Injectable weight loss drugs offer modest, costly results. Dr. Vanita Rahman urges India to adopt plant-based diets as a safer, scalable, and effective solution for obesity and metabolic health.
The growing popularity of GLP-1 receptor agonists, such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro, Zepbound) has brought weight loss pharmacotherapy into the global spotlight. While these medications are often described as revolutionary in addressing obesity – a condition affecting millions worldwide, including an increasing number of individuals – it is crucial for healthcare stakeholders to closely evaluate their clinical efficacy, safety, and implications of long-term use.
As a physician and nutrition expert, I have seen firsthand the challenges that patients face in achieving and maintaining health weight loss. While the enthusiasm for these medications is understandable, it is time to critically assess their utility through a broader public health lens, especially in resource-constrained settings like India.
In a recent commentary published in JAMA Cardiology, I outlined three major concerns with semaglutide: limited effectiveness, high incidence of adverse effects, and significant barriers. The commentary was prompted by new data on widespread eligibility for the drug in the US, raising important questions for countries like India, where public health resources are more limited.
The SELECT trial found that after two years of continuous treatment, only 12% of participants acieved a healthy BMI, while 88% had a BMI in the overweight or obese range. These findings are consistent with the outcomes from the STEP and SURMOUNT trials, where weight loss plateaus after approximately 65 weeks, and participants regain the weight once the medication was stopped. These patterns suggest a non-durable effect, indicating that lifelong administration may be necessary to maintain the weight loss, posing significant clinical and logistical challenges. Moreover, research shows that nearly 2 out of 3 users discontinue the medications within 12 months. These patterns raise critical questions for doctors and patients evaluating long-term treatment of obesity.
Adverse effects are another area of concern. The SELECT study reported a 16.6% discontinuation rate due to adverse events, while SURMOUNT-4 found that 81% of tirzepatide users experienced side effects, including serious reactions in 16% of participants.
In addition, a recent observational study linked semaglutide to a four- to sevenfold increased risk of nonarteritic anterior ischemic optic neuropathy (NAION), a serious condition that can lead to vision loss. While further research is needed, these findings underscore the need for clinical vigilance while prescribing these drugs.
From a health economics perspective, the price points are unsustainable. A month’s supply of the medication can cost more than INR 20,000, making long-term use financially unfeasible for most. In India where out-of-pocket health spending dominates, these drugs could worsen the disparities in obesity care unless explicitly covered under public health insurance schemes – an outcome that remains uncertain.
Lost in the discussion about weight loss drugs is the fundamental principle that nutrition plays a crucial role in the pathogenesis and treatment of obesity. Research has consistently shown the clinical advantages of plant-based dietary interventions in terms of effectiveness, cost, safety and long-term sustainability. In the BROAD study, a low-fat plant-based diet led to an average weight loss of 12.1 kg over six months – nearly double of that achieved in several pharmacotherapy trials – alongside significant improvement in LDL cholesterol and blood glucose levels. Furthermore, participants maintained the weight loss at 12 months.
India stands at a pivotal moment. With obesity on the rise, healthcare stakeholders must prioritize scalable, evidence-based, and culturally adaptable solutions. Policy architects, hospital administrators, and clinicians need to include plant-based nutrition as a central, high impact tool for addressing India’s obesity and cardiometabolic disease crises. With the appropriate education for healthcare providers and patients, this model is not only feasible but also transformative.
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