With weight-loss drugs, going under the knife may lose edge

Mumbai: Inroads of blockbuster weight-loss medications such as Eli Lilly's Mounjaro and Wegovy that Novo Nordisk is expected to bring to India may result in a decline in the number of people opting for bariatric surgery to manage obesity, healthcare experts said.

The global fad and curiosity surrounding the semaglutide weight-loss drug, like Wegovy and Mounjaro, may prompt many Indians in the obese zone to try out medication as the first option to shed excess weight, they said.

In a country of 80 million obese people, many may find the new drugs a boon. According to a recent study published in The Lancet, 70% of India's urban population is classified as obese, or overweight.


Rising obesity has led to an increase in weight-loss, or bariatric, surgeries. The number of this invasive procedure more than tripled in 10 years to around 75,000 in 2024, according to estimates by GlobalData. While the data analytics platform predicts the number to more than double in the next five years, doctors are of the view that medications give one more option to shed weight to those who are obese and have a body mass index (BMI) of 30-35.

The Grey Zone
Those with a BMI above 35 and morbidly obese may still need surgery.

"The grey zone where people have a 30-35 or 25-30 BMI and don't want to do any diet, those people may not want to go for surgery and they may opt for it (medication)" in case they are able to tolerate side effects, said Neeraj Tulara, general medicines and infectious diseases specialist at LH Hiranandani Hospital at Powai, Mumbai.

While GLP1 - drugs like semaglutide mimic this hormone that helps regulate appetite - will not replace bariatric surgery, their numbers may come down because people in the 'grey zone' of BMI may go for the medicines first, Tulara said.

Doctors say drugs will help reduce body weight by only 15-20%, compared with as much as 70-80% by surgeries. But still people who are reluctant to go for surgery will first prefer to try out medication, said Aasim Maldar, consultant - endocrinologist and diabetologist at Mumbai's PD Hinduja Hospital.

He cited the case of a patient with a BMI of 59, who should ideally go for surgery. "But those people were reluctant to go for surgery. For such people at least there will be some relief with these medications," said Maldar

"Surgery also has its side effects and there could be a weight gain in 3-4 years," said Nitin Kumar Sinha, consultant physician at Mumbai-based WeCare Wellness, adding: "Increasing awareness about GLP1 drugs will prompt many in favour of the drug before they go under the knife."

COMPLEMENTARY TREATMENTS
The number of bariatric surgery procedures performed in India is projected to reach more than 86,000 in 2025 and over 170,000 by 2030, according to Rohit Anand, director - research & analysis, Medical Devices, at GlobalData.

According to a US study cited in The Harvard Gazette, demand for bariatric surgery declined by nearly 26% during 2022-2023 in the US, coinciding with doubling of demand for weight loss drugs Ozempic and Wegovy. The study, by Brigham and Women's Hospital in collaboration with Harvard T.H. Chan School of Public Health and Brown School of Public Health, was conducted on patients with a diagnosis of obesity without diabetes. However, doctors said bariatric surgery is still the most effective means to lose weight for those morbidly obese. It can lead to a weight loss of 70-80% over a year to a year-and-a-half. "Medical treatment and surgical treatment will work hand in hand because none of them cover 100% of the spectrum. But yes, drugs have a strong potential to control the disease and may cause the number of complications to come down drastically," said Jayashree S Todkar, a visiting bariatric surgeon at Powai's LH Hiranandani Hospital. However, she said drugs may only complement surgical treatment.

COST FACTORS
Doctors also said in terms of cost, weight loss drugs do not come cheap. Also, it is not still clear whether or not there could be weight gain once the drug is stopped. The cost of bariatric surgery is ₹ 3-5 lakh in Metro cities like Mumbai, and ₹2-3 lakh in smaller cities, while a six-month Mounjaro treatment will cost nearly Rs 1 lakh, with one injection weekly that costs about ₹3,500.

In the long-term, bariatric surgery is cheaper, costing only a tenth compared with drugs where the patient will gain weight if the person stops taking the drug, said Dr Sumeet Shah, secretary of the Obesity and Metabolic Surgery Society of India.