If you are a little overweight you would have definitely not missed the advertising and media coverage around the new obesity medications. Efforts by the global pharma majors are on to build awareness around obesity and the way it is perceived.
What is obesity and why does it matter? Overweight and obesity are measured through what is called the Body Mass Index (BMI), a measure of your weight in relation to your height. What is yours? It is easy to calculate if you know your weight in kgs and your height in metres (BMI = weight in kg / (height in metres)2 ). Medical fraternity has been trying to define / redefine what is ideal BMI. The general consensus is that underweight is BMI 18.5, normal BMI is 18.5 to 24.9, overweight is 25.0 to 29.9 and obese is 30.0. Numerous illnesses like heart disease, diabetes, osteoarthritis, sleep apnea, high blood pressure have been shown to be associated with obesity.
We Indians have had a different perspective around obesity. Our mothers have always obsessed about our weight, but the other way around. ‘Itne patle ho gaye ho’ (oh no, you have become so slim), ‘Itne duble patle ho, ki bimari to nahi hai?’ (you are so thin are you sure you are not unwell) have been heard by many of us from our moms and grandmoms. Growing up in a poor country, being overweight was seen as a sign of prosperity. The rich were fat. The poor were thin. That was the way it was.
The old equation is changing and changing rapidly. Recent reports (Business Standard 17 March 2025) have said that India is facing an obesity epidemic. The number of obese adults in India has risen from 5.76 million in 1991 to 46.78 million in 2021; this is set to reach 173.73 million by the year 2050. The number of overweight adults is also expected to rise to an astounding 449.95 million, almost a whopping 30% of the entire population, by the year 2050.
Most adults who are overweight / obese are inactive and have poor dietary habits. This paper’s editorial (18 March 2025) has spoken about the need for dietary diversity: “our diets are largely skewed towards consumption of subsidized wheat, rice and sugar”. Our protein consumption, both vegetable and animal sourced continue to be suboptimal. Providing eggs with noon meal schemes in schools was a welcome move in this regard however it has been abandoned by some states.
When asked, an overweight / obese person is possibly going to say that he has an ‘overweight body type’ ‘it runs in the family’ ‘I have tried everything and nothing works’ ‘I have no time to exercise’. The problem is often not acknowledged and is externalized by the consumer. In this regard the recent media coverage around obesity is good in a way. It is bringing obesity to the centre of the health argument. Obesity is not something that you can ignore or externalize. You need to take ownership. And you are lucky since help may be at hand.
The recent barrage of ‘obesity is a disease that is curable’ advertising reminded me of yet another ‘illness’ that was identified and tackled by the global pharmaceutical industry. While reading an article in the Fortune magazine in around the year 1997 I was piqued to notice a new term: ED. This term is today common knowledge but in the late 1990s it was new. What ED or erectile disfunction did was to reframe the illness that was then known as impotency. The term ‘impotent’ had a permanence associated with it. It was something that happened to you and you could do nothing about it. Then comes the pharma industry that tells the world, no no, it is not impotence, you are suffering from ED. Go to your doctor and he has a medicine for it. Viagra was launched in 1998 and went on to become a blockbuster brand for Pfizer. Today there are many newer medications for ED but Viagra, also referred fondly as the ‘little blue pill’ continues to dominate popular culture.
In a similar vein the discovery that a new class of drugs used to treat Type 2 diabetes can actually reduce weight was a big breakthrough moment. In the US this class of drugs, GLP-1 agonists, are promoted to offer triple benefits: reduce HBAIC (diabetes), reduce risk of cardiovascular events and weight loss. But like many other treatments for chronic diseases this class of drugs takes time to deliver results. Weekly injections over a period of one year can help an obese patient lose up to 15% of their body weight. And this is a big deal.
The treatment is not cheap but I am sure Indian companies are waiting to launch their own branded generic variants soon. I do hope this increased attention to overweight and obesity will also drive consumers to become more conscious about what they eat and their (inactive) lifestyle. There is the nagging worry that overweight and obese consumers will take the medication but will end up overindulging. I only hope that the pharma companies ensure that doctors who dispense these expensive medications also insist on patients improving their dietary habits and exercise routines. If this happens then it will be a win win win. A win for pharma industry. A win for doctors. And a win for the obese.
Appeared originally in Business Standard March 2025