Diabetes drug hailed weight-loss miracle is well and truly here. But is it worth it?

(Left to right) Dr Roshani Sanghani, Dr Siddhant Bhargava and Dr Karishma Balani debate the pros and dangers of now-trending semaglutide drugs like Ozempic with Sunday mid-day. Pic/Rane Ashish

In the pages of a 300-page book about a magic pill revolutionising the wellness industry is an affectionate tale of friendship. As the only two individuals in the audience who couldn't help but find humour in a serious dramatisation of a "lousy" play that unfolded before them, Johann Hari and "Hannah" struck up a lasting bond. Hari is generous with his words when painting a vivid picture of the woman with "mousy brown hair", a "huge stomach", who spoke with a "musical lilt" as he describes how their subsequent search to sample the "worst-sounding plays" helped their friendship blossom.

In the just released title that chronicles how the world became obsessed with Ozempic, a weight-loss drug, this seemingly incongruous story is, in fact, its most appropriate addition. While narrating his shenanigans with his friend, the author picks the choicest words to describe how their mutual love for "grease-laden kebab" and banana milkshake became rather integral to their bond. In doing so, he bears open an honest depiction of how Hannah, he, and a significant proportion of the world's population tread the path to obesity that's often hard to retreat from.

Illustration/Uday Mohite

A study of the social media comments on the use of Ozempic is testimony that the semaglutide drug - the magic pill touted as this era's answer to obesity - has indeed polarised the world. While those who've benefitted from the medicine are celebrating acquiring the svelte frame they had long desired, individuals who've never needed to lay their sight on it are hitting back at the former for endangering their lives for aesthetic benefits. In this virtual bickering, however, what's left unaddressed is the horror caused by obesity. "I interviewed a prominent British doctor named Max Pemberton, who said something that sounds shocking, but, when you look at the evidence, you understand where he is coming from. He said that if given a choice between becoming diabetic or HIV positive, he would choose the latter. He argued that an individual who is HIV positive can live as long as anyone else if he is treated properly; this is not true for diabetics. Those who have diabetes die earlier, and are more likely to suffer a series of serious conditions leading up to their death, like blindness, amputation, and dementia," Hari tells mid-day in an interview preceding the launch of The Magic Pill. It narrates his experience of using semaglutide to tackle obesity after a string of exhausting attempts to address weight gain with diets and exercise regimens remained unsuccessful.

Hari manages to put the spotlight on the crippling effects of obesity when he makes a case for the use of Ozempic. "I'm older now than my grandfather ever got to be. He died of a heart attack when he was 44. We know that since these drugs reduce obesity, they dramatically reduce heart problems [too]. If your BMI is higher than 27, and you choose to use the drug, you become 20 per cent less likely to have a heart attack in the next couple of years. This is significant. For me, that benefit outweighed the risks."

Ali Fazal

On international turf, semaglutide iterations have attracted both, fans and critics. While American celebrities like Tracy Morgan and Elon Musk openly claim to have benefited from it, comedian Amy Schumer reportedly discontinued using the drug due to the side effects that left her incapable of playing with her child. "This isn't liveable for me," she stated after her brief dalliance with Ozempic.

Back in India, however, experts say that the wave is yet to catch on among the public per se. "There is chatter about its use among celebrities," says celebrity nutritionist Dr Siddhant Bhargava, who supports Hari's notion on the use of the drug. "Often people think of it as the last resort; something they want to try after having failed to lose weight using traditional methods for 15 to 20 years. If you have to choose between being obese and consuming semaglutide to overcome obesity, the second situation is far superior. When you aren't dealing with obesity, your joints, heart, liver, kidneys, bones, and gut become healthier," he says, quick to caution individuals to only consider it if they have earnestly attempted to fix their dietary habits before taking the plunge. "I'm not against the idea of using it, but it needs to be done under a doctor's supervision."

In 2023, Ali Fazal took to his Instagram asking people not to use Ozempic. He shared an article on the side effects of Ozempic saying: "Been hearing that a lot of people are on this to lose weight…… plz plz plz click on the link below and for god sakes STOP!!!!!!"

Dr Roshani Sanghani, an endocrinologist with experience in dealing with diabetics, explores the argument from a different lens. "I could make you wear a life jacket and put you in a pool, but, to call yourself a swimmer, you will need to learn how to swim without it. Swimming without the vest is an entirely different skill.

Similarly, you may lose weight while you are on a drug. But, learning to maintain the weight loss is a new skill that you will have to learn when you are no longer consuming it. We are being told that as soon as you stop taking it, the weight piles back on within two years. This implies that for sustainable weight loss, one needs to be on it forever. So, if there's no exit strategy, why will I put you on it? Based on my professional practise, I can tell you that if I don't think it's good for you three years from now, I'm not going to give it to you."

Dr Karishma Balani

The experience that an MD working in the hair transplant industry encountered while consuming the drug aligns with Dr Sanghani's observations. "I've been off the drug for a few weeks now, and I've already piled on a few kilos," he tells mid-day on condition of anonymity. However, the development hasn't diminished the joy he experienced at having shed 12 kilos after being on rybelsus - the semaglutide available for Indian consumers in the form of a pill - for six months. "I was 85 kilos when I started taking the drug, and lost the weight over a short period. Since my appetite drastically reduced, I would consume only 50 per cent of what I usually had. I am not currently taking semaglutide, and have gained two kilos because my food intake has increased again. I will start taking the drug again if I gain any more weight." On more occasions than one during our chat, he refers to the pill as "magical". "As a doctor, I understand that every medicine has side-effects, but the ones [I experienced] were negligible; I did not even have nausea. For people like me, who are fat but may not have the time to exercise, or live a sedentary lifestyle, this is a magical drug. It is the perfect medicine for those who are pre-diabetic."

Peppered within the pertinent conversations we have with the experts who've contributed to this story is a whole lot of, ‘we don't know'. "We don't have long-term data about what is going to happen to these consumers of the drug if they take it for 10 to 15 years," says Sanghani, as she enlists the side-effects of semaglutide use that are categorised as rare. "Pancreatitis, thyroid cancer, kidney damage, muscle loss, paralysis of the stomach and the small intestine, and regurgitation of stomach contents into the lungs during surgery. The muscles and pancreas are important metabolic organs, and these medicines cause them to become inflamed. We don't know how rare these side effects are. Considering the rate of obesity, open these drugs to large populations of people and you're going to see those rare ailments appear more frequently. I have been prescribing certain diabetic drugs since 2006 and in all these years, I've seen only one person with severe pancreatitis; their pancreas were fully damaged. But, I have seen at least five to 10 people who have had mild pancreatic inflammation while being on these drugs. And I only learned that they were affected after I got them tested for it. So, we'll never know how many people are walking around with mild cases of pancreatic inflammation."

Dr Siddhant Bhargava, celebrity nutritionist; (right) Dr Roshani Sanghani, endocrinologist

An Indian-origin homemaker based in the US recalls becoming so impassive about eating food that her family was compelled to encourage her to discontinue the drug-use. "They felt that the drug had a psychological effect on me, because I was no longer drawn to the foods that once brought me joy. Even if they encouraged me to have them, I couldn't consume more than a few bites because my appetite was suppressed," she tells mid-day.

Malnutrition and sarcopenia, or the progressive loss of muscle mass, have been linked to the consumption of semaglutide. "People claim that if we don't encourage the use of semaglutide, we are refusing to treat obesity. That's not accurate. There are many things that we should be doing to help people with obesity. But, is semaglutide the best way to do it? If you are going to lose 10 kilos while consuming it, the chances are that almost half of that weight loss is brought about by the loss of muscle mass. Muscle mass is directly connected to longevity. Would I be willing to put such a prescription on a piece of paper that causes somebody to lose muscle mass when I know that muscle is life-saving? Of course not," Sanghani argues.

Tracy Morgan, Elon Musk and Amy Schumer have lost weight on semaglutide. Oprah Winfrey was rumoured to use it too. Pics/Getty Images

However, city-based dermatologist Dr Karishma Balani, who has been prescribing the oral medications to several individuals battling skin-related issues due to PCOS, impresses upon the need to work with a nutritionist to get an adequate amount of protein in the diet. "Most of the people who took the drug were very happy. But, we also them that there's no alternative to dietary changes. People need to exercise. They can't simply depend on the medicine. In our practice, we ask patients to take it for three months and then stop. Subsequently, we keep a check on the amount of weight they regain. They do put on some weight, but they don't go back to square one." Like Balani, Bhargava agrees that semaglutide is administered to patients in "cycles". "It doesn't have to be a lifetime commitment. People who use it to lose weight do so in cycles. We tell them to have it for six to eight weeks, and then try to wean them off it. It's not advisable to stop the dose entirely because you'll find that your appetite increases suddenly."

It is during this window of consumption that users are encouraged to bring about lifestyle modifications. Like a freelancer who charges in advance before commencing work on a project, the drug seems to offer a peek into a life where an individual no longer needs to wage a war against the bulge. "It really plays with the reward centres of the brain. It essentially shows you how great your life could be if you were no longer overweight, and you might be able to get a grip on your eating and training habits," says the US-based user. But, unlike a freelancer who would be inundated with reminders to complete the task, semaglutin users, once rewarded, may no longer be encouraged to bring about lifestyle modifications.

In the culminating chapters of his book, Hari appears to make an impassioned plea to users to understand their relationship with food. So moving is his narration that even those who are healthy may be compelled to make smarter choices. But, when we ask him if he has subsequently built better habits, he responds stating, "Not really." "You're right, I should learn to do that. I'm better than I was before, but I don't want to present myself as a model of fitness. My breakfast this morning was a bag of potato chips. So, I'm still eating the same s''t, just in smaller portions. I'm thinner than I was. I lost three stones. My health has improved. But, I've still got a long way to go when it comes to [changing my lifestyle]."

Hari excels in his ability to showcase how an individual's actions may be altered by emotional triggers, and thereby paints an authentic picture of how the use of semaglutide can affect masses across the globe. "There are three ways in which this pill could be magical: The first is that it could be the solution to the problem of obesity. I've got to admit, there are days when it really feels like magic. I've been addicted to junk food all my life, and now, I inject myself in the leg once a week and I eat a lot less. The second is a more disturbing analysis. It could be harming you in ways that will eventually undermine the benefits. I do not rule that out. That is a real risk. And the third [traces back] to the stories of magic we've heard. Like a genie who fulfils your wish, but does so in [certain undesirable] ways, the drug gives you what you want, but it could have unpredictably weird effects. I think, that's the most likely scenario."

Battling the bulge

Weight-loss drugs of the past
.  In his book, Hari chronicles a list of weight-loss drugs that have been hurled at consumers for decades. Doctors learned, in due course of time, that a chemical marketed as Redusols, "a safe way to lose weight", could "cook you from the inside" when consumed in high doses.

.  Amphetamine pills sold to individuals in subsequent years were linked to paranoia, anxiety, and psychosis. Hari claims that one of the first crusades of the ‘Fat Pride' movement in the 1970s was created by people who wanted to warn others of the dangers of taking the pills.

.  Fen-phen, touted as a miracle drug in the 1990s, made users more likely to develop primary pulmonary hypertension, and caused heart defects in a third of the users.

How semaglutide works
.  Semaglutide, sold as Ozempic, Wegovy, or Rybelsus, works by suppressing one's appetite by connecting with the GLP-1 receptors in the body. They also help the pancreas release the right amount of insulin when blood sugar levels are high.

Known side-effects
.  The common ones include nausea, vomiting, gastritis, loss of appetite, and constipation. Other listed side-effects, which may be rare, include pancreatitis, thyroid cancer, kidney damage, and muscle loss. The psychological effects of the drug are also in discussion, and continue to be studied.

Obesity in India
.  According to a study published in Lancet, 70 per cent of India's urban population is classified as obese or overweight. It is argued that a major chunk of individuals who lose weight via exercise and dieting, regain the weight in due course of time.