Is social media fuelling Ozempic demand in India?

New Delhi: Social media for the past few years has been rampant with before-after pictures of celebrities having undergone Ozempic treatment, where they appear to have lost immense weight due to the drug along with other such gimmicks that advertise the weight loss benefits of the diabetes drug, Ozempic. Famous talk show host Oprah Winfrey and singer Kelly Clarkson along with many other celebrities have attested to using weight loss drugs as part of their fitness regimen. The drastic weight loss or “zero” figures of Hollywood actors have been speculatively attributed to weight-loss injectable drugs such as Ozempic and have consequently garnered great popularity around the medication and a seismic surge in demand.
Marketing strategies for greater use of Ozempic also include plus-size activists and influencers being asked to promote the weight loss benefits of Ozempic as part of an industry-wide strategy to market injectable weight-loss medication. Novo Nordisk along with several pharmaceutical companies in the business have created marketing strategies that address body-positive communities and target them for creating promotional content that advertise Ozempic as a weight loss drug. The company has also heavily funded projects that promote discussions on topics of obesity and being overweight such as the sponsoring of two documentary projects centred on weight stigma: the feature “Embodied” and the docuseries “Thick Skin”.
Internet users all around the world have witnessed a sharp uptick in the ads and posts related to weight-loss injectable drugs that appear on their feeds. In a 2023 article published by NBC News, it was noticed that more than 4000 ads for Ozempic-style drugs were found running on Facebook and Instagram. This surge in ads being floated across social media platforms is being kickstarted by online pharmacies, medical spas, and diet clinics, as a means to capitalize on the increasing interest in the weight-loss injectable drugs market.
Global Obesity Levels in India
Developing nations like India are at a high risk of an obesity crisis and its consequences due to factors such as consumption of energy-dense food (i.e. unhealthy food habits), sedentary lifestyle, lack of health care services, and financial support. Ranking third in the list of top 10 obese nations in the world, India is entering a nationwide crisis of obesity at a rapid pace.
In a study/survey conducted by NCD Risk Factor Collaboration, close to 80 million individuals in India are identified as obese, and one-eighth of them belong to the age group of 5-19. Lancet reports show some startling facts, a recorded 30 million adults in India are living with obesity or are overweight, almost 70% of the urban population is obese and 62 million Indians with diabetic issues exhibit obesity-related characteristics such as excess body fat, abdominal adiposity (abdominal obesity), and fat deposition in ectopic sites.
According to the ICMR-INDIAB study in 2015, the prevalence rate of obesity and central obesity varies from 11.8% to 31.3% and 16.9%-36.3% respectively. In India, abdominal obesity is one of the major risk factors for cardiovascular disease (CVDs). Various studies have shown that the prevalence of obesity among women was significantly higher as compared to men. Obesity is one of the main medical and financial burdens for the government. This problem of obesity can be preventable by spreading public awareness about obesity and its health consequences.
In India, the rate of annual increase in adult obesity is “very high” at 5.2 per cent, while that of child obesity is also at 9.1 per cent. A land that was notorious for malnutrition decades ago is now a land of obesity. The National Family Health Survey-5 (NFHS-5) data from 2019-2021 reveals that 33.2 percent of urban women and 29.8 percent of urban men (in the age group of 15-49 years) are overweight or obese.
Weight Loss Market in India
Asia-Pacific is a developing market for the weight reduction and management sector since per capita fast-food consumption has skyrocketed in countries such as China and India, exacerbating the region’s obesity epidemic. As a result, the area is seeing a steady rise in demand for fat-burning weight reduction products, such as diet pills. The better-for-you food and beverage industry is expected to increase significantly globally in the coming years.
According to IMARC, a market research group, the weight management industry in India will be worth Rs1.72 lakh billion by 2022. It is estimated to reach Rs3.15 lakh crore by 2028. (Graph) This is true across all categories, including drinks, food, nutritional supplements, fitness equipment, and applications, and services such as health clubs, medical consultations, and surgeries. The weight reduction or anti-obesity medications industry, which includes tablets, fluids, and injectables used in situations of grade 3 obesity, has more than quadrupled since 2022, fuelling demand generated by India’s rapidly increasing obesity rate. Women are dominating the market because of social pressure and media representation of a “ideal” body type, which often targets women more than males. These pressures lead to a larger number of women seeking weight reduction treatments in order to comply to society norms and beauty standards. Educational ads addressing weight management and its relation to general wellbeing are more appealing to women, resulting in increased adoption of weight reduction methods.
What is Ozempic?
Semaglutide (Ozempic) was developed by the Danish pharma company, Novo Nordisk and was primarily prescribed for type 2 diabetes treatment. It was approved by the US Food and Drug Administration (FDA) for subcutaneous injection in December 2017. The tablet formulation was approved for oral administration in September 2019. In addition to two other semaglutide products, Wegovy Injections, and Rybelsus Tablets, the FDA also approved Ozempic Injections for the treatment of obesity or for people who are overweight. Increasingly being sold as weight-loss drugs, the Danish Pharma company, Novo Nordisk has witnessed an off-the-charts jump in its sales and overall company value due to its “wonder drug” Ozempic. In an article by Forbes, Novo Nordisk reported $33.7 billion of sales for 2023, an increase of 36% at constant exchange rates, 90% of which ($31.2 billion) came from its obesity and diabetes care division, which includes Ozempic and Wegovy respectively. Moreover, the company’s valuation rose to $506 billion in January of 2024.
How does Ozempic Work?
Ozempic (Semaglutide) injections or tablets contain semaglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Semaglutide works by binding to and activating the GLP-1 receptor, thereby stimulating insulin secretion and reducing blood glucose. This reduction in blood sugar levels and regulation of insulin is what makes this drug crucial for people with Type 2 diabetes. The subcutaneous injection is administered once weekly and the tablet is administered once a day. Semaglutide offers a competitive advantage over other drugs used to manage diabetes, which may require several daily doses.
The drug also imitates a hormone called glucagon-like peptide-1 that we naturally produce in our intestines, limiting appetite by signaling to our bodies that we feel full and prompting our stomachs to empty more slowly. As a result, people with obesity and accompanying health concerns have lost weight while taking it. People feel fuller faster, said Dr. Janice Jin Hwang, chief of the division of Endocrinology and metabolism at the University of North Carolina School of Medicine. For patients taking the medication, “foods that used to be exciting to them are no longer exciting,” she said. Some people report that their “food noise,” or ruminations about food, disappear after taking drugs like Ozempic.
Prices of Ozempic
The excessive popularity of the drug Ozempic as a purportedly breakthrough weight loss drug has caused serious supply shortages of the injectable drug. The demand for the drug in several places has risen to the extent that there hasn’t been enough supply to meet the crucial demand by diabetic patients or patients with obesity who have been prescribed the drug.  While in several other places, the skyrocketing demand for the drug has caused a seismic surge in prices, making it extremely difficult for patients to afford the life-saving diabetic medicine. The sharp rise in demand has also created an incentive for pharmacies to make or dispense unauthorized copycat versions of the drugs, prompting several states to threaten legal action against the pharmacies.
In 2023, US citizens paid $936 a month for Ozempic, almost 10 times more than what patients paid in the UK, France, Sweden, and Australia, which was $93, $83, $96, and $87 respectively.
Why Virality of miracle weight loss drug is worrying the doctors?
The proper way of taking Ozempic as prescribed by doctors is by using it as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. In research conducted by Novo Nordisk and presented at the 59th annual meeting of the European Association for Studies on Diabetes (EASD), data from more than 23,000 diabetic patients on semaglutide medication was analysed. Significant reductions in a patient’s average glucose levels (falling an average of 0.77% after six months, 0.76% at a two-year mark, and 0.43% at the three-year mark) along with weight loss were recorded. Reduction in glucose levels (HbA1c) also leads to a reduction in the risk of diabetic complications like vision loss, heart disease, stroke, kidney failure, amputation, and premature death. The “wonder drug” is also known to combat other diseases like heart disease and heart failure.
But it’s not without its risks, especially if the injections are being used as over-the-counter weight loss medications. People taking Ozempic and Wegovy for both F.D.A.-approved and off-label use may experience nausea and dehydration. They might also feel fatigue and malaise. Their bowel movements might change, with some patients having diarrhea and others becoming severely constipated. Doctors have advised that patients who are on Ozempic should be monitored while taking these drugs and doctors may prescribe anti-nausea medications and laxatives or stool softeners. In rare cases, the medication could increase the risk of pancreatitis, a painful condition that inflames the pancreas. Some patients might also form gallstones, leading to cases where patients experienced such severe vomiting that they had to stop taking the medication. There is also a risk that, in extreme instances, patients could become malnourished because of how little nutrients they can consume.  Along with the possible side effects, the burgeoning weight loss industry in India has set out to capitalize upon the increasing demand and subsequent market growth for the weight-loss injectable medicine, Ozempic. Although the drug remains unapproved for prescription in India, counterfeit copies along with smuggled versions of Ozempic have started floating in the market.
Tricky Road Ahead
Stashing boxes of injectables in their carry-on luggage, buying counterfeit formulas online. importing boxes from Europe the race to score blockbuster weight-loss drugs is pushing one of the world’s largest populations of obese people to creative lengths. Endocrinologists, cosmetologists and wellness clinics all around the country have been approached by clients in search of weight loss “wonder drugs”. The clientele base mostly includes celebrities, wealthy locals, expatriates, and Indians visiting home from abroad. While many are obese or diabetic, several of the customers only have a small amount of weight to lose, signally the growing popularity of the drug as a “slimming” tool.  Increased off-label use of these drugs is contributing to supply shortages for people who use these drugs for diabetes and employer health plans and insurers are scrutinizing the prescribing of the drugs. How these drugs are priced will influence how accessible they are to patients, how insurers cover them, and ultimately overall health spending.
Meanwhile, brand managers, marketers, and social media strategists need to exercise caution while marketing Ozempic and similar weight loss drugs. They should exercise caution in fanning the popularity of non-prescriptive use of the drug. For a long time, in the dark and congested ‘galis’ of India with dilapidated buildings and dank rooms, illegal drug manufacturing and counterfeiting on customer orders have been taking place and have long acquired the size and scale of a generational business.
Drug Units in Modi Nagar, situated on the outskirts of Delhi along with other such places from the underbelly of the Pharma Industry exist because of poor inspection. These units are responsible for supplying fake copies of the drugs and selling them at high prices. Such falsified products can have harmful implications on the health of consumers and can cause serious complications in patients with diabetes or obesity. While legalizing weight loss drug use might be just around the corner, the larger population remains vulnerable to the dangerous side effects of the miracle weight loss solution.
Stakeholders, including healthcare providers and marketers, must prioritize patient safety and ethical considerations in promoting such medications. As India grapples with an obesity crisis, responsible usage and awareness are paramount.
The article is authored by:

Prof Bhavika Bali is an Assistant Professor of Marketing, BML Munjal University (Hero Group).
Prof. Arup Majumdar is a professor of practice at the UPES Business School, Dehradun.
Satakshi Raj is an accomplished writer and a student from the prestigious Lady Shriram College, Delhi University.