GLP1-RA and Weight Loss Boom in India – Trends, Concerns and Caution – Dr. Amit Bhargava, Dr. Varsha Narayanan

Abstract

Glucagon-like peptide-1 receptor agonist (GLP1-RA) semaglutide and tirzepatide are becoming commonly prescribed medicines for weight loss with even semaglutide generics now available in India. With the boom in weight loss agents’ market, it is important to be cautious of risks involved and avoid indiscriminate use. Diet and lifestyle modification should always be the first approach and individualised prescribing decisions after thorough evaluation of patient fitment and risks, along with regular and meticulous monitoring for adverse effects is pertinent for these drugs. Ready availability of these drugs without prescriptions or medical consultations in pharmacies and online platforms needs curbing. Launch of OTC oral GLP1-RA as health supplement without published clinical data or adequate safety evaluation is highly concerning.

Keywords: GLP1-RA, Diet, Nutrition, Physical training, Weight loss, Obesity, Semaglutide, Tirzepatide, Korglutide

Introduction

Our editorial in November 2025, discussed Glucagon-like peptide-1 receptor agonist (GLP1-RA) drugs semaglutide and tirzepatide in detail, used in both type 2 diabetes and weight management, mimicking the body’s natural GLP1 hormone. In India, among GLP1-RA for weight loss, as on 2025 there were mainly 2 approved branded innovator drugs as injections at high price: Semaglutide (Wegovy) and Tirzepatide (Mounjaro), a dual GLP1 and GIP receptor agonist. However, with patent expiry for semaglutide in 2026, a number of generics have entered the fray. Anticipating the same, the innovator brands themselves reduced prices significantly, making these injections far more accessible to the general public. World Obesity Day is observed on March 4^th and this is an apt time to address this weight loss market boom and associated concerns.

The mechanism of action of these drugs involves enhancing glucose-dependent insulin secretion from the pancreas, slowing gastric emptying, decreasing appetite, increasing satiety, reducing food cravings and reducing glucagon release, all contributing to weigh loss.^1,2  For weight loss, the approved GLP1-RAs are indicated for adults who have obesity (body mass index [BMI] of 30 kg/m² or greater) or are overweight (BMI of 27 kg/m² or greater) with at least one weight-related health condition like high blood pressure, type 2 diabetes, high cholesterol or obstructive sleep apnea. These drugs can help lose 5-10% of body weight or more, over a year and may also help lower the risk of major adverse cardiovascular events (MACE), Acute MI, stroke or cardiovascular-related death), chronic kidney disease (CKD) along with weight loss.^3,4

Currently there is no oral GLP1-RA approved in India for weight loss. As of early 2026 in India, Semaglutide (Rybelsus), an oral GLP-1RA is approved only for managing type 2 diabetes. However, its potential for off-label or indiscriminate use for weight loss in non-diabetics needs vigilance and caution. Additionally, Korglutide, a GLP1 and IGF1-RA has been concerningly approved for the Indian market as an oral functional food supplement for weight loss without any peer-reviewed evidence.

Prescribing Decision Concerns

Studies have shown weight loss between 13-20% over 12-18 months with semaglutide and tirzepatide.^5,6 Monitoring adverse effects and potential risks are very important. They include (a) GI side-effects (most common), (b) renal dysfunction, (c) restricting use in patients with severe gastroparesis and/or history of pancreatitis and/or gallbladder disease, (d) risk factors for colorectal cancer. Regular ophthalmic retina screening, vigilance for muscle loss (sarcopenia) and psychiatric effects are also necessary.

Therefore, there are clearly risks involved and these 2 medicines should not become indiscriminate first line weight-loss agents as a ‘one size fits all’ measure.⁷ This is the biggest concern perceived with this market boom, that anyone wanting to lose weight will access these agents. Individualised prescribing decisions after thorough evaluation of patient fitment by approved indication, risks, lifestyle and diet should always be the way to go along with regular and meticulous monitoring for adverse effects. Ready availability of these drugs without prescriptions or medical consultations in pharmacies and online platforms often marketed as miracle weight-loss solutions should be strictly curbed and stopped. Indiscriminate use will lead to greater occurrences of side-effects and their publicity amongst patient-groups & public, leading to genuine patients shunning these medicines.⁸ For those without diabetes or not having high BMI and comorbidities, who still want to lose weight for personal or professional reasons, lifestyle modification with supervised healthy diets and physical exercise are always the most appropriate. For those patients who qualify for a GLP1-RA based on approved indications, the following priorities need to be included in their management⁹:

• Patient-centred initiation with weight loss/ health goals.
• Baseline screening including (a) usual dietary habits, (b) emotional triggers, (c) cravings and (d) all associated relevant medical conditions.
• Comprehensive examination including (a) muscle strength, (b) muscle function and (c) body composition assessment.
• Lifestyle assessment including (a) aerobic activity, (b) strength training, (c) sleep, (d) mental stress, (c) substance use, (d) social connect and (e) health determinants.

During GLP-1 use, apart from strict monitoring and vigilance for adverse effects as mentioned, nutritional counselling, preventing nutrient deficiencies, preserving muscle and bone mass through resistance training with diet and connecting to support groups and digital platforms are also important to improve compliance as well as long-term weight maintenance post-cessation.

The role of exercise is often underplayed and direct comparisons reveal that though GLP-1RAs generally produce greater short-term weight loss than exercise alone, exercise is superior for maintaining lean mass and cardiorespiratory fitness and reducing risk of cardiovascular disease and atherosclerosis.¹⁰ Body weight and body composition are maintained one year after termination of supervised exercise, in contrast to weight regain after termination of treatment with obesity pharmacotherapy alone.¹¹ Weight management should prioritise integrated approaches that combine pharmacotherapy with lifestyle interventions and exercises rather than replacing lifestyle changes with medication alone.

New OTC Agent Raising Concern

Korglutide, (company – Cargen, South Korea) a GLP1 and IGF1 RA has entered the Indian market as a functional food supplement for weight loss, intended to be sold as an over-the-counter (OTC) oral product as a powder (mixing the contents of one sachet with approximate 100mL water and consumed at any time of day, with or without meals).¹² A 12-week clinical trial conducted in India with 100 participants, though registered on CTRI, has not been peer-reviewed & published anywhere with the results only reported in news releases and industry media.¹³  The pharmaceutical industry has raised concerns over the study, its claims and data and approval of korglutide¹⁴:

• The company noted that the results were only “partially disclosed” and has not announced plans for formal publication in a peer-reviewed international journal.
• In obesity drug clinical trials, high accuracy dual-energy X-ray absorptiometry (DEXA) is employed to enhance the accuracy of body composition analysis and differences in density of fat, muscle and bone. On the other hand, korglutide study used bioelectrical impedance analysis (BIA) equipment, similar to body fat measurement devices commonly seen in gyms, that can generate errors based on hydration levels or meals, leading to limitations in accuracy.
• The design of the study also raises concerns, as the sample size is only 100 patients and the study is 12 weeks, rather than 6 months, 1 year or beyond as seen with the approved GLP1-RA drugs. Therefore, long-term efficacy maintenance, plateauing or reduction of effects has not been evaluated nor has weight gain studied after stopping korglutide.
• There is lack of adequate and long-term safety data which is a crucial point for a GLP1-RA. In fact, no adverse effects data has been published anywhere. Compliance issues or withdrawal due to gastrointestinal or other side effects has also not been addressed.
• For weight loss effects >5% drug approval is recommended but still korglutide is approved as a health functional food with the company stating that the regulatory barriers for health functional foods are lower than for pharmaceuticals, making market entry easier. This “quick-to-market” approach by by-passing a rigid scientific review makes one wonder at the intent of the company’s Indian partner as well as at the molecule itself.
• Furthermore, it claims that even as a health functional food, korglutide has higher efficacy and safety than existing obesity drugs, making it competitive but if that is indeed the claim, it should not be categorised as a health functional food.
• The bottom line unequivocally remains that no drug or supplement can be granted approval without adequate studies and their publication in peer-reviewed journals of significant repute.

Conclusion

The weight loss market of India is booming and GLP1-RA semaglutide and tirzepatide are becoming commonly prescribed medicines for weight loss with even semaglutide generics now available in India. However, it is important to be cautious of risks involved and prescribe these drugs only in their approved indication. Diet and lifestyle modification should always be the first and concomitant approach. Prescribing decisions should be patient-specific after thorough evaluation of fitment, history, clinical assessment and risks, along with regular and meticulous monitoring for adverse effects. Availability of these drugs without prescriptions or medical consultations in pharmacies and online platforms needs urgent curbing. Launch of OTC oral GLP1-RA as health supplement without published clinical data or adequate safety evaluation is highly concerning and this needs to be jointly addressed by the health authorities and medical professional organisations. Even with the data, long-term real-world studies have clearly shown that serious adverse events can occur and therefore as of now, it is not appropriate for any GLP1-RA should be an OTC or have supplement status.

References

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¹Medical Affairs Consultant and Family Physician, Holistic Evidence-based Advice, Research and Treatment (H.E.A.R.T), Mumbai

Corresponding author: ²Chief Editor, The Indian Practitioner and Medical Director, Dr Varsha’s Health Solutions, Mumbai. Email: info@drvarsha.com