When generic versions of semaglutide entered the Indian market earlier this year, many expected a weight-loss drug revolution. Prices dropped sharply, from innovator brands costing several thousand rupees a month to generic versions priced at roughly Rs. 1,000-2,500 monthly, making these medicines accessible to far more people. However, the boom appears to be losing momentum.

Recent reports suggest that several pharmaceutical companies have revised down their sales expectations for generic GLP-1 drugs by nearly 25-30%, citing slower-than-expected patient retention rather than a lack of initial interest. While demand surged immediately after launch, many patients are either delaying treatment, discontinuing therapy or not staying on these medications long enough to achieve sustained benefits. The slowdown raises an important question: why are Indians quitting weight-loss drugs despite falling prices?

Obesity Is A Chronic Disease, Not A Short-Term Problem

One of the biggest misconceptions surrounding GLP-1 medicines is that they are a 'quick fix' for weight loss.

Current obesity guidelines describe obesity as a chronic, relapsing disease that requires long-term management, much like hypertension or diabetes. GLP-1 receptor agonists work by suppressing appetite, slowing stomach emptying and improving blood sugar regulation. However, these effects persist only while the medication is being taken.

Evidence from the landmark STEP-1 extension trial found that participants regained around two-thirds of the weight they had lost within a year of stopping semaglutide, alongside a reversal of many cardiometabolic improvements. Similar findings have been reported in subsequent reviews, suggesting that long-term treatment may be necessary for many patients.

Retention May Be The Bigger Barrier

Affordability was expected to be the main hurdle in India. Instead, early market data suggest that continuing treatment is proving far more difficult than starting it.

Here are some reasons that impact retention:

  • Weekly self-injections
  • Gastrointestinal side effects such as nausea and vomiting
  • Unrealistic expectations of rapid weight loss
  • Need for long-term treatment
  • Price sensitivity despite lower costs
  • Limited physician familiarity with obesity medicines outside diabetes care

Rather than a shortage of patients willing to try these drugs, companies appear to be struggling with keeping patients on therapy over time.

Psychology Of Long-Term Injections

Unlike antibiotics or short courses of medication, GLP-1 drugs are intended for chronic disease management.

For many people, the idea of taking a weekly injection indefinitely can be daunting, especially if weight loss slows after the initial few months. Research shows that weight loss often plateaus over time, even though the medication continues to provide metabolic benefits.

Experts also note that obesity treatment carries significant stigma in India. Many patients continue to view excess weight as something that should be controlled solely through willpower, diet and exercise rather than medical treatment.

Doctors May Also Be Prescribing More Cautiously

Unlike in the United States, where GLP-1 medicines have seen explosive uptake, Indian physicians generally adopt a more cautious approach to newer therapies.

Endocrinologists point out that these medicines are prescription drugs with recognised adverse effects and specific eligibility criteria. Most are recommended for adults with obesity or overweight accompanied by obesity-related conditions and not for cosmetic weight loss.

Experts also emphasise that medication should always be combined with dietary modification, physical activity and behavioural counselling to improve long-term outcomes.

Could Pills Make The Change?

One potential shift may come from oral GLP-1 medicines. Several studies suggest that patients generally prefer tablets over injectable medicines for long-term therapy. Oral semaglutide is already available for diabetes, while newer oral obesity medicines are under development globally.

If oral therapies prove to be equally effective and become more affordable, they may reduce one of the biggest barriers to adherence: fear or inconvenience linked to injections.

It's Not Just About Weight Loss

Another misconception is that GLP-1 medicines are only cosmetic treatments. Recent large clinical trials have shown benefits extending beyond weight reduction. GLP-1 medicines have demonstrated reductions in cardiovascular events and improvements in blood sugar control, fatty liver disease and other obesity-related complications.

These broader health benefits highlight why experts increasingly describe obesity as a chronic medical condition requiring sustained treatment rather than a temporary lifestyle issue.

India's slower-than-expected growth of generic GLP-1 medicines is unlikely to reflect a lack of need. Instead, it highlights a more complex challenge: helping patients stay on treatment long enough to realise its full benefits.

Lower prices have improved access, but affordability alone cannot overcome concerns about injections, side effects, unrealistic expectations and the lifelong nature of obesity management.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.