"My friend got it for me, it worked for her"

In the weeks after the patent expired, we have seen a surge of patients starting GLP-1 based on a friend's recommendation, a gym trainer's suggestion, or an Instagram ad. Some have never had a single baseline blood test.

What gets missed:

• Personal or family history of medullary thyroid cancer or MEN-2 syndrome — an absolute contraindication.
• History of pancreatitis or gallstones — GLP-1 can precipitate both.
• Baseline HbA1c, kidney function, liver function, thyroid, lipid profile — without these, you have no way to know if the drug is actually helping you or quietly hurting you.
• Pregnancy or planning pregnancy — GLP-1 must be stopped at least 2 months before conception.
• Interactions with oral contraceptives, insulin, sulfonylureas, and certain psychiatric medications.

The Ministry of Health is explicit: these drugs must be prescribed only by a qualified specialist. The Indian Medical Association has separately asked for stricter enforcement after multiple hospitalisations were reported in early 2026.

"I just want to lose 4–5 kg for a wedding"

This is now the single most common reason people walk into my clinic asking for a GLP-1 prescription. And in almost all of these cases, I say no.

The approved indications are straightforward:

What actually happens when people in this group take GLP-1:

• Disproportionate muscle loss (because they don't have much fat to lose to begin with).
• Disordered eating patterns — patients describe "food noise vanishing" so completely that they forget to eat for 12–14 hours, triggering old or new eating-disorder patterns.
• Facial volume loss ("Ozempic face") that is much more pronounced at lower BMIs.
• Rapid regain within 6–12 months of stopping — often above the original weight.

If your BMI is in the normal range and the goal is cosmetic, the honest answer is: the risk-to-benefit ratio is unfavourable. That conversation is worth having in consultation — not with a gym trainer.

"The injection will do the work"

This is the mistake I find hardest to explain, because the injection genuinely does suppress appetite. So people eat less, lose weight, and assume it's all working.

Here is what they don't see: up to 30–40% of the weight lost on a GLP-1 can be lean muscle, not fat — especially if protein intake is inadequate. In the Indian diet, where carbohydrates dominate and protein is typically under-consumed, this is the default outcome unless actively corrected.

The visible sign that this is going wrong: patients look tired, their hair is thinning, they feel weaker at the same workouts, and their clothes fit in a strange way — they've lost weight but look less toned, not more. Body composition analysis almost always confirms the problem.

At our medical weight loss programme, every GLP-1 patient gets a parallel protein and nutrition plan. It is not optional.

"I don't have time for the gym, that's why I started this"

I understand the logic. The point of the drug — the marketing promise, anyway — is that effort isn't required. That promise is false.

What the evidence shows: every major GLP-1 trial that demonstrated meaningful, durable weight loss included structured counselling on nutrition AND physical activity. The drug alone, without lifestyle changes, gives you a temporary loan of weight loss that has to be repaid when the drug stops.

Why resistance training specifically matters:

• Preserves lean muscle when you're in a calorie deficit.
• Improves insulin sensitivity — which is the actual metabolic problem underlying most obesity.
• Supports bone density (important as cardiometabolic patients are often older).
• Protects the metabolism from slowing down, which is the primary driver of rebound after stopping.

You do not need a gym. Two to three sessions per week of bodyweight, resistance-band, or household-object training at home is enough to make a measurable difference. Thirty minutes, three times a week. I'll say it plainly — if you cannot commit to this, GLP-1 is probably not the right strategy for you.

"I hit my goal, so I stopped"

This is now backed by strong evidence. A 2025 systematic review and meta-analysis in eClinicalMedicine (Lancet group) looked at 18 randomised trials covering 3,771 patients:

The STEP 1 extension trial showed that within one year of stopping semaglutide, patients had regained two-thirds of the weight they had lost. By week 120, the net loss from starting weight was only 5.6%.

What this means in practice: GLP-1 is not a short course like an antibiotic. It is more like a blood pressure medication. Current thinking in obesity medicine is that it is a long-term — potentially indefinite — therapy, much like thyroid replacement or statins.

If you do plan to come off the drug, it has to be done slowly, with a structured transition that includes nutrition, training, and sometimes bridging with a different medication. That is a conversation with your doctor — not a "I'll just stop next month" decision.

"I got a great deal on Instagram / at the gym / from a WhatsApp group"

In the weeks following the patent expiry, the Drug Controller General of India inspected 49 businesses across the country — online pharmacy warehouses, wholesalers, retailers, and weight-loss clinics — for illegal sale of GLP-1 drugs. Enforcement is ongoing.

What can go wrong:

• Counterfeit pens. Either inert liquid, or the wrong dose, or — in the worst reported cases — an entirely different substance.
• Broken cold chain. GLP-1 drugs are peptides. Above 30°C for extended periods, they degrade. In Delhi NCR summers, anything shipped without refrigeration is suspect.
• Wrong dose. A "0.25 mg" starter pen that actually contains 1 mg can cause severe nausea, vomiting, dehydration, and acute kidney injury. I have treated two such patients this year.
• No guidance on titration. You're supposed to titrate up every 4 weeks — 0.25 → 0.5 → 1.0 mg for semaglutide, similar schedule for tirzepatide. Without a doctor, you either under-dose (no results) or jump ahead (severe side effects).

"A little nausea is normal, I'll push through"

Most GLP-1 side effects are mild and transient — nausea, mild constipation or diarrhoea, occasional vomiting in the first few weeks as the body adjusts. These are manageable. But some are not.

The Ministry of Health's April 2026 guidance explicitly lists the serious adverse effects reported with these drugs: pancreatitis, acute kidney injury, bowel obstruction, gallstones, and an association with medullary thyroid cancer.

Most of these are rare. But they are the reason these drugs need a doctor following up every 3 months — checking blood counts, kidney function, HbA1c, and listening to new symptoms.