Does Metformin Work for Weight Loss?

The close connection between type 2 diabetes and obesity has been understood by healthcare providers for decades in the United States, but unfortunately both conditions have continued to increase in prevalence. Because the link between the two is related to insulin levels and blood sugar levels, the main treatment for diabetes is medication that aims to manage those levels. One of the go-to diabetes drugs doctors turn to first is called metformin. Metformin is known to perform well at regulating blood sugar, but can that effect also promote weight loss? 

Facts About Diabetes

Diabetes is a chronic health condition involving the body’s process for converting food into energy. Any time we eat food, our gastrointestinal system breaks down most of it into glucose molecules that are released into the bloodstream. As glucose levels go up, the pancreas is signaled to release insulin, a hormone that increases the absorption of glucose by the body’s organs and tissues. When people have diabetes, their body either doesn’t produce enough insulin or no longer responds to it as well. Over time, excess glucose in the bloodstream causes numerous serious health problems. 

There are three main forms of diabetes: type 1, type 2, and gestational. Gestational diabetes is rare and only occurs during pregnancy, and type 1 diabetes is an autoimmune condition most likely passed on through genetics. The most common type, with over 90% of the cases, is type 2 diabetes. Though a genetic component may be involved, type 2 diabetes is primarily caused by environmental factors like a diet high in refined carbohydrates and a sedentary lifestyle. These lifestyle factors also play a role in prediabetes, the precursor to diabetes that is characterized by elevated blood sugar levels but without the associated symptoms.   

Even before prediabetes, though, the process starts with insulin sensitivity and insulin resistance. The typical American diet includes a lot of processed foods and refined sugars, many of which have a big impact on blood sugar and insulin production. Over time, having sustained high blood sugar causes cells to stop responding to insulin. Without insulin to promote glucose absorption, it stays in the bloodstream and eventually leads to diabetes. Insulin resistance also tends to lead to gains in body weight; glucose gets stored as fat rather than being used for energy.  

What is Metformin?  

Metformin was first discovered over 100 years ago (though it wasn’t used in humans until much later), and it has become the first-line choice for the treatment of type 2 diabetes. This is in part because it has a high tolerability; the only side effects of metformin that most patients experience are mild nausea, diarrhea, or abdominal pain. Metformin, also known by the trade name Glucophage, is by far the most common medication prescribed for diabetes and one of the most commonly prescribed medications in general. It is also used to treat polycystic ovary syndrome.

As high blood sugar is the principal concern in diabetes, the purpose of metformin is to take on the role of insulin in reducing blood glucose. In this case, though, metformin lowers the amount of glucose released by the liver. It also improves the effectiveness of available insulin by helping muscles use glucose more efficiently. Though there is currently no cure for diabetes, the combination of medication and lifestyle change can make the condition manageable indefinitely. 

Can Metformin Cause Weight Loss?     

Most other diabetes medications can cause weight gain, but the metformin treatment is notable for being associated with weight loss. The reasons for weight loss are not fully understood, but recent research suggests a connection to the drug’s effect on the gut microbiome. The same gut interactions that can cause nausea and diarrhea can also seemingly lead to a reduced appetite. This loss of appetite may be in part be due to discomfort from the symptoms themselves; for instance, routine bouts of nausea cause you to eat less in general.    

It’s important to note that, even though weight loss has been broadly seen with metformin, the actual magnitude of shed pounds is marginal. According to a placebo-controlled study in Diabetes Care, a publication of the American Diabetes Association, the average amount of weight loss after one year was six pounds. Yet even with metformin, the patients who lost weight only did so after adopting healthier eating habits and increasing their physical activity level. In other words, just taking the medication alone will not lead to weight loss. 

Who Can Take Metformin?

Right now, doctors are primarily prescribing metformin for diabetic patients. Yet it is because of its potential weight loss properties that metformin is beginning to be investigated as a weight loss solution. To date, however, it has only been approved by the FDA as a diabetes treatment, and only some doctors have been willing to prescribe it “off label” for weight management. People who have a chronic kidney disease or other health concerns may not be able to take metformin at all. 

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