When to start pharmacotherapy

Añadido: 2026-05-27

[00:00:25]Good evening. You are watching Dr. KK's Med Talks Non-Stop Show. Welcome to Med Talks Live, Conversation That Matter, an educational initiative supported by Ili.

[00:00:37]I, Dr. Anise Joseph. I'm your host for today's session. Obesity is no longer viewed as merely a cosmetic concern. It is now recognized as a complex chronic disease that affect overall metabolic health. Despite increasing awareness, many individuals continue to struggle with weight management even after repeated attempts with diet and exercise. This has raised important questions around when medical therapy should be considered as part of obesity care. In this episodes of OBC talk, our experts will discuss the evolving signs of obesity photherapy who may benefit from treatment and how early intervention can help to reduce long-term health complications. This session aimed to promote informed stigmafree and evidence-based conversation around obesity management.

[00:01:28]Let's start with today's session. Can we have obesity update video?

[00:01:40]Recent research highlights that obesity increases the risk of over 200 medical conditions including heart disease, sleep apnea, infertility and certain cancers. International obesity discussion increasingly emphasized early screening for MASH narl in patients with obesity and type 2 diabetes. At Echo 2026, expert emphasized that obesity management should focus on organ protection, metabolic health, and long-term disease prevention, not just BMI reduction. The Echo 2026 suggested that greater weight loss with GLP-1 therapies may reduces a risk of heart failure, sleep apnea, osteoarthritis, and kidney diseases.

[00:02:25]So, let's go to the topic of today.

[00:02:37]Now let me introduce our guest for today Dr. Gobinad N. Dr. Gobinad N is a renowned consultant endocrinologist with specialized expertise in endocrinology, diabetes, metabolism and obesity management. He completed his MBBS and MD in general medicine followed by DM in endocrinology and metabolism. Currently associated with Manipal Hospitals Elena and herbal unit Bangalore. The gobin Dr. Gobinad has extensive experience in managing complex metabolic disorders including obesity, diabetes, thyroid disease and hormonal imbalances. He is known for his patient centric and evidence-based approach towards obesity care with a strong focus on early intervention and long-term metabolic health. His academic contributions and practical insights make him a respected voice in preventive endocrinology.

[00:03:31]Um sir welcome to the talk show sir.

[00:03:36]>> Yeah thank you Dr. Anise and good evening all. Thank you for having me.

[00:03:41]>> So shall we uh start with our first question sir?

[00:03:45]>> Yes.

[00:03:47]>> So uh the first question for you sir at what BMI should weight loss medication be considered?

[00:03:54]Yes. So uh currently there is so much of buzz going on around this uh weight loss medic medications to be specific GLP or do agonist that is GLP plus uh GIP agonist therapy. So uh there are specific uh BMI cutoffs that is body mass index which is calculated by weight in kes divided by height in me squares.

[00:04:20]we get a value based on that BMI cut offs we are initiating these medications so currently these cut offs are taken from western data we don't have our own Indian evidence as such but we are just uh taking the same data and starting the medications upon those cut offs to be uh to emphasize the cutffs uh any patient with BMI of 30 or more without any obesity related ED complications can be uh started on these medications. If the patient is having BMI of 27 plus one or more obesity related complications, we can go ahead with these medications. But at the back end uh we should also understand that uh this BMI is not an accurate indicator of a fat mass in our body. Like we Indians we are though our BMI is on the lower side. So we are having this increased visceral adiposity. So I feel personally as Indians or Southeast Asian population we are more prone for obesity related complications and these cut offs have to be much lower in our population.

[00:05:37]>> Uh thank you sir. I think the second question is a repetition of what you uh it's it second questions um I think you have already answered but I think just to highlight I'm just asking you are medications only for severe obesity >> severe obesity I'm assuming we are talking in term uh with as per the definition we are talking about morbid obesity as per the definition BMI of more than 40 we label them as morbid obesity Whereas uh uh it's not only for those patients any obese patient more than 30 I think we should consider more than 27 as I previously told we can uh go ahead with this medications >> and for Indians maybe a lesser cut off uh based on their body fat percentage.

[00:06:30]Okay sir. The next question >> to you is can pharmacotherapy be used alongside lifestyle changes?

[00:06:40]>> Yes. So we need to remember uh lifestyle changes like exercise, mindfulness, stressfree, sleep plus diet whatever it is either low calorie, low carb, high protein diet uh should be our uh fundamental approach for managing obesity and these medications will be an add-on. It's not an replacement for diet or exercise. These medication should be an add-on for the good diet and exercise. With that in conjunction of all these effective exercise, diet plus medications, we'll be able to get uh good results in terms of weight loss and further going on uh a benefits of glycemic control and other cardioral benefits.

[00:07:31]>> Okay sir. Uh thank you sir. uh just to uh highlight you said BMI more than 28 with co-obidities we should uh start medications can you explain which all conditions that you will consider while starting anti-obesity medications >> yes correct so first and foremost diabetes or pre-diabetes status that is the most common prevailing or uh thing as India has become a diabetic capital of the world after that hypertention PP P levels of more than 140 by 90 or dysipidemia to be specific or raised cholesterol levels and um other obesity related complications like obstructive sleep apnea in common terms snoring or osteoarthritis or any obesity related complications uh we should uh think of starting these meditations.

[00:08:28]Uh so PCOD also uh like you know the renamed term PMOs do we start uh like do we consider?

[00:08:38]Yes, PCOD patients if their BMI is more than 27 we are going ahead with the medications because PCOD patients the issue uh is not only with specific to glycemic status or cholesterol in most of the patients what we see bedside so either they will be married planning to conceive or with irregular cycles or not able to conceive or being evalated for primary infertility.

[00:09:08]So the rational of starting these medication in those patients are with good weight loss uh if uh menstrual cycles become regular if they become ovulatory their chances of spontaneous conceiving will uh go up. So that is the reason we start these um medications in PCOD patients.

[00:09:29]>> Okay. So um so like you know most of the times when you suggest phicotherapy for patients they feel like is it a sign for that you know lifestyle measure fails that they have to uh be started on medications >> not necessarily it's not that lifestyle measures have failed there are so many aspects for uh this statement for example uh biology of obesity per se. Our body is built in such a way that it will once we lose certain amount of weight with the help of diet or exercise the body will try to go back to its own baseline state. The obesity biologies as such. So it's not that lifestyle measures have failed. It we can also think like lifetime measures is not enough to just to sustain this weight loss to help diet and exercise sustain weight loss further we can add on these medications. So this is one part of the u discussion. So in other part uh there are so many other things uh other aspects when we sit in a patient's chair and think so when they are going about their their routine daily activities.

[00:10:58]So some patients feel that they'll not be able to give their full uh self to diet or exercise maybe because of for example if the patient is suffering from osteoarthritis mage or elderly female patient suffering from osteoarthritis you can't expect her to do some moderate intensity exercise at least 30 to 40 minutes per day or uh for example what set of patients I get they Say they are in front of PC, their tech is sitting in front of PC for 12 hours, 14 hours a day. They're not able to give enough attention to diet and exercise.

[00:11:38]In from patients perspective, sometimes we need to understand their concerns, their issues, what they are going on with their uh lifestyle and then accommodate accordingly plus add on these medications.

[00:11:53]That should be our approach.

[00:11:55]>> Yes sir. uh as you rightly said starting uh somebody medication on somebody is not a lifestyle feeling that is just an add-on to lifestyle measures uh in some patients where they have resistant to lifestyle measures adding these medications early would help. Uh so next questions when we start a patient on uh these anti-obesity medication the common questions that we address every day is how do these med medicines work in our body?

[00:12:25]Okay, this medication act in our body at several points to be specific. Uh this molecule GLP1 analog or GLP-1 to be specific it is secreted from our small intestine after having food. This goes and then stimulates our pancreas to produce more insulin. It has some other pleotrophic effects also. So, so these medications what they're trying to do is they're trying to mimic our own GLP1 which is being secreted from our body or in diabetics or obese patient which is being secreted rest or it is being resistance. So by giving this we are trying to mimic the same. So to be exact how all it acts so we need to understand it acts at multiple junctures. Firstly it acts on our gut.

[00:13:22]It slows down our gut. the metabolism or the gut motility will be slowed down so that we are kind of pull our uh satiety uh is on the higher side and it also stimulates the pancreas to produce more of insulin. It also acts the level of liver to reduce the amount of glucose output and it also acts on the brain which reduces our cravings or appetite.

[00:13:52]Then furthermore I think uh that will be more complex mechanisms to understand.

[00:13:59]>> As you rightly said sir it just not reduces the appetite it has multiple levels of action which help an individual to lose weight. So other common question which we encounter is are these medications safe for long-term use.

[00:14:15]>> Okay. So that is an valid question. most of our patients come back to us uh with that question. So I think that is valid because for every new molecule there is that uh which comes into the practice or market there is initial skepticism from the patient side whether it's safe or not. So whatever data we have so it's from last 10 to 15 years they are safe there are no any uncovered or serious adverse events yes there are some uh uh noted boxed side effects again the reason why we are using them in spite of those side effects or benefits clearly outweighs the side effects and apart from that there are some contra indications which I'll be telling further. So there are no notable serious side effects as of now from what data we have from last 10 to 15 years.

[00:15:18]>> Yeah, thank you sir for highlighting that point and the other common question is how long should I be on pharmarmacothotherapy? How long do I have to take these medication? This is one common question which we encounter in our day in our daily practice.

[00:15:33]>> Yes. So basically when we start this patient u these medications in a patient so we need to understand uh the disease per se what the patient is suffering from uh maybe it will be only obesity or obesity plus some complications. We need to convey to the patient that these are lifestyle disorders. These are disorders which can be only controlled. There is no specific cure for this conditions. So the basic idea is so we have to continue it for long. Yes, patients will question that why long or how long because of either the compliance issues or financial issues. So before starting what we should be clear in those patients or so we should have a target at our back of the head. So maybe target in the terms of target weight or target sugar levels or HBNC levels. So once we achieve that specific target we try to reduce the dosage or keep the dosage in the maintenance levels and continue the same or even since the recent uh patent has gone off with semaglutide there are cheaper versions are also available. So if the patients are unable to continue for long with the original versions we can also uh try to keep them on uh uh generic or biosimilar versions of some magotide to be specific but uh the idea is it is for long-term because since it's lifestyle uh non-curable uh disorder and we also need to understand that once I stop this medications slowly the drug effect will also wean off. That is the bottom line.

[00:17:38]>> Okay. Uh and thank you sir. Uh and next question to you is what are the common side effect that a person should be aware of while starting this medications?

[00:17:50]>> Okay. So I'll start from most common then I'll go to least common. Most common it is the gastrointestinal side effects. uh some initial side effects like bloating sensation, nausea, in few cases vomiting, diarrhea or itching can be there and in few patients uh some occasional pain abdomen also has been noted and the appetite or the cravings will go off. I have seen patients coming back and saying that sir I'm not having even appetite to have one meal per day. So that is also one of the uh effect what we have seen um uh bedside coming to the more serious and rare side effects. Yes, we have seen some occasional or rare causes of pancreatitis being maybe if there it was indolent phase or in the subclinical phase maybe it got aggravated with the medications or patient coming to us with pain abdomen and find found out to have pancreatitis and occasional uh again rare incidence of vision blurring due to some disc edma is also possible but again these are very less in uh numbers maybe less than 1%.

[00:19:19]And if you ask me is there any specific causal association established still studies are going on there is no actual causal association with these uh rare side effects but caution is advised.

[00:19:37]>> Okay. are like um uh so um these um side effects you have explained uh sir but in uh social media and internet and all lot of u lot of uh information is going around regarding this vision loss and all so do they have to take any precautions or like you know when when they start uh these medications >> okay so a precaution has to be taken from the medical fraternity side.

[00:20:10]Suppose when I am starting an weight loss medication one patient. So what I need to uh grasp is how obese is the patient and how uncontrolled is the diabetes state and was there any previous history of any diabetic related retinopathy issues or not. So, so the basic idea is if there is rapid weight loss, if there is rapid sugar control and if there was any evidence of background retinopathy, there are increased chances of developing this discma in these set of patients. So if I see any of these red flags, so first I refer the patient to an opthromologist to screen for any disc issues. Once it is cleared from offthormologist then only we can start or go ahead with the medications. That should be our approach.

[00:21:12]>> Okay sir. Thank you. Uh can medication prevent weight regain after diet after failed diet attempts?

[00:21:21]>> Yes of course. So I think we have discussed um earlier. So once we lose weight or u or after we have lost weight the patient comes back to us quoting that um though he has continuing with the low calorie diet he's not able to lose much more or the weight has become stagnant or old time he has started regaining weight. So as explained earlier, it's the basic biology of obesity or of our body which push us to go back to its original state. So once we see that weight loss is being plateaued or not going up to the mark, we can add on this medications along with the diet part.

[00:22:09]>> Okay. Okay. Uh sir you have said about the side effects just uh to highlight the point who should avoid weight loss medications.

[00:22:20]>> Okay.

[00:22:21]So there are uh some contraindications.

[00:22:25]So so generally these medications are approved only for type 2 diabetes plus or minus obesity. If the patient is having any pancreatic related diabetes or pancreatic stone related diabetes, this should be avoided. Again in type 1 diabetes, it's still not yet approved.

[00:22:45]Again, studies are going on. If there is any family history of thyroid cancers to be specific, medilary thyroid carcinoma or in the patient itself there was any thyroid nodule or on examination you find a thyroid nodule. So until unless it is evaluated properly uh we'll have to withhold uh the thought of starting this medications.

[00:23:13]>> Okay. Okay sir. Uh so like you you have seen lot of uh this Amazon and all lot of alternatives like are herbal or OTC fat burner safe alternative for anti-obesity medications?

[00:23:26]>> No clearly the answer is no. Um the rational is simple. Today we are in the world of evidence-based medicine. So if someone asks what is the evidence, I can show the trial data or the previous data of last 10 to 15 years on GLP monologues. First thing uh regarding the over-the-counter medications or other supplements or weight loss supplements um these are not approved by the regulatory bodies and what is the exact composition or what is the exact mechanism by which the act is not known and on the flip side we have seen patients coming with severe health issues after consuming this medications. So we urge the patients to avoid over-the-counter medications.

[00:24:20]Please consult a nearby endocrinologist and only then um uh they can go ahead with this supplements. There are some meal replacement powders. So for the um education purpose of the population purpose I'm telling yes those are specifically advised something like meal replacement supplements which is of zero calorie or low calorie powders with good amount of protein supplements. Yes they can be used but it should come that way should come from an practicing uh physician or an endocrinologist.

[00:24:59]Yes sir as you rightly said it's better to avoid over-the-counter medications without a proper consultation uh by an with an endocrinologist. So next question uh to you is sir how often should patients be monitored on treatment.

[00:25:17]>> Okay very valid question. So once I start the uh treatment uh initial few days uh where the side effects will be uh silently kicking in in those set of patients I would like to assess the tolerance at much uh frequent intervals.

[00:25:38]So initial 1 to two months I'll ask them to come back at the end of first month and the end of second month and from the third visit onwards I will assess the patients once in every 3 months. So what I would assess is what is the uh extent of weight loss, the speed of weight loss the patient is uh having and along with that the metabolic parameters like sugar levels, HBO C, cholesterol levels and other inflammatory marker levels how well they are improving. We will assess the patient as a whole and um we will take the final call on whether to continue on the same dosage or increase the dosage or reduce the dosage likewise.

[00:26:26]>> Okay sir. Uh sir you have already answered this question but can phicotherapy improve metabolic parameters like sugars and cholesterol?

[00:26:35]>> Yes. So um it has shown firstly I would like to say these DLP1 analoges or weight loss medication was approved initially for sugar control for better glycemic control and then found out to have good weight loss then the focus is shifted towards the weight loss. So of course we can use it for improved diabetes control and um improved u cholesterol lowering of the cholesterol and other inflammatory markers like uh HRCP or lipoprotein A we have seen we call it pleotrophic or other benefits of these molecules we have seen significant drop in these markers as well.

[00:27:23]Okay. So, and many of times we will be able to reduce the diabetic medication dose once these patients are on correct.

[00:27:31]>> Yes.

[00:27:32]>> So, u the next question to you is what is the biggest myth about obesity medications?

[00:27:41]>> Okay. biggest myth would be I have patients uh they read about um they read about this molecules or they hear in social media and uh come back to me uh stating that this medication will damage u the kidney or damage the liver. So I would like to stress that these medications have been approved by all eligible regulatory bodies in India and rest of the world. So there is no direct link to any uh organ damage per se. On the flip side, these molecules help in preventing cardiovascular, renal and even uh liver u damage.

[00:28:34]And the second most myth what I've experienced is um patient want to uh take this medication for just 2 months 3 months then uh have u rapid weight loss because of some personal or social reason and they want to stop this medications.

[00:28:58]So we would like to tell that um these medications are approved for uh specific indications only as we have previously described and u if the there is no proper indication for starting this medication I think uh we shouldn't uh start this medications.

[00:29:19]>> Okay. Uh thank you. Uh so there are some audience questions. uh can I'll just uh uh take uh them.

[00:29:28]>> And will I regain weight once I stop obesity medications?

[00:29:35]>> Yes. Um so like I explained biology of obesity.

[00:29:41]So the issue basic issue will be persisting. So once I stop the medication whatever the beneficial advantages were there of these medications will be going away. Maybe there is an added advantage initial push upon diet exercise plus the add-on medication. Maybe we have achieved a good chunk of weight loss but once we have stopped the medications there are very good chances uh the weight will be regained again. At what interval you the patient will usually regain the weight. Again that is again very subjective. We have seen patients able to maintain weight for a good chunk of 6 months, one year and some few patients even 2 years without the medications. Later they started gaining weight. But once we stop the medication the benefits will go away and uh weight gain will occur.

[00:30:41]Okay. Uh I think Miss Akida has asked a question. How long should someone try diet and exercise before consulting obesity doctor?

[00:30:51]>> Okay. So I would put the patients on a strict diet and lifestyle at least for 3 months. I would want to assess how well the patient is able to sustain a low calorie low carb diet and plus moderate intensity exercise for 40 minutes 30 to 40 minutes per day for 3 months and I will see how the how well the patient is losing weight and how well the patient is coping up with this newly changed lifestyle. Only after that I would like to start this medications.

[00:31:31]Next question is can semagruide be started in children and old uh children and old age.

[00:31:40]Okay. Children and old age. Yes. Uh as per the latest data I'll first tell about children. As per the latest data um it is approved for age to be specific. I'll have to go through the data but lautide is one GL21 molecule.

[00:32:01]It was approved for adolescent type 2 diabetics also. I think the age cutff was 11 or more. Again the recent data on semaglutide is u it to come out. we we should be uh able to get the data but any child with 11 or more we should be able to use this medications. Old age of course we can start but in old age like I initially said certain red flags about the vision and uh the pancreatitis or other active uh tumors or thyroid normal thyroid nodules should be assessed once we rule out all these conditions we can go ahead with this molecules in voltage also.

[00:32:53]>> Uh thank you sir. Uh then uh the last question for you, what is the maximum dose of semlutide?

[00:33:02]>> Okay. So we usually start with 0.25 from 0.25 we increase slowly to 0.5 then 1. Then from 1 to 1.7 from 1.7 to 2.4 mg subcutaneous every week. 2.4 4 mg is the highest dosage of simaglotide.

[00:33:27]>> I think uh that was your last question.

[00:33:29]Uh thank you Dr. Gobinad uh for joining us today. And that will be all uh for today. Dr. KK's Med Talk will return tomorrow at 700 p.m. with another edition of the show. Keep watching Dr. KK Med Talks. Namaskar.

[00:33:46]>> Thank you Dr. Anise. Good evening all.

[00:33:49]>> Good evening.