Midday Explains | Weight-loss drugs, diet fads, viral trends: Are they worth it for weight management? Experts answer

If you've ever tried to lose weight, there's a good chance you might have heard about weight-loss drugs like semaglutide (Ozempic) and tirzepatide or stumbled upon viral diet trends on social media. There is a lot of weight loss advice on the Internet. Not all of it is proven. Not all of it is suitable for everyone.

As pills offering quick weight loss solutions flood the market and new diet trends that can significantly alter your eating habits emerge every few days, navigating one's weight loss journey can become a complex process, sometimes even leading people to fall into ineffective and harmful traps.

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According to the World Health Organisation (WHO), 2.5 billion adults worldwide were overweight in 2022. Of these, 890 million were living with obesity, which translates to 1 in 8 people in the world living with obesity.

Weight loss aspirations can range from a lifestyle choice to a serious medical necessity for managing chronic diseases. Hence, it becomes important to follow proven methods and advice from medical experts to navigate the journey.
We speak to experts to determine the effectiveness and side effects of weight-loss drugs and bust myths about viral dieting advice.

Are weight-loss drugs worth it?

While Ozempic, originally meant for treating type 2 diabetes, has been a buzzword for a good part of 2023 and 2024 for its weight loss benefits, other drugs like tirzepatide are also gaining traction for the same purpose. In July this year, India gave the initial nod to tirzepatide being marketed and sold in India for type 2 diabetes treatment. Its weight loss effects are still under review.

Dr. Aparna Govil Bhasker, Consultant Bariatric and Laparoscopic Surgeon, MetaHeal- Laparoscopy and Bariatric Surgery Center, Mumbai, Saifee, Apollo and Namaha Hospitals, Mumbai, Dr. Rajiv Kovil, Head of Diabetology, Zandra Healthcare and Co-founder of Rang De Neela initiative and Dr. Sonali Kagne, Consultant - Endocrinology, Sir HN Reliance Hospital, Mumbai, shed light on the functioning, benefits and side-effects of weight-loss drugs.

How does tirzepatide drug work on weight loss?

Bhasker: Tirzepatide works by mimicking two natural hormones in the body, GLP-1 and GIP, which help control blood sugar. This drug is sometimes referred to as a "twincretin". By activating the receptors for these hormones, tirzepatide helps the body release insulin more effectively and reduces the release of another hormone called glucagon. This improves the body's ability to manage blood sugar levels. Additionally, it slows down how quickly the stomach empties and increases feelings of fullness and satiety after eating, which can lead to reduced food intake and subsequent weight loss.

Govil: Tirzepatide, which is a twincretin, recently got a DCGI approval to be marketed in India for diabetes based on its Surpass group of studies. It also has another group of studies called Surmount, based on which it has got an indication for obesity also in many countries, including the US.

So, these drugs, the whole class of drugs, which are called GLP 1, at smaller dosages they work as a anti-diabetes or ant- hyperglycemic drugs and at slightly higher dosages they work for weight loss. They have multiple mechanisms of action.

One is that they secrete insulin only in the presence of nutrition in the stomach, so there is no low sugar. Two, it makes the gastric emptying or the movement of the stomach slightly slower, so, satiety is faster. It also works on the brain and satiety for food is lesser and you feel satisfied with food at lesser sugar or amount of food or what is actually required for you. So that's how all these drugs work on diabetes as well as weight loss.

Kagne: Tirzepatide is a dual glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP) receptor agonist (dual agonist). It was originally developed to improve blood sugar control in people with type 2 diabetes. These drugs mimic the action of GLP-1, a hormone that helps regulate blood sugar levels by enhancing insulin secretion and inhibiting glucagon release. However, they also have significant effects on weight loss, primarily through the following mechanisms:

• Appetite Suppression: GLP-1 receptor agonists slow down gastric emptying and promote a feeling of fullness (satiety), which reduces overall food intake.
• Reduced Food Cravings: These drugs stimulate areas of the brain that control appetite and reward, leading to reduced cravings for high-calorie foods.

Are drugs like tirzepatide and semaglutide (Ozempic) safe for weight loss? Do they pose any harms/side-effects?

Bhasker: Tirzepatide can primarily cause gastro-intestinal side effects like stomach pain, constipation, decreased appetite, diarrhoea, nausea, and vomiting. Other less common side effects include heartburn, rapid heart rate, fever, swelling of the face, and itchy or red skin.

People who are already taking similar medications (like liraglutide or semaglutide) must avoid taking this drug. People at risk for certain thyroid cancers or with a history of specific endocrine tumours (multiple endocrine neoplasia syndrome type 2) must avoid this drug, because it might increase the risk of developing these cancers.

Kovil: Tirzipatide and semaglutide have gone through a lot of studies. And there's a lot of robustness of data and pharmacovigilance on both these molecules, which are blockbuster globally. There is no signal of any significant harm or side effects. GLP 1 works by reducing the movement of the stomach. So you're bound to have some upper GI side effects like nausea, vomiting, diarrhea. There used to be a theoretical risk of pancreatic pancreatitis, which has not been seen in the Sustain, Pioneer, Step, Surpass and Surmount studies of both these molecules.

Kagne: Using semaglutide and tirzepatide for weight loss has shown promising results in clinical trials, with many patients achieving significant weight reduction. Both molecules are now approved for weight loss in individuals without underlying diabetes mellitus. However, the decision to use these drugs solely for weight loss should be made carefully, considering the following points:

• Eligibility: Not everyone is a suitable candidate for these medications. They are typically recommended for individuals with a body mass Index (BMI) over 30, or over 27 with weight-related comorbidities, such as hypertension or dyslipidemia.

• Side effects: Common side effects include nausea, vomiting, diarrhea, and constipation. In some cases, patients may experience more serious side effects like pancreatitis or gall bladder disease.

• Medical supervision: Timely guidance of a healthcare professional is essential.

• Long-term use: The long-term safety and effectiveness of these drugs for weight loss are still being studied. Continuous monitoring is essential to assess potential risks and benefits

Are these drugs a magical solution for weight loss?

Bhasker: There are no magical solutions for chronic conditions like obesity, but these drugs offer significant hope. They can be very effective for managing weight in patients with grade 1 and grade 2 obesity and can even help maintain weight loss after bariatric surgery in patients with very severe obesity. While they don't guarantee success for everyone, many people find them beneficial. It's important to remember that results can vary, and what works for one person might not work for another.

Kovil: Drugs can never be a magic solution for weight loss. Weight loss requires a lot of cognitive behavioural change. It requires a very motivated person who follows strict lifestyle changes, which includes timing of meal, type of meal, nutrition of meal along with a lot of exercise. The lifestyle as well as cognitive behavioural change continue to remain the cornerstones for weight loss, but supplementary drugs are going to be required and pharmacotherapy gives a helping hand to the lifestyle measures. We treat many other chronic disorders like diabetes, blood pressure and cholesterol abnormalities, where lifestyle remains the cornerstone of treatment and drugs are added on. Similarly, obesity is a disorder. Lifestyle will remain the cornerstone of treatment, but drugs and pharmacotherapy will be required for long term.

What treatment options and lifestyle changes are advisable for weight loss and battling obesity?

Bhasker: Obesity, like diabetes, hypertension, heart disease, and cancer, is a chronic progressive condition. The treatment depends on the stage and severity of the disease. Prevention is ideal, but medical help is necessary for those already above a certain weight.

For someone who is overweight, supervised dietary changes and lifestyle modifications may be sufficient. For individuals with grade 1 and grade 2 obesity, treatment might include a combination of diet & lifestyle changes, drug therapy, or endoscopic bariatric procedures, depending on the severity and associated health conditions. In cases of uncontrolled diabetes, metabolic surgery might be considered. For those with grade 3 obesity and beyond, bariatric surgery, possibly combined with drug therapy, may be the appropriate treatment.

Ultimately, the right approach depends on a clinical evaluation and tailoring the treatment to the individual's needs. There aren't simple alternatives to treatment options; each case requires a specific strategy. Both Dr. Bhasker and Dr. Kovil revealed that there is great demand for such weight-loss drugs in India.

As awareness about health risks of overweight and obesity grows, so does the interest in medical interventions to complement lifestyle changes and dietary modifications. However, it is crucial to consult a medical expert before using these weight-loss drugs.

Debunking nutrition myths about viral diet trends for weight loss

Rajeshwari V Shetty, HOD (Nutrition & Dietetics), S. L. Raheja Hospital, Mahim - A Fortis Associate, debunks nutrition myths about diet trends that claim to aid weight loss.

Can only ‘eating right' lead to weight loss?

Shetty: No. Four pillars are necessary for weight loss. One is eating right, eating a balanced diet. Second is exercise. Third is holistic wellness. Fourth is taking care of your sleep. If you are sleeping for less than six hours, it can affect your circadian rhythm also, which can result in hormonal imbalance, affecting your weight. So, all these factors are important.

Do these viral diet trends really help in weight loss?

1. Oatzempic and Rice-zempic

A clever wordplay on the popular weight-loss drug Ozempic, these trends are touted to be a safer and cheaper version of the same for weight loss.

Oatzempic is a breakfast drink of oats blended with lime juice and water whereas Rice-zempic is made by soaking uncooked rice with lime juice and then straining it to drink the leftover starchy water. Proponents claim these are effective in weight loss.

Shetty: These are all short-term weight loss remedies. You can't survive only on oats or rice. Rice is also a carbohydrate, which is not going to help you. If people have uncontrolled diabetes, they cannot have this rice drink. You lose out on other nutrients also because you're just focusing on a single nutrient. One needs to follow a balanced diet also.

2. Intermittent fasting

Shetty: Yes, it does help in weight loss. But I wouldn't advise it for a long term. Also, intermittent fasting is not safe for everyone. If you are pregnant or have medical issues like diabetes, you need to talk to your doctor before starting intermittent fasting. It has to be structured. An expert has to tell you exactly what to do and then to do and what, how much to eat, etc.

3. Dukan diet

The Dukan Diet is split into four phases, each one focusing on specific nutrients.

Phase 1 (Attack): Lean proteins
Phase 2 (Cruise): Lean proteins, vegetables, 2 tablespoons of oat bran daily
Phase 3 (Consolidation): Lean proteins, starchy fruits and veggies, two celebration meals a week
Phase 4 (Stabilisation): Eat anything, one high-protein day, oat bran daily

Shetty: The people who are behind the Dukan diet claim that it does help in weight loss. But it also has limitations. It is based on cutting down on so many things and only focusing on lean proteins. So, only focusing on one or two things leads to missing out on other nutrients, which can also cause nutrient deficiencies also. With such restrictive diets, people also get tired. They lose interest.
It also has positive points. One, lean proteins are good. Second thing, the diet doesn't ask you to measure or weigh things. So, you feel more satiety full for a longer time. This can lead to a decreased calorie intake.

4. 7-second coffee loophole

It states that drinking black coffee, with added ingredients like lemon and cinnamon, within seven seconds of feeling hungry can curb hunger and reduce appetite.

Shetty: It does help to reduce your appetite. But, it's only caffeine. It releases hormones which temporarily suppress the appetite. The timing is important. However, there are no studies supporting it. Just taking coffee is not going to help because this is also again focusing on a single nutrient and caffeine also has its side effects.

What are some healthy nutrition tips that can aid weight loss?

• You can consume healthy salads in which you add a little of everything - seeds, vegetables, proteins etc. You can add something for flavour also and a little of vitamin C like lemon.
• Healthy vegetable soups are also fulfilling. You can do variations, adding different whole grain cereals, barley, oats, dals, etc.
• Evening time is a very dangerous because this is a time when people generally feel hungry if they have missed a meal because of their busy schedule. So that is a time when they go in for their vada pav, etc. I would suggest to have roasted chana or healthy nuts as a snack.
• There are two types of fruits - water-based fruits and fleshy fruits. One should focus more on water-based fruits like muskmelon, watermelon, papaya, etc.
• Plate pattern is important. If you divide your plate into four parts, one half of the full plate should be vegetables, one fourth should be carbs and one fourth should be protein.

Disclaimer: This information does not replace professional medical advice. Consult a qualified specialist, nutritionist or your physician for personalised guidance.