The world is in the midst of a weight-loss revolution. In December 2023, the red carpet revealed a visibly transformed Oprah Winfrey, who later shared publicly that she was using a GLP-1–based medication for weight management. “The fact that there is a medically approved prescription for managing weight and staying healthier, in my lifetime, feels like relief… like redemption,” she said. In the US alone, nearly two crore people are estimated to be using weight-loss medications today. This revolution is no longer confined to the west. With the recent launch of Ozempic (semaglutide) in India, the epicentre of the global diabetes and metabolic disease burden, a new chapter has begun.
India is home to one of the largest populations poised to benefit from GLP-1 therapies. More than 10 crore adults live with diabetes—second only to China—with an additional 14 crore affected by pre-diabetes. Equally concerning is the rapid rise in obesity. While undernutrition persists in parts of the country, overweight and obesity now affect over 30 per cent of adults in urban India, with growing prevalence in semi-urban and rural areas.
Importantly, Indians develop diabetes and cardiovascular disease at lower body mass indices compared with western populations, making modest weight gain metabolically dangerous. This unique “thin-fat” phenotype has fuelled an earlier onset of diabetes, fatty liver disease and cardiovascular disease—often in individuals in their 30s and 40s.
Why India stands to benefit disproportionately
GLP-1 receptor agonists are approved not only for type 2 diabetes and obesity, but also for cardiovascular risk reduction and obstructive sleep apnoea—conditions that disproportionately affect Indian patients. Cardiovascular disease remains India’s leading cause of death, with diabetes a major contributing factor.
Emerging data suggest that weight loss—whether achieved through bariatric surgery or medications—may also reduce the risk of obesity-associated cancers. Our group at Cleveland Clinic has previously shown that bariatric surgery–associated weight loss is linked to reduced cancer mortality. Similar benefits may eventually extend to pharmacologic weight loss, though long-term data are still evolving.
Challenges
Despite their promise, access to GLP-1 therapies remains a major challenge in India. At current prices, these medications are out of reach for large segments of the population, particularly outside major cities. Insurance coverage for obesity treatment is limited, and concerns are growing about inappropriate cosmetic use driven by social media rather than medical need.
Side effects—most commonly gastrointestinal symptoms such as nausea, vomiting, diarrhoea and constipation—are well recognised. Rarer but serious risks, including pancreatitis, gall-bladder disease, bowel obstruction, kidney injury, and emerging concerns about vision-threatening eye conditions, require careful monitoring.
The term “Ozempic face” has also gained attention. It refers to facial changes such as a hollowed or sunken appearance, reduced fullness of the lips, cheeks, and chin, increased wrinkling and sagging skin. These effects, however, are not unique to Ozempic and can occur with any rapid weight loss.
Long-term safety data—particularly for younger patients who may remain on therapy for decades—are still being accumulated.
Looking ahead
Weight-loss medications are here to stay. As costs decline, oral formulations become available, and clinical evidence expands, their impact in India could be transformative—improving diabetes control, reducing cardiovascular disease, and potentially lowering cancer risk in one of the world’s largest patient populations. However, both short- and long-term risks are not yet fully understood, and these medications should be used strictly under medical supervision and physician guidance.
Shyla Jovitha Abraham, is a health and wellness writer, based in Cleveland, and Dr Jame Abraham, is chairman, department of hematology/medical oncology and professor of medicine at Cleveland Clinic. The views expressed are his own and do not represent the views of Cleveland Clinic.