By Arunima Rajan

In an interview with Arunima Rajan, Dr Anil Bhoraskar, diabetologist at SL Raheja Hospital, Mumbai, explains why GLP-1 drugs such as Semaglutide and Tirzepatide are no substitute for healthier habits, why a normal BMI can still hide dangerous abdominal fat, and why he prescribes these medications only when they are clinically essential, never for cosmetic reasons alone.

When you started prescribing GLP-1 drugs, can you let us know about the type of patients who were sitting across from you in that consultation room? And what sort of patients are you seeing now?

Initially, the individuals who chose to go with GLP-1 drugs included obese patients suffering from diabetes or related diseases who have already tried other approaches to lose weight. Nevertheless, today, there are more and more young people, living in cities, who have heard of the existence of drugs such as Semaglutide and Tirzepatide and regularly ask to use them solely for aesthetic reasons. The Internet contains plenty of information on these drugs, even though not all sources are trustworthy. There are also certain social pressures to look a particular way, especially among young women, which makes people want to get a quick solution to their problems. While GLP-1 treatment offers significant benefits for certain individuals, it risks becoming a substitute for healthier lifestyle habits rather than a complement to them.

Before you write a prescription for weight management, what does a patient need to bring to that conversation besides money and a desire to lose weight?

Prescription of GLP-1 treatment should not be considered solely based on losing weight. There are many things that need to be considered, especially metabolic risk factors, especially abdominal obesity. This is important because the presence of abdominal fat increases the risk of getting many diseases like heart disease, diabetes, high blood pressure, and stroke. Many Indians are referred to as “thin fat Indians.” What this implies is that even though their Body Mass Index (BMI) may be within the range, they possess excess fat in the abdominal region. Even with a BMI of 21, they may have a waist size above 90 cm.

After due consideration, if a patient does not qualify for medication, my next action will be to concentrate on:

Exercises
Nutrition
Diet restrictions

Do you feel pressure to prescribe GLP-1 drugs more widely than your clinical judgment would allow?

I will only prescribe a medication when it is absolutely essential, and extremely beneficial to the patient. It is also important for people to understand that rapid weight loss can have side effects, including:

Hair thinning
Fragile nails
Concentration problems
Facial sagging
Weak immunity
Digestive complications

There should never be a compromise between quick results and long-term health.

When things go wrong and patients land in the emergency room after taking GLP-1 drugs without proper supervision, what happens then?

I will prescribe the medication only if it is necessary for the patient. People should know that rapid weight reduction may lead to side effects like:

Hair fall
Brittle nails
Difficulty in concentration
Sagginess of face
Weak immunity system
Digestive problems

The pursuit of rapid results should never come at the expense of one's health and safety.

More than half of patients stop GLP-1s within the first year, and the weight tends to come back. How do you communicate that risk honestly?

Those who use drugs without medical advice from a qualified doctor can get into serious trouble — not only with new medicines, but with any medicine. Thus, it becomes highly imperative to brief patients regarding the side effects of these medications. The complications include:

Pancreatitis
Severe Gastrointestinal disorders like vomiting, diarrhoea, dehydration, and low blood pressure

A comprehensive history of medication and adequate medical assistance becomes highly important.

For hospitals, GLP-1 prescribing is sitting at an uncomfortable place right now. Does your institution have a formal position on this?

Every prescription issued at this hospital is ethically grounded and driven exclusively by patient welfare.

If you could speak directly to endocrinologists in India who are seeing a wave of patients asking for these drugs for cosmetic purposes, what would you want them to know?

If patients seek to lose weight purely for cosmetic reasons and are prepared to pay enormous sums of money to avail these drugs, they should be counselled in an ethical manner. The drugs might work for some time, but once discontinued, their effects will reverse, resulting in weight gain that poses risks since the weight gained will be predominantly fat and not muscle. All Indian endocrinologists are ethical, and the drugs must always be prescribed with caution in mind, keeping the wellbeing of the patient's paramount.

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Mumbai Diabetologist Warns Against Cosmetic use of GLP-1 Weight Loss Drugs