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“Doctor, should I just take the injection?”
This is now the most common question in our consultation room. It deserves a straight answer — neither the hype you read online, nor the fear you hear from people selling something else.
What these medicines actually are
Tirzepatide (Mounjaro) and semaglutide (Ozempic, Wegovy, oral Rybelsus) belong to a class called GLP-1 receptor agonists — tirzepatide acts on two gut-hormone receptors, GIP and GLP-1. They slow the emptying of the stomach, blunt appetite, and change how the brain responds to food. Mounjaro launched in India in March 2025 and is now the country's largest-selling weight-loss medicine, typically costing ₹14,000–25,000 a month.
They work. We will not pretend otherwise.
For a patient with type 2 diabetes, established obesity with complications, or high cardiovascular risk, these are genuinely valuable drugs. Under a physician who is monitoring them, they can be the right decision.
What concerns us is not the molecule. It is how it is being used — bought on a WhatsApp forward, started without a single baseline investigation, injected for a wedding or a holiday, and stopped the moment the target is reached, by people who never met the criteria in the first place.
The side effects to know before you start
- Nausea, vomiting, diarrhoea, constipation, indigestion and abdominal pain, worst during dose escalation
- Marked loss of appetite, sometimes to the point of eating too little to stay nourished
- Reflux, heartburn, burping, an altered taste, fatigue
- Injection-site reactions
- Dehydration — a particular risk in Indian summers, when thirst falls along with appetite
- Acute pancreatitis — severe, persistent upper abdominal pain radiating to the back
- Gallstones and gallbladder disease, made more likely by rapid weight loss
- Acute kidney injury, usually following prolonged vomiting and dehydration
- Severe gastroparesis — food remaining in the stomach for hours; this carries an anaesthetic risk, so always declare these drugs before surgery or endoscopy
- Hypoglycaemia, especially alongside insulin or sulphonylureas
- Allergic reactions, and a rare optic nerve condition (NAION) reported with semaglutide
- A boxed warning on thyroid C-cell tumours: contraindicated with a personal or family history of medullary thyroid carcinoma or MEN 2
The three consequences that matter most — and are rarely discussed
In the trials, roughly a quarter of the total weight lost came from lean tissue rather than fat. In a population that already eats too little protein and carries a high burden of sarcopenic obesity, this is not a footnote. Losing muscle lowers your resting metabolic rate, weakens bones and joints, and makes every future attempt harder. Without adequate protein and resistance training alongside the injection, you can end up thinner and metabolically worse off.
The withdrawal studies are unambiguous: about two-thirds of the lost weight returns within a year of discontinuing the drug. Appetite hormones, gastric emptying and the brain's reward response revert within weeks. If nothing about your eating has changed, the weight has nowhere to go but back — and what returns is disproportionately fat, because muscle does not return on its own. This is why these are correctly understood as long-term treatment, not a course.
When you can manage only a few spoonfuls at a meal, those spoonfuls must be exceptionally well chosen. Most people on these injections are given no guidance at all. What follows is protein, iron and B12 deficiency — hair fall, brittle nails, poor wound healing, disturbed periods, low mood, cramps and deep fatigue, often dismissed as a “detox phase” when it is simply undernutrition.
Anyone with a personal or family history of medullary thyroid cancer or MEN 2, previous pancreatitis, gallbladder disease, significant kidney disease, severe gastroparesis or a history of eating disorders. Anyone pregnant, planning pregnancy or breastfeeding. Anyone on insulin or sulphonylureas needs their doses reviewed first. And anyone whose BMI does not meet the treatment threshold should be asking why an injection is being offered at all.
Where we stand
We do not campaign against these medicines, and we will never ask you to stop a drug another doctor has prescribed — that decision belongs to you and your prescribing physician.
An injection can suppress your appetite.
It cannot teach you how to eat.
The day it stops, your body meets food again with no more understanding than it had before — and now with less muscle to defend itself. If you and your doctor decide the medication is right for you, we are glad to work alongside it: protecting your lean mass, keeping your nutrition adequate while your intake is low, managing the gastrointestinal effects, and building the eating pattern that will hold your weight when you eventually come off it.
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We work alongside your treating physician — and will never ask you to stop a prescribed medicine on our advice alone. Herbs are medicine, not daily food; what suits one person may not suit another.