What is metformin, the old diabetes drug some people are taking for weight loss? - chof 360 news

The telehealth company Hims & Hers has made waves for its Super Bowl ad that plugged its lower-priced form of injectable semaglutide, the active ingredient in weight loss juggernauts Wegovy and Ozempic. But some people who filled out the company's screening questionnaire report being prescribed a different medication instead: metformin. Metformin is a much more affordable medication than GLP-1s — even the cheaper, compounded or non-FDA regulated versions offered by Hims & Hers.

But what exactly does metformin do, and is it effective for weight loss? We spoke to three experts to put the drug in perspective.

What is metformin?

Metformin is an old drug. In its earliest form, it was an extract from lilacs and was purportedly used in the 1700s to treat what the French called “sweet urine disease,” which we now know as diabetes. A more modern form was introduced in the 1950s in Europe, and the main active ingredient is still derived from French lilacs.

The drug works by combatting insulin insensitivity, the main precursor of type 2 diabetes, and reducing the amount of glucose that the liver produces. These two functions can help slow the progression of type 2 diabetes and may even help to prevent it in those at-risk for developing the condition.

Who is it for?

The Food and Drug Administration approved metformin for treating people with type 2 diabetes in 1994. It’s also frequently prescribed for those under age 60 with prediabetes.

But research suggests that it can help a wide variety of health conditions. People with type 2 diabetes taking metformin face lower risks of death from heart disease. The drug helps to treat gestational diabetes and polycystic ovarian syndrome, both of which cause high blood sugar and insulin resistance in women. Studies also suggest it may even lower the risk of cancer, dementia and stroke and also slow aging, leading some physicians to ask whether metformin, like aspirin, is a veritable wonder drug.

Metformin is also sometimes prescribed to help prevent excess weight gain for people taking antipsychotic medications, for which weight gain is a common side effect.

Is metformin a good weight loss drug?

“Most of the data we see finds metformin to be fairly weight-neutral,” Dr. Arti Thangudu, an endocrinologist and founder of Complete Medicine, tells chof360 Life.

Studies show that people on metformin tend to have “modest” weight loss of about 2% to 3% of their body weight. While it’s known that excess body weight, high blood sugar and insulin resistance often go together, scientists only recently began to learn how metformin may aid weight loss. It’s still not entirely clear, but the drug appears to mimic the hunger-fighting effects of vigorous exercise, according to a study published last year.

That said, experts don’t consider metformin a substitute for medications like Wegovy, which are FDA-approved for weight loss. “Sometimes people do lose weight on [metformin], and most people don’t gain weight on it, but we don’t typically use it as a weight loss medication because there just isn’t great data on it,” says Thangudu.

Metformin has relatively mild side effects. At higher doses in particular, it can cause an upset stomach, nausea and diarrhea. However, most people tolerate it well, especially by going to a lower dose and building back up, says Thangudu. Plus, it shouldn’t be taken by those with liver or kidney disease, heart failure or type 1 diabetes, according to the Mayo Clinic.

Why are telehealth providers prescribing metformin for weight loss?

Despite its modest weight loss effects, Hims & Hers offers metformin for exactly that purpose. A bit of weight loss is not an uncommon side effect of the medication, Ranti Akiyode, a professor of pharmacy practice at Howard University College of Pharmacy, tells chof360 Life. But it wouldn’t usually be a go-to treatment for weight loss, she says. For that reason, “the big concern is the expectations that [prescribers like Hims & Hers] are setting up for patients,” Dr. Scott Kahan, director of the National Center for Weight and Wellness, tells chof360 Life. He doesn’t think that a drug like metformin can meet patients’ expectations for weight loss.

But Hims & Hers may not be expecting metformin to fulfill that promise on its own either.

Metformin is just one of the drugs included in Hims & Hers’s “Medication Kit 1.” In addition to metformin, the kit contains addiction medications (to “reduce cravings and appetite”), a seizure medication that suppresses appetite and vitamin B12 (“for balance”). It’s worth noting that Hers says a licensed medical provider reviews a patient’s health history and treatment plan before sending the medications.

Some of the medications in the kit may cause people to eat less, which may, in turn, lead to minor weight loss, experts say. The drugs also aren’t contraindicated — meaning they aren’t dangerous when taken together — according to Akiyode. But it’s not a medication potpourri that she’s familiar with using for weight loss. And Kahan worries that “this cocktail of stuff” won’t help people lose much weight and may even cause harm.

How to decide if metformin is right for you

Even though doctors don’t consider it a first-line treatment for weight loss, an upside of metformin is that it’s much cheaper than drugs such as Wegovy or Ozempic. A month’s supply of generic oral metformin without insurance costs between $10 and $30, according to GoodRx. At nearly $1,000 without insurance, a month’s supply of Ozempic can cost up to 10 times more than metformin.

Despite research showing only modest benefits from metformin, many Hims & Hers customers say on Reddit forums that they’ve had success with the drug (though, in most cases, it was prescribed along with other medications in their Medication Kit 1). After a month on the cocktail, one user said they were down almost 9 pounds. A commenter in the same thread said they were down to 186 pounds from 245 after using kit 1 for a year — a 27% reduction in body weight. Others sang the praises of their slow and steady progress with the program combined, in many cases, with exercise.

Thangudu says that if her patients want to try metformin alone for weight loss and don’t have any health conditions, such as kidney disease, that could make the medication harmful, she will prescribe it. However, Kahan says that his patients who lose significant amounts of weight on metformin alone are “outliers.” And while he’ll allow that there may be instances when the cocktail of medications included in Hims & Hers’s Kit 1 are appropriate, he finds the drug combination in Kit 1 “very concerning” and thinks prescribing it is “bordering on malpractice.”

Nevertheless, if you’re considering taking metformin, experts agree that you should consult with a health care provider to be sure that it’s safe for you to take and that it’s the right medication for your goals. Second, be aware that you may have diarrhea and nausea when you start metformin. Taking it with a meal, especially later in the day, may help stem these effects, which are also milder at lower doses or when using an extended-release form of the drug.

Kahan says that if his patients are going to lose weight on metformin, they will know fairly quickly. So, if it’s been three months since you started your first dose or one month at a high dose and you’re not losing any weight, it might be time to try something else.