Injectable obesity drugs such as semaglutide and tirzepatide, which have been widely praised for their spectacular weight-loss outcomes in clinical studies, appear to produce more moderate results in real-world use, according to a recent Cleveland Clinic study published in the Obesity Journal. The study's findings could have major public health consequences for nations such as India, Bangladesh, and Pakistan, where obesity and diabetes rates are quickly rising but access to long-term medication therapy is limited.

"Patients treated for obesity with semaglutide or tirzepatide lost less weight on average in a regular clinical setting," stated Dr Hamlet Gasoyan, the study's lead author. Dr. Hamlet Gasoyan noted that early treatment cessation and lesser drug dosages, when compared to controlled clinical trials, most likely caused the discrepancy. 

The trial tracked 7,881 persons with severe obesity (average BMI greater than 39) who began injectable therapy with semaglutide or tirzepatide between 2021 and 2023. Of these, 1,320 had prediabetes, a condition in which blood sugar levels are high but not yet diabetic. 

A recent study found a troubling tendency in the long-term use of weight-loss medications such as semaglutide and tirzepatide. More than half of the individuals discontinued their medication during the first year—20% within three months and another 32% between three and twelve months. Even among those who remained, more than 80% were taking lower-than-recommended maintenance doses, specifically 1 mg or less of semaglutide and 7.5 mg or less of tirzepatide. This finding is crucial since the maintenance dose is the consistent quantity needed to maintain health advantages such as weight loss and blood sugar control. Without adequate administration or ongoing use, the long-term efficacy of these medications is questionable. 

The data on weight loss outcomes with medications such as semaglutide and tirzepatide show a clear pattern: the longer people stay on the treatment, the more weight they lose. Early quitters lost only 3.6% of their body weight, whereas those who stopped later lost 6.8%. Patients who kept on the medicine throughout experienced a substantially larger 11.9% loss. Notably, at maximum dosage, semaglutide resulted in a 13.7% reduction, while tirzepatide did even better, with an 18% drop—data that could influence future treatment decisions. However, the discrepancy between clinical trial success and real-world outcomes is not exclusive to the United States. High costs, unequal supply chains, and inferior health-care systems exacerbate the issues in South Asia. As a result, the benefits reported in studies may not be as effective in practice, raising questions regarding equitable access and long-term use in these places. 

The study found a strong correlation between medication adherence and better blood sugar control in individuals with prediabetes. Only 33% of those who discontinued treatment early were able to return to normal blood sugar levels, compared to 41% of those who quit later. However, those who continued their medicine showed the greatest improvement—nearly 68% of them were able to reverse their disease. This finding is especially relevant in South Asia, where prediabetes frequently leads to type 2 diabetes. With over 77 million Indians already suffering from diabetes, the International Diabetes Federation believes that early and consistent treatment could play a critical role in decreasing the region's increasing diabetes pandemic. 

"This study highlights that treatment discontinuation, especially early, negatively affects both weight and blood sugar outcomes," says Dr Gasoyan. 

Many individuals abandon treatment not because it is ineffective, but because it is simply too expensive. In India, most middle- and low-income households cannot afford injectable medications, which can cost up to ₹10,000–15,000 per month. This burden is exacerbated by limited or no insurance coverage—government programmes do not currently cover these prescriptions. Even those who can initially afford them may discontinue due to negative side effects such as sickness. Occasionally the pharmaceuticals aren't available at all due to supply concerns and delays in local production. As a result, financial and systemic impediments impede medical advancement. 

South Asian populations are more likely to develop diabetes at lower BMIs than Western populations, owing to genetic and metabolic reasons. However, awareness, access, and follow-up care remain inadequate. 

While lifestyle changes such as diet and exercise remain the primary line of treatment, GLP-1 medicines such as semaglutide and tirzepatide are seen to be promising for patients with severe obesity or resistant prediabetes. However, without addressing cost, supply difficulties, and structured medical follow-up, its impact in nations such as India may be limited. 

The Cleveland team intends to conduct a follow-up study to investigate the specific reasons for stopping as well as the post-discontinuation weight-management measures used by patients. 

The report emphasised an important message for South Asian public health leaders: miracle treatments only work if people stick with them. Without strong systems for affordable access, counselling, and long-term care, these pharmaceuticals may only serve a small elite, leaving the broader obesity and diabetes epidemic unaddressed.