Ozempic and other weight-loss drugs: Cost, risks, who really needs them

As Ozempic and other GLP-1 drugs gain popularity, experts explain who needs it, the real health benefits, potential side effects, and why supervision is critical

Ozempic, Mounjaro, and other GLP-1 drugs are no longer just diabetes medications - they have become central to the global conversation on weight loss. On a recent episode of the podcast All About Her, actor Soha Ali Khan spoke with Dr Ambrish Mithal, group chairman – endocrinology and diabetology, Max Healthcare, and clinical nutritionist Dr Juhi Agarwal to unpack the science behind GLP-1 drugs. From rising prescriptions to social media hype, the experts discussed how these medicines work, who should take them, what they cost, and the risks involved, urging people to view them as medical tools, not cosmetic shortcuts.

 

“Obesity is defined as excess adiposity, which means excess fat in the body. The problem is that the excess fat we look at cosmetically is actually the harbinger of a disease process,” says Dr Mithal.

 

In 1997, the World Health Organization classified obesity as a disease. Yet culturally, it is still treated as an aesthetic issue.

 

“Obesity for modern non-communicable diseases is the starting point. It’s the mother of all NCDs,” Dr Mithal explains.

 

Type 2 diabetes. Hypertension. Heart disease. Fatty liver. Even some cancers. Excess body fat, especially visceral fat around organs, fuels them all.

 

Nutritionist Dr Juhi Agarwal points out that India has a unique vulnerability and many Indians are what experts call “thin outside, fat inside”.

 

“Women and men may look thin, but internally, their visceral fat and body fat percentage are higher. That is one of the main culprits of these diseases,” she says.

 

The doctors underlined that this conversation is not about how one looks, but about metabolic health.

What are Ozempic and Mounjaro?

Both drugs belong to a class called GLP-1 receptor agonists.

 

GLP-1 is a natural gut hormone which slows gastric emptying, stimulates insulin and, crucially, acts on the brain’s appetite centres.

 

“Obesity has links to the brain,” says Dr Mithal. “Some people’s brains are wired in a way that they have such intense cravings that despite genuinely trying, they cannot control them.”

 

That relentless internal chatter around food, popularly called “food noise”, is what these drugs help quieten.

 

Ozempic (semaglutide) was the first to break the 15 per cent weight-loss barrier in clinical trials. Mounjaro (tirzepatide), which works on two hormonal pathways, pushes that closer to 20 per cent.

 

However, the doctors pointed out that weight loss is only part of the story. According to Dr Mithal, “Diabetes improves dramatically, cardiac risk reduces by 20–25 per cent, kidney disease progression slows, fatty liver improves significantly. We didn’t have any drugs to treat fatty liver. Now we do."

 

Dr Agarwal recalls a patient who told her: “You don’t understand how good I feel. The food noise has gone. I’m not constantly thinking about what I’m going to eat next.”

Who is the right candidate?

Dr Mithal says candidacy depends on BMI and comorbidities:

• BMI 30–40: Eligible, especially if lifestyle attempts have failed
• BMI 27+ with conditions like diabetes, fatty liver, hypertension: Strong candidates
• BMI above 40: Surgery may still be necessary

But not everyone who wants it should take it.

 

“Half my day is spent convincing people who need it to take it. The other half (is spent) convincing people who don’t need it not to take it,” he Dr Mithal.

 

The doctors highlighted that people who should avoid weight-loss medications include those with:

• Family history of medullary thyroid cancer
• History of pancreatitis
• Active diabetic retinopathy
• Eating disorders
• Hypothalamic amenorrhoea (period loss due to under-eating)

"And importantly, self-prescribing is dangerous," Dr Mithal emphasises. "These are medical drugs. They must be taken under the supervision of an endocrinologist or internal medicine specialist,”.

The side effects everyone is worried about

The most common issues are gastrointestinal:

• Nausea
• Bloating
• Reflux
• Constipation or diarrhoea

“Side effects are significantly attenuated with proper nutritional advice,” Dr Mithal says.

 

According to Dr Agarwal, the following can help in minimising side-effects:

• Eat small, structured meals, even if you’re not hungry
• Prioritise protein
• Stay hydrated
• Avoid very high-fat diets
• Use natural aids like ginger for nausea
• Use a supplement where necessary

Muscle loss, ‘Ozempic face’ and the protein problem

According to the experts, weight loss always involves some muscle loss,  not because of the drug, but because of rapid weight reduction.

 

“These drugs do not cause muscle loss. Muscle loss is part of weight loss,” Dr Mithal clarifies.

 

Without adequate protein and resistance training, patients may look gaunt, leading to terms like “Ozempic face”.

 

“Protein, protein, protein,” Dr Agarwal says.

 

She recommends increasing intake to 1–1.5 grams per kg body weight and aiming for body fat percentage targets rather than obsessing over scale numbers.

 

Because once you lose muscle, metabolism drops, and regaining weight becomes easier.

What happens when you stop?

“The drugs will work only as long as you take them. That’s the harsh reality,” Dr Mithal says.

 

The experts explain that obesity, like diabetes or hypertension, is a chronic condition. Some patients may need long-term low-dose maintenance, while others may be able to taper off gradually.

 

“We require data. We don’t have trials yet,” he says.

 

Dr Mithal says the current best strategy is to use the medication as a bridge to build sustainable habits around diet, sleep, and strength training from day one.

What about women's health during postpartum, PCOS, perimenopause?

Hormones complicate everything.

 

Dr Agarwal sees many women struggling during perimenopause. “Your 40s is an age where things start to stagnate and a lot of people struggle with that.”

 

Women with PCOS often benefit significantly from weight loss via GLP-1 therapy. But fertility planning complicates long-term use.

 

During the postpartum period, if a woman is not breastfeeding and BMI criteria are met, it may be an option, but always personalised.

The price problem, and what’s coming next

Currently, GLP-1 drugs in India cost roughly ₹12,000–22,000 per month.

 

But there is good news.

 

Dr Mithal notes that semaglutide’s patent in India is due to expire soon, and generic versions are expected to enter the market.

 

“It will be less than half for sure,” he says.

 

“The world is divided into deciding whether it’s a hero or a villain. Nobody understands that it’s neither. It’s just a tool,” Dr Agarwal says.

 

They noted that in India, body scrutiny is relentless. “Culturally, we are tuned to getting into others’ lives and commenting on appearances,” Dr Mithal observes.

 

Women, especially, are hesitant to speak openly about using these drugs.

 

“Every drug works for as long as you use it. It’s not like an antibiotic that kills an infection and sends it away. This is a chronic condition.”

 

The goal should not just be to lose weight, the doctors say. "It is to gain health."