How novel weight loss drugs help 40-year-old lose 16 kg over a year: First she was on semaglutide pill, then Mounjaro shots

Indian Express

3 days ago

For the first time, 40-year-old Manmeet Bindra feels motivated to exercise and has set up a home gym, cleaned up her diet and has more energy to ride out her 10 am to 7 pm work days and the pressure of deadlines. Tired of seeing the weighing scale needle tipping over the 90 kg mark and her blood sugar levels spiral despite fad diets, gym routines and natural supplements, she is now 74 kg. For the past year, she had been on the oral weight loss drug semaglutide (Rybelsus) but since she couldn't tolerate its side effects well, has had better results with tirzepatide (Mounjaro) this year.
'I needed that one push to get off the weight plateau, steel my mind and focus on getting better and be disease-free. Mounjaro accelerated the process,' says Bindra, who has battled uncontrolled diabetes, PCOS (polycystic ovary syndrome), hypothyroidism and fatty liver because of her weight. Her appetite has now gone down by 30-40 per cent, her binge cravings are zero and she has managed to tame the 'food noise' that made her peckish through the day.
Food was not just her pleasure but escapism, something that Dr Jasjeet Singh Wasir, her endocrinologist and diabetologist at Medanta, understood when she consulted him last year. That's why he put her on a new class of weight loss drugs. Her blood sugar readings are better and her HbA1c (average blood sugar count of three months) has gone down from 8 per cent to 7.3 per cent (normal is less than 5.6 per cent).
The new drugs are more than a life-saver for people like Bindra as they help them eliminate several obesity-related risk factors. The GLP-1 receptor agonists mimic natural gut hormones responsible for blood sugar and appetite control, such as semaglutide – the active ingredient in Wegovy. It improves secretion of insulin, inhibits glucose production in the liver and slows down digestion. Tirzepatide, sold as Mounjaro, additionally mimics the GIP hormone, primarily by stimulating insulin release from the pancreas. GIP also influences lipid metabolism.
THE INSIDIOUS WEIGHT GAIN
Bindra never realised how a sedentary lifestyle, long work hours, performance anxiety and stress-eating had turned into belly fat. Then she gained weight all over. After developing Covid in 2020 and 2022, her random blood tests showed a blood glucose level of 190 mg/dL and a HbA1c count of 5.8 per cent. In April 2023, during her executive health check-up, she was diagnosed with type 2 diabetes as her HbA1c shot up to 8.4 per cent.
Looking at her body weight, family history of diabetes and her dual role as professional and caregiver for her parents, Dr Wasir put her on oral semaglutide or Rybelsus pills, mainly to control her diabetes though it also helps in some weight loss. According to randomised controlled trials, one starts losing weight immediately after taking Rybelsus. After one month, the average weight loss on Rybelsus is around 2 kg; after two months, it's over 3 kg.
THE SIDE EFFECTS OF A PILL
'I constantly had nausea, vomitting, diarrhoea, fatigue, constipation and headaches. My body simply did not take to semaglutide,' says Bindra. Then Dr Wasir put her on the injectable tirzepatide. 'Around 300 patients of mine on weight loss pills had extreme gastric symptoms. The same patients are tolerating the injectable Mounjaro better,' he says.
Since Mounjaro mimics two hormones involved in appetite regulation and glucose control, this dual action may result in more significant weight loss and potentially better blood sugar control. This can indirectly improve overall tolerability.
However, Dr Wasir attributes tolerability to the grading of doses. Most of his patients begin from 2.5 or 5 mg, which is a kind of stage one and stage two doses. Then it goes up to 7.5 mg and a maximum dose of 15 mg. 'It's still very early for us to arrive at an observation,' he says.
BEGINNING WITH MOUNJARO
Bindra started with a low 1.25 mg dose. Once she could tolerate it, Dr Wasir upgraded the dose to 2.5 mg. But at the same time, he insisted she make lifestyle changes, particularly her diet and exercise. 'I cut down on junk food, fried items and oily meals. I used to binge-eat when I was stressed and that's significantly reduced now. I am into plant proteins,' she adds. Now Bindra focusses on simple, home-cooked foods that keep her stomach happy. 'Looking back, that kick we seek in our food rather than exercising was the reason I always craved the spicier and heavier chole bhature or rajma rice. This dietary shift has influenced some of my health markers, too,' she says.
Mounjaro has been an effective appetite suppressant. 'I used to eat two rotis but now I'm comfortable with one. I can portion-control. Interestingly, I no longer feel as hungry as before or feel dizzy. I have given up alcohol too, though I was nothing beyond a social drinker,' says Bindra.
WATCH OUT FOR MUSCLE LOSS AFTER USING MOUNJARO
For Dr Wasir, the key challenge remains her protein intake, now that she only has plant proteins. 'There's always a risk of muscle loss alongside fat loss, which can be hard to reverse. We're working on optimizing her protein intake to support muscle health during weight loss,' he adds. On her part, Bindra never misses her strength training sessions. 'I repeat it at every visit — your investment in muscle is as important as your medication,' says Dr Wasir.
DO THE DRUGS NEED TO BE TAKEN INDEFINITELY?
Dr Wasir says clinical trials for both semaglutide and tirzepatide have lasted between 72 and 88 weeks. But they don't provide a clear answer on how long treatment should continue. Trials show taking off the drug midway leads to weight regain. 'Based on current evidence, these medications appear to be intended for long-term use. As for long-term efficacy, we rely on two things: the duration of clinical trials and real-world experience after approval. For example, even if a drug was trialled for two years, if it has been used safely for five years since, we consider that seven years of practical experience,' he adds.