Dr. Narendra BS
Lead Consultant  Endocrinology & Diabetology, Aster Whitefield Hospital

GLP-1 drugs are revolutionary, but require nutritional monitoring and strength training to
remain safe and effective, per a doctor.

While these drugs are being hailed as 'miracle' shots for weight loss, they come with a
complex set of side effects and long term considerations  especially for the Indian
population. Also read | Doctors warn ‘Mounjaro brides’ against taking risky shortcuts
amid rise of pre wedding weight loss injections in India
To break down the science, we tapped Dr Narendra BS, lead consultant endocrinology and
diabetology at Aster Whitefield Hospital, Bengaluru. With 11 years of experience, Dr
Narendra breaks down the most frequent queries:

1. What are the most serious long term risks of GLP-1 drugs that Indians should know
about?The use of GLP-1 receptor agonists, including Ozempic, Wegovy, and  Mounjaro , provides
effective treatment but carries potential risks when used for extended periods. The most
consistently reported concerns include persistent gastrointestinal symptoms such as nausea,
which leads to vomiting and results in delayed gastric emptying that affects nutrition. The
body experiences weight loss, which increases the risk of developing gallstones and
gallbladder disease. The investigation shows a minor yet important risk of pancreatitis among
people who already have risk factors. Researchers still study thyroid C-cell tumour
development risks, which remain unclear because human data is insufficient. The Indian
population experienced muscle loss and fatigue, and micronutrient deficiencies, due to
appetite suppression that lasted for extended periods, resulting from dietary protein intake
that remained below recommended levels. Clinicians participating in 2025 medical
discussions should assess kidney function and hydration, as reduced oral intake may increase
the risk of dehydration-related medical problems in certain patients.

2. What are the minimum and maximum ages for Ozempic, Wegovy etc.?GLP-1 drugs have specific age limits for each medication and its designated medical purpose.
Wegovy has been approved in several countries for adolescents aged 12 years and above who
meet criteria for obesity, while Ozempic is primarily indicated for adults with type 2 diabetes.
Medical practitioners need to handle patients above 65 years because they face increased
dangers from frailty and muscle deterioration, and their existing health problems.
Unintentional weight loss in senior citizens poses a greater risk when it results in substantial
reductions in lean muscle mass. The medical profession uses these medications on younger
patients when they experience extreme obesity together with metabolic disorders after their
attempts to lose weight through lifestyle changes have failed. The determination of eligibility
requires an assessment of metabolic health and risk factors, and of the total capacity to
tolerate medication in a controlled medical setting, rather than using age as the sole
qualifying criterion.

3. Is Ozempic addictive? Can you get dependent on it?
GLP-1 drugs like Ozempic are not addictive in the conventional sense because they do not
activate the brain's reward pathways, which lead to substance addiction. However, many
patients develop what can be termed physiological dependence. The medications reduce
appetite by delaying stomach emptying while increasing feelings of fullness, which helps
users stick to their calorie-restriction goals. The cessation of the drug leads to a reversal of
these effects, which causes people to experience increased hunger and subsequent weight
recovery. People who lack proper lifestyle routines may develop a perception of
"dependence" on the substance. Long-term studies, discussed in recent clinical literature,
show that most patients regain the weight they lost after stopping treatment. The drugs should
be regarded as elements of chronic disease management, which require sustainable dietary
changes, behavioural modifications, and physical activity adjustments to achieve long term
results.

4. Do low protein Indian diets worsen muscle/bone loss on Ozempic?
The risk of muscle loss during GLP-1 drug treatment increases when Indian populations
follow their typical low-protein dietary patterns. The medications suppress appetite, leading
to decreased calorie intake, including protein. The body needs protein to prevent the
breakdown of lean muscle mass, which it uses for energy during weight loss. The loss of
muscle mass decreases both strength and functional ability and reduces basal metabolic rate,
which complicates long-term weight maintenance. The connection between muscle health
and bone health creates an indirect pathway that, over time, decreases bone density. The
clinical observations of 2025 indicate that people need to consume adequate protein from
pulses, dairy products, eggs, or lean meats, along with resistance training. The absence of
these measures results in individuals losing more muscle than fat, which creates negative
effects on their metabolic functioning and skeletal health.
5. Does Ozempic actually cause bone loss, or is it just the weight loss?

Current evidence shows that patients taking GLP-1 drugs experience bone loss because their
body weight decreases rapidly, rather than due to the drugs that they take. Reduced body
weight causes less mechanical stress on bones, leading to decreased bone stimulation and
subsequent bone density reduction. Appetite suppression leads to reduced consumption of
calcium, vitamin D, and protein, which are vital for bone health. The 2025 analyses
demonstrate that the rate of weight loss is the primary factor determining how bones will
change in response to the medication. The risk should not be treated as unimportant. Bone
strength will decrease over time unless individuals receive adequate nutrition and engage in
both weight-bearing and resistance physical activities. People who already have risk factors
for osteoporosis should have their bone health closely monitored.
The most effective way to counter muscle and bone loss that occurs during weight loss with
GLP-1 medications is through strength training. (Unsplash)

6. Can GLP-1 drugs increase osteoporosis or fracture risk in Indians over 40?
People who weigh less than 40 need to handle their weight loss process carefully, or they will
face a greater chance of experiencing fractures. Low bone mineral density in Indians resultsfrom insufficient calcium intake and common vitamin D deficiency. The use of GLP-1
medications results in substantial weight reduction, which automatically decreases bone
density when users lack proper nutritional and physical training. The existing research
evidence does not establish that these drugs increase fracture risk as an independent factor.
The risk appears to be multifactorial linked to age, baseline bone health, and lifestyle
factors. Implementing preventive measures requires proper calcium and vitamin D levels,
along with sufficient protein intake and consistent strength training. Periodic bone density
tests are necessary for high-risk individuals because they enable doctors to identify and treat
osteoporosis at its early stages.

7. Does strength training prevent Ozempic-related bone loss?
The most effective way to counter muscle and bone loss that occurs during weight loss with
GLP-1 medications is through strength training. The process of resistance exercise creates
mechanical tension, which stimulates muscle protein synthesis and bone development. The
method enables people to maintain their body weight while their bone density remains intact,
even when they eat fewer calories. The medical guidelines recommend that doctors use GLP
1 treatment in combination with exercise programs that include resistance training, three
times a week or more. The method improves both physical strength and functional ability,
enhances body metabolism, and supports weight loss maintenance over time. People who
want to lose weight need to do strength training because it helps them lose fat instead of
muscle, which is an undesired outcome. The process requires resistance exercise because it
helps people achieve better results while minimising health risks that come from losing
weight too quickly.

8. Do you have to take Ozempic forever to keep weight off?
Doctors prescribe GLP-1 medications as permanent treatments because the medicines treat
permanent medical conditions that include obesity and metabolic disorders. Recent research
findings demonstrate that when people stop taking Ozempic, their body weight increases
because their hunger returns to normal and their natural metabolic processes restart.
However, lifelong use is not mandatory for everyone. People who achieve permanent weight
reduction can maintain their new weight after they establish permanent changes to their
eating habits, exercise routines, and everyday activities. People encounter difficulties when
they need to maintain permanent lifestyle changes without taking medication. Clinicians
develop unique treatment plans based on their patients' objectives, their treatment outcomes,
and their medical history. Permanent results require patients to maintain their fundamental
lifestyle changes, while they may need to use treatment methods for multiple months or
longer.

9. Is it harder to lose weight the second time you go on Ozempic?
The amount of weight reduction which occurs during the second GLP-1 treatment depends on
how metabolic processes, lifestyle choices, and treatment compliance for the patient. The
human body enters a state of energy conservation after weight reduction because metabolic
processes become more efficient, which causes weight reduction to progress at a slower rate.
The medication's efficacy does not decrease over time. Patients who use the treatment again,
together with improved dietary and exercise strategies, achieve substantial results. The main
factor that affects results is human behaviour; people who work on previous deficits in theirfood intake or physical activity tend to achieve superior results. Clinical evidence shows that
different weight loss rates exist among patients, yet all of them can achieve substantial health
improvements. Patients need to develop realistic expectations about their weight-reduction
procedure because treatment requires a comprehensive program that lasts throughout their
weight control efforts.

10. Can Ozempic cause pancreatitis, and is the risk higher for Indians with gallstones?
The pancreatitis risk linked to GLP-1 drugs like Ozempic exists as a minor medical danger
which doctors recognise. The risk of hepatic disease increases for people who experience
gallstone disease and elevated triglyceride levels and who have already shown pancreatitis
symptoms. The medications cause patients to experience rapid weight loss, which creates a
heightened risk of gallstones that will lead to pancreatic inflammation. The Indian population
faces this risk because gallstones occur frequently in their community. Doctors need to
conduct thorough evaluations of patients before they begin treatment, while monitoring them
for symptoms, which include severe abdominal pain that travels to the back, nausea, and
vomiting. The medical field requires early diagnosis of pancreatitis because untreated cases
can progress to severe complications. The healthcare system needs to focus on patient
education and proper risk assessment procedures because they help decrease patient
complications, even though the actual danger remains minimal.