Ozempic Explained: Benefits, Dosage & Side effects | Dr Salgaonkar, Fortis

An Indian body reaches the obesity threshold at 27.5, not 30

Obesity care in India now runs across three tools: lifestyle, medication and surgery. Dr. Hrishikesh Salgaonkar, who leads the bariatric team at Fortis Hospital, Mulund, explains who each one is actually for.

India is often described as the diabetes capital of the world, and the reason is not simply diet. Asian populations carry a higher total body fat percentage at the same weight as Caucasian populations, which is why the same complications arrive at lower body weights and roughly a decade earlier in life.

That single fact reshapes everything downstream: the definitions, the treatment thresholds, and who qualifies for which intervention. With weight-loss injections now a mainstream conversation, the question is no longer whether treatment exists. It is which treatment is appropriate for whom, and what happens after it stops.

"No therapy, no medication, no surgery is a quick fix. They are not a magic pill at all."

The thresholds are different here

In a Western context, obesity begins at a BMI of 30 and severe obesity at 40. For Asian populations those figures are 27.5 and 37.5, and overweight in an Indian context sits between 23 and 27. The reason is body composition rather than body weight, and it is why young-onset diabetes is so much more common across India, Bangladesh, Singapore and Malaysia alike.

Clinically, obesity is graded in three classes by BMI: Class I from 30 to under 35, Class II from 35 to under 40, and Class III at 40 and above. But BMI remains a screening tool, not a diagnosis. It cannot distinguish fat from muscle, so assessment also uses waist-to-hip ratio and body composition analysis covering muscle mass, fat percentage, basal metabolic rate and visceral fat.

Why obesity is treated as a medical condition

The risk is not cosmetic. Obesity is linked to type 2 diabetes, heart disease, stroke, high blood pressure, unhealthy cholesterol, sleep apnoea, fatty liver disease, osteoarthritis, kidney disease and certain cancers. Type 2 diabetes in particular correlates closely with it. Nor is it a single-factor problem: genetics, body composition, food environment, movement, sleep and stress all contribute, and hormonal conditions including hypothyroidism, PCOS and Cushing syndrome are ruled out or corrected as part of assessment.

The first tier: lifestyle, and it is not optional

Lifestyle change is the foundation every other therapy stands on, and someone who is overweight or mildly obese is usually best served by it alone: mindful food choices, regular movement, and six to seven hours of sleep, without which metabolism is disturbed and results do not follow.

The practical starting point is walking. Exercise does not come naturally in Indian schooling the way sport does in the West, and urban infrastructure rarely helps. A working day in a UK hospital might produce twelve thousand steps without effort; the same day in Mumbai may not reach four.

The second tier: medication, and its limits

GLP-1 agonists mimic a naturally occurring hormone. They slow gastric emptying so fullness lasts longer, quiet persistent thoughts about food, and reduce insulin resistance. Newer dual agonists act on GLP-1 and GIP. They were developed for type 2 diabetes; the weight-loss indication followed the trial data.

In adults they are indicated at a BMI above 30, or between 27 and 30 alongside a related condition such as type 2 diabetes, sleep apnoea or fatty liver. Around 15 to 20% of patients experience side effects, most commonly gastrointestinal, with dehydration, hypoglycaemia, pancreatitis and gallbladder problems among the more serious risks. They are contraindicated where there is a personal or family history of medullary thyroid cancer or MEN syndromes.

Two limits matter. Long-term data does not yet exist, which is why Dr. Salgaonkar caps weight-loss prescribing at two years in his own practice. And cravings return within one to two months of stopping, with research suggesting 70 to 80% of patients regain within a year without lifestyle change. Prescribing is restricted to registered medical practitioners.

The third tier: surgery, and who qualifies

Bariatric surgery is for severe obesity, where the weight loss required is beyond what other therapies deliver. Someone weighing 150 kilos against an ideal of 70 is not bridging that gap with medication.

At Fortis Hospital, Mulund, the eligibility criteria are a BMI above 37.5 without comorbidities, above 32.5 with them, or above 30 where there is a life-threatening disorder, generally between the ages of 18 and 65. Surgery is not suitable during pregnancy, or where there is active substance abuse, uncontrolled psychological illness or high-risk medical conditions.

The procedures offered there include sleeve gastrectomy, which removes roughly 75 to 85% of the stomach, Roux-en-Y gastric bypass, one-anastomosis gastric bypass, SADI-S for very high BMI cases, biliopancreatic diversion, and revisional surgery for patients whose earlier operations failed. Work-up includes blood work, ECG, echo, pulmonary function tests, sleep studies, X-ray and endoscopy, and most procedures are performed laparoscopically or robotically.

Risks are real and include infection, bleeding, clots, gastrointestinal leaks, obstruction, gallstones, reflux, hernias, dumping syndrome, anaemia, ulcers and, rarely, death. Against that, Fortis reports that more than 90% of patients lose half their excess body weight and keep it off, and research indicates 85 to 90% maintain significant loss over 20 to 30 years.

The tools work together, not against each other

Medication and surgery are not competing options. Where a very high BMI makes operating technically difficult, GLP-1 drugs may be used first to achieve 10 to 15 kilos of pre-operative weight loss. After surgery, 10 to 15% of patients regain or lose inadequately, and medication is now available for that group where it was not a decade ago.

Muscle loss is the shared risk. Between 20 and 30% of weight lost is lean mass, and if weight returns it returns as fat, so adequate protein and strengthening exercise are part of every plan. That is also why the model is multidisciplinary: at Fortis Mulund every patient sees the surgeon, endocrinologist, nutritionist and behavioural therapist, with pulmonology or cardiology added as needed.

One misconception worth correcting

Many people assume insurers treat weight-loss surgery as cosmetic. In fact IRDAI approved bariatric surgery for coverage in 2016, subject to criteria: typically a BMI above 40, or between 35 and 40 with an associated condition such as uncontrolled type 2 diabetes, cardiac issues or obstructive sleep apnoea. Medications are not currently covered.

Whichever tier applies, the condition attached does not change. If a patient is not ready to make lifestyle changes, no therapy, medication or surgery will hold. Treatment creates the opportunity. What sustains it is what happens every day afterwards.

Listen to the full conversation with Dr. Hrishikesh Salgaonkar on FyndOutWithRagini.