Pranay Gupta may be 25 kg lighter today, thanks to the weight loss medication she started last June, but she doesn’t want to rely on it. Currently on Monjaro Injection, he wants to get rid of it one day and doesn’t want it to define his life. A 44-year-old telecommunications distributor from Prayagraj says, “It brought me back from a dangerous phenomenon called obesity, it gave me confidence, things I should have done in my 20s.
Now, he’s so self-conscious that he forgets his workout routine during busy days, craves mealtimes and doesn’t talk to sleep.
At a time when obesity medicine is surrounded by hype and frenzy, Gupta stays put, watches her scale and improves her lifestyle so that she won’t need medication when she drops from her current 94kg to 85kg and can maintain it. “I started working with 119 kilograms of drugs. And no matter what I did next, my body felt helpless and out of control. I needed help,” she says.
That’s when he met Dr. Subhash Wangnu, director of the Apollo Center for Obesity, Diabetes and Endocrinology (ACODE), New Delhi, who sees weight loss medicine as a treatment within a larger medical framework. Obesity is a chronic, relapsing, progressive disease. We now describe it as an anxiety-based chronic illness. It is driven by a combination of genetics, environmental factors and metabolism, rather than a lack of willpower alone. And it causes disease. Complications – especially those caused by obesity. Fat deep in the organs, especially the stomach and abdomen, causes insulin resistance and inflammation, which, if left unchecked, can lead to type 2 diabetes and heart disease.
For Indian patients, the “skinny fat” syndrome complicates the diagnosis. “It’s a type of obesity where a person has abdominal fat while having a normal body weight. It increases the risk of heart and kidney disease, fatty liver, and epicardial fat deposits around the heart,” says Dr. Wangno. He prescribed Monjaro for Gupta, a once-weekly, injectable prescription drug approved to manage type 2 diabetes. This molecule terzepatide works by mimicking two hormones (GLP-1 and GIP) to regulate appetite and slow digestion, which causes significant weight loss as a side effect.
“Cardiologists are increasingly prescribing terzapatide for type 2 diabetes and high-risk cardiovascular patients, as recent studies show it offers cardioprotective benefits, including a reduction in major adverse cardiovascular events,” says Dr. Wangno.
The onset of obesity
Since 2018, Gupta has been battling diabetes, obesity and a family history. The diabetes medication wasn’t working well enough and he never thought lifestyle changes would do much. The turning point was a serious road accident that left him paralyzed for six months. He gained a lot of weight during the Covid years of inactivity. “The road accident made me a quadriplegic. Although I wasn’t permanently confined to a wheelchair, my mobility was limited. I wanted to be free to walk,” says Gupta.
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By 2024, diabetes and inactivity had extracted observable rates. Cellulitis, a bacterial skin infection, is hospitalized with IV antibiotics for seven days. “That event was a wake-up call,” recalls Gupta. Blood sugar numbers were off the charts: fasting blood sugar was 288 mg/dL and HbA1c (average blood sugar for three months) was 8.8. High doses of insulin are common.
Side effects are not an easy journey
Dr. Wangnu put Gupta on Monjaro in June and gradually increased it from 2.5 mg to 10 mg per week, one of the reasons he lost weight so quickly in 10 months. “The first few days were strange, but after that my sense of taste changed completely. Sweet, salty, sour, everything felt the same. I also had constipation and nausea,” says Gupta. Metallic or bitter tastes are usually temporary side effects as the body adjusts. “This is due to a decrease in cravings, especially for sweet or fatty foods, which is the result of a change in taste receptors and a decrease in reward signals in the brain,” explains Dr. Wangno.
By September 2025, Gupta’s fasting blood sugar dropped to 102 mg/dL and HbA1c to 5.4. Today, his fasting level is 96 mg/dL. Insulin is no longer part of the diet. His sleep apnea, when breathing frequently stops and starts during sleep, and because he needs a C-PAP machine to keep his airways open, has improved. “The side effects went away. What started was control and self-discipline,” he says.
Why should lifestyle modification be implemented?
One of the first pieces of advice Dr. Wangno gives his patients is explaining what the medicine does. “When blood sugar rises, it increases insulin release, reduces the release of sugar from the liver, slows gastric emptying, so sugar enters the bloodstream more slowly and reduces appetite, which helps with weight loss,” he says.
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He balances diet, exercise, and sleep to maintain the drug’s gains and not wear them off. “Many will not be able to continue the medication for life and quit, as many trials show, weight regain and old risk factors reappear,” says Dr. Wangno.
Gupta has a regular meal plan, combining fiber and protein with complex carbohydrates and watches his meal times. He also eats small portions throughout the day and drinks plenty of water in between. “I finish breakfast at 8:30 a.m., usually nut poha, yogurt, dalia and almond idli. It’s fresh orange juice at noon, a vegetable salad and protein at 2 p.m., a bowl of lentils or paneer. Some days brown rice or chapati. Some days late afternoon and afternoon I feel like black coffee. Dinner is made for soup, before I easily have six or seven chips. Ate, if I didn’t feel like eating, but I knew about it.
His movement improved in parallel. Guided physiotherapy — stretching, strength training, balance exercises, chair exercises, knee stretches, arm and knee work, even picking up a ball off the floor — fills an hour each day. “I couldn’t walk or climb stairs. Now I can,” says Gupta. The emotional arc is remarkable. “I’m coming out of depression and seeing the changes in my body; even determined to get into high intensity routines.”
He can sleep on time. “The secret is to let your body digest before bed and get off the phone. Now I manage to get seven to eight hours of sleep.” Gupta is careful not to romanticize the injection. “It’s stress, not magic. Discipline does the heavy lifting.”
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A word of caution
Dr Wangno worries about the social media hype surrounding weight loss drugs and generics that have flooded the market, now that patents have expired. “These are prescription drugs that require supervision. Without medical supervision, who is going to ensure that the pharmacy is safe?” he asks.
Screening is non-negotiable, he insists, excluding stomach disease, pancreatitis, significant alcohol use, thyroid disorders including a history of cancer and gastroparesis. The dose should be increased gradually. Then there is this ability. “If stopped prematurely—say after a year or 18 months—the weight often returns. Patients should be counseled,” says Dr. Wangno.
Quality control remains a concern in a crowded market. “Original molecules go through rigorous lab procedures. Real-world confidence comes after consistent prescription experience,” he adds. Notably, Indian patients often show stronger responses, which may be associated with differences compared to the Caucasian population, says Dr. Wangno.
As for Gupta, his story is a reminder that while drugs can open doors, discipline must go into your weight loss journey. “Building muscle mass is insurance. Continuity beats intensity. Exercising with protein while getting good sleep supports weight stability,” advises Dr. Wangno.
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