Body Weight is Not Enough to Monitor Incretin Therapy in India

Abstract

Falling body weight is not a reliable marker that incretin therapy is helping the patient. This is a counterpart to the concern raised in this journal by Misra and colleagues, that a low body mass index is not a reliable marker of malnutrition [1]. We wish to raise a related problem.

The Indian patent for semaglutide ended on 20 March 2026. The next day several DCGI approved generic brands were launched, costing about ₹1,290 to ₹4,200 a month [2]. Prescribing has moved from endocrinologists to general physicians. These doctors will watch body weight, because that is what they already measure.

Body weight does not show what the drug is really doing. A network meta-analysis of 22 randomised trials found that about 25 per cent of the weight lost was lean mass, not fat. The strongest drugs were the worst in this respect. Tirzepatide and semaglutide caused the most weight and fat loss but were among the least able to protect lean mass. Only liraglutide reduced weight without a significant loss of lean mass [3]. Semaglutide, the drug now becoming widely available in India, is among the least protective of lean mass.

Citation

Rahul Garg. Body Weight is Not Enough to Monitor Incretin Therapy in India. WebLog J Endocrinol Diabetes. wjed.2026.j0106. ISSN 3071-3986 https://doi.org/10.5281/zenodo.23301838