‘Doctor, I started this after seeing it on Instagram’: Tales of weight-loss drugs in Delhi’s OPDs

“The problem is not the drug,” Dr Wangnoo says between consultations. “The problem is how casually it is being started, without evaluation, without understanding, and without follow-up.”

One of his patients that day is 27-year-old Riya*, who walks in visibly exhausted. Her wedding is approaching, and she had one goal: to lose 10 kg in two months. A friend suggested an injection, and she obtained it directly from a pharmacy.

Within five weeks, she had lost 7 kg. But it came at a cost: Nausea, vomiting, dehydration, and nutritional deficiencies. Her menstrual cycle had also become irregular. When asked why she did not consult a doctor at the onset of these symptoms, she says, “Everyone around me was taking it. It felt normal.”

Dr Wangnoo says, “We are seeing normalisation of misuse. These are not cosmetic shortcuts. These are metabolic therapies that need proper screening, dose titration, and monitoring.”

Another patient, Karan* (34), an IT professional with borderline diabetes and fatty liver, began taking injections while continuing intense workouts and skipping meals. Within weeks, he developed acidity, constipation, fatigue, and low blood sugar.

He had followed his gym trainer’s advice instead of a doctor. “He told me this works faster than dieting,” Karan explains.

He poses a question to Dr Wangnoo, one he hears often: “If appetite is reduced, should food intake be cut drastically?”

“These drugs are not starvation tools,” the doctor says firmly. “They work best with balanced nutrition, not extreme restriction. When patients start using them to justify not eating, that is where the danger begins.”

Then comes a patient who illustrates what careful, supervised use can achieve.

Bina* (52) had long struggled with Type 2 diabetes, obesity, joint pain, and poor sleep. Her treatment began with full metabolic evaluation, structured therapy, nutritional guidance, and regular follow-ups.

Over eight months, her blood sugar improved significantly, she lost 14 kg, her blood pressure stabilised, and her knee pain reduced. “For the first time, I feel like the treatment is helping me,” she says.

Dr Wangnoo emphasises that when used correctly, these medications are powerful tools.

During his consultations, questions from patients also reflect the growing uncertainty around these drugs: Can I take this just for a wedding? My friend lost 8 kg, can I take the same dose? Will I regain weight after stopping? Is this what celebrities use? Can I buy it directly from a pharmacy? Can I stop eating normally if I’m on it?

“These questions reflect how social media has medicalised weight loss without educating people,” Dr Wangnoo observes. “Patients are coming with decisions already made. They are only looking for validation.”

The question of generics

Doctors are also observing how rapidly expanding access to these drugs, with generics flooding the market, is reshaping both demand and prescribing patterns.

Dr Ambrish Mittal, Group Chairman – Endocrinology & Diabetology at Max Healthcare, says his practice had already been using GLP-1 drugs even before their wider rollout, so the introduction of generics did not significantly change prescription patterns in his own clinic. But he notes that the broader availability of these drugs has significantly expanded access.

According to him, cheaper generic versions, especially of Semaglutide, have made these therapies affordable for many more patients who previously could not access them due to cost, thereby widening their reach across lower-income groups.

This shift, he says, has also led to more doctors prescribing these medications and more patients actively requesting them, often asking specifically for less expensive options.

While the market now has a large number of generic formulations, with dozens of companies manufacturing Semaglutide, he says his department has chosen to rely on a limited set of established, trusted pharmaceutical companies. Established firms, he says, inspire greater confidence because of their long-standing track record and global exports, which reduces concerns around quality.

At the same time, he cautions that it is too early to draw firm conclusions about differences in efficacy or safety between branded drugs and generics. Any perceived differences, he says, are often based on anecdotal impressions rather than robust comparative data. Claims that one version works better than another, he adds, should be treated cautiously unless backed by proper scientific analysis.

He also clarifies that the arrival of generics has not altered clinical guidelines. Doctors, he stresses, must continue to follow established protocol for patient selection, dosing, and monitoring. The primary impact of generics, in his view, is improved affordability and accessibility, not a change in how these drugs should be used.

Dr Mittal, too, echoes concerns about misuse. These medications should be used strictly under medical supervision and not casually for minor or purely cosmetic weight loss goals, he stresses.

Use with caution

Back in Dr Wangnoo’s clinic, he offers advice to patients with a dose of caution.

“One of the biggest problems I’ve seen is what I call the starvation mindset,” he says. He recalls a patient who, after experiencing appetite suppression, drastically reduced food intake.

“She believed eating less would accelerate results. Instead, she developed sarcopenia: significant muscle loss, weakness, and metabolic compromise. Weight loss should not come at the cost of strength.”

He recalls another case of a patient casually mentioning a past thyroid nodule while already on therapy. “We stopped the medication and carried out further evaluation. It turned out to be malignant,” he says. “This is exactly why proper screening matters. There are hidden contraindications, and missing them can have serious consequences.”

Stressing again on the need for pre-evaluation, he says, “There are genuine concerns involving the pancreas, gallbladder, and gut — pancreatitis, gallbladder disease, severe gastrointestinal slowing, even bowel obstruction in susceptible individuals. These are not common in every patient, but they are significant enough that we cannot ignore pre-evaluation.”

He adds, “Rapid improvement in blood sugar can sometimes worsen diabetic retinopathy. I may not have personally encountered it yet, but that does not mean we should ignore the risk. A baseline retinal check is always wise.”

He recalls yet another case of a patient mentioning loosening of teeth. “It sounded dental initially, but we identified it as bone health. Rapid weight loss, especially with poor nutrition and protein deficiency, can affect bone strength. Sometimes patients celebrate weight loss while silently losing muscle and bone underneath.”

“Obesity treatment cannot be reduced to a number on the weighing scale… the goal is not just weight loss, it is safe, sustainable, medically meaningful improvement in health.”

As consultations wind down, his final message is simple but firm. “GLP-1 therapies are powerful metabolic tools, not cosmetic shortcuts. They work beautifully when used correctly and dangerously when used casually.”

(*Names changed to protect patient identities)