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What India has seen so far may just be the tip of the iceberg. Come March, the patent for semaglutide - the active ingredient in Ozempic and Wegovy - expires here, potentially unleashing a flood of cheaper generics and making them more accessible. Jefferies, an investment bank, calls it a "magic pill moment" for India, predicting the semaglutide market could reach $1bn with the right pricing, uptake, and government incentives. "What we have heard is that nearly a dozen companies are already ready with generic versions of Rybelsus, the oral drug," says Sheetal Sapale, vice-president at Pharmarack. "But as affordability improves, the risk of misuse rises too." Doctors tell stories of patients being put on high dosage of weight-loss drugs by gym trainers, dieticians and beauty clinics with no authority to prescribe them. Some online pharmacies are delivering drugs after a cursory phone consultation in the absence of a prescription. Beauticians offer "bridal packages" promising rapid slimming before the big day. There are fears of spurious medicines flooding the market. Federal minister Jitendra Singh has "advised caution" on the new drugs. "One patient asked me if these new medicines could help his daughter lose seven kilos before her wedding - in three months," recalls Dr Bhaumik Kamdar, a Mumbai-based chest physician. "He wanted to know if they really work." One challenge in India, doctors say, is the way people perceive obesity - and how that shapes attitudes toward weight loss. "Most don't realise that obesity is a chronic, relapsing disease," says Dr Muffazal Lakhdawala, a Mumbai-based bariatric surgeon. "Many people with chronic obesity try crash diets, lose some weight, then regain even more." "Here, if you're overweight, people assume you're well-fed and affluent. We've gone so far in avoiding the elephant in the room that we've normalised it." Obesity, doctors warn, is a gateway to a host of diseases. "It's linked to at least 20 cancers, infertility, osteoarthritis and fatty liver - now one of the leading causes of cirrhosis," says Dr Lakhdawala. Yet, despite it affecting nearly one in eight people globally, there's still no universal consensus on how to define or classify obesity. "The arrival of these drugs has changed the conversation - obesity is now being treated as a disease, not just a lifestyle issue." Doctors across specialities are now turning to weight-loss drugs for more than just obesity or diabetes.
