India is now facing an obesity crisis, with around 24 per cent of adults (aged 15-49) classified as overweight. In numbers alone, this is a massive public health problem. Seventy per cent of our urban population is at risk. As lifestyles change, the rural population is also catching up.
Obesity is a problem not just of aesthetics or appearance; it is a chronic disease that affects the heart, increases the risk of heart attacks and stroke, precipitates diabetes, causes breathing difficulties and arthritis, reduces fertility and increases the risk of certain cancers. It also increases depression and anxiety and reduces efficiency and mobility, making everyday activities difficult.
Losing as little as 5 per cent of body weight significantly reduces these risks. Unfortunately, despite calorie restriction and exercise, this remains an unachievable dream for some.
Newer drugs, the semaglutides, seem like a miracle to those who have struggled with obesity and have documented failure with diets and exercise. Semaglutides act as GLP-1 receptor agonists. They treat both type 2 diabetes and obesity. They mimic the GLP-1 hormone to increase insulin secretion, decrease glucagon secretion, slow digestion and promote fullness.
The medication was under patent and therefore prohibitively expensive. As of this month, the patent has expired. Many Indian companies are about to release more affordable versions of these drugs.
Semaglutides can be taken as weekly injections or daily tablets. They help people stay full longer. Many lose their desire to keep eating and blood sugar levels are better controlled.
The downside to weight loss is that people tend to lose muscle. They need to increase their protein intake and also do strength training. Older adults and postmenopausal women are particularly at risk. Muscle loss can cause weakness and fatigue. There may be falls, injuries and fractures.
Semaglutides are not a quick fix for obesity. Weight loss starts 4-12 weeks (1-3 months) after starting semaglutides. Maximum weight loss usually takes one-and-a-half years. The medication has to be continued indefinitely because if it is discontinued, 50 per cent regain the weight they lost and more.
Fat loss typically occurs first in the face, neck and upper body. Visceral fat (the dangerous fat around internal organs) is often lost faster than subcutaneous fat, which sits just under the skin. Initially, there may not appear to be fat loss, even though the scale shows weight loss. Loss of subcutaneous fat can lead to reduced skin elasticity and “Ozempic face”, with sagging skin and hollowed cheeks.
These medications must be taken under the guidance of a health professional. They may affect the absorption and efficacy of other essential medications. Regular follow-up and evaluation are essential.
Weight loss is a profitable business. Now that weight loss drugs
are about to become widely available, the market is set to boom. Be careful and review your options before opting for treatment.
The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues, please write to yourhealthgm@yahoo.co.in