People are taking a diabetes drug for weight loss—no, it's not Ozempic
Key Takeaways
Industry Buzz
"[This drug] can reduce your risk for cancer, age-related conditions, the aging process, [and] you can use it to improve your metabolic function over time. [...] It's a great alternative for people that don't have access to [GLP-1s]." — McCall McPherson, PA-C @McCallMcPherson
“Understanding how these pathways are controlled may lead to viable strategies to lower body mass and improve health in millions of people.” — Jonathan Long, PhD, Stanford Medicine press release
Find more of your peers' perspectives and insights below.
There’s a new medication trending for its weight loss benefits, and it’s been around longer than semaglutide drugs like Ozempic and Wegovy.
Metformin—which is FDA-approved for managing type 2 diabetes—is increasingly showing promise in weight management. As a result, the number of physicians prescribing it off-label is growing. Let’s explore this developing trend.
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How it works
"Metformin enhances insulin sensitivity in individuals with insulin resistance, which is the primary mechanism behind its glucose-lowering effect,” explains Jill Crandall, MD, professor at Albert Einstein College of Medicine and director of the Diabetes Clinical Trials Unit. “However, it remains unclear whether this improvement in insulin sensitivity, which leads to lower insulin levels, directly contributes to weight loss.”
Related: 'Ozempic personality' and the psychological toll of GLP-1sWhile not prescribed for this purpose, some patients have reported modest weight loss over time, and its weight management effects are the focus of a growing body of research.[]
But how exactly does metformin contribute to weight loss?
Metformin works by reducing elevated insulin levels, making it easier for the body to burn fat. Additionally, the drug is believed to influence appetite-regulating hormones like ghrelin and leptin. Many patients taking metformin have reported a decrease in food cravings and a reduction in overall food intake.[]
Dr. Crandall tells MDLinx, "Along with medication adherence (actually taking the drug), genetic factors likely affect how metformin is absorbed and, thus, its effectiveness. Lifestyle factors are also crucial—those who modify their diet and exercise more while taking metformin generally see greater weight loss."
Metformin triggers the release of an "anti-hunger" molecule called lac-phe, according to a 2022 study by Stanford researchers.[] The study found that lac-phe plays a crucial role in metabolism, exercise, and appetite regulation. In a related press release, researchers said their findings prove that metformin acts through “the same pathway as vigorous exercise to reduce hunger.”[]
"Understanding how these pathways are controlled may lead to viable strategies to lower body mass and improve health in millions of people."
— Jonathan Long, PhD, Stanford Medicine press release
Other recent studies suggest that metformin influences the gut microbiota in humans, offering new insights into how changes in gut bacteria might enhance the body’s ability to process food more efficiently, potentially aiding in weight loss.[] However, further research is needed to fully understand the mechanisms behind these changes, though some research points to metformin’s potential to reduce visceral fat,[] a key concern due to its association with an increased risk of heart disease and type 2 diabetes.
By targeting visceral fat, metformin not only helps regulate blood sugar but also contributes to weight management.
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The growing appeal among patients
Metformin has been a staple in the treatment of type 2 diabetes for decades. In comparison to higher-priced weight loss medications (like Ozempic or Wegovy), it offers a more affordable and relatively safe alternative. While it is not FDA-approved for weight loss, many healthcare providers prescribe metformin off-label, especially when other methods have not been effective.[][]
Related: A woman had to remove a foot of her colon after taking OzempicThe drug is generally well-tolerated, though it may cause occasional side effects such as nausea, diarrhea, or stomach cramps. In addition to its role in weight management, metformin offers other health benefits, including improved heart health, lower cholesterol levels, and a reduced risk of complications related to type 2 diabetes.
What this means for you
While drugs like Ozempic and Wegovy are commonly prescribed for weight loss, metformin—typically used to treat type 2 diabetes—has also been shown to aid in weight management. Metformin works by reducing glucose production in the liver and improving insulin sensitivity, both of which can contribute to weight management. While existing research has shed light on how metformin affects the body, more studies are needed to fully determine its potential as a weight loss drug.