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Guide 4 of 9 · Stage: Decide

Should I consider a GLP-1 medicine? And when not to

Who doctors consider these medicines for, who should not take them, and how to prepare for an honest talk with a doctor.

GLP Guidebook teamUpdated 5 Oct 202613 min read29 sourcesWritten from published sources
The short answer

Doctors in India may consider a GLP-1 medicine for type 2 diabetes, or for obesity that affects your health. Meeting a weight number does not mean you should take one. Some people should not take them at all, including anyone pregnant or with a family history of a rare thyroid cancer. The decision is one to make with a doctor.

Key facts

Names you'll see
Ozempic and Wegovy contain semaglutide. Mounjaro contains tirzepatide (sold as Zepbound in the US).3,5,6,7
A doctor may consider it
BMI above 27, or above 25 with a weight-related condition (Indian guideline)1
That is not a yes
Counselling on benefits, limits, side effects and cost comes first1
Never take it if
You're allergic or pregnant, or (US label) you or family had medullary thyroid cancer, or you have MEN23
Results vary
In the main trials, 9 to 14 in 100 people lost less than 5% of their weight; about 31 in 100 if they had type 2 diabetes11,12,13
When you stop
Most of the weight lost tends to come back within a year14
Prescription
Yes. In India, from an endocrinologist, internal-medicine specialist or cardiologist, per a 1 Apr 2026 government statement. Committee minutes of CDSCO, India's drug regulator, set a similar condition for some approvals25,26,27
On this page
  1. What do doctors look at?
  2. Who should not take a GLP-1?
  3. What about pregnancy, PCOS and the birth-control pill?
  4. Teens, older adults, kidneys, liver, other medicines, surgery
  5. What if I only want to lose a few kilos?
  6. What results can I honestly expect?
  7. A way to think it through
  8. What to bring to the doctor
  9. Should I tell my family?
  10. Questions people ask

What do doctors look at?

Doctors look at your weight, your health conditions, and what you've already tried. A BMI number alone does not decide it.

Two different sets of numbers get mixed up online. One set describes your weight. The other is where a doctor may start to think about medicine. They are not the same thing.

Describes your weight Indian BMI cut-offs

Under India's 2009 consensus, a BMI of 23 to 24.9 is overweight and 25 or more is obesity.22 A newer 2025 proposal from the India Obesity Commission counts a BMI above 23 as Stage 1 obesity.2 Waist size matters too. Guide 1 explains this.

Where a doctor may consider medicine Indian guideline (ESI 2025)

Medicine "should be considered" at a BMI above 27. Or above 25 with a condition like high blood pressure, high cholesterol, type 2 diabetes or sleep apnoea.1

Meeting a number does not mean you should take it. "Considered" means a doctor weighs it up with you. The same guideline says proper counselling on benefits, limits, side effects and cost must come before any prescription.1

The drug labels use higher numbers for weight. In Europe, Wegovy and Mounjaro are approved for adults with a BMI of 30 or more. Or 27 or more with a weight-related condition.4,23 An Indian doctor quoted at the India launch of Wegovy gave the same numbers.8

Type 2 diabetes is a separate reason. Ozempic is approved to control blood sugar in adults with type 2 diabetes. That approval has no weight cut-off.5 Your doctor will look at your HbA1c (a blood test of your average sugar level) and your other medicines.

Other approved uses exist. In the US, Wegovy is also approved to lower the risk of heart attack and stroke in adults with heart disease and excess weight.3 In India, Wegovy is also approved to lower the risk of heart attack and stroke in some people with heart disease.8 In July 2026, India's drug regulator also approved Wegovy for a type of fatty liver disease that has caused scarring in the liver.10

Semaglutide for diabetes comes as an injection and as a tablet.28,29 In July 2025 and November 2025, an expert committee of CDSCO, India's drug regulator, recommended approving both to lower the risk of heart attack and stroke in adults with type 2 diabetes.28,29 A committee recommendation is a step before approval. We did not find the final approval notices.

Who can prescribe. A government statement on 1 Apr 2026 said only endocrinologists, internal-medicine specialists and cardiologists can prescribe GLP-1 medicines.25,16 CDSCO expert-committee minutes attach a similar condition to some approvals (endocrinologist or internal-medicine specialist), but we found no rule covering every brand.26,27

Who should not take a GLP-1?

Some people should never take these medicines. Others need extra care, and a doctor may decide it isn't safe for them.

The US labels give two firm "do not take" groups. The first is anyone with a personal or family history of medullary thyroid cancer (MTC), or a rare inherited condition called MEN2.3,6 The second is anyone with a serious allergy to the medicine.3

The thyroid warning comes from animal studies. Semaglutide caused thyroid tumours in rodents. Nobody knows yet whether it does the same in people.3

The table below lists the main conditions. "Do not take" means the label or guideline lists it as a firm reason not to use the medicine. "Not recommended" means the label or guideline advises against it. "Caution" means a doctor may still prescribe, but watches you more closely.

ConditionWhy it mattersWhat it means
You or a close relative had medullary thyroid cancer, or you have MEN2Thyroid tumours seen in animal studies; human risk unknown3Do not take Listed as a contraindication on the US labels3,6
Allergy to the medicine or its ingredientsSevere allergic reactions have been reported3Do not take3
Pregnant, or trying to get pregnantMay harm the baby3Stop Stop semaglutide at least 2 months before trying5
BreastfeedingSemaglutide should not be used while breastfeeding4Do not take Listed as a contraindication (a reason not to take it) by ESI1
Past pancreatitis (swollen pancreas)Pancreatitis, sometimes fatal, has happened on these medicines3Caution European label advises caution4
Severe gastroparesis (very slow stomach) or bowel diseaseStomach side effects can be more severe3,4Not recommended if severe Caution with inflammatory bowel disease4
Gallbladder problemsGallstones are more common on these medicines3Check first ESI advises ruling out gallbladder disease1
Type 1 diabetesWegovy has not been studied in people with type 1 diabetes3,4Not recommended for weight (European label)4
Severe kidney diseaseLittle experience; vomiting and diarrhoea can dry you out and harm kidneys3,4Specialist decision See kidneys below
Severe liver diseaseLittle experience in severe liver impairment4Not recommended for weight (European label)4
Diabetic eye disease (retinopathy)Eye complications reported in people with type 2 diabetes3Caution Needs eye check-ups3
Severe heart failureNot studied in the most severe stage4Not recommended for weight (European label)4
Eating disorder, now or in the pastStrong appetite effects may make disordered eating worse19Tell your doctor Not on the labels, but researchers flag it19

From the US Wegovy and Zepbound labels, the European Wegovy label and the Indian ESI 2025 guideline. We could not open the full Indian label texts.

What about pregnancy, PCOS and the birth-control pill?

Don't take a GLP-1 while pregnant. If you could get pregnant, plan contraception with your doctor before you start.

The Indian guideline says contraception is essential for women who could get pregnant on weight-loss medicines. It should continue for 3 months after stopping.1 Semaglutide stays in the body a long time. So its label says to stop at least 2 months before a planned pregnancy.5,4 For tirzepatide (Mounjaro), the European label and the UK regulator say to stop at least 1 month before; the US label gives no interval.23,24,7

Tirzepatide can make the birth-control pill less reliable. It slows the stomach, which can affect how well the pill is absorbed. The effect is largest after the first dose.6

The Mounjaro and Zepbound labels advise switching to a non-pill method, or adding a condom. Do this for 4 weeks after starting, and 4 weeks after each dose increase.6,7 Methods that aren't swallowed, like a hormonal IUD (coil), are not affected.6

Semaglutide is not expected to make the birth-control pill less effective, according to its European label.4

PCOS note. If you have PCOS (polycystic ovary syndrome) and take the birth-control pill, the advice above applies to you.6 Tell your doctor before starting, especially on tirzepatide. Plan contraception at the same visit.1 Whether these medicines help PCOS itself is covered in our article on PCOS and GLP-1 medicines.

Teens, older adults, kidneys, liver, other medicines and surgery

These groups can sometimes use GLP-1 medicines. But each one needs extra checks, and some need a specialist.

Teenagers

In May 2026, India approved Wegovy for weight management from age 12. It is for teens with obesity who weigh over 60 kg, alongside diet and activity.9,21 The European label says to stop and rethink if a teen's BMI hasn't dropped by at least 5% after 12 weeks on the full dose.4 Gallstones were more common in teens than adults on Wegovy.3 The US label for tirzepatide for weight (Zepbound) says it has not been shown safe and effective under 18.6

Older adults

Older people can lose muscle along with fat, which raises the risk of frailty. Direct evidence in older adults is scarce.20 In a large Wegovy trial, people aged 75 and over had more hip and pelvis fractures than on a dummy injection.3 Dehydration from vomiting or diarrhoea can harm the kidneys, so drinking enough matters.3

Kidney disease

Kidney injury has been reported, mostly in people who got dehydrated from stomach side effects.3 The European label does not recommend Wegovy if kidney function is very low (an eGFR blood-test result below 30).4 But in people with type 2 diabetes and kidney disease, Ozempic is approved in the US to help protect the kidneys.5 So this is a decision for your kidney or diabetes doctor.

Liver disease

Wegovy is approved in India for a type of fatty liver disease with moderate to advanced scarring, but not cirrhosis.10 It is not recommended in severe liver impairment, and needs caution in milder cases.4

If you take insulin or a sulfonylurea

Sulfonylureas are diabetes pills like glimepiride and gliclazide. Taken with a GLP-1, they and insulin raise the risk of low blood sugar (a hypo), including severe hypos.3 Your doctor may lower their dose when you start, and should explain the signs of a hypo.3

Before surgery or an endoscopy (camera test)

GLP-1 medicines slow your stomach. Rarely, food has stayed in the stomach despite fasting, and been breathed into the lungs under anaesthesia.3 Always tell the surgeon and anaesthetist you take one.3

US guidance from 2024 says most people can keep taking it before planned surgery. Higher-risk people may need a liquid-only diet for 24 hours first. That includes people in the early dose-increase weeks, on higher doses, or with stomach symptoms.15

What if I only want to lose a few kilos?

These medicines are not meant for a few kilos before a wedding, or for losing fat for bodybuilding. You'd take on the same risks with no proven benefit.

It's not what they are approved for. The weight approvals cover obesity, or overweight with a weight-related condition.3,8 The big trials only included people like that.11,12

The risks don't shrink because your goal is small. Stomach side effects, gallstones and pancreatitis can still happen.3

The weight tends to come back. A year after stopping semaglutide, people had regained about two-thirds of what they'd lost.14 A short course before an event is likely to be undone afterwards.

Some of what you lose is muscle. In studies, muscle made up as much as a quarter of the weight lost.20 That works against a gym goal.

Fakes are a real risk. The US regulator warns that fake products may contain the wrong ingredient, too little of it, or harmful substances.18 In India, a government statement says these are prescription-only, and officials are inspecting online sellers and slimming clinics.16 In July 2026, some batches of licensed generic semaglutide were recalled, after one maker found an impurity in the medicine.17

What to read instead. Guide 3: Your options covers food, activity and other routes. The few-kilos path pulls it together.

What results can I honestly expect?

Most people in trials lost a meaningful amount of weight. But results vary a lot, side effects are common, and the weight returns if you stop.

Trials use losing 5% of body weight as a key marker.11,12 For an 80 kg person, that's 4 kg. Out of every 100 people in each trial, this is how many reached it:

STEP 1Semaglutide 2.4 mg, weekly

Adults without diabetes, 68 weeks.11

Semaglutide86 in 100
Dummy injection31 in 100
SURMOUNT-1Tirzepatide 15 mg, weekly

Adults without diabetes, 72 weeks.12

Tirzepatide91 in 100
Dummy injection35 in 100
STEP 2Semaglutide 2.4 mg, weekly

Adults with type 2 diabetes, 68 weeks.13

Semaglutide69 in 100
Dummy injection28 in 100

Put the other way, about 1 in 7 people on semaglutide and 1 in 11 on tirzepatide lost less than 5%. With type 2 diabetes, it was nearly 1 in 3.11,12,13

If you stop, most of it comes back. A year after stopping semaglutide, people had regained about two-thirds of the weight they'd lost.14

Side effects make some people stop. In the semaglutide trial, 4.5 in 100 people quit because of stomach side effects, against 0.8 in 100 on the dummy. This count includes only stomach side effects.11 On tirzepatide 15 mg, 6.2 in 100 stopped because of any side effect, against 2.6 in 100.12 So the two numbers measure different things.

People with diabetes tend to lose less. The average was 9.6% in the diabetes trial, against 14.9% in people without diabetes.13,11

Think of it as long-term. The study on stopping concluded that ongoing treatment seems needed to keep the benefits.14 The Indian guideline suggests a 3-month trial first, to see whether a medicine works and suits you.1 Guide 9 covers stopping.

Cost adds up. You pay for medicine, doctor visits and tests, month after month. Guide 6 works out the all-in cost over 12 months.

A way to think it through

Use this to sort your thoughts before a doctor visit. It does not give you a yes. Only a doctor who knows your health can.

1Is it for a health reason? Type 2 diabetes, or weight that affects your health?
If noA few kilos, or an event? These medicines aren't for that. Read Guide 3.
2Does anything in the "should not" table apply to you?
If yesDon't start. Tell the doctor; it may rule the medicine out.
3Are you pregnant, breastfeeding, or planning a baby soon?
If yesNot now. Plan timing and contraception with a doctor.
4Are you ready for long-term use, the side effects and the cost?
If unsureRead Guide 5 and Guide 6 first.
Talk it through with a qualified doctor.Take the checklist below. The doctor decides whether a medicine fits you, and which one.

Questions to ask yourself

There's no score here. These questions help you know what you want, and what you're ready for.

  • Why do I want this now? Is it my health, or pressure from others?
  • What have I tried before? What worked, even for a while?
  • Could I keep taking a weekly medicine for years, not months?
  • Can I afford it for a year or more, plus doctor visits and tests?
  • How would I cope with feeling sick or having an upset stomach for a few weeks?
  • Am I planning a pregnancy in the next year or two?
  • Have I ever struggled with an eating disorder, like bingeing or starving myself?
  • Who will support me with food changes and activity?

What should I bring to the doctor?

Bring your history, your medicines and any recent test results. Then ask the questions below. You can print this card.

My GLP-1 doctor visit

Bring

  • Your weight history: highest weight, recent changes, past attempts
  • Your waist size, if you've measured it
  • A list of every medicine and supplement you take, with doses
  • Recent test results, if you have them: HbA1c, cholesterol (lipids), liver, kidney and thyroid tests
  • Family history: thyroid cancer, MEN2, pancreatitis, diabetes
  • Your own history: pancreatitis, gallstones, stomach problems, eating disorders, eye disease
  • Pregnancy plans, and the contraception you use
  • Any surgery or endoscopy (camera test) you have planned

Ask

  • Is a medicine right for me, or should I try something else first?
  • Is this medicine approved in India for my condition?
  • How will we check if it's working, and when?
  • What should I do about my other medicines?
  • Which side effects mean I should call you, or go to hospital?
  • What will it cost all-in for a year?
  • What happens if I stop?
  • Who do I contact between visits?

From GLP Guidebook, Guide 4. General information, not medical advice.

Only certain specialists can prescribe these medicines in India. See who can prescribe, above. Guide 6 explains how to find one, and what a proper consultation includes.

Should I tell my family?

If you can, yes. The Indian guideline recommends bringing your spouse or family into appointments.1

The idea is that they learn about healthy food and activity too, and become your support.1 At home, that can mean smaller portions without comments, or support during festival meals. It also helps if someone knows your side effects and when to get help. The guideline also asks doctors to consider your money situation.1

Questions people ask

My BMI is 26. Do I qualify?

There's no "qualify". The Indian guideline says a doctor may consider medicine above 25 only if you also have a weight-related condition, like high blood pressure or type 2 diabetes.1 Even then, it's a decision the doctor makes with you, after weighing the risks.

Can I take it if my mother had thyroid problems?

Most thyroid problems, like an underactive thyroid, are not on the "do not take" list. The US label's ban is for a personal or family history of medullary thyroid cancer, or MEN2.3 Tell your doctor exactly what your relative had.

Is it safe with metformin?

Metformin is not one of the medicines the labels flag for low blood sugar. That warning is about insulin and sulfonylureas like glimepiride.3 Your doctor will still review all your medicines together.

How long would I need to take it?

Often for a long time. In the stopping study, most of the weight came back within a year, and researchers said ongoing treatment seems needed.14 A first check at around 3 months shows whether it suits you.1

Can I stop before I try for a baby?

Plan it with your doctor. The semaglutide labels say to stop at least 2 months before a planned pregnancy.5,4 For tirzepatide, the European label and the UK regulator say at least 1 month; the US label gives no interval.23,24,7 The Indian guideline (ESI) says contraception is mandatory for women who could get pregnant while on these medicines, and should continue for 3 months after stopping.1

I'm having surgery next month. Should I stop?

Don't decide alone. Tell your surgeon, anaesthetist and the doctor who prescribed it. Since 2024, US guidance says most people can continue, with extra steps for higher-risk people.15

Before you move on

  • A BMI number is where a doctor may start thinking, not a reason to take a medicine.
  • Never take one in pregnancy. The US labels also rule them out with a personal or family history of MTC, or MEN2.
  • On tirzepatide, the birth-control pill may not protect you for 4 weeks after starting and 4 weeks after each dose increase; use another method too.
  • They're not for a few kilos, and weight usually returns after stopping.
  • You have a checklist to take to a specialist doctor.
Your optionsSeeing a doctorStoppingFor a family member
Was this guide easy to understand?

Sources

  1. Madhu SV, Kapoor N, Das S, Raizada N, Kalra S. ESI clinical practice guidelines for the evaluation and management of obesity in India: an update (2025). Indian J Endocrinol Metab, 2025;29(4):355–365. Recommendations B.1, C.1–C.4, D.1–D.3. DOI
  2. Misra A et al. Revised definition of obesity in Asian Indians living in India. Diabetes Metab Syndr, 2025;19:102989. Declared interests: the lead author declares grants, lecture fees and travel from Novo Nordisk and Eli Lilly, and from Indian makers including USV, Lupin, Cipla and Glenmark; a second author declares grants and lecture fees from Cipla, USV and Lupin (paper's own declaration). DOI
  3. Novo Nordisk. Wegovy (semaglutide) US prescribing information, revised June 2026: boxed warning, sections 4, 5, 8. PDF
  4. European Medicines Agency. Wegovy summary of product characteristics: sections 4.1, 4.2, 4.4, 4.5, 4.6. PDF
  5. Novo Nordisk. Ozempic (semaglutide) US prescribing information, revised May 2026: sections 1, 8.3. PDF
  6. Eli Lilly. Zepbound (tirzepatide) US prescribing information, revised August 2026: sections 4, 7, 8.3, 8.4. PDF
  7. Eli Lilly. Mounjaro (tirzepatide) US prescribing information, revised August 2026: section 8.3. PDF
  8. ThePrint. Wegovy launched in India (includes Dr Ambrish Mithal on BMI 30, or 27 with conditions, for Wegovy and Mounjaro). 24 June 2025. Also reports the company's statement that Wegovy is approved in India to reduce the risk of major heart and blood-vessel events. Link
  9. IndiaMedToday. Novo Nordisk's Wegovy gets CDSCO nod for adolescent obesity in India. 29 May 2026. Link
  10. Medical Dialogues. CDSCO approves Novo Nordisk's Wegovy for fatty liver disease in India. 19 July 2026. Link
  11. Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). NEJM, 2021;384:989–1002. DOI
  12. Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1). NEJM, 2022;387:205–216. DOI
  13. Davies M et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2). Lancet, 2021;397:971–984. DOI
  14. Wilding JPH et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab, 2022;24:1553–1564. DOI
  15. American Society of Anesthesiologists. New multi-society GLP-1 clinical practice guidance released. 29 October 2024. Declared interests: in the guidance paper, 2 of 10 authors declare consulting or speaking fees from Novo Nordisk (paper's own declaration). Link
  16. Outlook India. Inspections, surveillance to continue against unauthorised sale and promotion of GLP-1 weight-loss drugs: Govt. 1 April 2026. Link
  17. Medical Dialogues. Recalls by Dr Reddy's, Torrent put spotlight on quality standards in India's semaglutide market. 10 July 2026. Link
  18. US Food and Drug Administration. FDA's concerns with unapproved GLP-1 drugs used for weight loss. Link
  19. The dual role of GLP-1 receptor agonists in weight management and eating disorders: potential benefits and risks. J Psychiatr Res, 2026. DOI
  20. GLP-1 receptor agonist therapy and skeletal muscle: a narrative review with implications for older adults. JAR Life, 2026. DOI
  21. Business Standard. Novo Nordisk's Wegovy gets CDSCO nod for fatty liver disease indication (also reports the earlier CDSCO nod for adolescents aged 12 or older with obesity and body weight above 60 kg). 17 July 2026. Link
  22. Misra A et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163–70 (healthy BMI 18.0–22.9, overweight 23–24.9, obesity 25 or more). PMID 19582986
  23. European Medicines Agency. Mounjaro (tirzepatide) summary of product characteristics, section 4.6 (stop at least 1 month before a planned pregnancy). PDF
  24. MHRA (UK medicines regulator). GLP-1 medicines for weight loss and diabetes: what you need to know (semaglutide at least 2 months, tirzepatide at least 1 month before trying to get pregnant). Published 5 June 2025, updated 5 February 2026. Link
  25. Press Information Bureau (PIB Research). GLP-1 Drugs: Use, Risks, and Regulation ("In India, GLP-1 drugs can only be prescribed by endocrinologists, internal medicine specialists, and cardiologists"). 1 April 2026. PDF
  26. CDSCO. Subject Expert Committee (Endocrinology & Metabolism), recommendations of 20–21 April 2023, tirzepatide ("The drug should be sold by retail under prescription of Endocrinologist or internal medicine specialists only"). PDF · Archived copy
  27. CDSCO. Subject Expert Committee (Endocrinology & Metabolism), recommendations of 13–14 February 2024, semaglutide (approved warning: "To be sold by retail on the prescription of an Endocrinologist, and Internal medicine"). PDF · Archived copy
  28. CDSCO. Subject Expert Committee (Endocrinology & Metabolism), recommendations of 17 July 2025, item 3: semaglutide injection 0.25, 0.5 and 1 mg (Novo Nordisk India), additional indication "to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease", "recommended for grant of approval". PDF (rolling file) · Archived copy
  29. CDSCO. Subject Expert Committee (Endocrinology & Metabolism), recommendations of 6 November 2025, item 1: semaglutide tablets 3, 7 and 14 mg (Novo Nordisk India), additional cardiovascular indication in adults with type 2 diabetes, "recommended for grant of approval". PDF · Archived copy

Last checked 5 Oct 2026 · Next review due Jan 2027 · Report an error

How this guide was made. Written by the GLP Guidebook team from the sources above: drug labels, the Indian ESI 2025 guideline, published trials and named news reports. It's general information, not medical advice. Talk to a qualified doctor before starting, stopping or changing any medicine. In an emergency in India, call 112. How we write