Diabetic drugs show promise for weight loss, but remain costly and limited in India

A class of diabetes medications is quietly reshaping how doctors think about weight loss. GLP1 receptor agonists and SGLT2 inhibitors, developed to help manage blood sugar, are proving remarkably effective at something else entirely: making people shed pounds. The mechanism is straightforward enough. These drugs work by removing glucose from the body through urine, which means calories leave the system without being absorbed. But the real power lies in how they work on the brain itself. Semaglutide, marketed as Wegovy by pharmaceutical company Novo Nordisk and approved by the FDA, acts on appetite centers in the brain, creating a sustained feeling of fullness while slowing the rate at which the stomach empties food into the intestines. The drug is injected once weekly and requires long-term use. Clinical trials have shown it to be safe, with side effects that are typically mild and fade shortly after treatment begins.

The global enthusiasm for these medications has become impossible to ignore. Elon Musk, the world's richest person and recent owner of Twitter, publicly credited Wegovy with helping him lose more than 13 kilograms. His endorsement crystallized what doctors and researchers have been observing: diabetic drugs are being repurposed for weight loss among people who do not have diabetes at all. Beyond weight reduction, these medications offer additional benefits that extend their appeal. GLP1 receptor agonists and SGLT2 inhibitors both provide cardiovascular protection, reducing the risk of heart attacks and strokes. SGLT2 inhibitors specifically help prevent heart failure and have become so effective that cardiologists now prescribe them as a first-line treatment even to patients without diabetes.

Metformin, a biguanide-class drug that has been the backbone of type 2 diabetes treatment for decades, also contributes to weight loss through its effects on the brain's appetite centers and the gastrointestinal tract's ability to absorb carbohydrates. Liraglutide, another GLP1 receptor agonist, has been approved in countries like the United States specifically for weight loss in non-diabetic patients. The evidence supporting these drugs is substantial and growing. Yet India presents a starkly different picture. The country currently has only one approved weight loss medication available, and it operates through an entirely different mechanism—blocking fat absorption in the intestines. The problem is that this drug is mild, helping patients lose only about 4 percent of their body weight. None of the SGLT2 inhibitors have received approval for weight loss in India. The GLP1 receptor agonists that have shown such promise globally remain largely inaccessible to Indian patients.

Cost is the primary barrier. Dr. Brij Mohan, a senior diabetologist and president of the Research Society for the Study of Diabetes in India, and Dr. Somashekara Reddy, a consultant in diabetology and endocrinology at Fortis Hospitals in Bangalore, both emphasized that these drug classes are prohibitively expensive for most Indians. The medications that have transformed weight loss treatment in wealthy countries remain beyond the reach of ordinary people in India. This creates a widening gap in treatment options. While patients in the United States and Europe can access highly effective GLP1 and SGLT2 medications for weight loss, Indian patients are limited to a single, modestly effective option. The regulatory approval process has not kept pace with the clinical evidence, and the cost structure makes even approved medications inaccessible to the vast majority of the population. As off-label use of diabetic drugs for weight loss accelerates globally, India faces both a regulatory challenge and an equity problem—the very medications that could help millions manage obesity remain locked behind price barriers and approval gaps.