For years, 28-year-old Aditi has learnt to shrink herself in social spaces and mute herself from conversations, a desperate act to invisibilise herself. “Only my body was visible to others, not my mind. Nobody was concerned about my health or how my hormones swung wild and moody because of PCOS (polycystic ovary syndrome) and a competitive work life. They would instead judge me for being careless. All through my adult years, I only listened: ‘Have you gained weight this month?’ or ‘Your face is looking rounder, try a detox drink, buy a tummy twister, go on so and so diet.’ There was fashion advice to hide my belly bump. So, when my mother chose a champagne-coloured mermaid lehenga for my wedding, thinking it would make me look slim in the photos, she had not thought of the challenge of slipping into it,” she says.Instead of feeling joyful, her midriff sat heavy on her chest as Aditi walked into a beauty and wellness clinic near her West Delhi home to clear up her acne, another side effect of PCOS. That’s where the cosmetologist suggested she get on the weight loss drug Mounjaro, which would not only knock off 12-15 kg in three months, but also help clear out her skin as an added benefit. The clinic had the injectable pens and she didn’t bat an eyelid. “I had read about Mounjaro transformations on social media. I even had some money saved up and I didn’t want my body and looks to dominate conversations on my big day out,” says Aditi.She wasn’t aware that off-label cosmetic use of Mounjaro was not allowed, that it was illegal for a cosmetologist (only cardiologists, endocrinologists and internal medicine specialists can) to prescribe and sell it or that the injectable could have been a compounded version of the original drug, and therefore, a mish-mash of ingredients sourced online and assembled in unregulated scenarios that could do more harm than good. “I had redness, swelling and a lump at the injection site. Nobody told me that three months were too little for stubborn weight to melt away,” says Aditi.She is not alone. Many like her and even to-be grooms are hitching an easy ride on the weight loss drug bandwagon, often for the wrong reasons. In a world of appearances and filtered glamour on social media, young people see weddings as a visible milestone, a photographic memory, a “coming out” of sorts and a measure of social ascension. In fact, the easy access to weight loss drugs, which are genuinely meant for morbid obesity and diabetes, is medicalising cosmetic makeovers and stratifying the appearance industry. This has birthed a new cultural phenomenon called ‘lookism’, which refers to discrimination based on physical appearance, disadvantaging those who do not fit conventional beauty standards. Social conversations are replete with terms like ‘beauty dividend’, which means higher income earned by good-looking people and ‘body capital’, which rates physical appearance as an asset, similar to human capital that can be leveraged for better economic opportunities.Brides, grooms and moreDr Swati Pradhan, former assistant professor at the government-run Sion Hospital and founder of the Live Light, Obesity and Weight Loss Centre in Mumbai, regularly gets patients who seek weight loss drugs for cosmetic makeovers even when they are not medically obese and need to trim a few inches. “Apart from the marriage market, most young people want to look sharp, earnest and trim for job interviews or work opportunities abroad. One can prescribe the drugs only when a person’s body mass index (BMI) is 30 and above or when the BMI is 25 to 27 with multiple obesity-related health conditions (diabetes, hypertension, cholesterol and sleep apnea). But I have had people with BMI of 24 or just about touching 25 requesting a quick weight loss before they tip over. Of course, I do not oblige everybody without doing a full panel of tests and ascertaining their needs. For instance, there was this one athlete who needed a certain body fat percentage to qualify for a certain flyweight category in mixed martial arts. I refused,” she says.However, most to-be brides, aged between 28 and 32, tend to be overweight. “These are high-achieving girls who are eating a lot of junk food amid punishing work schedules. So their weight usually is off the charts. With the drug, they can knock off three to seven kilos a month,” says Dr Pradhan. One such girl, wishing privacy, says, “For me GLP-1s are a breakthrough because I could lose around 4-5 kg a month and lost around 14 kg in three months. Now with cheaper generics, I will go on a maintenance dose and stabilise my weight. First appearances these days carry more weight than ever. And I don’t want people to think I am a slacker.” Although vanity dosing is a phenomenon, Dr Pradhan sees medical necessity too. “About 30 years ago, one patient in surgery at Sion Hospital would be diabetic, now every second patient is diabetic while childhood obesity is rising. Natural conception is rare because of obesity-induced infertility in men and women. That’s why many newly-weds come to us too,” she says.Dr Jothydev Kesavadev, research diabetologist and founder of Dr Jothydev’s Diabetes Hospitals and Research Centres, Kochi, has learnt to take the weirdest requests in his stride and counsel his young patients. “There was this man who wanted to lose weight in a few months to look good for his 40th birthday celebrations. Young people come to me and say, ‘Doctor, give us the drug, we have not had a girlfriend or boyfriend yet.’ These drugs are being seen as magic-makers for all of life’s problems and a jetpack to an aspirational life. Nothing could be further from the truth,” he says.A weekly jab is not a vanity tagStory continues below this adSemaglutide (sold under brand names Ozempic, Wegovy and now as generics in India), mimics a hormone called GLP-1, while tirzepatide (Mounjaro) mimics both GLP-1 and the hormone GIP. They control blood sugar and body weight by stimulating insulin release, delaying stomach emptying and reducing appetite via the brain.Dr Anoop Misra, chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, says that weight loss drugs appeal to food-loving, sedentary-happy Indians because they think they do not have to diet or exercise. “Fact is without a portion-controlled diet and regular strength training, the drugs won’t work. Which is why we have some non-responders as well. One in 10 of my patients only seek advice on vanity concerns. They are just looking to drop a few kilos although their BMI is in range. They are usually family members of drug users who have seen some effects. The most vulnerable patients are in the 22 to 40 age group, mostly women who are looking to shed post-pregnancy weight or preparing for marriage,” he says.Most worrying are those who come to him to rectify the after-effects of short cuts. “Many patients tell me that they got their drug from cosmetologists, gym trainers and the neighbourhood pharmacists. While awareness and regulation may be high in big cities, half my patients are from hinterland towns such as Aligarh, Panipat, Ludhiana who go by hearsay. Once they come to me, they listen. But if I say no, they will still go to somebody who will give them the shots, no questions asked.”The dangers are many. Microdosing for a few months may disrupt hormone functioning. “The food noise and weight return all too quickly. You have to continuously monitor liver, kidney and pancreas parameters and adjust the dose to ensure these organs are not stressed. Without guidance, you may develop conditions which did not exist before or react unpredictably,” he says. That’s why Dr Misra doesn’t put a timeline to the dose but a target weight loss, say 110 to 85 kg, which can happen over nine months to a year. However, self-medicators set their own limits.The grey market threatsDr David Chandy, director of endocrinology at Sir HN Reliance Foundation Hospital, Mumbai, remembers a young executive who walked into his clinic and demanded a weight loss jab to lose 15 kg in three months because he wanted to look good for his debut on the party circuit. “About 20 per cent of my patients want these drugs for cosmetic reasons rather than health. There is a desperation which is making them go to the grey market. Some of them are even faking prescriptions to get original brands at pharmacies,” he says. In fact, one of his patients told him how an advanced drug retatrutide, which in clinical trials has shown to reduce body weight by 20–24 per cent in 48 weeks and is not currently approved anywhere in the world, is being sold in the grey market as “compound” or vial versions.Story continues below this adALSO READ | Are violent films like Dhurandhar, Animal and O Romeo desensitising teensDemand is not driven by medical conditions but by guarantee of sales based on body insecurities. Some of the active ingredients and compounds can be bought online under the category of animal research. Some are sold online as ‘research peptides’, not for human use, a legal loophole that is exploited. These are then mixed with fillers like vitamin B12 in local compounding pharmacies or labs. “These experimental vials, which are unregulated and not tested, are routed through certain clinics and pharmacists, influencers and gym trainers in a well-oiled operation,” says Dr Chandy.Dr Jothydev fears that illicit weight loss drugs, which are experiencing a boom in tier-2 to tier-3 cities, may just change the narrative on benefits versus side effects. “Recreating a protein molecule of these drugs is difficult. I am not sure that all the 50 generic drugs will have the same quality and whether the cold chain maintenance, from the drug unit to the store, is uniform,” he says.Stigma or contentmentFor most users, who have strictly followed doctor guidance, the weight loss has been definitive and indeed been a turning point. But has the stigma been broken? Ask 34-year-old Kochi-based PR professional Mridul, who followed Dr Jothydev’s advice and simultaneously, cleaned up his diet and started working out. Although he feels 10 years younger and has a new-found self-esteem, he cannot shake off societal stigma still. “Now there is reverse discrimination. People ask me why I shrivelled up or if I have some dreaded disease like cancer. The questions around my weight continue,” he says.Meanwhile, at farmhouse parties in Delhi’s Chhattarpur, elite guests talk about “skinny shots, Ozzy and Mounj” in hushed tones. And since the collective food noise is down, both guests and hosts have taken to a new concept called ‘flying dinner’ where small, gourmet dishes are passed around by servers to standing guests, rather than being served at a table. Coin-sized parathas with mini kebabs topped by avocado foam may not look appetising but seem guiltless enough. “Without cravings, I feel full faster and these finger foods work for me,” says one of the party regulars.However, Bengaluru-based Anjali Pillai, 65, who recently retired as a consultant for Nielsen, has made peace with herself as she has now understood the science of obesity, although she too had tried crash diets before her wedding. “I was born a scrawny child but I gained weight after puberty because of a family history of obesity. My weight didn’t bother me when I looked at the mirror and though I did not exercise as such, I had an active life. But things got out of hand after my first pregnancy, I could not shed the weight. In fact, I weighed 85 kg when I became pregnant with my son,” she says.Story continues below this adShe had an insatiable hunger even after having a full meal. “I could eat almost anything. And despite my weight, my blood sugar levels were okay until I became prediabetic at 60. Doctors told me that the reward system in my brain wasn’t just switching off, and led to my persistent eating behaviour. That’s why I could not keep to any diet regimes for weight loss,” says Pillai. On Mounjaro for a year now, she has shed 24 kg, going down from 120 kg to 96 kg. “My target is 85 kg and I will be comfortable with that. I do 15,000 steps as I love walking and some resistance exercises. But yes, I will be content with my body.”Weight-loss drugs may promise transformation but they cannot fix the deeper anxieties driving their misuse. As Pillai says, “The real body image comes from an active mind and a fit body, not the mirror.”