What are my options for losing weight? Where GLP-1 medicines fit

Which options are for you?

It depends mostly on your BMI. Lifestyle changes are for everyone. Medicines come in at a lower BMI. Procedures and surgery are for much higher weights.

So if your BMI is in the high 20s, the choice is usually between lifestyle changes alone and lifestyle changes plus a medicine. At 165 cm, a BMI of 27 is about 74 kg. Surgery usually starts around a BMI of 35, about 95 kg at the same height.^2,22

These are points where you and a doctor can start a conversation, not rules that you must or must not have something. Guidelines also look at your health, not just your weight.^2,21,22

How do the options compare?

In trials, surgery led to the most weight loss. GLP-1 medicines came next, but only while people kept taking them. Lifestyle programmes and pills led to less.

The numbers below come from different trials, with different people. So treat them as rough guides. They are not a direct comparison. "Weight lost" is the average share of starting body weight.

Each option in detail. Weight lost is the average share of starting weight.

Costs are ranges published by private hospitals on their own websites, a pharmacy website, news reports and a medical journal. They are not quotes. Surgery and balloon costs are for the procedure; GLP-1 and orlistat costs repeat every month.

In the medicine trials, the dummy-injection groups lost 2.4% and 3.1%, or about 2–3 kg.^13,14 These are averages, and results vary from person to person. In those trials, about 14 in 100 people on semaglutide and 9 in 100 on tirzepatide lost less than 5% of their weight.^13,14

Can food and activity changes alone help?

Yes, for many people. Structured programmes helped people lose around 6–9% of their weight, and cut their risk of diabetes.

One large trial, Look AHEAD, followed 5,145 adults with type 2 diabetes.⁴ The programme set a calorie target and about 3 hours of activity a week, with frequent group and one-to-one sessions.⁴ People lost 8.6% of their weight in the first year, against 0.7% with usual care.⁴ After about 10 years, they were still 6.0% lighter, against 3.5%.⁴

In the US Diabetes Prevention Program, 3,234 people with high blood sugar (prediabetes) took part.⁵ The lifestyle group lost 5.6 kg on average over about 3 years, against 0.1 kg on a dummy pill.⁵ Their rate of new diabetes was 58% lower: 4.8 cases per 100 people a year, against 11.0.⁵

Food: how much to cut

Indian and US guidelines give the same figure: eat about 500–750 calories a day less than your body uses.^3,49 That's a cut from what you need, not a daily total. Someone whose body uses 2,200 calories a day would eat about 1,450–1,700.

India's national nutrition institute (ICMR-NIN) warns against cutting more than 40% of your daily needs, to protect muscle.³ Added sugar should stay under 25–30 g a day.³

Protein: the part most people miss

When you lose weight, some of it is muscle. Too little protein makes that worse, and a smaller appetite on a GLP-1 medicine makes protein harder to get.⁵⁰ Indian diets are already high in carbohydrate and low in protein.⁵¹

The same advisory says to pair protein with strength exercise at least 3 times a week, plus at least 150 minutes of moderate activity like brisk walking.⁵⁰ If you have kidney disease, ask your doctor before raising your protein. For where Indian vegetarians can get it, see protein for Indian vegetarians.

What to put on the plate

These are ICMR-NIN's suggestions for Indian meals.³

Activity, sleep and support

Activity. ICMR-NIN suggests 20–40 minutes a day of moderate activity, like brisk walking, plus 10–20 minutes of vigorous activity.³ It adds strength exercise 2–3 times a week to keep muscle.³ For people on a GLP-1 medicine, the US advisory above suggests at least 3 times a week.⁵⁰ If you have heart disease, diabetes or obesity, it advises checking with a doctor first.³

Sleep and screens. Poor sleep and long screen time are linked with weight gain, partly through snacking and sitting.³

Support. WHO says diet and activity programmes may be offered alongside GLP-1 medicines.¹ India's obesity guideline, from the Endocrine Society of India (ESI, 2025), suggests involving your family, and peer support groups, to help changes stick.²

What about pills, and other medicines that lower weight a little?

Only one older weight-loss pill, orlistat, is available in India. It helps a little. Some diabetes medicines also lower weight a little. Two US weight-loss pill combinations are not available here.

Orlistat blocks an enzyme that digests fat (a lipase), so some fat passes out unabsorbed.² In a 4-year trial, people on orlistat lost 5.8 kg, against 3.0 kg on a dummy pill.⁸ In a small Indian trial over 24 weeks, it was 4.65 kg against 2.5 kg.⁹ Loose, oily stools, oily spotting and urgent toilet trips were common.⁹ It can also lower the absorption of some vitamins and other medicines.²

Metformin is a diabetes medicine, not an approved weight-loss one.⁷ In the Diabetes Prevention Program it led to 2.1 kg of loss on average.⁵ In the Indian trial, 41 in 100 people on metformin got diabetes over 3 years, against 55 in 100 with no treatment. That is about 26% fewer.⁶ An international PCOS guideline says doctors should consider it for women with PCOS and a BMI of 25 or more.¹¹

SGLT2 inhibitors, such as dapagliflozin, lead to modest weight loss. Across 116 trials, people lost about 1.8 kg more than on a dummy pill.¹⁰

What's not available in India

• Phentermine-topiramate and naltrexone-bupropion are approved for weight in the US. They are not available in India.⁷
• Sibutramine and rimonabant, two older weight-loss drugs, are banned in India.¹² So are fenfluramine and dexfenfluramine.¹²

Where do GLP-1 medicines fit?

They lead to more weight loss than pills or lifestyle alone. But they are a long-term treatment, and most of the weight returns if you stop.

Semaglutide acts like the gut hormone GLP-1.¹⁵ Tirzepatide acts on GLP-1 and a second gut hormone, GIP.¹⁴ Guide 2 explains how they work. In every trial below, people also followed a diet and activity plan.^13,14

Average weight lost in each trial. Kilograms are for someone who starts at 90 kg.

Only the last trial compared the two medicines directly; the others each tested one medicine against a dummy injection, so don't compare across them. India's ESI guideline suggests either medicine when the aim is 10–15% loss, and tirzepatide when the aim is 15–20%.²

Tablets. Semaglutide also comes as a tablet (3, 7 and 14 mg), approved in India since July 2020.⁴⁷ It was launched here in January 2022 as a medicine for type 2 diabetes.⁴⁸ The trial results on this page are for weekly injections.^13,14

What happens when you stop. A year after stopping semaglutide, trial participants had regained about two-thirds of the weight they lost.¹⁷ In a tirzepatide trial, everyone first took the medicine for 36 weeks and lost about 21% of their weight.¹⁸ Then some were switched to dummy injections. Over the next year, their weight went up by 14% of what they weighed at the switch.¹⁸ For someone who weighed 85 kg by then, that is about 12 kg (85 × 0.14 = 11.9). Those who stayed on tirzepatide lost a further 5.5% over the same year.¹⁸ Guide 9 covers stopping.

Cost. Generic semaglutide launched in India in March 2026.¹⁹ Launch prices for one month's supply started at about ₹1,290 for lower strengths.³⁵ Another maker priced a pen of 4 doses for a month from ₹1,800.⁴⁵ A third priced its 2 mg and 4 mg pens at ₹4,200 a month.⁴⁶ Mounjaro (tirzepatide) pens have an MRP of ₹13,125 for 4 starting doses, rising to ₹25,781 at the top dose, as listed by pharmacies.^44,36 Guide 6 lists the MRP of each medicine. Health insurance in India generally doesn't pay for medicines you take at home.⁷

Who it's for. India's obesity guideline, from the Endocrine Society of India (ESI, 2025), says a doctor may consider them at a BMI above 27. Or above 25, with a weight-related condition.² That is a point where you and a doctor can start talking about it. It does not mean you should take one. Guide 4 covers who should and shouldn't take them.

Who is weight-loss surgery for in India?

Surgery is for people with a higher BMI, or with diabetes that other treatment hasn't controlled. It gives the largest, longest-lasting loss, but it is a major operation.

There are several types of operation. In India, sleeve gastrectomy is the most common, followed by mini gastric bypass and then standard gastric bypass. In 2018, these three made up almost all operations.³⁴ India's surgeons' society, the Obesity and Metabolic Surgery Society of India, counted 20,242 operations that year.³⁴

Indian thresholds

Asian surgical guidelines from 2011, which India's surgeons' society follows, say surgery should be considered at:^22,23

• a BMI of 35 or more, with or without other conditions²²
• a BMI of 30 or more, with type 2 diabetes or metabolic syndrome (a group of problems that occur together, such as a large waist, high blood pressure and high blood sugar) not controlled by lifestyle and medicines²²
• a BMI of 27.5 or more with poorly controlled diabetes, as a second-line choice²²

The Indian society adds that a large waist may also count, with related conditions. That means 90 cm (35.4 inches) or more for men, 80 cm (31.5 inches) for women.²³ Newer guidance from US and international surgeons (2022) sets a lower bar for Asian people: it says surgery should be offered from a BMI of 27.5.²¹ So the two sets of guidance differ, and your surgical team will say which it follows.

Results

A Swedish study followed over 4,000 people. Gastric bypass led to 32% loss at its peak, and 25% after 10 years.²⁴ Gastric banding, which puts a band around the stomach, led to less: 20% and 14%.²⁴ Banding is not one of the main operations done in India.³⁴ People who had surgery were less likely to die during the study than similar people who didn't.²⁴

Diabetes. In a US trial, 5 years after surgery, 29% (bypass) and 23% (sleeve) had near-normal blood sugar.²⁵ With medicines alone, it was 5%.²⁵ In a Finnish trial, about 1 in 4 to 1 in 3 had diabetes in remission at 10 years.²⁶

Risks

• Death around the time of the operation is rare: between 3 in 10,000 and 2 in 1,000.²¹
• Over 10 years, 16–19% needed another operation.²⁶
• Acid damage to the food pipe was found in 31% after a sleeve, against 7% after a bypass.²⁶
• You need lifelong check-ups, and help with vitamin and mineral shortfalls.²¹
• Women are advised to avoid pregnancy for 12–18 months after surgery.²

Cost. About ₹2–6 lakh, from 8 private hospitals that publish prices on their websites (checked 5 Oct 2026).^{27,37,38,39,40,41,42,43} Seven list a sleeve gastrectomy at ₹2–5.5 lakh.^{27,37,38,39,40,41,43} Six list a gastric bypass at ₹2–6 lakh.^{27,37,38,41,42,43} Five of the eight are in Hyderabad.^{37,38,39,41,42} Most give a range, not a fixed price. Only one spells out what its price covers, and it charges extra for complications.⁴³ Health insurance may cover it when it's medically needed, often after a waiting period.²⁸

What are gastric balloons and endoscopic sleeves?

Both are done through the mouth with a camera tube (an endoscope), without cutting the skin.^29,30 Neither removes any part of the stomach.^29,30

Gastric balloon. A balloon is placed in the stomach using the endoscope. In a US trial, it was removed after 6 months.²⁹ People lost 10.2% of their weight by then, against 3.3% with lifestyle alone.²⁹ By 12 months, loss had eased to 7.6%.²⁹ Nausea (87%) and vomiting (76%) were common, and 19% had it taken out early.²⁹ The trial included adults with a BMI of 30 to 40.²⁹ One large hospital group lists a price of about ₹40,000 to ₹1 lakh (checked 5 Oct 2026).²⁷ Two Hyderabad hospitals list up to ₹3.25 lakh, but one of them gives two different prices, and the other groups the balloon with a band.^38,39

Endoscopic sleeve gastroplasty (ESG) reshapes the stomach from the inside.³⁰ In a trial at nine US centres, adults with a BMI of about 30 to 40 (class 1 or 2 obesity) took part.³⁰ They lost 13.6% at 1 year, against 0.8% with lifestyle alone.³⁰ Serious problems happened in 2% of people.³⁰ Three private hospitals publish a price for it on their websites: about ₹2–4.8 lakh, checked 5 Oct 2026.^27,37,38

How do doctors choose between them?

There is no single fixed order. Options can be combined, and diet and activity stay part of every plan.^1,2

Guidelines describe treatment as building up from a base, rather than a fixed order.^2,21,22 Here is a simple picture of that idea:

For example, ESI suggests tirzepatide when the aim is 15–20% loss, and either tirzepatide or semaglutide for 10–15%.² For people with diabetes and a BMI of 30 or more, surgeons may suggest surgery sooner.²²

Questions people ask