Who should consider weight-loss medicines?

Since semaglutide and tirzepatide became widely available in India, many people ask whether they should be on one. Some people who would clearly benefit hesitate because of fear or myths. Others who do not need them want them for quick results. This page explains how doctors usually decide. It is a guide for a conversation with your doctor, not a substitute for one.

What are weight-loss medicines for?

The aim is better health, not a number on the scale. These medicines are for people whose excess body fat is harming their health, or is very likely to. Benefits beyond weight can include lower blood sugar, blood pressure and liver fat, better sleep apnoea and knee pain, and, for semaglutide in people with heart disease, fewer heart attacks and strokes.

For background on obesity as a disease, read what is obesity. For how the medicines work, read GLP-1 medicines in India.

What are the Indian criteria?

The 2025 guideline from the Endocrine Society of India suggests that medicines can be considered for adults with:

• a BMI above 27, or
• a BMI above 25 with at least one weight-related condition, such as type 2 diabetes, high blood pressure, abnormal cholesterol or obstructive sleep apnoea.

These numbers are lower than in Western guidelines, because Indians develop these problems at lower weights. You can check your BMI with the BMI calculator for Indians, and read why the cut-offs differ in BMI for Indians.

Newer frameworks, including the 2025 Lancet commission and a revised Indian definition, go further. They suggest looking beyond BMI at waist size and at whether excess fat is already affecting organs or daily life. People with this “clinical obesity” are seen as a priority for timely treatment.

Who is most likely to benefit?

Doctors are more likely to discuss medicines when someone has:

• type 2 diabetes or prediabetes with excess weight
• fatty liver disease
• heart disease, or high blood pressure that is hard to control
• sleep apnoea
• knee or hip arthritis made worse by weight
• PCOS with weight gain
• weight that keeps returning despite genuine, sustained lifestyle efforts

Do I need to try diet and exercise first?

Lifestyle changes are always part of the plan, with or without medicines. Medicines work best on top of better eating, activity and sleep, not instead of them. Many people have already tried hard for years before they see a doctor. Your doctor will ask what you have tried and what got in the way.

Who should avoid them or be cautious?

These medicines are usually avoided or used with great care in people who:

• are pregnant, trying to conceive or breastfeeding
• have a personal or family history of medullary thyroid cancer or MEN2, a rare inherited condition
• have had pancreatitis
• have active gallbladder disease or severe gut problems such as gastroparesis
• have an eating disorder, or are at a normal weight or underweight
• have diabetic eye disease that has not been checked recently, since rapid sugar lowering can briefly worsen it
• are children or teenagers, who need specialist assessment

People with type 2 diabetes on insulin or sulphonylureas may need their diabetes medicines adjusted by their doctor to avoid low sugars.

What does a medical assessment include?

Before starting, doctors usually:

• measure weight, height, waist and blood pressure
• check sugar or HbA1c, kidney and liver tests, cholesterol and sometimes thyroid function
• ask about pregnancy plans and contraception
• review other medicines, past pancreatitis or gallstones, and family history
• discuss cost over months, not just the first pen

What should I realistically expect?

Medicines are started at a low strength and increased step by step by the doctor, to reduce side effects. Weight loss is gradual over many months. Most people need long-term treatment, because weight tends to return when the medicine is stopped. Read stopping GLP-1 medicines and weight regain. Side effects and how doctors manage them are covered in GLP-1 side effects.

What should you ask your doctor?

• Do I meet the criteria, and what is the goal for my health?
• Is there any reason I should not take these medicines?
• How long would I need to take them, and what would it cost?
• What changes in diet and exercise should go with them?

If you think you might be a candidate, an endocrinologist can assess you properly. Book a consultation.