Experts provided comprehensive insights into three drugs reshaping longevity medicine: Metformin, semaglutide, and tirzepatide.
Published Nov 13, 2025 | 8:00 AM ⚊ Updated Nov 13, 2025 | 8:00 AM
Dakshin Health Summit panel on Skin Health & Ageing.
Synopsis: Experts declared at the Dakshin Health Summit that obesity treatments will dominate medical priorities for the next half-century, whilst clarifying that the 50-year-old blockbuster drug metformin remains indispensable.
In a prediction about the future of medicine, experts declared at the second edition of South First‘s Dakshin Health Summit that obesity treatments — particularly GLP-1 agonists — will dominate medical priorities for the next half-century, whilst clarifying that the 50-year-old blockbuster drug metformin remains indispensable.
The second edition of the Dakshin Health Summit 2025 was held at the Asian Institute of Gastroenterology in Hyderabad on Sunday, 9 November.
At the panel discussion on ‘Skin Health & Ageing’ held at the Asian Institute of Gastroenterology (AIG), Gachibowli, on Sunday, Dr Lakshmi Lavanya, an Endocrinologist and Diabetologist from Hyderabad, provided comprehensive insights into three drugs reshaping longevity medicine: Metformin, semaglutide, and tirzepatide.
Dr Malavika Kohli, Senior Dermatologist and Director of Skin Secrets, Mumbai, who moderated the discussion, posed the central question: “Do you think the storm around semaglutide and the torrential use of tirzepatide have pushed metformin into the background? Has it been minimised? Or do you still use metformin just as much and believe in it just as strongly?”
Dr Lavanya was unequivocal about metformin’s continuing dominance.
“Metformin is the first-line medication for diabetes, prediabetes, PCOD, and insulin resistance — no matter what the situation is. After lifestyle changes, metformin at its highest dose (2,000 mg per day) is used across all ages. It can be started from age three, continued pre-pregnancy, during prenatal care, throughout pregnancy until the last trimester, and even during lactation. It’s been a blockbuster molecule — a biguanide insulin sensitiser — for more than 50 years.”
She emphasised its enduring importance: “Metformin remains a blockbuster, and it’s not going anywhere.”
Dr Lavanya distinguished the newer medications’ specific indications: “Now, semaglutide and tirzepatide, at higher doses, have newer indications. I’ve been a PI on several GLP-1 trials for the last 15 years, but their current marketed indications are only from the last two to three years.”
“The dual agonist — GIP + GLP-1 (tirzepatide) — and high-dose semaglutide are approved specifically for non-diabetic obesity: BMI above 25 with one comorbidity, or BMI above 30 with no comorbidities or diabetes. This is purely for obesity—that distinction is very clear,” she added.
She acknowledged the complexity in clinical practice: “Where the lines begin to blur is when a patient has multiple overlapping issues: insulin resistance, PCOD, obesity, but no diabetes. In those cases, you can use both. Start with lifestyle modification. Add metformin. Add tirzepatide if needed. Increase the dose gradually. Explain all the pros and cons. Monitor closely. Counsel carefully. Follow up rigorously.”
Dr Lavanya outlined the cascading benefits of these medications: “Because weight loss is a huge advantage for these patients, and prevents everything that comes along with obesity. This is one class of medications that can eliminate the need for many others.”
“They can reduce or eliminate treatment for hypertension, hyperlipidemia, prediabetes, arthritis pain, sleep apnea (even the CPAP machine), PCOD treatment burdens, hypogonadism, and infertility treatments — the whole lot. When the weight goes, so much else goes with it.”
She positioned GLP-1 agonists carefully: “So GLP-1 agonists have a very high, very important place—as long as the patient deserves it and can afford it.”
Dr Lavanya provided a practical example: “Take a young 21-year-old woman with full-blown PCOD — oligomenorrhea, hyperandrogenism — referred by a dermatologist because of severe insulin resistance. I would start her on a high dose of metformin, plus a good anti-androgen OCP, and ask her to comply with dermatology treatment and lifestyle modification. But if her BMI is above 25, then I would add a GLP-1 agonist too—because that one medication can potentially clear up the entire problem in one go.”
When Dr Kohli asked whether GLP-1 doses should be lower when combined with metformin, Dr Lavanya clarified: “No, not necessarily. It’s pre-approved for chronic weight management and for long-term or even lifetime use. The dose is not restricted just because the patient is taking metformin.”
“As long as there’s no contraindication—and this is supported by researchers, experts, and guidelines—the dose is essentially open-ended. Safety has to be monitored by the prescribing doctor, and the final judgment call also involves the patient,” she added.
Dr Lavanya presented the clinical evidence: “The data show around 22 percent weight loss with tirzepatide and around 16 percent with semaglutide when used over roughly two to three years in pivotal trials. But once you stop the medication, about 50 percent of the lost weight tends to come back.”
She explained the mechanism: “These drugs act on the hypothalamic pathways that control liking of food, portion size, satiety, and hypothalamic insulin resistance. They block the response of the arcuate nucleus, which is why people eat less.”
The challenge of discontinuation was stark: “Stopping them becomes challenging unless there’s an internal transformation in the patient—real maturity, willpower, sustainability, and a high level of personal commitment. Otherwise, once you stop, the weight will come back. That’s why there is evidence supporting chronic, long-term use for weight management.”
Dr Maya Vedamurthy, Senior Dermatologist and Director of RSV Skin Clinic, Chennai, noted: “I think this is a dual agonist, and a triple agonist is coming up. That will probably be even better.”
Dr Lavanya confirmed: “There’s an entire pipeline of new GIP/GLP-1 agonists coming.”
Dr Lavanya made a sobering prediction about humanity’s trajectory: “The next 50 years of medical evolution will revolve around GLP-1 drugs. Researchers have predicted what humankind is becoming—a chair-bound species, sitting in front of computers, eating more because our minds are wired from thousands of years ago to like food, to seek food. The body doesn’t want to move, but the mind still wants to eat. So obesity, prediabetes, and insulin resistance are rising sharply.”
She drew a historical parallel: “Just like people once died of typhoid or cholera or smallpox, in future the biggest killer will be obesity. So obesity treatments will be at the top of medical priorities now.”
Throughout the discussion, Dr Lavanya emphasised careful patient selection: “So you have to choose the right patient, and the patient has to decide: when to start, how long to continue, and when to stop. Because stopping it usually leads to weight regain—even with diet and exercise.”
(Edited by Muhammed Fazil.)
