The Ozempic ‘miracle’: Bangladesh’s growing appetite for quick weight-loss fixes

Mohsin recalls the days when he was significantly overweight, with a Body Mass Index (BMI) over 33, and a big appetite that contributed to his condition. 

"At the time, not only was I dealing with diabetes, but I was also considerably overweight," he said.

Two years ago, he began taking medication to address the issue, and since then, his health has undergone a profound transformation — he reports having lost more than 25 kilograms and no longer needing insulin.

"I am not diabetic anymore," he said. 

Mohsin's story is one of many now emerging across Bangladesh, where the rising popularity of weight loss drugs is changing the way patients and doctors alike approach obesity and associated illnesses.

While exercise and calorie control remain central to medical recommendations, new pharmacological tools are offering a vital — and sometimes controversial — lifeline.

Obesity is no longer a distant Western concern. It is a growing problem in Bangladesh, with increasingly sedentary lifestyles and changing food habits.

Dr Jobaida Nazneen, assistant professor of Endocrinology and Metabolism at Shaheed Suhrawardy Medical College and Hospital, emphasised the seriousness of the issue.

"Obesity is a chronic, often relapsing disease with numerous metabolic, physical and psychosocial complications," she explained. "Obese individuals are 80 times more likely to develop type 2 diabetes, and at a two to three times increased risk of heart disease, hypertension and stroke."

According to Dr Nazneen, losing just 5-7% of one's body weight can already lead to significant health benefits. "It can delay diabetes progression and improve cardiovascular outcomes," she said.

However, she added that these outcomes require a combination of calorie reduction, exercise and sometimes pharmacological assistance.

Understanding the medications

In Bangladesh, several types of weight loss drugs are available, though none are from the original manufacturers. Local pharmaceutical companies produce biosimilar versions of the drugs, which are more affordable and widely accessible.

Among the most discussed drugs are Orlistat, Semaglutide (widely known by its original brand Ozempic), and Liraglutide (Victoza).

Orlistat prevents dietary fat absorption by blocking lipase, an enzyme in the gut. "Common side effects include oily spotting on underwear, flatulence with discharge, fatty stool, increased defecation, nausea, and vomiting," Dr Nazneen said. Orlistat is the least effective among the available options, but also the oldest.

Semaglutide and Liraglutide reduce appetite and slow gastric emptying, leading to a prolonged sense of fullness. A newer dual agonist, Tirzepatide, works even more powerfully by combining glucagon-like polypeptide (GLP-1) and gastric inhibitory polypeptide (GIP) agonist effects.

"These medicines often lead to gastrointestinal issues," Dr Nazneen explained, listing vomiting, constipation, abdominal pain and indigestion.

"But the more serious side effects such as kidney damage, gallbladder disease and stomach paralysis are rare — around 1-2% percent in studies."

The benefits, though, can be significant. As Mohsin's case shows, not only can weight be reduced, but illnesses like diabetes can also be managed or even reversed.

A worrying trend

While these drugs have opened doors to better health for many, their unregulated distribution is a cause for concern.

"These precious drugs are being sold by the pharmacy sales people without a prescription of a registered physician," Dr Nazneen warned.

"Some so-called beauty clinics are offering these medications as a 'magic cure.' Without the monitoring of the health ministry, this situation will worsen."

The marketing of these drugs as quick solutions has also raised ethical questions.

"Certainly, we could say that these drugs promote a quick fix mentality," Dr Nazneen said. "But we have to consider the weight stigma that people with obesity face since childhood. Fat bias is prevalent among healthcare professionals and the general public."

She argued for a more compassionate approach, suggesting, "Increasing empathy and understanding about the complexity of weight management has to be emphasised."

A tool, not a cure

Experts stress that medications are just one piece of the puzzle. Lifestyle modifications, including diet and physical activity, remain essential.

"Anti-obesity medications are a tool of treatment, not a cure," said Dr Nazneen. "Discontinuing these drugs without following lifestyle modifications often leads to rapid weight regain."

She advised that patients set realistic expectations — ideally, a 5-10% weight loss within six months.

Ongoing monitoring is also critical. "It is advised to assess their effectiveness and safety at least monthly for the first three months and quarterly thereafter," she added.

In long-term users, follow-ups should be arranged to check for pancreatitis, gastroparesis, gallbladder disease, and kidney injury.

"Each patient has to be counselled about gastrointestinal side effects and some common medications are given to lower the side effects. A routine follow-up at least within a month is advised," said the doctor.

Local market and concerns

Bangladesh's reliance on biosimilar drugs has both advantages and limitations.

The affordability makes the medications accessible to more people; for example, a local 1.34 mg vial of Semaglutide costs around Tk5,000, compared to the originator brand, which is priced at over Tk14,000.

While originator brands are scarce worldwide, Bangladesh is not facing a shortage, thanks to local manufacturing. 

But questions remain about long-term safety and efficacy.

"We are receiving biosimilar products manufactured by our Bangladeshi pharmaceutical companies," said Dr Nazneen.

"It is mandatory to pass a bioequivalence test for all biosimilar products. These are usually conducted at BCSIR [Bangladesh Council of Scientific and Industrial Research] or in India due to the lack of advanced labs locally."

Backed by science

Though these drugs are not miracle solutions, the science behind them is growing stronger.

A recent study from Washington University has found that weight-loss drugs like Ozempic and Wegovy may offer wide-ranging health benefits, including better heart health, reduced risk of dementia, fewer infections, and improved mental wellbeing.

The drugs, originally used for type 2 diabetes, mimic a gut hormone that influences appetite and also affects various organs. Researchers found a 12% drop in Alzheimer's cases and lower rates of substance abuse and chronic conditions among users.

However, the study also revealed increased risks of digestive issues, joint pain and inflammation in the pancreas. 

While the findings are promising, experts urge caution, noting the study's limited diversity and the need for further trials.

The full impact of these drugs is still being understood, and their broader use requires careful consideration.

Yet patients are satisfied with the outcomes.

Mohsin is currently on Tirzepatide, having previously been treated with Semaglutide.

"My life has been smooth sailing, without any notable side effects — I never felt better," he said. "As long as the diabetes remains under control, the weight will not go up again. It is important to keep diabetes in check."

Yet even the most advanced drug cannot replace the human side of care. Dr Nazneen emphasised a non-judgmental approach.

"We have to advocate that obesity management extends beyond physical appearance, targeting profound metabolic and cardiovascular risks. A non-judgmental interaction with a person with obesity will ensure that he or she understands the supreme importance of diet and exercise," she concluded.