Source: Business Today
Indian pharmaceutical companies are hungry for the next frontier: drugs to fight obesity, a condition that has become the biggest worry for the urban well-off as they gorge on calorie-dense food (read: junk and fast food) and lead unhealthy lifestyles.
Anti-obesity drugs are big business in the West, where obesity has reached epic proportions (according to the Global Obesity Observatory, 36.47 per cent of the US adult population is obese). As well-travelled Indians bring back the pills, Indian companies have scoped the business and want a share of the action.
Indian pharma companies already have a spectrum of drugs to tackle diabetes and a clutch of other medical conditions that are linked to obesity. But they are looking at specific pills to fight obesity as people want such pills from their doctor. “There has been a perceptible trend… among upper-income group obese patients who have connections in other countries where these drugs are accessible,” says Dr Anoop Misra, Chairman, Fortis C-DOC Hospital. “Many of these individuals have received recommendations for these drugs from relatives residing in Western countries, where such medications are widely used,” says Misra who is also the Director at National Diabetes, Obesity & Cholesterol Foundation.
Indians are not giving up on the usual tools such as diet and exercise to control weight. But these tools don’t work so well for the obese. Note: All obese people are overweight, but not all overweight people are obese. If you are the average Indian at 5 feet 6 inches tall (So says online data platform Statista, quoting a 2019 survey), and weigh 70 kg, you have just entered the overweight class (body mass index or BMI of 25.3). If you are 115 kg and above at that height, you are obese.
The number of obese people is rising in India. The National Family Health Survey-5 (NFHS-5) data from 2019-2021 reveals 33.2 per cent of urban women and 29.8 per cent of urban men (in the age group of 15-49 years) are overweight or obese. Obesity affects over 135 million individuals, making it a significant health concern. Childhood obesity is a particularly alarming issue in urban India, where it holds the record for the highest number of obese children globally (over 15 million). The prevalence of overweight and obese among children aged 5-19 has surged from 4 per cent in 1975 to an alarming 18 per cent in 2016, as reported by the World Health Organization (WHO). These children will grow up to add to the population of adult obese.
Doctors say several factors contribute to the rise in obesity in urban India, ranging from rapidly changing lifestyles and increased consumption of processed foods and high-sugar beverages to little physical activity. Genetic predisposition is another layer.
“There has certainly been a rise in the demand for weight-loss drugs. But weight-loss medications should be taken only under medical supervision, and the patient needs to comply with all other instructions given by the physician along with regular follow-ups,” says Dr Pradeep Chowbey, Chairman, Max Institute of Laparoscopic, Endoscopic, Bariatric Surgery & Allied Surgical Specialities. “Patients, unfortunately, see this as an easy fix and want to try this option even if they do not fit the criteria for these medications. Even people who are slightly overweight want to try these medications as an easy fix to stay in shape,” he says.
How the anti-obesity pills stack up
The intersection of medical advancements and consumer aspirations has made the battle against obesity the collective aim of patients, doctors and pharmaceutical companies.
Weight loss drugs have different mechanisms (see box ‘Fighting the Flab’). Some like the glucagon-like peptide-1 (GLP-1) agonists, work by making your stomach feel full by mimicking the hormone GLP-1. Some, like phentermine, suppress appetite and increase the metabolic rate, making you lose weight. Some, like orlistat, decrease fat absorption in the gut, reducing calorie intake and aiding in weight loss.
Globally recognised weight loss drugs include Novo Nordisk’s Wegovy/Ozempic (semaglutide) and Saxenda (liraglutide), which influence the GLP-1 hormone, promoting fullness and reducing food intake. Eli Lilly’s Mounjaro (tirzepatide) combines GLP-1 and glucose-dependent insulinotropic peptide (GIP) hormones produced in the gut for weight loss.
Denmark’s Novo Nordisk leads in weight management with Ozempic and Wegovy. Eli Lilly of the US offers Mounjaro. Vivus Pharmaceuticals, also of the US, developed Qsymia, a US-based combination pill that suppresses appetite and boosts metabolism. Switzerland’s Roche Pharmaceuticals has orlistat (Xenical), which reduces fat absorption. Orexigen Therapeutics, another US company, has Contrave, a combination pill targeting brain pathways to reduce cravings. But all these cost a bomb.
In India, weight loss options are limited, with orlistat, metformin, and liraglutide (Victoza). Metformin, a diabetes drug, increases insulin sensitivity and lowers blood sugar levels, helping in weight management. Liraglutide, originally a diabetes medication, is prescribed in lower doses for its GLP-1 mimicking effects, aiding in weight loss. Ozempic, introduced in India by Novo Nordisk under the brand name Rybelsus in January 2022 for blood glucose control in adults with Type 2 diabetes, is also prescribed by some doctors for weight loss as it works on the hormones responsible for making you feel hungry.
Doctors say Wegovy and Mounjaro are also undergoing trials for weight loss in India. “Indian pharma companies can only duplicate them if basic material is available and certainly cannot develop them as yet,” says Misra of Fortis.
Several Indian pharma companies are developing their weight-loss drugs, including Dr. Reddy’s Laboratories, Zydus Cadila and Sun Pharma. Sun Pharma discovered and is developing GL0034 (utreglutide), a long-acting GLP-1 receptor agonist (RA) used for non-obese and obese adults without diabetes.
In June this year, Sun Pharma presented data from the first-in-human Phase 1 studies for this molecule. The Phase 1 studies suggest that GL0034 is a candidate to provide therapeutic benefits for obese adults. Sun Pharma tells BT that further clinical studies are planned. “The rising incidence of obesity and diabetes places a significant burden on global healthcare systems, and GLP-1 agonists have emerged as a useful option for treating these conditions with a single agent,” says Dilip Shanghvi, Managing Director, Sun Pharma.
In October 2023, the Subject Expert Committee (SEC) on endocrinology and metabolism gave Dr. Reddy’s permission to conduct a bioequivalence study to assess the safety and effectiveness of the drug.

When fat is good
The IMARC Group, a market research company, says the Indian weight management market of `1,514 crore in 2022 will grow to `2,763 crore by 2028. According to Pharmarack, a B2B Indian healthcare management platform, the anti-obesity segment had been growing in single digits since 2019, but the launch of Ozempic in January 2022 was a game changer.
“The market has almost tripled in terms of value and doubled in terms of quantity if one compares the MAT Nov 23 with MAT 21,” says Sheetal Sapale, Vice President, Commercial, Pharmarack. MAT, or moving annual total, is the sum of a variable, such as sales figures and production output over the past 12 months.
Vikrant Shrotriya, Corporate Vice President and MD of Novo Nordisk India, tells BT that Ozempic is a GLP-1 RA-based therapy for people with Type 2 diabetes and the injectable form is not available in India. But, Rybelsus (Ozempic) tablets, used for treating Type 2 diabetes, are available in India. “We Indians prefer tablets to injectables, and oral semaglutide provides the benefits of the GLP-1 RA therapy with the convenience of a tablet,” he says.
Many doctors prescribe GLP-1 receptor agonists such as liraglutide for weight management for diabetics and are thinking of doing so for non-diabetic individuals.

Exercise with caution
Doctors say India must ensure the safety and efficacy of these medications with robust clinical trials and scrutiny. Most importantly, the government must prevent misuse.
“Some patients choose not to pursue these treatments due to concerns about cost and side effects. Despite this, these drugs are known for their high impact and yield so they are gaining prominence in diabetes treatment,” says Misra.
Doctors specialising in weight loss say drugs for diabetes help, but only for a certain BMI range (between 25 and 30-32.5, or just overweight) without any associated illness such as diabetes or high blood pressure. “If there are associated co-morbidities, medications have to be regulated, and monitoring has to be done more closely along with dietary changes and lifestyle modifications,” says Max’ Chowbey. Weight loss drugs cannot work for patients who are morbidly obese, that is, have a BMI over 37.5 kg/m2 or 32.5 and above with some co-morbidities, he adds.
In November, the US Food & Drugs Administration cleared Eli Lilly’s drug Mounjaro, which was used for diabetes, for use as an anti-obesity pill under the name Zepbound. “While weight loss drugs can be beneficial, they are not a quick fix. For optimal effectiveness, these medications should be complemented with adjustments to lifestyle and diet. Whether opting for medication or surgical interventions, incorporating both diet and lifestyle changes is fundamental for a successful weight loss journey,” says Dr Sukhvinder Singh Saggu, Director, Minimal Access, GI & Bariatric Surgery at the CK Birla Hospital, Delhi.
Chowbey says, “Typically, anyone who is overweight, taking in consideration all medical parameters, may be advised diet modifications, lifestyle changes, exercise regimes and these medications as a treatment option.”
Given the business sense in making local versions of anti-obesity drugs, India’s pharma industry is in a rush. And India’s obese and overweight will not have to wait for long. Till then, they are stuck with expensive pills.