr Mohan explained. More serious risks exist, though rare. “Pancreatitis, stomach paralysis, thyroid cancer, vision issues these are rare, maybe 1 in 5,000 to 10,000 patients. But we have to be careful because we don’t always know which patient will develop them,” he said, adding that while such adverse events have not been widely seen in India yet, they may emerge as usage increases. Dr Koul noted that in supervised settings, most side effects are manageable and severe complications remain uncommon.
Both experts raised strong concerns about how the drug is being accessed. “I have been hearing that pharmacies, online platforms, gyms, dieticians and weight-loss programmes are giving it. This is clearly misuse because the Central Drugs Standard Control Organization (CDSCO) and Drug Controller General of India label clearly says that only a qualified doctor should prescribe,” Dr Mohan said. Dr Koul agreed, stating that tighter regulation is needed and that use should ideally be more institutionalised.
Cheaper drugs will change access but not everything
Both experts believe falling prices will be a turning point. “In a price-sensitive market like India, affordability will change outcomes,” Dr Koul said, adding that he strongly advocates equitable access as a key driver in managing “diabesity.” Dr Mohan noted that while cost is important, prescribing decisions also depend on physician confidence in product quality. “Not all companies engage equally with physicians, and that influences prescribing. Out of the many brands entering the market, only a handful are likely to sustain in the long run,” he said. Dr Koul added that Indian patients are becoming less brand-conscious, supported by initiatives like the Pradhan Mantri Jan Aushadhi Kendra.
“Once-weekly dosing is convenient, so patients do take it, but dropout rates globally are 30–50%,” Dr Mohan said. He noted that expectations often drive discontinuation. “Patients say, ‘I lost 10 kilos, now it’s not reducing further—should I stop?’ They don’t realise the weight is maintained only because of the drug.”
He emphasised that treatment requires close monitoring. “This is not a drug you can prescribe and forget. We start at a lower dose and gradually increase it, but only after checking for side effects. Continuous follow-up is essential.” Dr Koul added that improved affordability could help sustain compliance over time.
Despite the hype, both doctors stressed that drugs alone are not enough. “Obesity is not just a lifestyle issue it is a chronic disease. But relying only on medication is wrong. Diet and exercise are even more important,” Dr Mohan said, warning that without proper lifestyle support, patients may lose muscle along with weight. Dr Koul added that adherence to lifestyle changes is much better in supervised programmes but remains a challenge outside structured care.
With wider access comes the risk of over-medicalisation. “Yes, there is a risk of over-medicalisation. We need stricter guidelines and better regulation,” Dr Koul said. Dr Mohan added, “You can regulate the drug, but you cannot regulate how much weight people want to lose.”
A powerful tool only if used right
Looking forward, both experts see semaglutide playing a major role in treatment. “It can become a first-line pharmacotherapy for obesity, but lifestyle should still come first,” Dr Mohan said.
Dr Koul pointed to evolving clinical guidance from bodies such as the Research Society for the Study of Diabetes in India, which are increasingly integrating GLP-1 therapies into treatment pathways.
“This is a very powerful drug. But it must be used correctly, under medical supervision,” Dr Mohan said.
“India has the ecosystem, the pharma strength, and the need. If we ensure equitable access along with responsible use, this can truly change how we manage diabetes and obesity,” Dr Koul added.
