After receiving the dubious and unpleasant tag of being diabetic capital of the world, India is on the verge of becoming the capital of obese people as well. In fact, rising incidence of diabetes in India is largely linked to the rising count of obese people in the country. On the other hand, though pharmaceutical companies and traditional medicine manufacturers were quick to offer remedies to tuck in Indian tummies, these sometimes came with worries attached.
India, the potential market
Padmashri Shanmugaraj, Managing Partner, Prime Health Consultants explains this market buzz saying, “Considering the shift in our lifestyle over the last two decades, obesity and associated lifestyle diseases have become rampant and inevitable. Unhealthy foods have become the norm of the day due to their ease of availability coupled with the lack of time/means to cook healthy food. Adding to this, hectic work routines leave very little time for any physical activity. People, therefore, are looking for quicker, hassle-free ways to shed the extra kilos. This is precisely the reason for the surge in the use of fat-loss pills, liposuction and lipolysis procedures.”
Deepak Desai Director, Aurochem India |
Deepak Desai, Director, Aurochem India, says, “Obesity has acquired epidemic proportions in the country with five per cent of the population suffering from it. According to the National Family Health Survey (NFHS), as many as 30 million Indians are obese. It was established that obesity raises the risk for several diseases and disorders such as type II diabetes, hypertension, and osteoarthritis. Obese women in particular are at high risk of breast cancer, uterus cancer, menstrual disorders and infertility. There is definitely a potential market for anti-obesity drug manufacturers considering number of obese people in India.”
As far as India is concerned there is a considerable difference in obesity levels among the two genders. Ajit Mahadevan, Partner, Ernst and Young, gives the exact figures, “As per the NFHS, survey 2007, obesity (includes category of people who are overweight) in India is prevalent in 12 per cent of the male population and 16 per cent of the female population. Thus, there is a large potential for treatment of people that are overweight in India.”
Dr M N Parkar Laparoscopic surgeon, Kohinoor Hospital, Mumbai |
But anti-obesity drugs are not the obese patient’s only treatment option. Dr MN Parkar, laparoscopic surgeon, Kohinoor Hospital, contradicts claims of a booming anti-obesity drug market and opines, “Drug treatment has never been a favoured modality of treatment in obesity and with the availability of bariatric surgery and increase in the number of well trained bariatric surgeons, drug treatment can never be a preferred treatment in obesity. Therefore drug manufacturing may be on rise due to increase in awareness but India can’t be the next potential market as stated.”
Market analysis
Obesity has a long history in the European countries. Market for anti-obesity drugs is also phenomenal in this part of the world. Though India is comparatively new to the obesity epidemic, with all market drivers properly placed, India is already a favourite destination for the anti-obesity drug manufacturers.
Ajit Mahadevan Partner, Ernst and Young |
Mahadevan provides market statistics, “The obesity-related pharma drugs are Rs 60-70 crore in 2011 that has grown at a CAGR of 10 per cent over the last three years. However, the market has been stagnant between 2010 and 2011 due to some of the drugs being banned in India because of their side effect profile. However, obesity tends to increase the risk of various diseases such as hypertension, blood pressure, and cardiac diseases, which is a much larger market. However, weight management through meal replacement options, supplements (herbal OTC) and other slimming products have seen an increase over the last few years and was forecast to reach almost Rs 9.2 billion in 2011, as per an industry report from Euromonitor International 2012.”
According to Desai, obesity is increasingly posing itself as a grave problem in India, just as in many developed countries such as the US and UK. Though India’s obesity levels are low as compared to the US and UK, (approximately eight per cent, comapred with over 25 per cent in US and 15 per cent in Europe), the concern is that the problem can soon reach that magnitude if not adequately addressed.
Risks and rewards
As obesity turned out to be the root cause of many health ailments, obese people started looking for solutions to shed the extra fat. There might be some genuine products, however, the sudden rise in different types of suspicious obesity drugs was also witnessed. In India, there are an enormous number of online shops that offer drugs to curb obesity. With no credible study, such drugs can even be spurious and in the worst case scenario, life threatening as well.
Padmashri Shanmugaraj Managing Partner, Prime Health Consultants |
Shanmugaraj says, “Some anti-obesity drugs work by decreasing or even blocking fat digesting enzymes in the stomach, thus preventing its absorption. A few claim to work by increasing the metabolic rate so as to burn more calories, even at rest. The remaining work by reducing appetite, thereby preventing excess food intake.”
She adds, “But then, the question is do these really work? The first type, the enzyme-blocking drugs, have not been as effective as they seem to be on paper. In fact, the side effects (loose motions, oily spotting, frequent or hard-to-control bowel movements etc) far outweigh the benefits. The metabolic rate enhancers lead to raised heart rate and high blood pressure, which is not healthy at all. The appetite suppressants are known to cause unpleasant symptoms like insomnia, dizziness, palpitation, nausea, vomiting, flatulence, gas, bloating and diarrhoea.” She also points out that most of these drugs are recommended for short-term use only and unless these are taken along with a low-calorie diet and exercise programme, they don’t work in the short term.
According to Mahadevan, the overall anti-obesity segment has remained stagnant over the last couple of years, because some of key drugs such as sibutramine have been banned in countries across the globe including India. “The reason for this (ban) has been the limited benefits in long-term usage of these drugs versus the potential side effects. As a result not too many companies have focussed their R&D efforts on this segment. Typically not too many new anti-obesity drugs have been approved globally and it was only in 2012 after a gap of 13 years that the US FDA has approved new drugs to treat obesity – Belviq (lorcaserin) and Qsymia (phentermine/ topimarate). However, at the same time Qsymia has not been approved in EU due to the perceived risk with phetermine,” informs Mahadevan.
Desai echoes Mahadevan’s views and says, “A number of single drugs as well as fixed dose combinations have been banned for manufacture, marketing and distribution in India, which include combination of fenfluramine and phenteramine, Rimonabant and very recently Sibutramine. The only product that is doing well is Orlistat (generic Xenical). Other products are either herbal or proprietary ayurvedic preparations.”
Surgery, the last option?
Nicholas Grogan Project Co-ordinator (Slim Asia), Unex Corporation Australia |
Recently, a leading politician in India underwent bariatric surgery. Within a few days after surgery the entire nation saw his physically trimmed body. This incident threw the spotlight on bariatric surgery as an alternative to anti-obesity drugs but it will take time to change the traditional aversion to surgery in a country like India, where it has always been considered as the last option for any health problems. Bariatric surgery may have to wait for acceptance.
Mahadevan says, “As per the guidelines for bariatric surgery laid down by the US National Institute for Health; one of the criterion for bariatric surgery candidates are people with Body Mass Index (BMI) >= 40 kg/m2 or candidates with BMI greater than equal to 35kg/m2 with significant obesity related co-morbidities. Bariatic surgeries have increased in India. In 2008, 3,44,221 surgeries were carried out world over, out of which US and Canada accounted for 2,20,000 surgeries amongst themselves. They were followed by Brazil (25,000), Mexico (13,500) and Australia (12,000). Only 1216 surgeries were performed in India in 2008. However, the number has been growing in India, as per the Metabolic/Bariatric Surgery Worldwide 2008, Henry Buchwald & Danette M Oien.”
According to Shanm-ugaraj, reports show that patients typically lose more than 50 per cent of their excess weight after such surgeries. Obesity-related diseases improve markedly after bariatric surgery, decreasing cardiovascular risk and improving quality of life.
However, she cautions, “Having said that, surgery need not be an option for moderately overweight or even slightly obese patients, but it may be a boon for morbidly obese patients. More so, if this obesity is accompanied with cardiovascular diseases and/or diabetes mellitus. Before opting for bariatric surgery, one must be aware of the possible side-effects like bleeding, wound infection, embolisms, and anastomotic strictures. Long-term complications may include ulcers, bowel obstruction, gallstones, and nutritional deficiencies. The US has seen a maximum number of patients opting for bariatric surgeries but in the last couple of years, the number of surgeries performed has shown a plateau, which may be a good sign.”
Over the last two decades, obesity has consistently shown an ascending graph in India across all age groups. If experts are to be believed, awareness would be the key to keep a check on rising epidemic of obesity in India.
Nicholas Grogan, Project Co-ordinator (Slim Asia), Unex Corporation Australia, signs off, “With our experience in the industry, we have noticed that the sale of drugs is growing at the rate of 22.6 per cent per annum. Unfortunately people are unaware of solutions available to curb obesity. Many people believe that drugs on obesity act as a shield against heart attack, stroke and even organ failure, which is a myth. In fact, a more proactive approach is to educate people about the risk of chronic disorders can be reduced by losing five or six kgs of body weight. The same was even proved by recent clinical trials conducted on obese and diabetic patients for Slim Asia programme by UNEX Corporation Australia.”