Generic semaglutide is now cheap in India. Here is what it does to your muscle

What changed in March

Semaglutide, the drug sold as Ozempic and Wegovy, lost its core patent protection in India on 20 March 2026. The next day a long list of Indian manufacturers launched their own versions, among them Sun Pharma, Dr Reddy's, Glenmark, Zydus and Alkem. Dr Reddy's priced its pen at about ₹4,200 a month. A drug that had been out of reach for most families is now within it.

I am a gym coach, not a doctor, and nothing on this page is advice about whether to take it, what dose, or for how long. That belongs to your doctor. But people on these drugs are already walking into gyms, and the part of the story that matters most to them is the part that happens below the skin.

It works, and that is not in dispute

In the main trial, published in the New England Journal of Medicine in 2021, adults with obesity who took semaglutide weekly for 68 weeks lost an average of 14.9 percent of their body weight, against 2.4 percent on placebo. For someone at 95 kg, that is around 14 kg. Very few diets achieve that, and fewer still hold it.

How much of the weight is muscle

Every kind of weight loss takes some lean tissue with the fat. The question is how much. A systematic review published in the Annals of Internal Medicine this year pulled together 35 trials of these drugs. The median share of weight lost from muscle-related measures was about 28 percent, and in roughly two-thirds of the studies it was higher than the authors expected for ordinary weight loss.

I want to be careful with that number. It varied widely between studies, some measured lean mass rather than muscle itself, and not one of them measured whether people became weaker or less able to climb stairs. So nobody can yet say the drug makes you frail. What can be said is that if a quarter or more of what you lose is muscle, you are losing the tissue that keeps your metabolism up, your joints supported and your blood sugar in check as you age. That is worth protecting on purpose.

What happens when you stop

The trial followed some participants for a year after the injections ended. They regained about two-thirds of the weight they had lost, and most of the improvements in blood pressure and blood sugar drifted back too. That is not a failure of willpower. The drug changes appetite while you take it, and when it stops, appetite comes back.

A separate Danish trial, with liraglutide, an older drug in the same family, is the most useful one I have found for this. A year after treatment ended, people who had combined the drug with supervised exercise weighed about 5 kg less than those who had taken the drug alone. Exercise was the part that kept working after the prescription stopped. This is the same pattern as weight regain after any diet.

What training can do about it

The case for strength training during weight loss is older than these drugs. A review of 52 studies in adults over fifty found that 81 percent of diet-only groups lost at least 15 percent of their weight as lean tissue, against 39 percent of groups that also exercised. Muscle that is being used is muscle the body holds on to.

Trials testing strength training and protein directly alongside semaglutide are only now running. One published this year is randomising 232 adults to resistance exercise, high protein, both, or neither, and its results are not out. So I will not tell you the combination is proven. I will tell you it is what I would do: two or three full-body sessions a week built around squats, presses, rows and hinges, with load that rises gradually, which is what strength training here already is.

One practical note. People on these drugs often eat so little that a normal session leaves them light-headed. Tell your coach you are on it, eat something before you train, and stop if you feel faint. If you are also on medication for diabetes, your doctor needs to know you are training, because low blood sugar is a real risk.

Protein, on a Gujarati plate

India's national requirement for healthy adults is 0.83 g of protein per kg of body weight a day. On a vegetarian Gujarati diet, plenty of people fall short of that before they start a drug that sharply reduces their appetite. When you can only manage small meals, what is on the plate matters more: dal, curd, paneer, chana and soya first, rotli and rice after. Protein for Indian vegetarians works through the numbers, and the protein calculator gives you your own figure. If you have kidney disease, ask your doctor before raising protein at all.

What a coach should not do

A trainer should not tell you to start, stop or change the dose of a prescription drug, sell you one, or source one for you. If a gym offers you semaglutide, leave. What a coach can do is make sure the weight you lose is fat rather than muscle, and that you have habits in place for the day the prescription ends. That is the job, and it is the same job it was before the drug existed. Fat loss coaching is set up for exactly that.