How Much Weight Can You Lose on Metformin, the Oral Ozempic Alternative?

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The type 2 diabetes medication Ozempic has been hugely popular when prescribed off-label for weight loss, thanks to its ability to regulate your blood sugar and curb your appetite. But between shortages, high out of pocket costs and the need for weekly injections, the medication is not suited for everyone. As an alternative, some doctors have been prescribing metformin—an oral diabetes drug—off-label for weight loss. But how does metformin work, and how much weight can you expect to lose? Here, experts explain everything you need to know. 

What is metformin?

Metformin is a prescription medication used to manage type 2 diabetes in adults. “Metformin works by decreasing glucose (sugar) production in the liver, improving the body’s response to insulin and reducing glucose absorption from food in the intestines,” says HaVy Ngo-Hamilton, PharmD, a pharmacist at BuzzRx. “It is FDA-approved for people with type 2 diabetes and is typically prescribed as a first-line treatment to help control blood sugar levels in patients with this disease.”

While it’s most often prescribed for diabetes, metformin can also be used off label to help manage polycystic ovarian syndrome (PCOS), prediabetes and obesity, says Katherine H. Saunders, MD, DABOM, obesity physician at Weill Cornell Medicine and co-founder of FlyteHealth.

Can you take metformin for weight loss?

Metformin is not currently approved by the Food and Drug Administration for weight loss. However, metformin can contribute to modest weight reduction in diabetic and non-diabetic individuals, explains Ngo-Hamilton.

“The weight loss associated with taking metformin is likely due to decreased caloric intake rather than increasing energy expenditure,” explains Eric Smith, DO, FASMBS, bariatric medical doctor at Pop Recovery Systems. He recommends consulting with your primary care provider to determine if metformin is the right medication for you.

While taking metformin for weight loss won’t deliver the same impressive results as Ozempic (dropping 15-20 percent of your body weight), it can help you shed around 5 percent of your body weight within the first year. For a 200-pound person, that’s 10 pounds.

How metformin aids weight loss

While it’s not an official weight loss medication, metformin is worth considering if you’re trying to shed stubborn pounds. Here’s how metformin can support weight loss: 

Metformin curbs appetite 

“Metformin can increase certain hormones that reduce hunger, like lac-phe, a molecule that makes you feel less hungry,” says Dr. Smith. Lac-phe was discovered in 2022 by Stanford University researchers, and it plays a critical role in metabolism, exercise and appetite. 

Metformin also affects the gut microbiota (the balance of beneficial and harmful organisms naturally found in your gut) and reduces food intake. “Metformin can shift the balance of bacteria in the gut, which plays a role in digestion and possibly in how the body processes and stores energy,” adds Dr. Smith.

Metformin improves insulin sensitivity

Since the diabetes drug helps the body use insulin more effectively, metformin also stabilizes blood sugar and may reduce fat storage. “Excess glucose in the blood will accumulate as fat,” says Ngo-Hamilton. “By getting blood sugar levels under control, metformin helps reduce fat accumulation.”

A study published in the Bariatric Times found that taking metformin decreased body weight for individuals with and without diabetes.  And Dr. Smith adds that metformin also helps with glucose production. “Less glucose coming from the liver means the body needs less insulin, which may also help with less fat storage.”

Side effects of taking metformin for weight loss 

If your doctor has prescribed metformin, it’s important to be aware of the potential side effects. “The most common side effects among our patients include diarrhea and constipation,” says Dr. Saunders. “Other potential side effects include nausea, dyspepsia, abdominal pain, gas, headache, dizziness, muscle pain and altered taste.”

Since metformin isn’t approved for weight management, there’s no recommended starting dose for weight loss. However, Dr. Saunders says a typical dose can range from 500 to 2,000 mg daily, and you must get a prescription from a doctor to take metformin.

Another important note: Weight loss with metformin is usually modest and not guaranteed “Lifestyle modifications, such as following a healthy diet and regularly exercising, are essential for meaningful and sustainable weight management,” says Ngo-Hamilton.

For more weight loss tips

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This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.