Editorial 1: No magic pill.
Context:
India faces the double burden of malnutrition persisting with obesity. The Semaglutide drug used for sugar control in diabetes is used in weight loss industry. It poses the risk of shifting the treatment of obesity as lifestyle disease to the drug-dependent condition.
Semaglutide drug and weight-loss industry:
- Even persons with healthy BMI suffer from unhealthy metabolism. This increases the risk of diabetes, fatty liver, heart disease.
- The weight-loss industry is majorly dominated by naturopathy, Ayurveda, yoga, and nutrition.
- Semaglutide, a specific drug in the class of GLP-1 receptor antagonists, is used for treating diabetes. It slows down digestion, helping patients to feel full for longer.
- This drug sis now being used for weight loss in the weight loss centers. They offer injections of Semaglutide, alongside diet and workout plans, as a part of weight-management regimen.
- The weight-loss pills industry is expected to reach $100 billion by the end of this decade. Demand may also increase rapidly by the end of 2026 when its patent expires. There will be increased supply of generic drugs at affordable prices.
Positive and negative effects of using Semaglutide:
- This drug slows the metabolism in human body. It has positive health effects such as weight loss, improved blood sugar control, reduced risk of cardiovascular risks, fatty liver and inflammation markers.
- It also helps in restoring regular menstrual cycles, and ovulation in women with polycystic ovary syndrome. It may also improve fertility when combined with lifestyle interventions such as healthy diet and exercises.
- It has negative effects such as appetite loss, nausea, vomiting, and constipation. Serious health conditions such as gall bladder disease, pancreatitis, and kidney issues.
- It may also lead to thyroid tumors, muscle and lean mass loss, and rapid weight gain.
- Weight loss with Semaglutide costs around Rs.13, 000-16, 000 per kilogram loss and include strong metabolic benefits. Diet and structured exercise costs around Rs.5000-6000 per kilogram weight-lost and improves long-term habits such as walking and jogging.
Semaglutide as a part of public health campaign to reduce obesity:
- This drug is largely imported. Using it as first line drug for weight loss may shift the focus from cost effective public health campaigns focusing on diet, exercise, and preventive health and nutrition programmes. Over-focus on this drug may crowd-out other cost effective alternative medicines.
- High dr4ug costs and shifting government resources from prevention programmes may increase urban-rural divide in obesity treatment. Elite urban classes may access costly drugs for weight loss treatment. Low income rural population may remain under-served with basic diabetes and obesity care.
- This may shift the focus from treating weigh loss as lifestyle or behavioral issue to a drug- dependent condition. This may discourage community- based health strategies such as healthy diets.
Way forward:
This drug must be selectively used for treatment of patients with obesity and diabetes risk coexisting. It must also be integrated in public health programmes. It should come under price control regime to make it available at affordable prices. This drug, when used effectively with lifestyle intervention, may reduce the obesity burden of India.