Mounjaro in India: There was a time when patients weighing over 100 kg were few and far between at the clinic of Dr Mala Dharmalingam, senior endocrinologist at the Bangalore Endocrinology and Diabetes Research Centre. “Not any more. Obesity is not just a bystander, it is a disease itself and a precursor of other conditions. In addition, Indians are at a higher risk because of visceral obesity — excessive fat accumulation around the abdominal organs. If diabetes was an epidemic a decade ago, it is obesity now,” she says.
Mounjaro, now in India, is the latest among a new class of weight loss drugs, which are being used globally and arose from the need to address obesity as a clinical condition and a public health challenge. Body weight is no longer a cosmetic issue but about minimising the burden of chronic diseases like heart disease, diabetes, fatty liver and even cancer. It is a nudge tool when no amount of will power, diet and exercise work to wear out your stubborn fat. It comprises molecules which mimic gut hormones that regulate both blood sugar, digestion and appetite, the key to controlling weight. Since the original hormones cannot work effectively, these do the job, helping a patient lose up to 20 per cent of body weight, the equivalent of a bariatric surgery.
HOW MOUNJARO CONTROLS WEIGHT
Explaining why Mounjaro is a weight loss accelerator, Dr Dharmalingam says, “When you put in your best effort and lose a kilo, your body goes against you. It starts releasing stress hormones because it thinks you are starving. So, most people attempting to lose weight are suddenly unable to follow their diet one day and give in to their hunger pangs. These drugs, however, suppress the hunger right in the brain, in the hypothalamus, making it easier for people to stick to their diets.”
Dr Dharmalingam, whose centre also participated in one of the clinical trials of the drug in India, has
seen a very good response but admits that the monthly cost of the injectable drug is certainly a challenge for long-term continuity. However, she sees a silver lining too. “The growing awareness around obesity means many may weigh the monthly cost of Rs 17,000 against several conditions triggered by obesity,” she says, implying that people might just be more keen to take preventive health seriously.
MOUNJARO FOR WOMEN
The drug gives a push to those who are already trying to lose weight and getting over the yo-yo effect, when crash dieting slows down your metabolism and leads to weight regain. “I see a lot of obese women in their 30s, who are advised to lose weight if they want to conceive. In these cases the drugs can give a leg-up, especially in those dealing with the yo-yo effect,” says Dr Dharmalingam.
HOW TO REGULATE DOSAGE PER PERSON
Dose escalation must be done under a doctor’s supervision. “Patients need education. They cannot be taken by those with pancreatitis or gallbladder disorders apart from regular contraindications. One has also to adjust doses to avoid hypoglycemia or low blood sugar,” says Mumbai-based endocrinologist Prof Shashank Joshi.
According to the journal Second Nature, Mounjaro supports weight loss of around four per cent of body weight after one month, and around six per cent after two months.
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DOES THE WEIGHT COME BACK? THE INDIAN CHALLENGE
While Mounjaro has been shown to reduce weight loss by about 20 per cent in tests, studies have shown that those that discontinue after six months regain 14 per cent of their body weight. While the residual effect of Mounjaro may be the longest among this class of weight loss drugs, continuing it for a longer time period has shown that 90 per cent of people could keep the weight off. So diet and exercise must be key pillars of the weight loss journey along with the drug.
“Weight loss drugs are just another option in our armament to address obesity. Once you start using them, you cannot stop. The weight simply comes back. With affordability a deterrent, a disciplined lifestyle works better long-term. Besides, we need to address what’s causing obesity rather than just tackling weight,” says Dr RM Anjana, president of Madras Diabetes Research Foundation.
Currently working on a study of obesity sub-types, Dr Anjana would much rather address the reasons for hidden obesity and junks the BMI formula. “People who may not look obese and have a normal BMI may also be metabolically unhealthy and living with conditions such as diabetes,” she says.
Then there are concerns about muscle mass preservation. “Indians have a thin fat phenotype, so we have to ensure that with weight or fat loss, muscle mass preservation is done by strength training exercises and proteins under medical supervision,” says Prof Joshi.
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WHY A LARGER APPROACH TO WEIGHT LOSS WORKS
For long, Dr Dharmalingam has been arguing for policy interventions to ensure discipline where it is needed most – our diet and eating habits. She insists guidelines that stipulate junk foods should not be sold in and around schools be strictly followed. There should be warning labels on foods in grocery stores and children should be taught about healthy eating practices from a young age. “Chubby children should not be considered healthy. Kids should not be given rewards like a restaurant meal or chocolate for accomplishing a task. This creates a life-long pattern of thinking that foods are a reward,” she says. In other words, India needs to begin at the basics to avoid drug dependence.