Weight loss drug debate: Experts urge strict guidelines for GLP-1 drugs

India Today

Amid the debate over GLP-1 receptor agonist drugs for weight loss, experts call for clear guidelines from the health ministry to prevent dangerous, over-the-counter use, suggesting prescriptions be limited to specialists like endocrinologists.

Transcript

00:00We also have some guests joining us on the same story.

00:02We've got Chandrakant Laharia, doctor, joining us,

00:05founder and director for the Foundation of People-Centric Health Systems.

00:08Also, Dr. Anupam Biswas, senior consultant and endocrinologist at Fortis Hospital.

00:13Dr. Laharia, thank you so much for being with us today.

00:16Like I said, it's quite, I don't know how to wrap my head around this.

00:20Are we moving ahead of the curve here?

00:22In the West, when it comes to GLP-1,

00:25there is perhaps the most expensive lawsuit the pharma industry has ever faced

00:31that has been filed now.

00:34Some 1,500 people have come together and said that Ozempic led to blindness.

00:40And that case is being heard.

00:42On the other, the guidelines here in India are being formed

00:46while we are trying to treat obesity.

00:48GLP-1, do you think it should be included or excluded

00:52till the time we understand the long-term impact?

00:55Dr. Laharia, you're on mute.

01:01If you could unmute yourself, please.

01:04One thing which we need to remember that the GLP-1 receptor

01:07is the new drugs are very effective in reducing weight.

01:10Yeah.

01:10But we also need to remember that the drugs are not for everyone.

01:15A qualified medical provider will guide that

01:17who should receive the drugs and what is the approach.

01:20And then second part we need to remember is that no matter which drug,

01:23whatever drug we take, paracetamol, also a very common drug,

01:27but it can cause side effects.

01:28So even GLP-1 receptor agonists can cause side effects.

01:32The thing is that one of the big contributions, in my opinion,

01:35of these drugs available in the Indian market

01:37is that the entire dialogue on obesity and overweight in India has started.

01:41But we need to be concerned that that's why guidelines are required,

01:45that the GLP-1 receptor agonists for weight reduction drugs are not the only solution.

01:51Right.

01:51In every case, the lifestyle modification, dietary modification of physical activity

01:58are the first line.

01:59And along with that, these drugs, the GLP-1 receptor agonists are the solution.

02:03That's why the guidelines will be very useful.

02:04And then fourth point is, I was hearing the feature which was done before this,

02:10that we know that it's not the double burden,

02:12but India has a triple burden of malnutrition,

02:15which essentially means overnutrition and micronutrition deficiency.

02:19You go to any place, there are iodine deficiency, vitamin D deficiency,

02:23other micronutrition deficiencies.

02:25We need to ensure to the people that they have a right weight,

02:28not the excess weight.

02:29And finally, coming to GLP-1 RA, definitely there is a need for more regulation,

02:35better control.

02:37Definitely the people who are not qualified to prescribe,

02:39essentially the other pathos should not be prescribing the medication.

02:42So what should be, so let me try and understand this, Dr. Lahiriya,

02:46Dr. Anupam Biswas is also with us.

02:48Dr. Biswas, if you could come in on this,

02:49what should be the ideal way to approach and ensure that misuse does not happen?

02:55I was reading up that in certain countries,

02:57what they've done is they've taken the rights to prescribe GLP-1 drugs

03:02and limited it to very specific doctors,

03:06doctors who are endocrinologists and perhaps doctors in a few more fields.

03:10They have limited and they prohibited any other form of doctor

03:14to even prescribe this drug.

03:16Is that a way that India can sort of go in?

03:20Yes, so that is a very important question,

03:22because if we misuse the drug, obviously there are going to be consequences.

03:28So it is very important for us to know who can prescribe these drugs

03:33so that only patients who require these drugs should benefit from it.

03:38So it should not be prescribed over the counter.

03:41It should be prescribed by either a certified endocrinologist

03:46or a physician who has worked in this field for a longer time.

03:51And even if you look at the European guidelines,

03:53they have restricted it to endocrinologist who can prescribe this drug.

03:58There are certain side effects of this drug also,

04:01but we have been using GLP-1 receptor analog for a very long time

04:06and we have seen very good results in our type 2 diabetes patients

04:10and even in our obesity patients.

04:12But again, it is very important to screen

04:15and after screening, we have to evaluate

04:19who are the patients who require these drugs.

04:23And based on the guidelines,

04:24we would recommend these drugs to these patients.

04:27Right, but you know, Dr. Leheria,

04:30you and I have spoken about this several times now

04:33and every time I hear a doctor saying

04:35it should be done this way, it should be done this way.

04:38But off camera, a lot of endocrinologists now tell me

04:42that the misuse is already happening.

04:45Every second person coming into clinics today

04:48does not need the GLP-1 but is asking for GLP-1.

04:53It of course doesn't help when Serena Williams,

04:56Oprah Winfrey actually endorse it.

04:59So clearly, we can't leave it for anybody's,

05:02for good sort of judgment to sit in on people.

05:05We need clear guidelines.

05:07We need clear guardrails.

05:09So we, and we can't perhaps wait for just these guidelines.

05:12There should be proper rules that are sort of rolled out

05:15by the health ministry even before.

05:16I think I cannot agree more on this topic

05:20because there is like a lot of surrogate marketing

05:22going on for the drugs and which is, in my opinion, worrying.

05:26Of course, any medication, especially when a new medication

05:29should be prescribed by a qualified provider

05:32who is trained in the area, endocrinologist,

05:34internal medicine specialist,

05:36even an ambivest physician who is trained.

05:38So the point which Dr. Vishwas mentioned

05:41that a person should be qualified to prescribe this medication.

05:44And second dimension of this is that the people,

05:46even before the drugs became available in Indian market

05:49were buying or purchasing over the counter

05:51from bringing from other countries.

05:54So there is a need to bring awareness in population

05:57that do not use these drugs for a cosmetic reason

06:01or unprescription of medical, qualified medical providers.

06:04And that's where these guidelines would be useful.

06:08Got it.

06:08I have last few minutes, Dr. Laharia,

06:10and I just want to quickly understand this from you.

06:13Like I said, we can't hope,

06:16I mean, we are doing everything in our capacity

06:18as media houses to ensure that the right information goes out.

06:21We are doing a health show every day

06:22and telling people almost on alternate day basis

06:25about obesity drugs, the pros and cons,

06:27the, you know, the red lines,

06:29the Lakshan Rekha that you must not follow,

06:31you must not cross, etc.

06:32But if you had to tell the government

06:34or give the government one advice

06:38on how to roll this out in a better manner,

06:40what would that be?

06:42I think the best approach would be

06:45what you had shown in your feature earlier,

06:47that we should remember,

06:48if we keep talking about GLP-1 receptor agonists,

06:51then they send a message that these are the only solutions.

06:55So whenever we have to talk about,

06:57whenever government guidelines need to be formed,

06:59they have to focus upon the childhood obesity,

07:02school-based intervention.

07:04They need to focus upon how to reduce the weight,

07:06the lifestyle modification, physical activity.

07:08They need to have attention on the training

07:11of the medical provider or doctors in this area

07:13in the better relation of these aspects.

07:15And more importantly, one of the key areas,

07:17we need to work upon the root cause of obesity.

07:21The need to be made aware about

07:22what is the overweight obesity rate.

07:24That is the starting point.

07:25People do not know whether they are overweight or obese,

07:27and then it's only when they cross the BMI body mass index,

07:31which is a crude indicator, well beyond the limit,

07:34then only they become aware.

07:35If we raise awareness,

07:36the moment people are becoming overweight,

07:39they can implement that lifestyle modification.

07:42There are a lot, many things to be done.

07:44And GLP-1 receptor agonists or a surgery

07:47are not the solution, rather they are the last lot.

07:50The guidelines to focus upon from the prevention,

07:53health promotion, treatment,

07:55and then of course use of these medications.

07:56I think my worry here is that, of course,

07:59GLP-1 is much more powerful,

08:01but a parallel can be drawn with antibiotics.

08:03There's an entire generation of kids

08:05who have grown up popping antibiotics

08:07which are available over the counter,

08:08and they're all resistant now to different viruses.

08:11The worry here is that this is what it's going to be.

08:14So we need clear guidelines.

08:16And hopefully the health ministry is listening in

08:18to what needs to be done now,

08:20not wait for guidelines to be formed tomorrow.

08:23Thank you both for joining us on this issue.

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