There has been a boom in obesity-fighting weight loss drugs. Celebrities are taking to social media to trumpet their benefits, and the global market for them is expected to exceed $100 billion by 2030.
Metformin is one of the most widely prescribed diabetes drugs. It is also gaining traction as a weight loss drug. However, some uncertainty remains around what metformin is and how it is used. This article will provide basic facts you need to know before taking metformin: how it works, its side effects, and who it may be right for.
What is Metformin?
Metformin is a prescription medication that has been approved by the U.S. Food and Drug Administration (FDA) to treat type 2 diabetes. It may also be used to treat prediabetes and induce ovulation in women with polycystic ovary syndrome (PCOS). It is available in its generic form or under the brand names Fortamet and Glumetza. It belongs to a sub-class of diabetes medications known as biguanides.
Biguanides help regulate blood sugar levels and improve insulin sensitivity. When you ingest metformin, it enters your bloodstream and travels to your liver, a central actor in blood glucose management. Here, metformin inhibits the liver's production of excess glucose and reduces the release of stored glucose into the bloodstream. By doing so, it effectively lowers the overall amount of sugar circulating in your blood.
Additionally, metformin enhances the body's response to insulin, making your cells more receptive to this vital hormone. In type 2 diabetes, the pancreas can produce insulin, but cells in the body do not use it properly. This misuse is known as insulin resistance.
Metformin’s double-action mechanism helps lower blood sugar levels and makes muscle tissue more sensitive to insulin, allowing the tissue to absorb more insulin and use the glucose for energy. In sum, metformin encourages your body to control its glucose levels better.
Metformin is generally supplied as a regular and extended-release oral tablet.
How does Metformin work for weight loss?
Metformin is FDA-approved to help manage blood glucose levels in patients with type 2 diabetes. Its use as a weight management aid is purely off-label, meaning that the FDA has not approved it to be used in this way. However, weight loss is a common side effect of metformin, leading many to speculate about its uses as a treatment for excess body weight.
Metformin works by reducing appetite, increasing insulin sensitivity, and affecting hormones like GLP-1, which helps control blood sugar and appetite. In people with type 2 diabetes, the body struggles to respond to insulin effectively, which can lead to weight gain and difficulty in losing excess pounds. The use of metformin helps by making the body's cells more responsive to insulin, which decreases blood sugar levels and reduces the body's tendency to store excess glucose as fat.
In a study involving non-diabetic obese participants, those taking metformin lost an average of 5.8 kg (about 13 pounds), while the placebo group gained weight.
Metformin is more effective in people with higher levels of insulin resistance. In the Diabetes Prevention Program Outcomes Study, participants who used metformin along with lifestyle changes like a healthy diet and regular exercise experienced more success with long-term weight loss than those who did not use metformin.
Metformin also helps with weight loss by affecting the gut microbiome and leptin levels. Leptin is a hormone related to appetite and energy balance. In a recent study using rat models, researchers discovered that metformin made leptin more effective in reducing appetite and fat in normal-weight and obese rats. Rats treated with metformin needed less leptin to control their appetite and reduce fat than those who did not receive metformin treatment.
Is Metformin safe?
The FDA has approved metformin to help regulate blood sugar levels in patients with type 2 diabetes. This approval was based on clinical trials, which showed that this medication is safe and effective when used correctly.
While metformin is considered safe, it may cause side effects in some individuals. These mainly include digestive issues. Gastrointestinal side effects of metformin include diarrhea, bloating, stomach pain, gas, indigestion, constipation, and heartburn. While these side effects are uncomfortable, they can reduce food intake, further contributing to weight loss.
More severe side effects include:
- Hypoglycemia (low blood sugar)
- Lactic acidosis (lactic acid buildup in the bloodstream)
In addition, metformin may not be safe for certain individuals with previously diagnosed medical conditions.
Your health care provider may not prescribe metformin if:
- You are over 65 years of age
- You have a history of heart attacks or heart disease
- You have had a stroke
- You have a history of diabetic ketoacidosis
- You have a history of liver or kidney disease
Metformin may not be prescribed to pregnant women, women who are trying to conceive, or women who are breastfeeding.
Before starting treatment with any prescription medication, you should tell your doctor about any medical conditions you have, any medications or supplements you are taking, and any allergies you may have. This information will help reduce the risk of any interactions or adverse metformin reactions.
Who should take Metformin for weight loss?
Metformin is FDA-approved to regulate blood sugar levels in diabetic patients. Its use as a weight reduction aid is off-label, meaning that weight loss is not the primary use of this drug.
Metformin may be prescribed to individuals with or without type 2 diabetes. When prescribed as a weight loss aid, it is specifically indicated for use in adults with obesity (with a body mass index— BMI—of 30 kg/m2 or greater) or overweight adults (a BMI of 27 kg/m2 or greater) who also have weight-related health conditions such as high blood pressure, high cholesterol, or obstructive sleep apnea.
Metformin is also sometimes prescribed to treat antipsychotic drug-induced weight gain. Some atypical antipsychotic medications can cause weight gain. If you are experiencing weight gain as a side effect of taking one of these drugs, talk to your healthcare provider about whether or not Metformin can help you.
It is important to note that metformin is prescribed along with other strategies like a healthy diet and regular exercise to help patients lose weight. Taking metformin alone is not an effective means of losing a healthy amount of weight.
Is Metformin better than Ozempic for weight loss?
Metformin and Ozempic (semaglutide) are different medications used for distinct purposes, although they both can contribute to weight loss.
Metformin is typically prescribed to manage blood sugar levels in people with type 2 diabetes. While it can help some individuals with diabetes lose a modest amount of weight, its primary function is improving insulin sensitivity and lowering blood sugar levels.
Ozempic, on the other hand, is a medication in the class of glucagon-like peptide-1 (GLP-1) receptor agonists. It is primarily prescribed for managing blood sugar levels in people with type 2 diabetes but has gained attention for its significant weight loss benefits. Clinical trials have shown that Ozempic can lead to more substantial weight loss than metformin.
However, whether Ozempic or metformin is better for weight loss depends on various factors, including an individual's specific medical condition, preferences, and the recommendations of their health care provider.
Are there alternatives to Metformin?
There are several drugs used for the treatment of obesity on the market. Talk to your healthcare provider about Wegovy for a more targeted treatment approach. Wegovy contains the same active ingredient as Ozempic—semaglutide—but has been approved expressly by the FDA for treating obesity.
Wegovy contains a higher dose of semaglutide than Ozempic. Wegovy is available in 1.7 and 2.0 mg dosages. These are given as once-weekly injections.
Wegovy is usually prescribed at a lower dosage that increases over several weeks—maxing out at 2.4 mg per dose. This medication is prescribed along with lifestyle changes such as a reduced-calorie diet and increased exercise. Wegovy is generally prescribed only when lifestyle interventions and other treatment options have failed to produce adequate results.
How do I get a prescription for Metformin?
Metformin is a prescription drug, meaning that you must have a written order from a licensed healthcare provider to get it. It is available in its generic form or under several brand names.
Weight loss drugs are prescribed to individuals with obesity or individuals who are overweight and managing a weight-related health condition. If you are curious about metformin or any other weight loss drug, talk to your healthcare provider about whether or not these treatment options are right for you. You should also discuss the cost, potential side effects, and any concerns you may have.
How Sesame can help
Sesame offers an affordable and comprehensive online weight loss program to help you get started on your weight loss journey. Success by Sesame is a month-to-month subscription that includes a video consultation with a weight loss doctor or specialist of your choice, compounded semaglutide medication (if appropriate), unlimited messaging with your provider, ongoing support, and more.
Weight loss results aren’t just something you see - they’re something you feel. Data shows that maintaining a healthy weight can have significant health benefits, such as a lower risk of heart disease, improved mobility, better sleep, and enhanced overall well-being. Get started on your weight loss journey today. Note that all prescriptions are at the discretion of your healthcare provider.
