The arrival of semaglutide-based injections in India, first as branded products, and now as generics priced as low as ₹1,300 a month has sparked excitement. For a country where over 100 million people
live with diabetes and obesity rates are rising sharply, an effective injectable that reduces weight and improves blood sugar control sounds like exactly what is needed.
But as Dr Gagandeep Singh, MBBS, Founder, Redial Clinic | Specialist in Reversing Diabetes, Hypertension, Obesity & PCOS without Medication cautions, “I would urge patients and the medical community to pause before declaring this a revolution.”
What GLP-1 Medications Actually Do And What They Don’t
Semaglutide mimics a gut hormone called GLP-1, which suppresses appetite and slows gastric emptying. Patients tend to eat less, lose weight, and see improvements in their glucose levels.
“The results from global trials are impressive,” says Dr. Singh. “The STEP trials showed an average weight loss of 12–15% of body weight, and the SELECT trial demonstrated clear cardiovascular benefits. These are significant outcomes.”
However, he adds a crucial caveat: “The clinical reality often missed in headlines is that the moment you stop the drug, the weight tends to return. Semaglutide does not fix the underlying metabolic dysfunction, it only manages the consequences while the medication continues.”
The Muscle Problem No One Is Talking About
One of the biggest concerns, particularly for Indian patients, is muscle loss. “Studies suggest that up to 40% of the weight lost on GLP-1 medications can come from lean muscle mass, not just fat,” explains Dr. Singh. “For Indians, who are already prone to the ‘thin outside, fat inside’ phenotype, this can be metabolically harmful.”
He further explains, “Muscle is the body’s largest glucose sink. It helps regulate blood sugar even at rest. Losing muscle mass can worsen insulin resistance in the long term.”
This creates a paradox, “A patient may come off semaglutide significantly lighter, but metabolically more vulnerable, with less muscle and a slower metabolism.”
The Malnutrition Risk in Unsupervised Use
Another concern is nutritional deficiency due to appetite suppression. “When appetite drops significantly, patients often end up eating less of everything including essential nutrients like protein,” says Dr. Singh. “Without proper guidance, what appears to be weight loss can actually be progressive malnutrition.”
He adds, “In India, where protein intake is already low, this becomes a serious public health concern.”
With generics making these drugs more accessible, the risks may increase. “Lower cost removes the financial barrier, but it does not ensure medical supervision. That’s where the real danger lies,” he notes.
What Should Patients Actually Do?
Dr Singh emphasises that these medications are not inherently problematic but must be used responsibly.
“GLP-1 medications do have a role, especially for patients with severe obesity or those needing a metabolic bridge,” he says. “But they should never be seen as a standalone solution.”
He recommends a structured approach:
Ensure high-protein nutrition to preserve muscle mass
Incorporate resistance training to counter muscle loss
Have a clear long-term plan for life after the medication
“The real question isn’t whether semaglutide works, it clearly does,” concludes Dr Singh. “The question is whether we are prepared to use it wisely, or if we will continue treating symptoms while ignoring the root cause of metabolic disease.”
