Are Indians predisposed to NAFLD?
Definitely, Indians are predisposed. We have more insulin resistance and other factors. In many cases, insulin doesn’t work leading to many complications including heart problems. It is also known as syndrome X or metabolic syndrome. However, our research has shown that there is something more to it, something more than just plain insulin resistance.
Our people are much leaner compared to the western people and yet they have this problem. Dr Yajnik, in his research published in Lancet, has found that despite having the same BMI, an American is absolutely lean and has no fat, while Indians have a lot of fat. We have to set our BMI limit accordingly. We have set our BMI at a level of 25, though 23 is the lower limit as far as ICMR is concerned. In fact, I have seen among Odias that once BMI exceeds 22, fatty liver deposition starts. This is the cut-off where we need to be cautious. Gut microbiota also has a huge role in pathogenesis of fatty liver disease in Indians. That is why it is advised to eat curd.
But ultimately, the treatment doesn’t go beyond these two things – diet and exercise. Keep weight down. Even if you bring down your weight by 1 or 2 kgs, it is going to bring results.
Ozempic and GLP-1 agonists have generated both excitement and controversy. What is your view on their growing use in India for weight loss?
These are no miracle drugs and in fact, may cause more harm than benefits. There are many safe options for obese people to reduce weight before they go for this option. Patients should be educated about their benefits and side-effects before they take the medicines. I doubt if the patients are properly educated.
This class of drugs has a lot of side-effects. It slows down gastric emptying and produces gastric stress. Patients on such medication also complain about esophagitis. People can have acute pancreatitis and ocular problems. Many are also complaining about mounjaro rebounds. They gain twice the weight they had before, once they stop the medication. It is like a mirage. Studies are also not being conducted properly.
There is no clear indication about how much weight loss was due to mounjaro (drugs) and how much reduction was due to lifestyle modification. Real-world data also do not corroborate the claims of the manufacturers that the drugs lead to magical weight loss. Doctors are partly responsible for it and they must educate the patients about the benefits of lifestyle changes and side-effects of weight loss drugs.
