Real-World Outcomes of 25 Indian Patients Treated with Tirzepatide for Weight Loss: A 20-Week, Resource-Constrained Case Series

Abstract

Background: India faces a rapidly growing obesity epidemic, with 40.3% of adults classified as overweight or obese, yet access to advanced anti-obesity medications remains severely limited by both cost and regulatory constraints. Tirzepatide, a novel dual Glucose-Dependent Insulinotropic Polypeptide (GIP)/Glucagon-Like Peptide-1 (GLP-1) receptor agonist, has demonstrated unprecedented weight loss efficacy in global clinical trials, though real-world evidence in resource-constrained settings remains limited.

Methods: This retrospective case series analyzed 25 consecutive adults (BMI ≥27 kg/m²) who initiated tirzepatide therapy between March-July 2025 at a high-volume urban metabolic clinic in India. Due to cost constraints and local practice patterns, treatment duration was limited to 20 weeks maximum. Primary outcomes included percentage weight loss, glycemic control (HbA1c) and safety parameters.

Results: Participants (mean age 41 years, 52% female) had baseline weight 99.4±16.1 kg and BMI 32.3±3.9 kg/m². After 20 weeks, mean weight loss was 11.3 kg (11.9%), with 72% achieving ≥10% weight reduction. Significant improvements were observed in HbA1c (-0.55±0.32%), systolic blood pressure (-14.5±4.2 mmHg) and LDL cholesterol (-52.0±8.1 mg/dL). Gastrointestinal adverse events occurred in 60% of patients but were predominantly mild and transient. Treatment completion rate was 84%, with cost cited as the primary barrier to continuation.

Conclusions: In this real-world Indian cohort, short-course tirzepatide therapy demonstrated clinically meaningful weight loss and metabolic improvements comparable to international standards, despite abbreviated treatment duration. However, prohibitive costs limit broader accessibility, highlighting the urgent need for health policy interventions to improve access to effective obesity pharmacotherapy in developing economies.