Published Feb 15, 2026 | 7:00 AM ⚊ Updated Feb 15, 2026 | 7:00 AM
Even with intensive behavioural therapy, 35 to 50 percent of patients fail to lose 5 percent or more within months.
Synopsis: If you lose weight through strict dieting and regain it within months, it is often not a failure of willpower. The body responds to weight loss by increasing hunger and slowing metabolism to defend its weight. In India, treatment has long relied on advice to eat less and move more, but studies show most people lose only five to 10 percent of body weight and struggle to maintain it. Newer drugs such as GLP-1 receptor agonists aim to counter this biological resistance.
If you follow a strict regime of diet and exercise for three months and manage to shed 8 kilograms, chances are that within a few months you will gain back 10 kilograms. This can feel like failure. But it is not. It is how the human body works.
For decades, obesity treatment in India followed the same advice: eat less, move more. Doctors handed out pre-printed diet charts. Patients tried to follow them. When most regained the lost weight, it was put down to a lack of willpower. But the barrier is biological.
The push to develop the recently arrived weight-loss drugs came from this reality: lifestyle changes alone produce modest, unsustainable results for most people because the body’s regulatory systems actively resist sustained weight loss.
Studies tracking thousands of people on intensive lifestyle management show that diet and exercise alone usually lead to weight loss of only 5 to 7 percent of body weight.
Even with intensive behavioural therapy, 35 to 50 percent of patients fail to lose 5 percent or more within months.
“Weight loss medications are usually considered when lifestyle measures alone are not enough,” Dr Sundara Raman, Diabetologist and Internal Medicine Specialist at SIMS Hospitals, Chennai, told South First.
“It is also difficult for most people to consistently follow strict diet plans and exercise routines over a long period.”
When a person loses weight through lifestyle changes, the body undergoes metabolic adaptation.
“Hunger hormones increase, satiety hormones decrease, and metabolism slows down. The body starts to read this as a threat,” said Dr Vidya Tickoo, Consultant Endocrinologist and Diabetologist at Yashoda Hospitals, Hyderabad.
The basal metabolic rate, which determines how the body uses energy, resets to a lower level, Dr Raman said.
“Because of this, further weight loss becomes difficult, and maintaining it becomes harder. This is why medications are often needed in addition to diet and exercise,” he added.
This is a natural protective mechanism that evolved over thousands of years.
“Our genes developed over centuries during periods of starvation. The body is programmed to conserve energy. If food intake suddenly drops, hunger increases and metabolism slows to conserve energy. You feel hungrier, so you look for food. Counter-regulatory hormones rise because the body assumes food is scarce,” Dr Tickoo explained.
That response made evolutionary sense. Humans who conserved energy during scarcity survived and passed those genes on. Today, in a food-rich environment saturated with calorie-dense options, the same survival mechanism is a hindrance.
“Because of this, sustaining weight loss is always challenging. Losing weight is relatively easy, but maintaining it has always been difficult. When someone relies only on lifestyle modification, they usually cannot maintain the loss and regain the weight,” Dr Tickoo said.
In India, obesity treatment historically relied on lifestyle changes, medical nutrition therapy and behavioural interventions.
But implementation failed. Pre-printed diet charts and generic advice ignored regional diets, festivals and urban sedentariness. Medical nutrition therapy faltered because patients paid out of pocket, trained nutritionists were scarce, and plans were not individualised.
More than 100 million Indians now live with obesity, and another 136 million are in the prediabetes range.
The genetic “thin-fat” phenotype common among Indians—high abdominal fat at a lower body mass index—meant standard weight-loss approaches missed the core metabolic risk. Abdominal obesity reached 23.7 percent despite lower BMI cut-offs for Asian populations.
These failures unfolded within a healthcare system without insurance cover for obesity treatment and with unstructured care that frustrated both patients and doctors. Projections estimate that 11 percent of Indian adults will be obese by 2035. National Family Health Survey data show that 20 to 36 percent of adults are already overweight or obese.
“The maximum weight loss is usually seen with bariatric surgery, where individuals can lose about 15 to 30 percent of their body weight. In some cases, people with diabetes are even able to reduce or stop their medications after surgery,” Dr Sundara Raman said.
“However, bariatric surgery is generally recommended only for individuals with severe obesity, particularly those with a body mass index above 35, and not everyone is willing to undergo surgery.”
Furthermore, cost and availability restrict access to bariatric surgery for most patients who might benefit.
Pharmacotherapy increases weight loss to 15 to 20 percent with GLP-1 receptor agonists and helps sustain it when combined with lifestyle changes.
“Newer weight loss medications, especially GLP-1 receptor agonists, work by acting on the satiety centre in the brain, making a person feel full and reducing food intake. These medications also improve insulin secretion and reduce glucose levels, which help achieve sustained weight reduction,” Dr Sundara Raman explained.
GLP-1–based therapies increase insulin release only when glucose rises, which avoids hypoglycaemia. They reduce appetite and slow gastric emptying. For Indian patients with central obesity and early beta-cell stress, this matters because it targets both excess weight and glucose control. The drugs align treatment with how obesity and diabetes behave in Indian bodies.
“So why does a person require a drug for obesity, particularly in today’s time? The reason a drug becomes necessary is that lifestyle modification, historically, has not shown very good success rates. Sustained weight loss is usually difficult through lifestyle modification alone,” Dr Tickoo said.
“That is where interventions come in, and that is where drugs come in. These drugs act on the body’s set point and hunger centres. Once that happens, those counter-regulatory mechanisms do not dominate in the same way.”
GLP-1 agonists, including exenatide, liraglutide and semaglutide, emerged from diabetes trials and later gained approval in India for obesity treatment. Indian trials showed haemoglobin A1c drops of 1 to 1.5 percent and weight loss of 3 to 4 kilograms.
The drugs address the overlap between type 2 diabetes and obesity, which affects 65 million Indians.
The Union government’s Production Linked Incentive scheme, set to launch in 2026, aims to boost local production of these medications to improve affordability.
(Edited by Dese Gowda)
