Can anti-diabetic drugs that can also reduce weight be taken by those who do not have diabetes?
Yes, these drugs can be taken by people who do not have diabetes. These can be used for weight loss. These are approved by the US Food & Drug Administration. I’m sure the process of approval by Indian authorities will also take place in due course. I see nothing wrong in [prescribing] them as long as you evaluate the patient properly, do clinical analysis, blood test, etc.
What is the downside of taking these medicines?
They have a potency that is unprecedented. There’s concern about the amount of muscle loss that happens along with weight loss. That’s a significant concern for Indians who have lower muscle mass generally. There are numerous and conflicting studies on this. Some suggest that some proportion of the weight that is lost with GLP 1 (glucagon-like peptide-1, which is used to treat type-2 diabetes and obesity) is muscle, which can be detrimental to Indians.
These molecules are very measured advances in the treatment of chronic and noncommunicable diseases, as there is evidence that they promote weight loss, control type-2 diabetes, probably help in reducing fatty liver and very likely bring down coronary events. They overall fit in well with what we need.
But nothing comes without a downside. These molecules do produce significant nausea and vomiting in some people — to the extent that they have to discontinue the medication. Some may develop diarrhoea, some may have severe constipation. Others may not like the way they lose weight—they may feel very shrunken or their face may seem very thinned out. That’s another sort of downside.
How long should one take these medicines?
That remains a bit unclear. At the moment, obesity treatment is supposed to be lifelong, like diabetes treatment. However, there are numerous studies underway trying to look at how to taper them off. Should the drugs be stopped completely? Should they be tapered off gradually? Is there a lower maintenance dose? Or, should one continue with the same dose? By and large, it is seen in shorter trials that when you stop the medicine for two years, the patient tends to put the weight back on. The rate of weight regain depends on how well the patient is following lifestyle measures. Those who are following good exercise plans and are convinced about the diet and don’t sort of let go of the effects of the drug do well.But there are others who depend solely on the drug effect for weight loss. That’s an issue. They tend to put most of the weight back on. One has to remember that these molecules are part of a weight loss programme. My concern is that it is being used as if it is a cosmetic agent; just to reduce weight, people somehow procure them and take them. I think that’s challenging.We really should be encouraging people who are obese to join or opt for a structured weight loss programme that includes diet and exercise, along with this medication. Otherwise, I think, it will be misused all the time.
