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Use Weight-Reducing Drugs Judiciously - Insights from Dr. Jitendra Singh

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  Published in Science and Technology on Saturday, December 20th 2025 at 9:40 GMT by Daily

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Use Weight‑Reducing Drugs Judiciously – Insights from Dr. Jitendra Singh

An in‑depth look at the emerging conversation around pharmacotherapy for obesity, its clinical nuances, and the need for a balanced, evidence‑based approach.

The Rising Tide of Obesity and the Pharmacologic Response

Obesity has reached epidemic proportions worldwide, with the World Health Organization estimating that more than 650 million adults were clinically obese in 2016. In India, the prevalence has risen sharply over the last two decades, driven by rapid urbanization, dietary shifts, and sedentary lifestyles. As the condition progresses, patients become increasingly susceptible to type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease—leading to higher morbidity and mortality rates.

Lifestyle modification remains the cornerstone of weight management, yet the stubborn persistence of excess weight in many patients has propelled the medical community to consider pharmacotherapy as an adjunct. “We need to be very mindful of how we use these agents,” Dr. Jitendra Singh, a seasoned clinician and industry expert, stresses in his recent interview with Medical Dialogues. His remarks come at a pivotal moment when several weight‑reducing drugs, including GLP‑1 receptor agonists, SGLT‑2 inhibitors, and newer agents like tirzepatide, are gaining traction globally and in India.

Dr. Singh’s Core Message: “Use with Caution and Context”

1. Patient Selection Matters

Dr. Singh emphasizes that pharmacotherapy should not be the default for every individual with excess weight. A thorough evaluation—including BMI, waist circumference, comorbidities, lifestyle factors, and psychosocial assessment—is essential. He advises prioritizing patients who:

• Have a BMI ≥ 30 kg/m², or a BMI ≥ 27 kg/m² with at least one obesity‑related comorbidity.
• Have failed or are unable to achieve meaningful weight loss through diet and exercise alone.
• Show a realistic commitment to ongoing monitoring and lifestyle support.

“Treating someone with a BMI of 26 who is otherwise healthy could expose them to unnecessary drug risks without substantial benefit,” he notes.

2. Evidence‑Based Choice of Agents

Dr. Singh discusses the pharmacological landscape, highlighting:

• GLP‑1 Receptor Agonists (e.g., semaglutide, dulaglutide): These have consistently shown weight loss of 5–15 % over 12–52 weeks and additional metabolic benefits. Side effects such as nausea, vomiting, and rare pancreatitis warrant monitoring.
• Combination GLP‑1/SGLT‑2 Drugs (e.g., tirzepatide): Emerging data suggest superior weight reduction, though the safety profile is still under scrutiny.
• Central Sympathomimetics (e.g., phentermine): Useful as short‑term adjuncts but limited by tolerance and cardiovascular risks.

He points out that regulatory approval in India remains limited, with only a handful of agents currently authorized for obesity treatment. This, he argues, underscores the importance of clinical judgment and adherence to national guidelines.

3. Monitoring and Follow‑Up

Regular assessment is critical. Dr. Singh recommends:

• Baseline labs (fasting glucose, HbA1c, lipid profile, liver enzymes).
• Monthly weight checks for the first three months, then quarterly.
• Monitoring for gastrointestinal disturbances, hypoglycemia (especially when used alongside glucose‑lowering agents), and changes in appetite.

The article cites the Indian Association of Clinical Endocrinologists (IACE) and the Indian Council of Medical Research (ICMR) guidelines, which advocate for a structured follow‑up protocol.

4. Lifestyle Synergy

Even the most potent pharmacotherapy is most effective when paired with lifestyle modification. Dr. Singh underlines that diet, exercise, behavioral counseling, and, where appropriate, bariatric surgery should form the backbone of obesity management. “Pharmacology can tip the scales, but we need to keep the foundational pillars intact,” he says.

The Regulatory and Industry Perspective

In India, the Drug Controller General of India (DCGI) has recently begun to streamline approvals for obesity drugs. Dr. Singh points to a 2023 directive that encourages the development of generic weight‑loss formulations, provided they meet stringent efficacy and safety benchmarks. He also notes that the industry’s role extends beyond drug development; it includes educational initiatives for clinicians, patient outreach programs, and post‑marketing surveillance.

A reference in the article links to a DCGI press release detailing the criteria for approving new weight‑loss drugs, including the requirement for phase‑III trials demonstrating ≥ 5 % weight loss with a clinically meaningful reduction in cardiovascular risk markers. Dr. Singh applauds this move but cautions against “rush‑to‑market” mentality, which can compromise patient safety.

Common Concerns and Misconceptions

The interview touches upon several frequently raised questions:

• Is weight‑reducing medication “magic” for weight loss?
  No. Dr. Singh reiterates that the drugs work best when patients adhere to diet and exercise plans. The effect is additive rather than substitutive.

• Can these drugs be used in children or adolescents?
  Most agents lack sufficient pediatric data. Current guidelines recommend lifestyle interventions first, with pharmacotherapy reserved for severe cases under specialist supervision.

• What about long‑term safety?
  Long‑term data are still evolving. While GLP‑1 agents have a strong safety record, new drugs like tirzepatide are being monitored closely for cardiovascular outcomes.

Key Take‑Home Points

1. Individualized Therapy – Weight‑reducing drugs should be tailored to patient profile, comorbidities, and risk tolerance.
2. Evidence & Guidelines – Adherence to national and international guidelines (e.g., IACE, WHO, FDA) ensures safe, effective use.
3. Lifestyle as the Cornerstone – Pharmacotherapy is an adjunct, not a replacement for diet, exercise, and behavior change.
4. Rigorous Monitoring – Regular check‑ups and lab work are vital to mitigate side effects and assess efficacy.
5. Regulatory Compliance – Only drugs approved by the DCGI for obesity should be prescribed, and clinicians should stay updated on new approvals.

Final Thoughts

Dr. Jitendra Singh’s perspective serves as a timely reminder for clinicians and policymakers alike: “The tools we have for obesity management are powerful, but they must be wielded with precision and care.” As the global and Indian landscapes of obesity treatment evolve, the confluence of robust clinical evidence, thoughtful regulatory oversight, and patient‑centered care will be the linchpin of successful outcomes. By following a judicious, evidence‑based approach, healthcare professionals can harness these pharmacologic advances to help patients achieve sustainable weight loss and, consequently, improved quality of life.