A life-saving drug for heart attacks is becoming more accessible in India, but millions are being priced out due to outdated BMI guidelines. The patent on semaglutide, a proven heart attack prevention medication, expires soon, making generic versions cheaper by 90%. However, the current eligibility criteria set by the FDA in the US don’t apply to India’s population, who carry higher cardiovascular risk at lower BMIs.
In South and Southeast Asia, cardiovascular risk starts accumulating at BMIs below 27. The “thin-fat phenotype” causes people to appear normal weight on the outside but have visceral fat inside, which increases their risk of heart disease. The World Health Organization recommends starting BMI assessments for Asian populations at 23.
The problem is that India’s regulatory body hasn’t defined who should receive semaglutide yet. If they adopt the FDA’s BMI threshold, they’ll ignore the thin-fat phenotype. A nationally representative study found that 43% of Indian adults are metabolically obese despite having a BMI below 25.
Only waist circumference measures can identify those at risk and prescribe them with semaglutide. India has already recommended using waist circumference to guide prescribing, while Korea’s guidelines recommend a lower BMI threshold for initiating obesity GLP-1 pharmacotherapy.
The issue is not just about access but also safe infrastructure for monitoring muscle loss in lean populations. The key to expanding access lies in setting the correct eligibility criteria and building safety protocols.
Source: https://www.statnews.com/2026/03/17/generic-semaglutide-india-bmi-obesity-definition