Whether you have type 2 diabetes, obesity or just a few extra pounds that you’d like some help shedding, chances are you’re one of the millions of adults worldwide who heard about Novo Nordisk®’s remarkable brand name drug Ozempic® and how it can help you reduce your body weight.
People have been paying a lot of attention to these drugs recently, since it was discovered they can lead to a “side effect” of significant weight loss.
But that doesn’t mean you should be rushing out to get yourself a prescription. Smart people — like you — probably have some questions about these medications, and it’s important to get those questions answered. Specifically, you might wonder whether they are actually effective means of weight management, or whether medications that reduce blood sugar levels are even safe for people without diabetes.
Below, we’ll help fill some of the gaps in your knowledge, including which FDA-approved diabetes drugs can cause weight loss, how effective they are at helping people shed pounds and whether they’re safe for the average person to use.
But before we wade into the risks and study data, let’s get on the same page about the list of active ingredients that could help reduce the number you see on the scale.
Diabetes drugs generally affect your weight in one of two ways. Some diabetes medications cause your pancreas to produce more insulin, while others lower your body’s production of glucose — and some even do both.
There are several types of diabetes medications that can promote weight loss, or that have weight loss as a side effect. These diabetes drugs for weight loss include:
GLP-1 receptor Agonists . Glucagon-like peptide-1 receptor agonists (mercifully abbreviated to GLP-1 RAs) are a class of medications that stimulate the GLP-1 receptor in your pancreas. This causes the pancreas to produce more insulin, which in turn helps to lower blood sugar and promote weight loss. Medications in the receptor agonists group include the generic semaglutide and its brand name versions Ozempic, Rybelsus and Wegovy, as well as Mounjaro (tirzepatide) and Saxenda (liraglutide). The current crop of medications gaining notoriety in this category are injectables, and they tend to be pricey.
Metformin. Metformin is an oral diabetes medication that helps keep your blood sugar in check by causing your liver to produce less glucose. It was approved by the FDA in 1994 for the treatment of type 2 diabetes.
As we’ve tried to hammer home so far, these drugs were not initially designed for people without diabetes, so there’s not a lot of data yet on the weight loss benefits for people outside of this category.
That said, two recent studies have shown that glucagon-like peptide-1 RAs offer a lot of potential:
A 2021 study of nearly 2,000 adults with a body mass index (BMI, a measure of your body fat based on your height and weight) of 30 or more and without diabetes studied semaglutide vs a placebo and found that, on average, the semaglutide users lost seven times as much weight over the course of a 68-week treatment.
A 2022 study of more than 2,500 adults with a BMI of 30 or more and without diabetes tested the effectiveness of tirzepatide for 72 weeks at different doses. At the end, the drug led to significant weight loss across dosages of 5, 10, and 15 mg delivered weekly, with a higher dose showing more benefits.
A 2020 meta-analysis of 21 metformin trials found the drug had a clinically significant impact on lowering BMI — particularly in folks considered to have obesity.
A smaller study on metformin also found that the average amount of weight lost in 154 patients was between 5.6 and 7 kg, or 13 to 15 pounds.
More research is needed to confirm these findings — and to see if long-term use could be dangerous.
Generally speaking, we’re in the early stages of looking at using medications for diabetes as weight loss solutions for people without diabetes or obesity. So, if you’re someone in a healthy weight or BMI range looking for superficial improvements, there’s not much long-term data about the risks involved.
The most common side effects of medications like Ozempic are basically a lot of stomach issues, including:
More serious issues you can experience with GLP-1 receptor agonists include raising your risk of:
Thyroid cancer, especially in people with multiple endocrine neoplasia
For people with seriously high BMI numbers, medications can be effective treatments, and the side effects may be worth it. But if you’re just trying to trim down a jean size or two, weekly injections probably aren’t necessary and the risk of side effects may be too high.
The latter group of people might also consider alternatives for weight loss, like lifestyle changes. This includes walking, dietary changes and improvements to things like your stress, sleep and other habits — and as a bonus, all of these changes also have the power to lower blood sugar over time.
For example, a 2022 meta analysis of nearly 50,000 people found a correlation between the number of steps you take each day and your risk of mortality — any steps you take up to the 8,000 to 10,000 range were associated with a lower risk of death generally.
More specifically, a 2015 study found that stabilizing your weight requires about 150 minutes of walking per week, and losing weight requires an average of 300 minutes of walking. Changes to your diet and increases in the intensity of that exercise reduced the total time required.
Losing weight is often a significant priority for people who have obesity or are otherwise overweight. Carrying around too many extra pounds and having a high BMI can lead to medical conditions like high blood pressure, high cholesterol, heart attacks, diabetes, heart disease and much more.
Most healthcare professionals will advise you to do everything in your power to lose weight, but if you prefer to ask them for weight-loss medications, you should be cautious and listen to any warnings they give you.
Above all, keep the following in mind:
American culture has latched onto the weight-related benefits of at least one new diabetes drug, causing shortages for people who need this medication to manage their chronic condition.
While most of these drugs have been approved by the U.S. Food and Drug Administration only for use in people with diabetes, recent clinical trials yielded convincing data for their weight loss benefits.
For the newer medications, many questions are still unanswered, particularly about the long-term risks.
Of the diabetes drugs prescribed off-label for weight loss, metformin is one of the most well-researched. Alongside other oral medications like bupropion, naltrexone, and topiramate, metformin is considered an affordable alternative to injectables like Wegovy and Ozempic.
If you have obesity or you’re struggling to lose weight, talk to a healthcare provider about the potential benefits of weight loss drugs. But keep in mind that there are a number of other ways to lose weight safely without medication, like lifestyle changes, dietary changes and exercise.
Want to lose weight the safe and healthy way, or just want to learn more about how to get the most out of your current weight loss strategy? Learn more about weight loss treatments that can help.
Dr. Craig Primack MD, FACP, FAAP, FOMA is a physician specializing in obesity medicine.
He completed a combined residency in Internal Medicine and in Pediatrics at Banner University- Phoenix, and Phoenix Children's Hospital. He received post-residency training in Obesity Medicine and is one of about 7,000 physicians in the US certified by the American Board of Obesity Medicine.
In 2006, Dr. Primack co-founded Scottdale Weight Loss Center in Scottsdale, Arizona, where he began practicing full-time obesity medicine. Scottsdale Weight Loss Center has grown since then to six obesity medicine clinicians in four locations around the greater Phoenix Metropolitan area.
From 2019-2021, he served as president of the Obesity Medicine Association (OMA), a society of over 5,000 clinicians dedicated to clinical obesity medicine. He has been on the OMA board since 2010, currently serving as ex-officio trustee.
Dr Primack routinely does media interviews regarding weight loss and regularly speaks around the country educating medical professionals about weight loss and obesity care. He is co-author of the book, “Chasing Diets”.