Let’s take a break from politics this week and talk about something that will, at some stage, affect most of us, if not all — yet is rarely discussed in opinion columns.
We all know that many — I refrain from saying most — Indians start putting on weight after turning 35 or 40. And we also know that weight can contribute significantly to rising blood pressure and heart disease. Similarly, diabetes remains a huge issue for middle-aged people; in no other country have I seen successful and high-profile men discuss their sugar levels over glasses of Scotch at parties.
Indian doctors are aware of these problems and commonly offer the same advice to anyone over 40: give up smoking, start exercising, eat healthy food — and less of it. By now, doctors must know the spiel by heart, and patients, inured to the advice, let it go in one ear and out the other.
But here’s what we don’t realise: patients have accepted that they have a problem — they just don’t necessarily want to do what doctors suggest. Instead, they are increasingly turning to a new generation of drugs.
The second-largest selling branded medication in India is already Mounjaro, a rival to the better-known Ozempic — both hailed as miracle drugs. Even though it has only just been introduced in India, Mounjaro is flying off the shelves.
According to The Economist analysts at JPMorgan Chase, the Indian appetite for weight-loss drugs is so great that the market is expected to grow from $179 million in 2025 to $1.5 billion by 2030.
After years of (not) listening to doctors lecturing them about the dangers of obesity and the threats of diabetes and heart disease, Indians are finally doing something about it.
And no, it is not what the doctors have been recommending for decades.
Also read: ‘Fat-shamers are now Ozempic-shamers’ — new book takes on India’s weight-loss obsession
Indians’ affair with drugs
Indians have a complicated relationship with new drugs. When finasteride was introduced in the US as a proven arrester of male-pattern baldness in 1997, it was expected to do well in Indian market because of baldies like myself. However, while it has done reasonably okay thanks to affordable generic versions (sales are growing at around 6 per cent a year), it has not become the panacea for follically challenged Indians that many expected. I suspect most people don’t even know what it is.
Viagra, on the other hand, is the success story nobody dares talk about. The market is around $90 million a year and is expected to grow at 10 per cent annually because of cheaper Indian-made versions of the drug originally launched by Pfizer. But, of course, nobody admits to taking it and it is rarely discussed — though one measure of its popularity may be the decline in advertisements for ‘sexperts’ and other quacks.
Mounjaro is different. It outsold all versions of Viagra within months of being launched. Along with Ozempic, it is hailed as a wonder drug around the world, and there is only a tiny hint of embarrassment in admitting you take it, because its medical benefits are now so widely acknowledged. Besides significant weight loss, Mounjaro brings sugar levels down and may help fight heart disease, kidney problems and Alzheimer’s — and could even help people live longer.
The science behind these new drugs can be tedious to explain, but what you need to know is that they act on the body’s pleasure centres and create a sense of satiety much more quickly. So you can still eat delicious food — you just feel full sooner, and end up eating less.
Initially, it was believed that the other medical benefits were simply related to weight loss. But it now appears that these drugs may offer additional advantages that are independent of weight — and scientists are still researching those effects.
What’s behind the success
So why have these new drugs taken off so quickly in India? Part of the reason is prescriptions from doctors — but that alone cannot explain their success, given that most doctors tend to be cautious about prescribing new medicines.
Price is also a factor. Mounjaro can cost as little as one-third of the US price if you buy it in India. Manufacturers are actively targeting Asian markets because they want to avoid the class-action suits and “nuisance” litigation they fear in the US.
But mostly, the success of these drugs tells us something about the changing psyche of the Indian middle class. Though this is neither medically advisable nor strictly illegal, many consumers are self-prescribing and buying them on their own. There can be side effects — nausea, for instance — but people are willing to endure them for a couple of weeks until they subside.
I would like to say this surge is purely because we are becoming more health-conscious. And while that is certainly true, there is no denying that weight loss remains the most powerful driver of sales. The Indian middle class is getting fed up with being paunchy and plump.
And this is just the beginning. Two important developments are expected over the next couple of years.
First, the patent for Ozempic expires in India in early 2026. That means any Indian company can make its own version and sell it at a much lower price. Even though Ozempic is currently cheaper in India than in the West, it is still expensive. But once Indian manufacturers start producing it, cost will no longer be a major impediment to adoption.
The second development is the arrival of a pill that delivers the same effect. Right now, these drugs must be injected because the stomach would otherwise destroy their potency. But scientists seem sure that an oral version that stands up to the gut is coming. It may not be available next year, but it is almost certain to arrive the year after.
What does that mean for India? If a relatively inexpensive tablet that controls diabetes and offers a host of other benefits becomes widely available, its use will extend far beyond the weight-conscious upper middle class, and it could alter India’s public-health landscape.
A few months ago, when The Weight Loss Revolution — a book authored by Dr Ambrish Mithal, India’s leading endocrinologist, with writer-commentator Shivam Vij — was released, I anchored its launch discussion. The hall was packed with what might be described as the great and the good of Delhi (as well as some of the bold and beautiful). All of them were fascinated by the weight-loss aspect of the drugs.
But when Dr Mithal told them that, in the long run, weight loss may not be the main consequence of these medicines — that their other health benefits could outweigh the reductions in weight — they looked sceptical.
He was right, of course. The instant success of these drugs in India tells us how quickly the country is changing. And for once, the change is for the better.
Vir Sanghvi is a print and television journalist and talk show host. He tweets @virsanghvi. Views are personal.
(Edited by Prashant)