Health and Medicines

Gauri Kamath

India is getting fatter. While estimates vary, it is widely accepted that genes, diet and a sedentary lifestyle are making more Indians overweight than before. New Delhi’s Nutrition Foundation of India suggests that 29 per cent of urban India’s adult male population (roughly three out of 10) is overweight. The number for women is higher at 45 per cent.

This mirrors the global trend and is seen as one reason behind India’s dubious rise as the diabetes capital of the world. According to the World Health Organisation’s fact sheet on obesity and overweight, the likelihood of developing Type 2 diabetes and hypertension rises steeply with increasing body fatness. It points out that India and the Middle-East are set to have the highest number of diabetics by 2025.

The good news is that more Indians are now trying to lose their extra kilos, which is evidenced in the explosion of fitness clinics and brown bread vendors in the market. And if developments in the past couple of weeks are any indication, decibel levels on cutting flab will only rise in the following months.

Sales people at some of India’s leading drugmakers are fanning out across the country to promote a new weight-loss pill to doctors. The medicine, rimonabant, works on what an executive in one company calls the ‘pleasure centre’ in the brain. The result is a decreased craving for food. Torrent Pharmaceuticals in Ahmedabad claims that it has tested rimonabant on over 200 volunteers weighing 90 kg on an average in the country’s hospitals. It saw an average weight reduction of 6-8 kg in the first few weeks, it claims. Zydus Cadila Healthcare, another drug company in the same city, announced its own brand of the medicine the same day as Torrent. “We are getting news of prescriptions from all over,” claims Ashok Bhatia, senior vice-president, Zydus Cadila.

There are other weight-loss medicines in the domestic market. But companies say that rimonabant works better and has fewer of the side-effects such as diarrhoea and high blood pressure that others cause. In fact, so much store is being set by this product that it is expected to almost single-handedly drive sales for the anti-obesity pills market to over Rs 100 crore by 2010 from a relatively paltry Rs 23 crore now, according to Ruchir Modi, vice-president (marketing), Torrent. More drug companies are expected to market this pill by then.




There is a caveat. Depression is the known side-effect that the medicine could cause. Shah says he does not intend to prescribe it to patients for long periods of time until there is more long-term safety data. Plus, it is not a replacement for diet changes and exercise, warns Shah. “Patients will be thrilled when they hear of this pill, but good lifestyle is more important,” he says. The companies also say that rimonabant is most effective when used along with change in food habits and exercise.

In fact, many still believe that medicines are only a quick-fix and that lifestyle change is long-lasting. “I would never recommend medicine for weight loss,” says Veena Aggarwal, senior vice-president (R&D and technical operations), VLCC, a Gurgaon-based chain of weight loss and beauty clinics. Aggarwal’s team has 26,000 people under its care over 100 centres across India and the Middle East. Aggarwal, who hasn’t heard of rimonabant, says that many of her clients have tried other weight-loss medicines but regained their weight when taken off it. “We use a holistic approach, there has to be lifestyle modification,” she says. Chakrabarti of SaharaOne also believes that losing weight sans medicine intake is the unique selling proposition of Biggest Loser…. “This is what has made the show taste success in 22 countries,” he claims.

But while their weight-loss solutions differ, what is interesting is that both Sahara and rimonabant makers are working on the premise that the issue has mass appeal, and is not being brushed under the carpet. “Illness can put a considerable dent in your bank balance,” says Chakrabarti. The new show has cash reward prize waiting at the end. Modi of Torrent remarks that an earlier weight-loss pill called sibutramine that it marketed was popular only in “high society”. That pill cost Rs 40 a bob, and was imported. But now, Torrent is using local manufacturing for rimonabant, allowing it to be priced at Rs 8 per pill. “Treatment is now affordable, it is no longer a niche market,” says Modi.

Not surprisingly, all the noise around overweight mirrors the West. It was researchers in those markets that first found a link between obesity and diseases like diabetes, heart disease and cancer. And it is in the US that the international format of the show Biggest Loser was first aired in America in 2004 and reportedly kick-started a fitness revolution. Rimonabant, too, has been discovered by Europe’s largest drug maker Sanofi-Aventis. Indian companies are merely copying it — legally — by a different process. Sanofi-Aventis, ironically, is awaiting permission from the Indian regulator to launch the original. “We applied last year,” says a company spokesperson. There are reportedly 60 drugs under development for obesity mainly in the West, and if they ever get approved, many will no doubt reach Indian shores.

The question is whether all these efforts are good enough to avert the epidemic of obesity that India is careening towards, and safely. That, after all, is the ultimate test.

# posted by Airavat @ 2:46 AM