Weight Loss: The Lean Season

 IT WAS IN 2015 when Dr Sandeep Kawlra, a senior radiologist who now practices in Delhi, began to notice something unusual. Every few months, and sometimes sooner, his vision would get hazy and he would find that the power of his prescription glasses had changed. “I would go to an optometrist, and they would give me new glasses. But three or four days later, I would be back because I was seeing every­thing hazy again,” he says.

What Dr Kawlra was suffering from, unknown to him, was diabetes, and the uncontrolled sugar levels were play­ing havoc with his eyesight. Kawlra, who was then living in Nairobi in Kenya, suffered from this problem the entire year until a blood test the following year revealed the diagnosis. He had also become, as is often the case with diabetics, very overweight. The scales hovered between 104 and 105kg.

To bring his blood sugar levels under control, it was es­sential that he also brought his weight down. But that was easier said than done.

Dr Kawlra would spend what is now nearly 10 years try­ing to achieve this. It seemed to be working at first, when he was living in Nairobi, and then for a short period in Zurich when, with a combination of anti-diabetic medication, good nu­trition and exercise, he brought his weight down to around 85kg. But it all spiralled out of control once he returned to India in 2017, as he slipped up on the lifestyle changes he had adopted, and his weight once again went upwards of 100kg. His endocrinologist also put him on liraglutide, the then new diabetes management drug also known to help with weight loss. While this drug helped a little, it was also tedious. It always needed cold storage and daily injection, and had to be injected daily, and if you ever hit a vein, which happened quite often, the whole area would bruise alarm­ingly. Sold as Victoza by Novo Nordisk, it also went off the market sometime around the end of last year once its patent was wearing off. Dr Kawlra was looking for a replacement.

That’s when his doctor introduced him to Mounjaro, the new class of weight loss drugs that has taken the world by storm and had only just been officially launched in India. Kawlra was 107kg then. Today, about nine months since he began taking the jabs, he weighs just 77kg. “I haven’t been this low (in weight) since my col­lege days probably,” the 64-year-old says. “Just in the first month itself, I lost 5kg. And my weight kept going down progressively,” he adds. Losing as much as 30kg, even when on Mounjaro, is rare. Kawlra also credits much of his weight loss to the new changes he has brought to his lifestyle, from consulting a nutritionist to help him come up with the correct diet plan and a physical trainer who helps him with his exercises.

Dr Kawlra’s case is illustrative of the transformation slowly occurring in India in people’s relationship with their weight. Mounjaro might have been launched just this March, and at a price (depending on dosage, between  ₹14,000 and  ₹27,500) that may be about a quarter of what it costs in the US, but which is still prohibitive for Indian markets. And yet by September, it had become the country’s second bestselling branded medicine. To­day, a user in Mumbai or Delhi or any of the larger cities can have his weight loss drugs delivered within minutes from an online pharmacy the way he orders groceries on quick commerce apps.

The popularity of these drugs may be limited right now to mostly the wealthy in larger urban centres, but even this will soon change. Eli Lilly, Mounjaro’s maker, has announced that it will be launching Yurpeak, the same drug under a new brand name with Cipla, hoping to leverage the Indian pharma company’s extensive distribution network, especially outside the major cities and in the country’s interiors. Next year, the patents of some of these drugs will expire, and cheaper versions, which many Indian pharma compa­nies are known to be developing, will flood the market. And then there is the manner in which these drugs have broken into popular culture, transforming many of us into internet sleuths, looking for sunken faces and dramatic weight loss in our celebrities, the kind that no amount of intermittent fasting and Pilates could explain.

“These molecules (drugs) have been a game-changer,” says Dr Ketan Pakhale, a bariatric and metabolic physician who is the director and founder of Metabol India. “Obesity is a chronic dis­ease and leads to other diseases like early diabetes, hypertension, cholesterol issues, obstructive sleep apnoea, and also PCOD in women. We didn’t have any major, or combination, drug for the treatment of all this before.”

Dr Pakhale specialises in endobariatrics, a field within bariat­rics that includes minimally invasive and endoscopic weight loss procedures like endoscopic sleeve gastroplasty and the intragas­tric balloon. Many of his patients are now on these drugs, and he has witnessed, he says, that combining endobariatric procedures along with these drugs gives particularly good results. “It is all about the patient’s preference. The thing is we now have options to give,” he says.

THESE DRUGS, INITIALLY meant for diabetics, help lose weight by tricking the body into feeling full sooner and making it less interested in food. They copy natural hormones the body makes after eating—Wegovy and Ozempic mimic one called GLP-1, while Mounjaro mimics both GLP-1 and another called GIP—to help signal to the brain that we have had enough food and gets the stomach to slow down the process of emptying the consumed food so we stay satiated longer.

That said, much about these drugs still remains something of a biochemical mystery. We still do not exactly know why they pro­duce the results they do; what long-term side effects, if any, they could have; or even why they appear to have added benefits like helping deal with addictions or cardiac complications. Dr Kawlra used to be a social drinker, but since he was started on Mounjaro he hasn’t felt any urge to drink. Similarly, a patient of Dr Pakhale who was obese and happened to chew tobacco, hasn’t just found himself losing weight ever since he was started on Mounjaro but has also, Dr Pakhale says, landed up kicking his tobacco habit.

What we do know for certain is that these drugs work as a weight-loss mechanism. The constant chatter that goes on in our brains about food and eating is disappearing in those on the drugs. And they are subsequently losing weight.

These drugs were not available in India earlier. Affluent Indi­ans were stashing them in their bags on their return trips from Europe, Dubai, and elsewhere, or procuring them for many times over the original price on the black market. This changed when Mounjaro was launched in March this year, followed by Wegovy, a weight-loss drug by Novo Nordisk, in June. The business has since boomed. Of the two, Mounjaro has been particularly suc­cessful. Helped by both the buzz about its efficacy and a big mar­keting push, it has been witnessing rapid sales. According to data from the Indian Pharmaceutical Market, Mounjaro sales have been growing month-on-month, 43 per cent from just August to September (from  ₹56 crore to  ₹80 crore in sales). It has become the second highest selling branded drug in India (after the popular antibiotic Augmentin which registered sales of  ₹85 crore).

This should not come entirely as a surprise. India has a huge obesity problem. One recent estimate suggests that one in every five households in the country is obese. According to the National Family Health Survey-5 (NFHS-5) of 2019-21, 29.8 per cent of urban men and 33.2 per cent of urban women between 15 and 49 can be categorised as overweight or obese. This is not to speak of child­hood obesity, which is also said to be growing at an alarming rate. Then there is diabetes, which is linked to obesity. A 2023 paper in Lancet estimated that 101 million people in India, that is about 11.4 per cent of the country’s population, are living with diabetes. The Indian Council of Medical Research’s (ICMR) INDIAB study reported that 77 million individuals aged 18 and above are affected by Type 2 diabetes, with nearly 25 million being prediabetic.

It is unsurprising then how much of an appetite there is for this new class of weight-loss drugs in India. One research firm (PharmaTrac) estimates that the anti-obesity drug market in India has reached  ₹628 crore as of June 2025, a fivefold increase over the last five years. The popularity of these drugs as of now might be limited mostly to larger cities, but they are being quickly lapped up by these markets.

IN MUMBAI, SUKANT MANGAL and his 70-year-old mother are both on Mounjaro. Mangal, who runs a real es­tate firm, was put on the drug about five months ago when the weight he lost after a bariatric surgery began to slowly return.

“I weighed about 152.5kg when I got my bariatric surgery done two-and-a-half years ago. And the weight came down for the first year-and-a-half, but then it stabilised between 103 and 104kg. I wasn’t very happy with that. I wanted to lose another 10 to 15kg,” he says. Mangal had kept losing weight after his surgery but he suspects a lax attitude towards exercise and his diet had led to his weight loss plateauing. When his doctor put him on Mounjaro, his weight had in fact begun increasing again, and had reached 108kg.

Mangal has lost around 10kg since he got on the drug. He cur­rently weighs 98kg and he estimates he should reach his target of 92 or 93kg in another couple of months. Mangal has been tolerat­ing the drug quite well apart from experiencing the common side effect of some acidity, but his mother, who began consuming the drug about five months ago, has had a much harder time. “She gets a lot of nausea, and feels pukish all the time, but she has lost around 5.5kg already,” he says. Mangal’s mother, who is diabetic, had a sudden weight gain after a change in her anti-diabetes drug.

For Mangal, who has struggled to lose weight all his life, the drug for the first time gives a semblance of control to the individ­ual. “You have a control which you never had. I mean even if you land up eating a bit more, say during the Diwali festival, and you have piled on some extra four or five kilograms, this drug now al­lows you to address that,” he says, adding that the drug, combined with lifestyle changes like a good diet and regular exercise, can be something like a magic bullet.

Mangal, currently on a 7.5mg dose, plans to taper off the dose once he reaches his target of 92kg, and then hopefully completely get off it at some point. But that, as he admits, can be difficult.

These drugs are typically expected to be taken for life. Stop taking them, and the noise in our brain about food and eating returns, and so does invariably all the lost kilograms. Dr Hrishikesh Salgaonkar, a consultant in bariatric and laparoscopic surgery at Mumbai’s Fortis Hospital, who practised in the UK earlier where Ozempic had been the rage, says that although data suggests these medications have to be lifelong, most doctors prescribe them for no more than two years. “The drug makers say this needs to be lifelong because the moment you stop this medication, the company data shows about 70 per cent patients will regain their (lost) weight in the next one year. Actually, we see patients gaining weight much earlier and slightly more. But we are a bit reluctant to prescribe that because we really don’t have any robust long-term data,” he says.

Not everybody loses a lot of weight either. “Most people lose around 10 to 15 per cent of their weight, which is still very good. Of course, drug companies claim you can lose up to 20 to 22 per cent. But that’s like the car dealership talking up a car’s mileage. You have to take it with a pinch of salt,” says Dr Sanjay Borude, a bariatric surgery consultant at Mumbai’s SL Raheja Hospi­tal. Unless one combines the drug with lifestyle modification, Dr Borude says, the full impact will be limited.

As the hype about these drugs grows, so does the scope for abuse. These drugs can currently only be obtained with a prescription, and there are guidelines about the type of patients who should qualify for them. But many people fear there is a growing cohort of indi­viduals who may not be particularly overweight but are acquiring prescriptions and taking the drugs without medical supervision.

Just some days ago, Dr Salgaonkar was visited by a woman looking for the drug so she could get in shape be­fore her wedding six months down the line. “She wasn’t even all that over­weight. She must have been around 75kg, when her ideal weight should have been around 68kg,” Dr Salga­onkar says. He may not have rolled his eyes as he turned down her request, but he must surely have felt that way given how frequent such requests have become. “Every few days I get a patient asking for the drug because they are overweight by just four or five kilos. The kind of weight you can easily shed by some lifestyle modification,” he says.

Dr Chiranjiv Chhabra, a dermatologist and the founder and medical director of Alive Wellness Clinics, a string of centres that provides aesthetics and dermatology services across Delhi-NCR and Punjab, warns against the drug being taken without medical supervision. Her clinics offer a popular Mounjaro management programme whereby patients are not just constantly monitored while they are on the drug—with nutritionists ensuring a well-balanced diet negating any likelihood of muscle mass loss or obe­sity specialists and doctors checking for side effects or the need to tweak the dosage—but also checked and treated for things like skin laxity and stretch marks. “Weight loss is a journey. It’s not like we give you a medicine and you can come to me after three months. A patient needs to be monitored right through that journey,” Dr Chhabra says, as she talks about how those who have gone through the programme and followed the regimen required have witnessed a great transformation not just in their physical lives but even in their self-worth. “When I started this programme, I thought only the ultra-rich would want to do it. But it has been an eye-opener. I have got people from all strata, even those from lower middle-class sections. And that is because, I guess, being overweight is a disease, and it can create other diseases and co-morbidities,” she adds.

In Mumbai, Rakhi (name changed on request), a 48-year-old health professional who has for long dealt with weight issues, started taking Mounjaro in May this year. While being on the low­est dose, she has managed to bring her weight down from 112kg to 92kg, whereas another friend of hers, an actress, who has also been on the drug but who hasn’t made much lifestyle modification like Rakhi, has witnessed very little weight loss. “Obesity is a vicious cycle. As you become more obese your lethargy increases and your activity levels, no matter what you try, go down even more,” she says. “But with Mounjaro, I started losing weight rapidly, and as I started exercising I realised I was losing even more weight. I lost like four kilos just in the first month,” she says.

Her appetite also went down drastically. She would eat her first meal—a salad during lunch hours—followed by a bowl of soup or dal, her last meal, along with some vegetables in the evening. There was a feeling of constant fullness, and if she ate a bit more, she would feel nauseous.

But while her weight went down rapidly, the drastic weight loss also trig­gered irregular menstrual cycles. Rakhi has been off the drug for about 10 days now. She is trying to guard herself from falling back into her old habits—and she was especially worried when she gained a few kilograms during a holiday she took in the Deepavali break—but for now she is waiting and watching. “It’s too early to say whether I can keep the weight from coming back,” she says. “But I know if I don’t continue with this new lifestyle, I’ll get all the weight back.”

Back in Delhi, Dr Kawlra jokes about how the drastic weight loss led to a peculiar struggle. Like how his uncontrolled blood sugar levels had once led him to frequently change his glasses, he now had to keep getting new pants, because his waist size keeps shrinking. “When I started this (drug Mounjaro), I used to get trousers made to order from Raymond because my waist size was 50 at that time. But then it kept going down, from 50 to 48, then 46, and so on till it reached 38,” he says. “Every time I got trousers of a smaller waist, by the time I got their length adjusted, I would find that I had lost (some inches) again.”

Kawlra hopes to taper down the dosage of the drug and com­pletely get off it after he loses another seven kilograms, which he expects he might manage by the end of this year. The drastic weight loss has also elicited much interest in Kawlra’s circle of friends, and many will often walk up to him at a party, and ask him for the name of the drug. Kawlra, who believes this drug should always be taken under medical supervision and after a thorough check-up, will instead pass on the number of his doctor’s secretary. “I’ll give them the number and ask them to book an appointment with my doctor instead,” he says. “I’m no expert after all.”