There's a new conversation happening everywhere: at family weddings, in office WhatsApp groups, and across Instagram feeds. Your cousin lost 15 kilos before her engagement. Your colleague is suddenly two sizes smaller. That uncle who always struggled with diabetes? Suddenly lean. The secret? A weekly injection. You might know them by their brand names like Ozempic, Mounjaro, or Wegovy, or perhaps by their scientific name, GLP-1 receptor agonists.
What actually is GLP-1?
Let me start with the basics, because understanding what these drugs do is important.
GLP-1 stands for glucagon-like peptide-1. It's a hormone your body naturally produces in your gut after you eat. Its function is to signal your brain that you're full, slow down how quickly food leaves your stomach, and help regulate blood sugar.
GLP-1 drugs are synthetic versions of this hormone, originally developed for people with Type 2 diabetes. They work by mimicking what your body already does, but at much higher, sustained levels. The result is that you feel full much sooner. You eat significantly less. And that’s how you lose weight.
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On paper, it sounds simple. In practice, it's considerably more complicated.
What happens when you take these drugs
When someone starts a GLP-1 medication, the changes are often immediate. They feel full in just a few bites. Foods they used to love now suddenly seem unappealing. The appetite just disappears.
In clinical terms, this is "appetite suppression." In lived experience, many people describe feeling mildly nauseous most of the time, food losing its appeal, or having to remind themselves to eat.
People on these medications often report eating significantly less than usual, in some cases as little as 800–1,000 calories a day, based on patient-reported observations in clinical settings.
What the studies are showing
Here's where we need to pay attention to the emerging data.
Research is showing that when people lose weight on GLP-1 drugs, they're not just losing fat. Studies suggest that anywhere from 25 to 40% of the weight lost can be lean muscle mass (Metabolism: Clinical and Experimental, 2024 meta-analysis; STEP-1 and SUSTAIN-8 semaglutide trials). That's significant.
Muscle isn't just about strength or appearance. It's a metabolically active tissue that helps regulate blood sugar, supports bone density, maintains metabolism, and preserves physical function as we age. Losing substantial muscle in your 30s, 40s, or 50s has implications that extend far beyond the number on the scale.
The challenge is that we don't yet have long-term data on what this muscle loss means five, ten, or twenty years down the line for people who used these drugs primarily for weight loss.
The nutritional concern
When you're eating 800-1000 calories daily, even without feeling hungry, basic nutritional needs become difficult to meet.
Protein requirements don't disappear just because your appetite does. Neither do your needs for iron, calcium, B vitamins, vitamin D, omega-3 fatty acids, and other essential nutrients. But meeting these requirements becomes nearly impossible when you can barely eat.
The drugs suppress appetite so effectively that people aren't eating enough to maintain basic health, let alone preserve muscle mass.
What we don't know yet
These drugs have been used for diabetes management for years, but their widespread use for weight loss in otherwise healthy individuals is relatively new.
We don't have robust long-term data on:
- What happens to muscle mass and bone density over 5-10 years of use
- The impact on people who start these medications in their 20s or 30s
- Impact on fertility/reproductive outcomes
- Early data is showing that GLP-1 might help in PCOS, but what about long-term hormonal regulation?
- Long-term effects on digestive function and gut health
- What happens to metabolism and hormonal regulation after years of use
- The psychological impact of having an appetite artificially suppressed for extended periods and the impact of GLP-1 on pleasure in general.
There are concerns about potential impacts on gallbladder function. There are questions about thyroid effects, though research is ongoing.
These drugs were developed for diabetes management. Their mass use for cosmetic weight loss is new territory, and we are navigating it in real time, with millions of people as the data.
The rebound question
Here's what we do know: when people stop taking GLP-1 medications, weight regain is common. Very common.
The STEP 1 extension trial, published in Diabetes, Obesity and Metabolism (Wilding et al., 2022), found that participants regained approximately two-thirds of the weight they had lost within one year of stopping semaglutide. This raises important questions.
If the medication is doing all the work of appetite suppression, what happens to the behaviours and habits around food during that time? If someone hasn't learned to recognise natural hunger cues, prepare balanced meals, or address the emotional or environmental factors that contributed to weight gain, what changes when the drug is stopped?
The Indian reality
These medications cost ₹8,000–₹15,000 a month. Insurance rarely covers weight loss.
That’s ₹1.5 lakh a year, big money for most families.
Yes, generics are making them more accessible. But that also means people are taking them without proper medical guidance. And meanwhile, life hasn’t changed. Long work hours, tiring commutes, late dinners, family food pressure, endless festive eating.
An injection can reduce appetite, but it doesn’t fix your routine, stress, or environment.
And when you stop, you’re back to the same life with the same triggers.
What needs to happen now
At a systemic level, we need better oversight urgently. Mandatory patient registration before starting these medications. Digital prescription trails so online pharmacies and chemists can't dispense without proper medical verification. Standardised counselling protocols before any prescription, ensuring patients understand what they're taking, the risks, and what happens after. Regular monitoring requirements, not just at the start but throughout treatment. Follow-up protocols for safe discontinuation.
Right now in India, increased affordability through generics is outpacing medical supervision and patient education. That's a dangerous gap that will have consequences we'll only see years from now.
Important questions to ask your doctor if you are recommended GLP-1 or if you are already taking -
1. How will you monitor my muscle mass and nutritional status, not just my weight?
2. What's the plan for ensuring I'm eating adequate protein and meeting nutritional needs while on this medication?
3. How long do you expect me to be on this? What's the plan for stopping?
4. What support will I have for building sustainable eating and movement habits during treatment?
5. How will we address the underlying factors that led to weight gain in the first place?
The bottom line
Patients should have clear information about what these drugs can and cannot do, along with proper medical supervision that goes beyond just tracking weight, looking at muscle mass, nutrition, and overall health. It’s also important to recognise that this is a medical intervention, not a lifestyle shortcut.
Responsible use means healthcare professionals addressing nutrition, activity, and long-term sustainability alongside the prescription.
Weight loss is only meaningful if it's sustainable and doesn't cost you your muscle mass, nutritional health, or relationship with food.
Your body deserves to be understood and nourished in ways that build lasting health, not just temporary weight loss.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.