Pharmaceuticalisation of Obesity: The Promise, Perils & Policy Choices

Obesity has emerged as a defining public health challenge of the twenty-first century, with rising prevalence across the globe. Advances in endocrinology, metabolism, and neurobiology have shifted obesity from a behaviourally framed condition to a chronic, relapsing disease, a reconceptualisation endorsed by global health authorities. This shift has not only reduced moral blame, but it has also accelerated pharmaceutical approaches, particularly with the advent of highly effective anti-obesity drugs such as GLP-1 receptor agonists and dual incretin therapies. Ozempic, Wegovy, Mounjaro and many others are the buzzwords today. People are increasingly ingesting semaglutide and tirzepatide as if these were sugar pills.

This report critically examines the global and regional forces driving the pharmaceutical pathologisation of obesity and its clinical, ethical, economic, and policy implications, with particular focus on low- and middle-income countries (LMIC), especially India. While obesity pharmacotherapy represents a major scientific advancement for individuals with severe obesity and metabolic disease, its rapid mainstreaming raises concerns about equity, long-term safety, stigma, and the narrowing of public health priorities.

Globally, obesity’s disease classification reflects evidence that body weight is regulated by complex hormonal, neural, and genetic systems that actively resist sustained weight loss. Formal recognition has catalysed innovation, positioning obesity drugs as a highly lucrative pharmaceutical market. New agents, such as semaglutide and tirzepatide, achieve weight loss comparable to that of bariatric surgery, and improve key cardiometabolic risk markers. However, discontinuation commonly leads to weight regain, implying the need for long-term or lifelong use, even while evidence on the safety of such use over decades remains limited.

These issues are amplified in India, where obesity coexists with undernutrition, micronutrient deficiencies, and profound socio-economic inequalities. Earlier metabolic risk at lower BMI thresholds creates a greater imperative for anti-obesity intervention, while simultaneously increasing the risk of over-medicalisation.