At 43, Sophia Purohit believed she understood her body. A type 2 diabetic since her mid-20s, with a family history of diabetes and heart disease, she had spent nearly two decades navigating medications, sugar charts, doctors’ visits and lifestyle tweaks. “I was the go-to medical person in my family,” she says. “I thought I knew it all.”
In January 2024, just days after returning from a family holiday in Shimla that included paragliding and trekking, she developed a dull, persistent chest pain. She dismissed it as severe acidity after gorging at a Parsi Navjote in Navsari, Gujarat. The pain lingered through the night and during the drive back to Mumbai.
By the time she walked into the emergency room at Kokilaben Dhirubhai Ambani Hospital in Mumbai, her ECG was already capturing a catastrophe in progress. “While the ECG was happening, I had a massive heart attack,” she recalls. “People started running around me. That’s when I knew this wasn’t gas.”
Sophia Purohit | Amey Mansabdar
Purohit would later learn that she had likely suffered two heart attacks within a week—one possibly during the holiday, and the second inside the hospital. Angiography revealed four major blockages; one artery was 99 per cent blocked and required an immediate stent. Significant portions of her heart muscle had died. Her heart’s pumping capacity had dropped to 20 per cent, far below the normal 60 per cent.
“I had to buy a wheelchair,” she says. “For six months, I couldn’t walk from my bedroom to the living room without collapsing.”
The turning point came when Purohit’s cardiologist drew a hard line: her heart would not recover unless her diabetes was aggressively controlled.
“I kept resisting,” she admits. “I thought, ‘why is a cardiac doctor talking about my diabetes?’ I already had a renowned diabetologist.”
But the numbers told a different story. Her HbA1c hovered at a dangerous 12.9–13, despite insulin, oral drugs and years of ‘management’. Also, she weighed 85kg.
Eventually, Purohit switched her diabetes care entirely under her cardiologist’s supervision, someone who had spent years studying the overlap between diabetes and cardiac disease. She was placed on continuous glucose monitoring, recalibrated insulin doses, structured cardiac rehab and later, tirzepatide—a GLP (glucagon-like peptide) dual agonist.
“The first time in my life, I saw my sugars drop to the 80s,” she says. “I had never seen that number before.”
Purohit’s insulin requirements began to fall dramatically—from four injections a day at higher doses to minimal doses, and on some days none at all. Her HbA1c dropped from nearly 13 to 8 within months.
Her weight reduced steadily—from 85kg to about 75kg—without drastic drops. More important, her heart function improved from 20 per cent to nearly 40 per cent.
“I walk up three flights of stairs now. Twice a day. That was unthinkable a year ago.”
Purohit’s father, 75, who is based in Canada, was diagnosed with diabetes about six years ago. “He has been taking Ozempic for about a year and a half. It has been very effective,” says Purohit. “His sugars are in control. And, he lost about 8kg in the first six to seven months.”
Purohit’s story is echoed in millions of Indian households. Obesity, once dismissed as a cosmetic issue or a personal failure, is now one of the nation’s most urgent health challenges. For decades, obesity was thought to be only the result of indulgence and indiscipline. But in clinics across India, specialists insist that obesity must be recognised as a chronic, relapsing, multifactorial disease with genetic, hormonal, psychological, environmental and behavioural components.
It affects children before they understand the word ‘calorie’, women struggling with hormonal conditions, men trapped in sedentary routines and older adults managing slowing metabolisms. India now stands at the epicentre of a dual epidemic: obesity and diabetes, each fuelling the other and blurring the line between lifestyle and disease.
India may be home to an estimated 100 million people with diabetes, but the obesity burden is far larger. “We have around 300 million people with obesity—some estimates go up to 350 million. That’s nearly 35 crore people living with obesity,” says Dr Rajiv Kovil, diabetologist and obesity specialist.
What makes obesity particularly dangerous, he explains, is its role as the primary driver of disease. “Obesity drives nearly 200 medical disorders and is linked to at least 14 types of cancer. If we treat obesity—the core defect—we are actually treating a much bigger problem,” says Kovil.
We have always looked at obesity very simplistically—by saying, eat less and work out more. But that’s not entirely true, says Dr Arun Menon, endocrinologist, Aster Clinic, Bur Dubai. “It’s now well-recognised that obesity can be viewed as a chronic brain disease. What happens is that every person’s body has a higher ‘set point’ for defending weight. For instance, my body might recognise 75kg as my highest set point and will try to stay around that level. The brain defends this weight through two main mechanisms— it increases hunger and slows metabolism. So, even if someone has great willpower, their body is working against them, driving them to eat more and burn fewer calories.”
Scientific evidence reveals why simple advice like cutting carbs or joining a gym rarely delivers long-term success. The body, when pushed into weight loss, often pushes back, slowing metabolism, intensifying hunger signals, resetting hormonal pathways. This biological resistance is why 80–90 per cent of people regain weight after diets.
So obesity is not just calorie in, calorie out. Hormones like leptin, ghrelin and insulin are deeply involved in weight regulation. They influence hunger, fullness and how the body stores or burns fat. “When these hormones are unregulated, the metabolism slows down and the brain triggers hunger, trying to ‘defend’ that higher body weight,” explains Menon. “Genetics also plays a huge role, it sets the background. But when you add environmental factors like sedentary lifestyles and easily available high-calorie food, it becomes a perfect storm.”
Menon explains how the gut flora affects weight—there are good and bad bacteria, and the balance between them affects metabolism and weight. Research shows that people who are overweight often have a very different bacterial composition from those who are lean. So, even our microbes can influence obesity.
Experts warn that unless we overhaul how we understand, diagnose and treat obesity, we will be looking at a public health crisis as severe as cardiovascular disease or cancer.
Yet in India, obesity continues to fall through policy cracks. Obesity is still not recognised as a disease or medical disorder in India, says Kovil. “Most developed countries have already accepted obesity as a disease,” he adds. Without this recognition, obesity treatment cannot be brought under pricing controls, insurance coverage or structured public health programmes.
In early December 2025, the World Health Organization released a landmark guideline. Published in JAMA, the advisory recognises obesity as a “chronic, relapsing disease” requiring lifelong management. The WHO also emphasises that GLP-1 therapies are not cosmetic shortcuts but tools that should be paired with intensive behavioural therapy, including goal-setting, structured diet plans, physical activity guidance and frequent counselling sessions. This approach mirrors what clinicians in India, which now has one in four adults living with obesity and faces projections of one-third population with obesity by 2050, are already advocating—drugs can help, but they must be accompanied with lifestyle changes and strict diet monitoring.
Hope and promise
A revolution is underway in obesity care, led by GLP-1 receptor agonists like semaglutide and liraglutide and dual agonists (that combine GLP-1 and another hormone) like tirzepatide and upcoming triple agonists (involving three different hormones).
Novo Nordisk pioneered the GLP-1 era with Ozempic, Saxenda and Wegovy. GLP-1 receptor agonists work by mimicking the body’s natural satiety hormone (GLP-1), which regulates appetite and metabolism. Eli Lilly surged ahead with tirzepatide (Mounjaro/Zepbound), offering even greater weight reduction. AstraZeneca, Pfizer and Amgen are developing next-gen molecules, including oral GLP-1 and triple agonists. India’s generics market is gearing up. The global obesity drug market may hit $100 billion within a decade.
Mahesh Kumar, a 70-plus chartered accountant, company secretary and law graduate based in Mumbai, had been living with type 2 diabetes for over two decades when he decided to try tirzepatide earlier this year. Diagnosed in 2000, diabetes had remained “persistently difficult to control” despite years of treatment. By 2023, he was on an intensive insulin regimen, short-acting insulin three times a day and long-acting insulin at night along with multiple oral anti-diabetic drugs. While his sugar levels did improve under Kovil, an earlier prescription from another physician had caused a significant setback.
“In six months, my weight increased by nearly 10kg because of a drug I was given. I didn’t know at the time that it could cause weight gain and increase the risk of heart failure,” he recalls. “Dr Kovil immediately stopped it.”
Kumar’s medical history is further complicated by coronary artery disease. He underwent bypass surgery in June 2019. Though he lost some weight post surgery, it soon crept back up.
Kumar says he closely follows medical developments and had read about GLP-1 drugs. When news broke that Mounjaro had entered the Indian market in March 2025, he brought it up with his doctor. “He told me clearly this is not just for weight loss. This is a powerful drug for type 2 diabetes, and if it works for you, we can reduce your insulin,” he recalls.
Dr Rajiv Kovil
He was started on a 2.5mg dose in late March, with gradual increase every month—5mg, 7.5mg, 10mg and then 12.5mg. He is now prescribed 15mg. Over roughly eight months, Kumar lost about 9.5kg. “But more than the weight, I feel lighter inside, more energetic, more alive,” he says.
Unlike many patients who report nausea or gastrointestinal side effects, Kumar says he experienced none. What did change, however, was his appetite. “The craving for food has gone down drastically,” he explains. He describes an early sense of fullness and discomfort if he overeats. Lunch is often limited to salads, protein, curd or buttermilk, while carbohydrates are mostly consumed during breakfast.
His HbA1c has stabilised between 7.2 and 7.3, and his dependence on insulin and oral medications has reduced substantially. “There has been at least a 40–50 per cent reduction in my insulin and tablet dosage. That also offsets some of the cost of Mounjaro,” notes Kumar.
Quarterly tests, including renal profile, liver function, and lipid panels have all remained within normal limits for over a year now. “Earlier, that was not the case,” says Kumar. “Now everything is absolutely normal.” His cardiologist at Asian Heart Institute in Mumbai has also given him a clean bill of health.
“Obesity and heart disease are parallel epidemics,” says Dr Pravin Kahale, cardiologist, Kokilaben Dhirubhai Ambani Hospital. “Obesity leads to high blood pressure, high cholesterol and insulin resistance—all of which are major risk factors for heart disease. Insulin resistance, which occurs before full-fledged diabetes develops, is commonly associated with obesity. It is one of the key mechanisms through which obesity drives heart attacks.”
But there’s also another aspect—inflammation. The fat in our body is of two types: subcutaneous (under the skin), which is relatively harmless, and visceral fat, which is stored around the organs and is harmful because it is inflammatory. This chronic inflammation caused by visceral fat, along with insulin resistance, contributes to thickening of the blood and promotes cholesterol deposition in the arteries, leading to blockages and heart attacks.
Insulin resistance can make blood more viscous and increase the tendency for cholesterol to deposit along the vessel walls. This sets the stage for atherosclerosis and ultimately heart attacks.
Kahale shares a case of a 65-year-old woman who had both heart failure and a heart attack. Her heart pumping function was poor, and she was on very high doses of insulin. “When she came to me, she was admitted to the ICU with breathing difficulty due to heart failure,” he says. “We performed an angioplasty and also implanted a CRT (cardiac resynchronisation therapy) device to help her heart pump better. Along with that, we started her on a GLP-1 analog.”
Over the next three years, her progress was remarkable. “Her insulin requirement dropped gradually to zero. Her HbA1c came down from 9 to 5.5, which is almost a non-diabetic level—and this was achieved without any insulin. These GLP-1 drugs strengthened her heart, improved her insulin sensitivity, and rejuvenated the insulin-producing capacity of her pancreas,” says Kahale.
So, in essence, these drugs reduce the need for insulin itself. They have a large insulin-sparing capacity. Usually, insulin is given to control sugar, but high doses of insulin itself are not good for the heart. It can stimulate more blockages and clotting. So, one ends up trading one risk for another.
Experts hail GLP-1 drugs as a turning point in obesity and diabetes care. They go beyond blood sugar control as they protect multiple organs.
Cost and challenges
Mounjaro currently costs Kumar about Rs22,000 per month, even after discounts. “I can afford it for now, but if this becomes a lifetime drug, it does pinch,” he admits. “India is the diabetes capital of the world. When volumes grow, prices should come down.” Government intervention and future generics could make a difference, he adds.
For many Indians, GLP-1 drugs remain unaffordable. Annual expenditure may exceed Rs1 lakh–Rs3 lakh—unsustainable for middle-class households.
Governments globally are debating insurance coverage. In India, without its inclusion in the Essential Medicines List (EML), affordability remains a barrier. So what happens if they enter the EML? Prices drop drastically, generic competition increases, there comes wider access for diabetics and there can be greater oversight on misuse.
“If the government includes them and makes them more affordable, it will be a huge step forward. They are already considered first-line therapy for patients with diabetes and heart disease. But their cost limits access. Wider availability and price reduction would make a major difference in public health,” says Kahale.
When he asked his doctor whether Mounjaro is a lifelong therapy, Kumar says he was told that oral maintenance drugs may become available in the next six months. “The idea is to maintain this health and weight, not lose endlessly,” he says.
Sophia Purohit’s journey with GLP-1 drugs predates the current buzz. Over the years, she had tried Byetta, Victoza, Trulicity, Rybelsus, often abandoning them due to severe nausea, dizziness, extreme appetite suppression, or debilitating fatigue. “Mounjaro didn’t knock me out,” she says. “It didn’t starve me. It stabilised me.”
Unlike earlier drugs that made eating impossible, tirzepatide helped regulate her blood sugar without draining her energy, crucial for someone rebuilding cardiac stamina. “The biggest win wasn’t weight loss,” says Purohit. “It was control.”
She is clear-eyed about limitations. The first few months on Mounjaro came with gastrointestinal side effects, including diarrhoea and acidity. “It took time to settle. People need to know that,” she says.
Purohit currently takes 5mg once a week, carefully monitoring sugars on injection days to avoid hypoglycaemia. Her doctor has no plans to escalate the dose unless required. “This isn’t cosmetic weight loss,” she stresses. “This is survival.” Her story, she hopes, will shift the conversation—from vanity-driven weight loss to early, aggressive metabolic intervention. “If this hadn’t happened to me at 43,” she pauses, “I would probably be dead by 55.”
For most of his life, Kuku Thacker never saw his weight as a medical problem. “I was a plumpy boy and grew into a plumpy man,” he says, matter-of-factly. Through his 30s and 40s, his weight crept up steadily, settling around 85kg. Work kept him busy, excuses came easy, and physical activity remained optional. “My wife would ask me to walk with her,” he says. “I’d say she walks too fast. So I never went.”
The diagnosis of type 2 diabetes arrived quietly, almost casually. A routine blood test one day left him unusually drowsy. By the time he reached home, he collapsed into sleep. “That’s when I knew something was wrong,” recalls Thacker. The reports confirmed he was diabetic.
Medication followed, but education did not. “Nobody explained what diabetes actually does to your body,” says Thacker. For nearly five years after diagnosis, his lifestyle barely changed. He continued eating what he liked, including frequent indulgences, assuming tablets were enough. The wake-up call came gradually. Persistent fatigue, weakness and a sense that his body was no longer cooperating forced him to take stock. Around the same time, Thacker was diagnosed with prostate cancer and underwent surgery. He recovered well, but the experience sharpened his awareness of how vulnerable his health had become. “Once you are diabetic, even surgery becomes complicated. Doctors hesitate. You need clearance for everything,” he says.
By then, he had been under the care of a diabetologist for nearly 15 years. Despite being compliant with insulin and other medications, progress remained limited. Finally, after detailed discussions with his doctors, Thacker decided to start tirzepatide.
The response was immediate and sustained. Unlike many patients who escalate the dose quickly, Thacker stayed on the starting dose of 2.5mg for several months and continued to lose weight. When he asked whether he could stop, his doctor advised otherwise and explained the larger picture. Beyond glucose control and weight loss, the drug offered protection for organs that diabetes silently damages over time, including the heart, kidneys, liver, nerves and blood pressure.
He eventually moved to the 5mg dose and has been on it for about two months. Side effects, often reported by others, did not trouble him. Alongside medication, Thacker made deliberate lifestyle changes. He walks for about 30 minutes, five times a week, watches his protein intake, and eats more mindfully. The results are visible and deeply personal. “My son and I now wear the same jeans size—32,” he says, with a laugh. “Earlier, I couldn’t even find jeans that would fit me.”
Beyond physical comfort, the transformation restored confidence and energy. Today, Thacker is vocal about the need for better patient education in diabetes care. “Doctors prescribe medicines in pieces. One pill, then another, then insulin. But no one explains what diabetes will do to your eyes, your kidneys, your heart if you don’t act early,” he says.
He also questions the broader conversation around preventive use of newer obesity and diabetes drugs, especially amid concerns of cost and profiteering. While he believes such medications should not be used casually, he is clear that people living with obesity and uncontrolled diabetes should not delay treatment.
Gender manifestations
Women experience obesity differently due to pregnancy, postpartum shifts, PCOS, menopause-related metabolic slowdown, emotional eating linked to societal pressure and more. Stress, loneliness, disrupted sleep and anxiety also alter hormones like cortisol, pushing the body into survival mode encouraging fat storage and cravings.
Women tend to gain weight more easily at different hormonal stages— puberty, pregnancy, post pregnancy, and menopause. These hormonal transitions affect metabolism. The difference though is in fat distribution. Women generally accumulate subcutaneous fat that is under the skin—around the thighs and hips—whereas men tend to develop visceral fat, which surrounds internal organs. That’s why men are more prone to heart disease, diabetes and fatty liver, though women aren’t exempt either, explains Menon.
Akanksha S. was 34 and working in a mid-level managerial role in Gurugram when unexplained fatigue and rapid weight gain first appeared. Until then, her weight had been stable, her eating habits unremarkable, her routine active enough to keep her healthy. Blood tests revealed hypothyroidism. Medication followed, but the weight she gained during that phase never fully reversed. “Everyone assumed the problem was that I hadn’t tried hard enough,” she says. “But this started with my thyroid, not my plate.”
During her first pregnancy, Akanksha was diagnosed with gestational diabetes. Doctors reassured her that it would resolve after delivery. Initially, it did. But the combination of a disrupted metabolic system, postpartum hormonal shifts, sleep deprivation and an already underactive thyroid meant that weight gain accelerated instead of stabilising. Within a few years, what had been gestational diabetes quietly evolved into type 2 diabetes, confirming what her body had been signalling all along.
At that point, obesity was no longer a side effect; it had become part of a complex metabolic loop. Despite eating cautiously and attempting repeated weight-loss plans, her body resisted change. “It felt like I was constantly swimming upstream,” says Akanksha. A diabetologist later explained that hypothyroidism, diabetes and obesity often reinforce each other, making weight loss disproportionately difficult without medical intervention.
Today, under structured medical care, she manages her thyroid, blood sugar and weight together—not as separate problems, but as interconnected conditions. “If obesity were just lifestyle, it wouldn’t have followed a medical diagnosis so closely,” says Akanksha. “This wasn’t a lack of discipline. It was a disease unfolding, step by step.”
Modern science dismantles the myth that all bodies respond similarly to food and exercise—two people on identical diets see entirely different results. Also, obesity often coexists with diabetes, hypertension, fatty liver, sleep apnoea, PCOS, and infertility.
While biology matters, lifestyle cannot be dismissed. Nutritionists emphasise that obesity management involves behaviour change, not deprivation. So along with balanced meals, there has to also be strength training, better sleep, mindful eating, screen-time hygiene and stress regulation.
Crash diets often harm metabolism. Supplements marketed as “fat burners” may cause heart issues. Intermittent fasting works for some but worsens anxiety in others. Keto suits a small percentage; for most Indians, it is culturally incompatible.
Workings and warnings
Semaglutide (Wegovy/Ozempic) and tirzepatide (Mounjaro/Zepbound) mimic gut hormones that reduce appetite, slow gastric emptying, regulate insulin and lower cravings. Kovil says their effects are dose-dependent. “At lower doses, they help control blood sugar. As the dose increases, their effect on weight becomes more pronounced,” he says.
Their primary action is on the brain. “These drugs act on centres in the brain that regulate craving and satiety,” adds Kovil. “Hunger then becomes driven by metabolic need rather than pleasure.”
Over the past few decades, he notes, food has increasingly become a source of reward. “The pleasure and reward response we associate with pizza, ice cream or cake comes down,” says Kovil. “Even visual cues—seeing food on social media—trigger far less craving because the brain mapping changes.”
They also slow gastric emptying. “When you eat too fast, you eat more. These drugs reduce stomach movement, so you eat slower,” says Kovil. “That allows your natural satiety hormones, which take 15 to 20 minutes, to activate to kick in.”
Experts say these medications are metabolically safe. “They work on pancreatic beta cells only when glucose levels are high,” explains Kovil. “Once sugar levels fall, the drug switches off. That’s why they are safe in both diabetics and non-diabetics.”
Weight loss with these medications follows a predictable curve. “The first 20 to 30 weeks is when patients lose the maximum weight—about 50 to 60 per cent of their target. After that, weight loss slows because the brain has a weight set point it tries to defend,” says Kovil.
Realistically, Dr Dheeraj Kapoor from Kokilaben Dhirubhai Ambani hospital says patients can expect 10 to 15 per cent weight loss over nine to 12 months, and that is often enough to dramatically change health outcomes.
Other obesity-linked conditions also show meaningful improvement, say experts. Up to 15 per cent weight loss can reverse metabolic dysfunction-associated steatotic liver disease; high cholesterol often normalises with 10-15 per cent weight loss; moderate to severe sleep apnoea may improve with 20–25 per cent weight loss, explains Kovil.
Targeting weight through lifestyle, diet and, when needed, medications has ramifications across almost all non-communicable diseases, say experts.
However, it is agreed by doctors across specialisations that pharmacotherapy is not for everyone. But everybody should monitor their weight, prevent weight gain and try to bring it down with lifestyle changes. Medication, adds Kovil, should come only when required and under expert supervision.
So who qualifies for GLP-1 drugs? It is for those who have BMI over 30 and those with over 27 BMI and have comorbidities (diabetes, hypertension, fatty liver and PCOS). It is also for patients who have failed structured lifestyle intervention, diabetics needing metabolic improvement, people with high visceral fat, sleep apnoea or insulin resistance and those unsuitable for bariatric surgery.
Experts warn that these drugs are not suitable for children, pregnant or breastfeeding women, people with history of thyroid C-cell tumours and those seeking purely cosmetic weight loss.
“A lot of people are trying to use these drugs as cosmetic weight-loss agents,” says Kovil, adding that is not what these drugs should be used for. “These are medications for chronic weight management. Just like diabetes or blood pressure, obesity is a chronic disorder. Pharmacotherapy is therefore long term—often at least two to three years, and possibly lifelong.”
There is also no scientific basis yet for stopping therapy abruptly. “We do not have trials to tell us whether a patient can stop the drug once enough weight is lost, or whether the dose should be reduced or continued,” says Kovil. “What we do know is that this is not short-term treatment.”
Crash weight loss can be harmful. “Someone who wants to lose 10 kilos in two months, this is not the treatment for them,” says Kovil. In fact, that kind of drastic weight loss itself can have serious side effects.” Weight reduction, says Kovil, should be gradual: no more than two to two-and-a-half kilos in the first one or two months.
Initially, GLP-1 drugs were used only for diabetic patients, but recent studies show that even non-diabetic obese individuals benefit, especially those who have already had a heart attack. “These drugs significantly reduce the chances of repeat heart attacks because of their organ-protective capacity,” says Kahale. “In diabetic patients, they prevent future heart attacks. In obese but non-diabetic patients, they reduce the risk of repeat attacks. That’s why we now prescribe them as organ-protective medicines—not just for sugar control.”
Many have concerns regarding the rebound weight gain after stopping, gastrointestinal side effects such as nausea, constipation and gastritis, protein and muscle loss without strength training and psychosocial dependency when one tends to think that one can’t lose weight without the drug.
“Medication helps, but it’s not the complete answer,” says Menon. “If you don’t address the root causes—stress, lifestyle, sleep, food, environment—you will regain the weight once the drug is stopped or its effect wanes. The key is to use medication as a support system, not a shortcut.”
India stands at a pivotal moment. Obesity is rising, diabetes is surging, and GLP-1 drugs are transforming the treatment landscape. Experts urge for de-stigmatising obesity by educating families and schools, regulating the pharma industry, ensuring affordability for those who truly need help.
“Most important, we must replace shame with support,” says Akanksha. “For the first time, I feel like the world understands what I’m fighting.”