Obesity occurs when the body has too much fat and it can lead to serious health complications. In 2022, 2.5 billion adults aged 18 years and older were overweight, including over 890 million adults who were living with obesity, as per the World Health Organization (WHO).
Usually, overweight and obesity result from an imbalance of diet and physical activity. Over the year, weight management and as well as obesity treatment has evolved tremendously. Now various drug therapies are available that can help is reducing the unwanted weight significantly. According to a Morgan Stanley report, the global market for obesity drugs could increase by more than 15-fold by 2030 as their use expands beyond weight loss to treat a range of diseases. Sales of branded obesity drugs were $6 billion in 2023, the report stated.
In the current obesity drug market, GLP-1 agonists manufactured by Novo Nordisk and Eli Lilly have attracted the majority of the attention. Currently, the two companies hold a combined 68 percent of sales from weight-loss drugs, however, new entrants are set to challenge their market share, according to a report by Morningstar.
In an exclusive interaction with Financial Express.com, Professor Rachel Batterham, Senior Vice President, International Medical Affairs, Eli Lilly and Company talked about the prevalence of obesity in India, Eli Lilly’s upcoming plans for the India market, challenges faced by people living with obesity and more. Excerpts:
What is the prevalence of obesity in India? How is the status different from the global incidences?
Obesity is a chronic and progressive disease. Obesity rates are rising due to lifestyle factors such as sedentary habits and poor dietary choices. In 2023, the adult obesity prevalence in India was around 6.5%, affecting nearly 100 million people. The World Health Organization currently classifies obesity as individuals with a BMI of 30 or more. However, in India, due to the higher risk of obesity-related health issues among Indians at lower BMI levels, Indian consensus guidelines recommend classifying obesity as a BMI of greater than 25. These adjusted thresholds aim to better identify individuals at risk for conditions such as cardiovascular diseases and diabetes.
Waist circumference is another important measure, as it assesses central obesity, which is closely linked to metabolic complications such as type 2 diabetes and cardiovascular disease. According to a study analyzing data from the National Family Health Survey 2019–21, the prevalence of abdominal obesity among Indian adults aged 18–54 years was approximately 57.7%. Over 1 billion people live with obesity worldwide. Low-and middle-income countries have the fastest rising rate of people with obesity yet are often the least able to respond to obesity and its consequences. As a result, 79% of adults with overweight and obesity will live in low and middle-income countries by 2035. Tackling obesity must be a priority. While primary prevention is crucial, it is equally important to address the needs of the millions of people already living with obesity with evidenced-based healthcare and treatment for their disease.
What are the challenges associated with obesity? Can you share some insights on hurdles faced by people living with obesity?
Obesity is a chronic, progressive disease that can lead to serious health complications, reduced quality of life, and premature death. Each year, at least 4 million adults die due to obesity-related causes. The condition is linked to over 200 potential complications, including a 243% increased risk of type 2 diabetes, a 69% higher risk of coronary heart disease, and a 113% increased risk of hypertension.
People living with obesity face significant challenges, particularly in terms of weight stigma and bias. Misconceptions about obesity often lead to discrimination in daily life and healthcare, with many believing that weight is solely an individual’s fault. This stigma can prevent people from seeking or receiving the necessary medical care. Additionally, 82% of adults with obesity report reduced physical functioning, while 77% experience diminished mental and emotional well-being. Obesity also affects employment, with individuals facing higher rates of absenteeism, disability, lower productivity, and an increased likelihood of premature retirement compared to those with a healthy weight. These barriers make it harder for people with obesity to improve their health and overall quality of life.
Whilst obesity is recognized by several countries and professional societies as a chronic disease, the majority of health care professionals, policy makers and the public still view obesity as a lifestyle choice and people with obesity are stigmatized. Changing the narrative about obesity is critical in order for people living with obesity to receive a timely diagnosis and effective evidence-based, long-term obesity care that can improve obesity-related complications and quality of life, as well as reduce mortality and associated costs.
What are some emerging trends associated with the causes of obesity? What is the prevalence of these trends in India as well as globally?
Emerging trends associated with the causes of obesity include a combination of genetic, environmental and lifestyle factors. One significant trend is the increasing consumption of energy-dense and nutrient-poor foods. This dietary shift is coupled with increasingly sedentary lifestyles, contributing to the growing global obesity rates. In India, the prevalence of obesity is influenced by similar factors. The Economic Survey 2023-24 highlights that the increased consumption of highly processed foods, rich in sugars and fats, coupled with reduced physical activity, has worsened the obesity problem. The survey also notes that obesity among men aged 18-69 has risen to 22.9% from 18.9% in the previous NFHS-4 survey. For women, the rate increased to 24.0% from 20.6%. Additionally, obesity rates are significantly higher in urban areas compared to rural regions.
Globally, the World Obesity Atlas 2023 report indicates that most of the global population (51%, or over 4 billion people) will be living with either overweight or obesity by 2035 if current trends prevail. 1 in 4 people (nearly 2 billion) will have obesity. While all regions of India are seeing rising obesity rates the issue is becoming a global epidemic. If current trends continue, the prevalence of obesity will continue to grow, posing a significant public health challenge both in India and worldwide. Therefore, people with obesity deserve to receive early diagnosis, screening and effective intervention to implement evidence-based weight management.
What are the common misconceptions associated with obesity? How do these misconceptions make obesity diagnosis and treatment difficult?
Previously, overweight and obesity were viewed as lifestyle diseases, which stigmatized the people who were suffering. Our scientific understanding of obesity has markedly advanced, and it is now clear that obesity is a complex multifactorial disease. We can no longer place blame on the individual. What we know about how evolution and how our bodies store and use food is a good place to start as we educate people about obesity being a chronic disease that requires effective, long-term treatments, like other chronic conditions. For decades, diet and exercise have been the primary approaches to weight management for people living with obesity. Unfortunately, many find themselves stuck in a cycle of weight loss and gain. Research indicates that when people lose weight by cutting calories, their bodies may respond by increasing hunger and reducing feelings of fullness, making weight loss more challenging.
It is important that society starts to view obesity in the same way as other chronic diseases, such as asthma or arthritis, and that people living with obesity are able to access comprehensive care that can prevent and treat the disease, including lifestyle regimens, such as diet and exercise, obesity management medications and bariatric surgery, to improve their health rather than for cosmetic reasons. Lack of intervention to treat obesity can result in substantial long-term costs for people, economies and healthcare systems.
How has the treatment of obesity evolved over the years? What has been the role of Eli Lilly in this landscape?
Obesity treatment has advanced with new medications like incretin receptor agonists, less invasive bariatric surgeries, and personalized approaches combining medication, therapy and lifestyle changes. Technology, including fitness trackers and telemedicine, enhances monitoring, while integrated care addresses co-morbidities like diabetes. Lilly is working relentlessly to research and develop novel solutions to help people living with obesity or overweight and obesity-related complications. Tirzepatide is an innovative medicine that has already had a tremendous impact on millions of people living with obesity. This medicine is in a different class given it is the only treatment activating two incretin hormone receptors, GIP and GLP-1. The SURMOUNT (obesity) clinical trials have demonstrated that tirzepatide delivers significant weight reductions through the combined actions of GIP and GLP-1, resulting in better patient outcomes.
In the SURMOUNT-1 trial, individuals with obesity and pre-diabetes treated with tirzepatide lost on average up to 22.9% of their body weight based on the efficacy estimand and maintained this for over three years, while benefitting from a substantial decrease in risk of developing type 2 diabetes. In absolute terms, nearly 99% of individuals with obesity and pre-diabetes treated with tirzepatide remained diabetes-free for the 176-week treatment period. These results underscore the critical role of long-term therapy with effective treatments like tirzepatide to achieve and maintain weight reduction.
In addition to tirzepatide, other medications are also being studied. Retatrutide, for example, targets three hormones: GLP-1, GIP, and Glucagon. We believe that the combination of glucagon receptor agonism with GIP and GLP-1 receptor agonism may be one of the reasons retatrutide has shown significant weight loss of 17.5% at 24 weeks and mean weight reductions up to 24.2% (26.2 kg) at 48 weeks, as demonstrated in our phase 2 trial.
We look forward to the results of our phase 3 trials, which have a longer study duration and will enable us to more fully evaluate the efficacy of retatrutide for body weight reduction. We will continue to innovate to drive change in obesity care. But we know we cannot do it alone, that’s why we are working closely with key collaborators to establish a new paradigm for access to efficient and evidence-based long-term care. Lilly is committed to meeting the needs of people affected by obesity and reinforcing that medications are only to be used as indicated for the treatment of this serious disease, not for cosmetic purposes.
What are the challenges that exist with respect to treating obesity and preventing its complications and long-term effects?
There are more than one billion people worldwide living with obesity, which reduces quality of life and is related to premature death, with at least 4 million adults with overweight or obesity dying each year. Despite these numbers, obesity does not receive the same level of diagnosis, medical care, insurance coverage, or long-term care as other chronic diseases.
People with obesity deserve early diagnosis, screening and effective intervention to implement evidence-based weight management. Comprehensive care, including lifestyle regimens such as diet and exercise, anti-obesity medications, and bariatric surgery, should be accessible.
People living with overweight or obesity face stigma every single day. The idea that their weight is somehow their fault or individual responsibility is the biggest barrier preventing them from accessing the healthcare they need. The very idea that obesity is down to individual responsibility or can be tackled by lifestyle changes and willpower alone allows health systems to put off taking significant steps to address this major health issue.
What are your upcoming plans in the obesity landscape? Are there any product launches planned for the upcoming quarters or FY26?
India is a priority market for Lilly and we are committed to bringing this innovation to Indian patients as quickly as possible. We aim to launch tirzepatide in India by 2025 after obtaining all necessary regulatory approvals.
According to you, what should be some of the key focal areas to minimise the increasing burden of obesity? Do you have specific plans for countries like India which struggle with the massive burden of obesity?
There is an urgent need to prevent and treat obesity. Early diagnosis and timely management can prevent disease progression, reduce complications and lower healthcare costs. For most people with obesity, lifestyle changes alone often do not result in sufficient and sustained weight loss to improve health over the long term. Hence, obesity management medications have an important role to play in obesity management but must be part of a holistic approach alongside a healthy lifestyle, nutrition and exercise, under the guidance of a healthcare provider. Additionally, people with obesity face significant weight stigma, which discourages them from seeking help.
Combatting this stigma through healthcare provider support and educational campaigns is essential. In conclusion, obesity requires a multidisciplinary approach, including lifestyle interventions, medications and bariatric surgery. To achieve this, policy interventions are necessary to ensure access to patient-centred care, as failure to treat obesity leads to substantial long- term costs for individuals, economies and healthcare systems.
Lilly is working relentlessly to research and develop solutions to help people living with obesity or overweight, and obesity-related complications. However, we recognize that we cannot tackle this challenge alone. That’s why we are committed to collaborating with healthcare providers, policymakers, public health organizations and health startups to build a comprehensive ecosystem that raises awareness about obesity and promotes its holistic management. We are focused on accelerating the availability of our innovative obesity treatments to help address this growing health crisis and our goal is to launch tirzepatide in India by 2025 after obtaining all necessary regulatory approvals.
