GLP-1 drugs for weight loss: Who needs them, and who should avoid them?

A wedding deadline, a stubborn number on the weighing scale or the frustration of repeatedly trying to lose weight. For some people, GLP-1 weight-loss drugs may seem like the answer they have been searching for. But as these medicines attract growing attention, a bigger question is emerging: are they being used to treat a medical condition, or are they becoming the latest shortcut to a slimmer body?This debate took centre stage in a discussion featuring Dr Shashank Joshi, diabetologist and endocrinologist at Lilavati Hospital, and Jitendra Choksi, founder and managing director of Fitter. While Dr. Joshi highlighted the potential health benefits of GLP-1 medicines when prescribed appropriately, Choksi raised concerns about their misuse, regulation and the lack of adequate attention to preventive healthcare.The disagreement revealed an important distinction: these medicines can be valuable treatment options for some patients, but that does not make them suitable for everyone who wants to lose weight.WHAT ARE GLP-1 DRUGS, AND WHY ARE THEY IN DEMAND?GLP-1 medicines have gained attention for their role in managing conditions such as type 2 diabetes and obesity. Their appeal extends beyond weight loss, particularly for patients whose excess weight is accompanied by other health problems. During the discussion, Dr. Joshi explained that he does not view these medicines as cosmetic pills. He said some of his patients have experienced improvements in their overall health and have been able to reduce the number of other medicines they take under medical supervision.He also described patients with multiple health concerns, including sleep apnoea and cardiovascular or kidney-related risks, for whom treatment decisions need to consider more than the number on the weighing scale. For such patients, the objective is not simply to lose weight. It is to improve health outcomes and quality of life.However, growing demand has also raised concerns about people seeking these medicines for short-term weight loss, including before weddings and other important events.THE WEDDING WEIGHT-LOSS TREND: WHERE DOES THE CONCERN BEGIN?One of the concerns raised during the discussion was the use of GLP-1 medicines by people hoping to lose weight quickly before their wedding.Choksi referred to a reported case of a woman who lost weight while taking a medication but regained it after stopping treatment. According to his account, she subsequently restarted the medicine and ended up in intensive care.The case was presented as a warning about the potential consequences of inappropriate use. However, the discussion did not establish the woman's full medical history or the precise cause of her hospitalisation.The larger concern is the expectation that a prescription medicine can deliver rapid results without requiring a long-term approach to health.Dr. Joshi was clear that these medicines should not be used for cosmetic reasons. He argued that patients need careful selection, medical supervision and support with lifestyle changes.The distinction matters because a medicine prescribed to manage a health condition is not interchangeable with a quick fix for an upcoming event.ARE THESE DRUGS A SUBSTITUTE FOR DIET AND EXERCISE?This was one of the central points of disagreement.Choksi argued that society risks normalising medication while giving insufficient attention to nutrition, exercise and the underlying reasons people develop health problems. He called for greater investment in public health education and preventive measures instead of focusing primarily on pharmaceutical treatment.His concern was that people could become overly dependent on medicines without addressing habits and environmental factors that contribute to poor health.Dr. Joshi agreed that lifestyle changes remain fundamental but disagreed with the idea that medication and lifestyle must be competing approaches.He described lifestyle as the foundation of treatment, with medicines playing a role when clinically indicated. He also emphasised the importance of physical activity, adequate protein intake and building and maintaining muscle.For him, the objective is to improve body composition and overall health, rather than focusing exclusively on fat loss.The two perspectives point to a broader issue: medication should not automatically replace lifestyle changes, but lifestyle advice alone may not be sufficient for every person living with obesity or diabetes.WHY CALLING WEIGHT-LOSS MEDICATION A 'CHEAT' IS CONTROVERSIALThe discussion became particularly heated when Choksi compared using weight-loss injections with cheating in an examination, arguing that people should not abandon effort simply because a shortcut is available.Dr. Joshi strongly disagreed with that comparison.He argued that obesity and diabetes are medical conditions and that describing treatment as cheating unfairly stigmatises people who live with them. He maintained that appropriately prescribed medicines can make a meaningful difference to patients who have struggled with these conditions.The disagreement highlights the stigma surrounding weight management. Weight loss is often treated as a simple matter of willpower, even though people can have different medical circumstances and responses to lifestyle interventions.At the same time, recognising obesity as a medical condition does not mean every person seeking weight loss needs medication.The more useful question is whether a particular treatment is appropriate for an individual's health needs, rather than whether taking medication represents an easier or harder route to weight loss.SIDE EFFECTS, REGULATION AND THE RISK OF MISUSEGLP-1 medicines are not risk-free. As with other prescription drugs, their benefits and potential adverse effects need to be assessed in the context of the individual patient.Dr. Joshi emphasised the need for careful prescribing, appropriate patient selection and pharmacovigilance the monitoring of medicines for potential safety concerns.Choksi, meanwhile, questioned whether regulation and enforcement were adequate to prevent inappropriate use. He also raised concerns about advertising, access and the approval process for these medicines in India.Dr. Joshi disputed Choksi's claims about the legality of their approval, arguing that regulatory restrictions and specialist oversight were already in place. The two speakers also disagreed over the role of regulatory action in curbing promotional activity.Their exchange underlined the difference between a medicine's potential clinical value and the way it is marketed, accessed or used in practice.The discussion alone does not establish the prevalence of misuse or prove the allegations made about individual companies. It does, however, raise questions about how patients receive reliable information and how prescriptions are monitored.WHAT HAPPENS WHEN YOU STOP TAKING THE MEDICINE?Another important issue is what happens after treatment ends.Choksi's account of weight regain after discontinuation highlighted the risk of viewing these medicines as a temporary intervention for a long-term concern.Weight regain after stopping treatment can be a concern for some patients, but an individual case cannot establish what will happen to everyone. Treatment duration and decisions about reducing or stopping medication need to be discussed with the prescribing clinician.Dr. Joshi explained that some patients remain on treatment while others may have their doses reduced, depending on their response and clinical needs. He also described a team-based approach that includes monitoring body composition and supporting muscle strength.This reinforces the need to discuss the long-term treatment plan before starting medication, rather than focusing only on how quickly weight may come off.ARE WE IGNORING PREVENTION?Beyond the debate over injections, both speakers returned to the importance of healthier lifestyles.Choksi argued that greater attention should be given to nutrition education, exercise and the underlying causes of poor health. Dr. Joshi similarly highlighted sedentary behaviour, unhealthy eating habits and excessive screen use as concerns, while stressing the importance of physical activity and mindful eating.The challenge is to avoid treating medication and prevention as mutually exclusive choices.People who need medical treatment should not be made to feel that they have failed simply because lifestyle changes alone have not achieved the desired results. Equally, people should not be encouraged to view prescription medicines as substitutes for sustainable health habits.GLP-1 medicines have become the focus of a debate that goes well beyond weight loss. For some patients, they may be an important part of managing obesity and related health conditions. For others, particularly those seeking rapid cosmetic weight loss, the risks and appropriateness of treatment require careful consideration.The discussion between Dr. Joshi and Choksi did not resolve every question about regulation, access or long-term use. But it highlighted the need to distinguish medically supervised treatment from inappropriate use.The goal should not be to shame people for taking medication or to present injections as a universal solution. It should be to ensure that people who need treatment can access it appropriately, understand its limitations and receive the medical and lifestyle support necessary to protect their long-term health.- Ends