Published Feb 14, 2026 | 7:00 AM ⚊ Updated Feb 14, 2026 | 7:00 AM
What medical treatments actually work for obesity in India
Synopsis: In India, where 100 million people live with obesity and another 136 million hover in prediabetes territory, understanding what works beyond “eat less, move more” matters for both patients and doctors navigating a healthcare system that historically blamed individuals for a condition driven by biology.
When lifestyle modifications fail to produce sustained weight loss, medical interventions become necessary. Three categories exist: medications, bariatric surgery and endoscopic procedures. Each works through different biological mechanisms, carries different risks and suits different patient profiles.
In India, where 100 million people live with obesity and another 136 million hover in prediabetes territory, understanding what works beyond “eat less, move more” matters for both patients and doctors navigating a healthcare system that historically blamed individuals for a condition driven by biology.
The shift toward medical treatment reflects not defeat but recognition that obesity operates as a chronic disease requiring interventions matched to its biological reality. What’s available in India, how these treatments work and who qualifies for each determines whether people access care that actually addresses the problem.
“In India, these are the best available options. Tablet semaglutide is already available and was in use even before the newer molecules were introduced in March. We were prescribing it prior to that as well. Apart from semaglutide, liraglutide is also available under many brand names. Liraglutide comes in both tablet and injectable forms, with the injectable version being administered once daily. These medications have been in use for some time. Dulaglutide is another available injectable option. All of these drugs belong to the GLPs, but are distinct GLPs, such as dulaglutide and liraglutide” said Dr Vidya Tickoo, consultant endocrinologist and diabetologist at Yashoda Hospitals, Hyderabad.
The medication landscape in India shifted dramatically in late 2025 when Novo Nordisk launched semaglutide (marketed as Ozempic for diabetes and Wegovy for obesity) in December. Tirzepatide (Zepbound for weight management, Mounjaro for diabetes) followed, gaining approval from India’s Central Drugs Standard Control Organisation. Both drugs work as GLP-1 (glucagon-like peptide-1) receptor agonists, though tirzepatide adds a second mechanism through GIP (Glucose-dependent insulinotropic polypeptide) receptor activation.
These medications mimic the natural hormone GLP-1, which the gut releases after eating. The drugs slow gastric emptying, keeping people full longer. They signal the brain’s satiety centre to reduce appetite and hunger. They boost insulin secretion when glucose rises and curb glucagon, improving glucose control. For Indian patients carrying the “thin-fat” phenotype, where abdominal fat accumulates at lower body mass index, this mechanism addresses both obesity and the diabetes that often accompanies it.
Tirzepatide operates through dual pathways. It activates both GLP-1 and GIP receptors, enhancing insulin secretion, improving fat metabolism and amplifying satiety beyond what single GLP-1 agonists achieve. Clinical trials show these drugs produce 15 to 20 percent weight loss when combined with lifestyle modifications, far exceeding the 5 to 10 percent that diet and exercise alone typically deliver.
Indian trials confirmed effectiveness in local populations. Studies showed haemoglobin A1c drops of 1 to 1.5 percent and weight loss of 3 to 4 kilograms. Real-world data from 196 Indian patients confirmed tolerability despite transient nausea, with daily liraglutide showing superior compliance compared to twice-daily exenatide. The drugs address a critical overlap: 65 million Indians carry both type 2 diabetes and obesity.
“We no longer use orlistat. Honestly, we no longer use anything else except liraglutide and dulaglutide. Tablet semaglutide was something that I had been using. I have used a lot of it before these molecules came,” Dr Tickoo said.
Orlistat, the older option, works through a completely different mechanism. It blocks pancreatic lipase, the enzyme that digests dietary fat. Undigested fat passes through the gut unabsorbed, reducing calorie intake by 30 percent from fats. But it requires strict adherence to a low-fat diet to avoid gastrointestinal side effects including oily stools and flatulence. Clinical use has declined as GLP-1s proved more effective and better tolerated.
Other drugs approved internationally remain unavailable or limited in India. Qsymia (phentermine-topiramate) combines a stimulant that suppresses appetite with an anticonvulsant that enhances satiety, achieving 7 to 11 percent average weight loss. Contrave (naltrexone-bupropion) targets brain reward centres to curb cravings, yielding 5 to 9 percent loss. Neither drug is widely marketed in India. Phentermine alone exists as a short-term option under regulation but sees limited use.
The government’s Production Linked Incentive scheme launching this year aims to boost local production of GLP-1 medications for improved affordability. Indian pharmaceutical companies prepare for generic semaglutide production as patent exclusivity expires in 2026 across multiple countries including India. This could reshape access, bringing prices down for medications that currently require continuous use to maintain weight loss.
Emerging drugs including orforglipron, an oral non-peptide GLP-1 agonist awaiting approval, and retatrutide, a triple agonist activating GLP-1, GIP and glucagon receptors, represent the next wave. Retatrutide shows higher potential weight loss in late-stage trials through enhanced energy expenditure and fat burning, but approval remains pending.
“Bariatric surgery has its own patient population. It is indicated when the BMI is more than 35 without comorbidities, or if the BMI is more than 30 with comorbidities. The percentage of weight reduction for some bariatric procedures is much higher than with medicines. With some procedures, it is around 35 percent, which we do not yet achieve with medicines. So efficacy wise, bariatric surgeries are better. Durability wise, bariatric surgeries are better,” Dr Tickoo said.
In India, bariatric surgery guidelines recommend intervention at BMI of 37.5 or higher, slightly more conservative than international standards. The main procedures alter the stomach and sometimes the intestine to reduce food intake and change gut hormone production.
Sleeve gastrectomy removes 70 to 80 percent of the stomach, reducing the hunger hormone ghrelin and creating a smaller stomach capacity. It produces 50 to 70 percent excess weight loss and has become the most common bariatric procedure in India.
Roux-en-Y gastric bypass creates a small stomach pouch and bypasses part of the small intestine, combining restriction with malabsorption. It delivers 60 to 75 percent excess weight loss and shows strong metabolic impact on diabetes, sometimes allowing patients to reduce or stop medications.
Mini gastric bypass offers a simpler variation with a single intestinal connection, proving effective for both diabetes and severe obesity. Biliopancreatic diversion with duodenal switch represents the most powerful weight loss surgery, combining sleeve gastrectomy with major intestinal bypass, but carries higher nutritional deficiency risk and is reserved for very severe obesity.
“These molecules have to be taken continuously, but the effects of bariatric surgery generally last for 10 to 15 years, and sometimes longer if the patient follows lifestyle modifications. That is why bariatric surgery is more efficacious and more durable than medicine,” Dr Tickoo explained.
Surgery requires commitment. “Of course, every patient is apprehensive about going under the knife. The complications associated with surgery, although not very common, are still a concern. Surgeries are generally very good and very safe, but the apprehension regarding surgery is present in all of us. That is the main issue, nothing apart from that,” she said.
Cost and availability restrict access. Surgery requires infrastructure, trained surgeons and post-operative support systems that remain concentrated in urban centres. Most patients who might benefit from surgery never access it, leaving medications as the primary scalable intervention.
Less invasive options exist between medications and surgery. Intragastric balloon placement involves inserting a balloon into the stomach via endoscope and filling it with saline. The balloon occupies space, reducing intake. It remains temporary, removed after 6 to 12 months, and produces moderate weight loss.
Endoscopic sleeve gastroplasty uses internal sutures to reduce stomach size without removing tissue. Performed as a day-care procedure in many centres, it delivers less weight loss than surgical sleeve gastrectomy but avoids the irreversibility and higher risk of surgery.
These procedures fill a gap for patients with moderate obesity who don’t qualify for or don’t want major surgery, but they remain less available than either medications or bariatric surgery in India’s healthcare landscape.
A critical distinction separates metabolic interventions from cosmetic procedures. “Liposuction is not correct in this context. Liposuction is a cosmetic procedure. When we talk about medications or bariatric surgery, these are metabolic interventions. They are not for cosmetic purposes. They are for disease benefit and improvement in health. Liposuction does not offer any metabolic advantage. It is only cosmetic,” Dr Tickoo said.
Liposuction removes subcutaneous fat from specific areas but does not affect appetite, hormones or metabolic health. “Liposuction will remove fat from those particular areas. It will not completely reduce obesity. The obesity does not go down overall. Liposuction will remove that fat, but it will not remove visceral fat. It will not provide any metabolic benefit,” she explained.
This distinction matters in India, where cosmetic procedures are marketed alongside medical obesity treatments, creating confusion about what actually addresses the disease versus what changes appearance.
(Edited by Sumavarsha)
