Explainer: As weight-loss drugs throw weight around

The recent seizure of fake Mounjaro injections worth Rs 70 lakh in Gurugram not only exposes the chinks in India’s drug regulatory system, but also the exponential demand for such GLP-1 (glucagon-like peptide-1) drugs — highly effective medications for type 2 diabetes and chronic weight management.Most experts are concerned about the easy availability of these drugs, especially on online platforms.The patent on Novo Nordisk’s semaglutide (an FDA-approved medication), sold under the brand names Ozempic, Wegovy, and Rybelsus, expired on March 20. Within a month, over 50 branded generics from Indian manufacturers have hit the market.This has brought down the prices of semaglutide by over 80 per cent. The prices of other GLP-1 drugs like tirzepatide (brand names Mounjaro for diabetes and Zepbound for weight loss) though remain the same.Why the surge in demandIndia has a heavy burden of diabetes and obesity. After the patent expiry of semaglutide, the affordability and the ease of access have fuelled the demand for these weight-loss drugs. However, its rival drug Mounjaro, manufactured by US-based Eli Lilly, remains the market leader. According to Pharmarack, it had sales figures of Rs 114 crore last month, the highest for a drug in India.Much of the demand has been created by self-prescription because of its off-label use for weight loss.“The surge is driven by the perception of GLP-1-based drugs like semaglutide and tirzepatide as ‘magic drugs’, offering substantial weight loss in a short time without much effort. Social media and rapid weight-loss seen in celebrities have amplified the demand for these drugs for purely cosmetic purposes,” says Dr Anoop Misra, Chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, New Delhi.“Combined with falling prices after generic entry, widened access and informal promotion by non-medical channels such as gyms and wellness clinics, the result is a partial shift from therapeutic use to lifestyle-driven consumption,” adds Dr Misra.Misleading promotionBefore the patent’s expiry, the Central Drugs Standard Control Organisation (CDSCO) had issued a strict advisory prohibiting the misleading promotion of GLP-1 receptor agonists (semaglutide, tirzepatide) for weight loss, including surrogate advertisements, influencer marketing, and “awareness campaigns”. The regulator had warned that these are prescription-only medicines, and should not be marketed as “lifestyle” drugs.“But people care more for vanity than they do for health,” rues Dr Ambrish Mithal, Chairman and Head of Endocrinology and Diabetes, Max Healthcare, New Delhi. “So the consumption of these drugs is likely to increase for cosmetic purposes,” he adds.The widening gap between demand and supply, and the ease with which these drugs can be bought, has encouraged fraudsters to exploit the situation. One of those arrested in Gurugram was a listed vendor with IndiaMART, who got the material to make fake injections from another online site, Alibaba, and was making these at his flat, according to Drugs Control Officer, Gurugram, Amandeep Chauhan. At least 15 of these injections had already been sold through IndiaMART, which has been asked to give details of the buyers.Violating regulationsFor Dr Mithal, this “sale through pharmacies, both online and physical, and other online market platforms is a major concern, because these are not strictly honouring the regulations and the laws”.According to government regulations, GLP-1 drugs can only be sold on prescription signed by an endocrinologist or an internal medicine specialist. Both drugs are administered as weekly injections and should be given strictly under medical supervision.However, an investigation by India Today revealed that these GLP-1 drugs are readily available in Delhi at many pharmacies and online platforms without prescriptions or medical consultations. Most pharmacies supplied Mounjaro within hours of placing orders. One pharmacy even offered a 10 per cent discount.How these drugs workThese GLP-1 drugs regulate hunger and blood sugar, boost insulin release after meals, slow stomach emptying and curb appetite, leading to weight loss. They also reduce cardiovascular risk, progression of kidney disease and treat fatty liver and sleep apnoea. However, even when prescribed to genuine patients, these drugs have many side-effects. “Because these are powerful drugs and can’t be taken casually,” says Dr Mithal, author of the best-selling book "The Weight Loss Revolution". “Every drug has a risk: benefit ratio. When these drugs are being used for cosmetic purposes, the benefits would be much less because you’re not treating any medical condition, and weight may come back when you stop taking the drug,” adds Dr Mithal.When these drugs are taken without supervision, common adverse effects like nausea, vomiting, and dehydration are frequent and difficult to manage. More serious risks include gallstones, pancreatitis, and delayed gastric emptying. There is also loss of muscle mass. As weight regain after discontinuation is common, it can lead to dependency, warns Dr Misra.He also cautions against casual buying from online platforms as there is no way to check the veracity.The Way forwardDr Misra suggests stricter market control. “The use of GLP-1 drugs should be restricted to prescription by specialists. A centralised digital prescription tracking system can prevent misuse. Pharmacies, too, should enforce stricter dispensing norms. Supply chains need authentication mechanisms such as QR codes to detect counterfeit products. Regulatory bodies must actively monitor online platforms and informal providers like wellness clinics,” he says. Dr Mithal advocates more raids, “because we have to make an example of some people”.This has brought down the prices of semaglutide by over 80 per cent. Though the price of other GLP-1 drugs like tirzepatide (brand names Mounjaro for diabetes and Zepbound for weight loss) remain the same.Chauhan says the sale of GLP-1 drugs should be brought under the same rules and regulations as medicinal narcotic drugs like Morphine, Fentanyl and Amphetamines.Till the enforcement of drug norms remains lax, people are going to take the easy route to weight-loss, dangers to health be damned.

Explainer: As weight-loss drugs throw weight around

The seizure of fake Mounjaro drugs points to a lack of regulatory control and a blind trust in miracle claims

Renu Sud Sinha

Explainer: As weight-loss drugs throw weight around

The seizure of fake Mounjaro drugs points to a lack of regulatory control and a blind trust in miracle claims

Renu Sud Sinha

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