India’s weight-loss drug rush raises tough questions on health equity, medical ethics and quick-fix culture.
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Obesity has emerged as one of the biggest public health problems of contemporary society, impacting billions of people all over the world. As of 2022, almost 2.5 billion adults, or more than 40 percent of the world's population, were overweight. Out of this, nearly 890 million belonged to the obese class. India, too, is experiencing a deepening health crisis. The recent National Family Health Survey (NFHS-5) indicates that approximately one in four Indian adults is now overweight or obese, a considerable rise compared to previous years.
The recent National Family Health Survey (NFHS-5) indicates that approximately one in four Indian adults is now overweight or obese, a considerable rise compared to previous years.
Urbanisation, sedentary lifestyle, and dietary patterns with high-calorie intake and low nutritional value are propelling this trend. As lifestyle changes alone may not be sufficient, people are now increasingly resorting to medical interventions for weight management. This increased demand is an indicator of a major shift in the mindset of India towards obesity, perceiving it not merely as a cosmetic issue, but as a serious health condition that needs comprehensive, long-term intervention strategies. Concurrently, the popularity of pharmacological solutions also reflects a societal tendency to seek quicker fixes, sometimes to replace the sustained effort required through long-term behavioural changes such as diet and exercise.
In India, pharmacotherapy for weight management comprises a wide range of mechanisms beyond traditional appetite suppressants. Orlistat, sold as Xenical or Alli, is one of the first approved medications in India. It works by inhibiting pancreatic lipase, thereby preventing the absorption of about 30 percent of dietary fat. This action results in a reduced overall caloric contribution from fats. Xenical (a prescription-only drug, 120mg) and Alli (over-the-counter, 60mg) differ in dosage and availability, with the former intended for patients under medical supervision and the latter accessible for general consumer use.
More recently, glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide—sold under the brand names Ozempic or Wegovy— have transformed the landscape. Originally developed for managing type-2 diabetes, GLP-1 receptor agonists such as semaglutide were later found to aid individuals in achieving substantial weight loss that could not be attained through lifestyle changes alone. These drugs mimic the action of the GLP-1 hormone to suppress appetite, increase feelings of fullness, slow gastric emptying, and affect the brain centres that regulate hunger. Coupled with lifestyle change, GLP-1 agonists have been found to decrease body weight by up to 15 percent over the course of one year. Beyond these pharmacotherapies, there is also a move towards the use of peptide-based therapy, herbal, and homoeopathic interventions in India. However, these alternatives often lack sufficient clinical evidence and regulatory oversight, raising significant concerns about their safety, effectiveness, and long-term impact.
India's anti-obesity pharma market has seen spectacular growth in the last few years, increasing nearly fivefold from INR 133 crore in 2021 to over INR 628 crore by mid-2025. The increase accompanies the sharp rise in obesity levels across the country. Moreover, there has also been an increase in the percentage of Indians who are overweight or obese in the last decade, from 25 percent in 2013 to nearly 40 percent in 2023 (Figure 1). With increasing rates of obesity and associated metabolic diseases, including diabetes, health consciousness has increased, and consumers have become more willing to pay for long-term drug therapy.
Figure 1: Rising Trend of Overweight and Obesity in India (2013–2023)
Source: Data compiled from the ICMR-NIN obesity and related disorders report
India's weight-loss medicine market growth is primarily attributed to new effective oral and injectable therapies, particularly GLP-1 receptor agonists. The leading medicine is semaglutide, marketed under the names Rybelsus (oral) and Wegovy (injectable). Combined, they generated around INR 397 crore in sales as of June 2025, with Rybelsus contributing a staggering 69 percent market share. The recently launched tirzepatide (Mounjaro) in 2025 has also seen strong sales, with INR 26 crore alone in June 2025. Other drugs frequently prescribed include orlistat (INR 72 crore), dulaglutide (INR 72 crore), and liraglutide (~INR 34 crore), each contributing significantly to the increasing market.
Combined, they generated around INR 397 crore in sales as of June 2025, with Rybelsus contributing a staggering 69 percent market share. The recently launched tirzepatide (Mounjaro) in 2025 has also seen strong sales, with INR 26 crore alone in June 2025.
Semaglutide alone witnessed exceptional growth, with sales increasing by over 60 percent in 2022 and nearly 66 percent in 2023. Despite regulatory approval and pricing issues, the industry is likely to benefit from government schemes such as PLI (Production Linked Incentive) and upcoming patent expirations, which can boost domestic production and availability. The market is expected to grow at a compound annual growth rate of 23.5 percent between FY2026 and FY2033, which translates to approximately INR 4,564 crore by 2033. However, this rapid expansion is challenged by high drug prices, which may limit access for many despite growing demand.
Prescribed in combination with dietary modifications and lifestyle changes, weight-loss pharmacotherapies—especially GLP-1 receptor agonists such as semaglutide and tirzepatide—can facilitate a reduction in body weight between 10 percent and 15 percent annually. Aside from promoting weight loss, they also result in considerable metabolic advantages via increased insulin sensitivity, lowered blood pressure, decreased cardiovascular risk, better glycaemic control, and an overall enhanced quality of life.
However, these are not risk-free since prominent adverse effects include gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and constipation. While more serious complications such as pancreatitis, gallbladder disease, and hypoglycaemia are rare, they have been reported in post-marketing surveillance. Of particular note is the increasing risk of abuse, particularly among young individuals and young adults, potentially leading to nutritional deficiencies and long-term metabolic derangement. These health-related complications underscore the necessity for regulated, physician-supervised use of weight-loss medications within a broader, multidisciplinary treatment plan.
In the Indian context, this underscores the urgency for the Central Drugs Standard Control Organisation (CDSCO) to implement comparable surveillance, enforcement mechanisms and digital pharmacy regulation to prevent similar risks and ensure the safe and legal use of these medications.
The growing demand for weight-loss drugs such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) has generated serious concerns about their abuse and proliferation of counterfeit or illicit replicas. The counterfeit replicas ride the wave of demand and are sold illicitly through unregulated online platforms. To address this, the United States Food and Drug Administration (US FDA) has issued several warning letters to bring the unauthorised sale of semaglutide and tirzepatide under control. Such incidents place in sharp focus some serious ethical and safety concerns concerning drug access, pricing, and the need for proper medical supervision. In the Indian context, this underscores the urgency for the Central Drugs Standard Control Organisation (CDSCO) to implement comparable surveillance, enforcement mechanisms and digital pharmacy regulation to prevent similar risks and ensure the safe and legal use of these medications.
Furthermore, the growing popularity of anti-obesity drugs in India has created profound psychological and regulatory issues beyond clinical outcomes. At the population level, mass promotion and use of pharmacologic weight-loss interventions may unconsciously reinforce restrictive beauty standards, especially in younger populations and adults, thus reinforcing body dissatisfaction, low self-esteem and appearance stigma. The impact is likely to be more pronounced in rural and semi-urban areas, where exposure to urban ideals/standards of thinness is high but access to diverse body image narratives and adequate healthcare support remains limited. Additionally, those with insufficient financial means or access to such intervention are likely to internalise feelings of inadequacy or failure. This concern is heightened by the fact that nearly 70 percent of India’s population lives in rural areas while most doctors are concentrated in cities, underscoring a stark health access divide.
From the behavioural point of view, it is feared that greater reliance on drugs can replace health interventions of critical importance, such as exercise and a balanced diet, a process/concept in Economics referred to as ‘moral hazard’. Among youth in particular, this manifests as a preference for quick pharmacological fixes over sustained lifestyle changes, reinforcing habits rather than correcting them. Furthermore, the rampant use of online pharmacies and teleconsultation centres has further encouraged the risk of psychological dependence and improper self-medication, especially in the absence of professional guidance.
The impact is likely to be more pronounced in rural and semi-urban areas, where exposure to urban ideals/standards of thinness is high but access to diverse body image narratives and adequate healthcare support remains limited.
India's regulatory mechanisms are poorly established: even approved drugs such as orlistat and a few GLP-1 receptor agonists are regulated by the Central Drugs Standard Control Organisation (CDSCO), newer peptide-based drugs such as tirzepatide (Mounjaro) are pending formal approval. The spread of unregulated centres and the availability of spurious products further exacerbate public health outcomes. Therefore, there is an urgent need for strict enforcement of prescribing guidelines, pharmacovigilance mechanisms, transparency within pharmacy dealings, and public reporting of adverse events to ensure the safe and ethical use of these drugs.
India's market opportunity for weight-loss medications appears promising, with estimates suggesting a compound annual growth rate (CAGR) of about 23.5 percent between 2023 and 2033. With patents lapsing, the expected rollout of low-cost generic formulations is likely to make them more affordable and expand their coverage across socio-economic strata. However, without safeguards on affordability, tighter CDSCO oversight, and integration with lifestyle-based care, the benefits may remain concentrated in urban areas while risks of inequity and misuse increase. To unlock the full therapeutic and public health potential of these drugs, collective action by the government regulator, the healthcare community, industry players, and patients will be needed. The opportunity is real, but the central policy challenge is ensuring that India’s pivot toward drug-led weight management evolves safely, ethically, and in ways that strengthen rather than replace holistic health practices.
Nysa Arora was a former Research Intern with the Health Initiative at the Observer Research Foundation.
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Nysa Arora was a former Research Intern with the Health Initiative at the Observer Research Foundation. ...
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