Scientists have also been trying to understand how metformin leads to weight loss. Because it alters gut bacteria, digestive issues are common side effects. So one early theory was that stomach pain caused people to lose their appetite and eat less, or that they lost water weight from diarrhea. But most of these side effects go away in a few weeks. People who lost weight on metformin continued to lose pounds after that time.
Does Metformin Cause Weight Loss?
If you’ve been diagnosed with type 2 diabetes, metformin may be the first medication your doctor recommends. Research has found that it helps with blood sugar control and helps the body use its own insulin better.
Studies have also shown that many people taking the drug lose some weight. That’s different than many other diabetes drugs, some of which cause weight gain. It’s one reason metformin helps prevent diabetes in people who are overweight and at risk for type 2 diabetes. But the medication isn’t considered a weight loss pill.
How Metformin Works
Metformin starts to work in your gut. Some scientists think it changes the balance of the natural bacteria in your digestive system. It also turns on specific enzymes that help the body use fat more effectively.
Scientists have also been trying to understand how metformin leads to weight loss. Because it alters gut bacteria, digestive issues are common side effects. So one early theory was that stomach pain caused people to lose their appetite and eat less, or that they lost water weight from diarrhea. But most of these side effects go away in a few weeks. People who lost weight on metformin continued to lose pounds after that time.
A more likely explanation is that metformin’s changes in the gut tamp down appetite. It may raise the body’s levels of the hormone leptin, which makes you feel full. Since your appetite isn’t working overtime, you eat less.
The weight you lose on the drug comes mostly from fat stores, not the mix of fat and lean muscle that happens with dieting. People on metformin also saw lower waist measurements and waist-to-hip ratios, two ways to measure body fat.
Is Metformin an Effective Weight Loss Pill?
No. The amount of weight you’re likely to lose is low. In one diabetes prevention study, 29% of people lost 5% or more of their body weight and just 8% lost around 10%. On average, that was about 5 pounds. That might be enough to start to improve your health, but not enough to make a big impact if you’re overweight. Metformin is not going to make the difference for someone who needs to lose 30 pounds or more, for instance.
That study also included a group of people who made diet and exercise changes instead of taking the drug. Of the 29% who lost weight on metformin, just over half kept it off for the next 14 years, but so did nearly half of the people who lost about the same amount of weight with diet and exercise. So the long-term weight loss success rate for metformin isn’t much different than for lifestyle changes, which have other health benefits, like improving your heart’s health.
So metformin is a drug to treat or delay diabetes, not to lose weight. It’s best to think of any pounds you shed as a happy side effect. Also, metformin isn’t a substitute for healthy eating and regular exercise. In fact, experts recommend that anyone who starts the medication make both those lifestyle changes at the same time.
Show Sources
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American Diabetes Association: “What Are My Options?”
Mayo Clinic: “Metformin revisited.”
Medical Hypotheses: “Metformin exerts anti-obesity effect via gut microbiome modulation in prediabetics: A hypothesis.”
The Journal of Clinical Investigation: “Role of AMP-activated protein kinase in mechanism of metformin action.”
Molecular Endocrinology: “Convergence of IPMK and LKB1-AMPK signaling pathways on metformin action.”
Diabetes Spectrum: “Anti-Diabetes and Anti-Obesity Medications: Effects on Weight in People With Diabetes.”
Current Opinion in Endocrinology, Diabetes and Obesity: “Effects of metformin on weight loss: potential mechanisms.”
Current Obesity Reports: “Metformin: Mechanisms in Human Obesity and Weight Loss.”
Diabetes, Obesity & Metabolism: “Metformin-associated prevention of weight gain in insulin-treated type 2 diabetic patients cannot be explained by decreased energy intake: A post hoc analysis of a randomized placebo-controlled 4.3-year trial.”
World Journal of Diabetes: “Crosstalk between gut microbiota and antidiabetic drug action.”
Diabetes Care: “Long-Term Safety, Tolerability, and Weight Loss Associated With Metformin in the Diabetes Prevention Program Outcomes Study.”
Annals of Internal Medicine: “Long-Term Weight Loss With Metformin or Lifestyle Intervention in the Diabetes Prevention Program Outcomes.”
American Heart Association: “Lifestyle Changes for Heart Attack Prevention.”
Current Opinion in Clinical Nutrition and Metabolic Care: “Metformin: old friend, new ways of action-implication of the gut microbiome?”
Does Metformin Cause Weight Loss? What to Know Before You Take It
Are you struggling to lose weight? Metformin can do more than improve blood sugar control — it may also help you lose stubborn pounds. Here’s what you need to know about metformin and weight loss.
By Valencia Higuera Medically Reviewed by Justin Laube, MD
Reviewed: November 28, 2022
Although metformin can cause weight loss, a healthy diet and regular exercise are still important if you want to keep the weight off. Darren Lehane/Alamy
If you’re managing type 2 diabetes with Glucophage (metformin), you may be well acquainted with the unwanted side effects of this drug — namely, upset stomach, diarrhea, muscle aches, and sleepiness. These can be a figurative and literal pain, but you may welcome one side effect of metformin with open arms, particularly if you’ve struggled to lose weight.
Metformin wasn’t designed to be a weight loss drug, but researchers have found a link between the drug and weight loss. Past research concluded the drug could serve as a treatment for excess body weight, although more studies are needed.
Diabetes 101: What Is Metformin?
What Is Metformin and How Does It Work?
Metformin is a common type 2 diabetes drug that the U.S. Food and Drug Administration (FDA) has approved to treat high blood sugar, or hyperglycemia, in people with type 2 diabetes.
“[Metformin] has been considered a first-line medication in the treatment of type 2 diabetes, and it mainly acts by lowering the amount of glucose released by the liver,” says Minisha Sood, MD, a board-certified endocrinologist in New York City. “It also helps a hormone called insulin to work better by helping muscles use glucose in a more efficient manner. When insulin works better — and insulin sensitivity improves — a person’s insulin levels are lower than they would be otherwise.”
There’s no cure for type 2 diabetes, but the right combination of medication and a healthy lifestyle can stabilize blood sugar levels, according to the Mayo Clinic, and in some cases even put type 2 diabetes in remission, according to a study published in Nutrients in April 2019. This, of course, is the end goal of any diabetes treatment.
As the medication helps your body reduce your overall blood sugar levels and restore your ability to respond to insulin, you’ll not only feel better, but you may reduce the risk of future complications of high blood sugar, such as heart disease, kidney damage, nerve damage or diabetic neuropathy, and eye damage (clinically called retinopathy), the Cleveland Clinic notes.
Why Does Metformin Cause Weight Loss?
The relationship between metformin and weight is unclear, but several theories provide possible explanations for weight fluctuations.
For example, metformin may affect hunger cues. In one small study, 12 women with obesity and type 2 diabetes who were not taking insulin were randomly given two dose levels of metformin — 850 milligrams (mg) or 1,700 mg — or a placebo three times a day for three days, with each participant going through the study three times so they had each dose and the placebo. Participants received a meal test on each third day and rated their hunger level before eating. Researchers found that hunger levels in the metformin group were significantly lower, especially so with the 1,700 mg dose compared with the lower metformin dose or placebo.
Another study, published in May 2020 in the journal Diabetes Care, found that when participants increased their metformin dose by 1,000 mg or more, they lost significantly more weight than those who didn’t change their metformin dose or decrease their dose. Emerging research reported in journals including Current Obesity Reports suggests metformin may also lead to weight loss as a result of changes in the appetite centers of the brain, shifts in the gut microbiome, and reversal of metabolic changes that usually happen with age.
Then there’s the possibility that the drug’s side effects can affect your food intake. “Some people who take metformin may experience gastrointestinal side effects like nausea and diarrhea,” says Rahaf Al Bochi, RDN, a Baltimore-based media spokesperson for the Academy of Nutrition and Dietetics and the owner of Olive Tree Nutrition.
According to a study published in the April–June 2017 Journal of Research in Pharmacy Practice, gastrointestinal side effects are a primary complaint from those who receive metformin tablets in their original formulation. The most common symptoms are vomiting, diarrhea, and nausea, which affect anywhere from 2 to 63 percent of people on the drug. Discomfort can be so severe that you may not feel like eating much and subsequently consume fewer calories. The extended-release forms of metformin have fewer documented side effects, according to a past review.
Is Long-Term Weight Loss Possible on Metformin?
Even though metformin may lead to some weight loss, the amount you lose may be far less than expected. On average, weight loss after one year on the drug is only six pounds, according to past research.
So while metformin is often given to people with high insulin levels who have difficulty losing weight, it’s not a miracle weight loss solution, says Dr. Sood. In other words, don’t expect a dramatic change in weight if you overeat and lead a sedentary life. You must follow a sensible weight loss plan with healthy eating and physical activity to see any significant change in weight.
“If someone isn’t following healthy habits, then taking metformin will not result in weight loss,” she says. “It’s important to follow a healthy diet low in refined sugars and carbohydrates if [you are] prone to high insulin levels so that maximum benefit from the medication is received.”
Keep in mind that while the number on the scale may drop while you’re taking this medication, this weight loss might be temporary. You could regain pounds once you stop taking the drug and your appetite returns to normal — hence the importance of a healthy lifestyle.
And yet one study, published in May 2019 in the Annals of Internal Medicine, did find that people in the diabetes prevention program who lost at least 5 percent of their body weight after a year were more likely to maintain the weight loss long term if they were in the metformin group than if they were assigned a placebo or a lifestyle intervention.
Can People Without Diabetes Take Metformin?
What if you don’t have type 2 diabetes? Can you take metformin for weight loss? This is an excellent question, and the short answer is yes.
Sood explains that metformin has been used off-label, or outside its intended purpose as approved by the FDA, for weight management in people without type 2 diabetes.
Some evidence suggests metformin may benefit these individuals: A 2018 review examining the efficacy of metformin for weight loss in people who were overweight and had obesity without diabetes concluded that the drug significantly decreased body mass index (BMI) in adolescents and adults.
But keep in mind that this drug is available only by prescription and is not FDA approved for people without type 2 diabetes. Your doctor will likely first recommend some of these traditional strategies for weight loss:
- Get support for your emotional health.
- Avoid sugary drinks.
- Drink water before meals to fill your stomach so that you eat less.
- Exercise for 30 minutes most days of the week.
- Prepare whole foods, such as fruits, vegetables, and grains.
- Limit your intake of processed foods.
- Eat a high-protein, low-carb, low-fat diet.
- Practice portion control.
If you don’t have type 2 diabetes, your doctor may sign off on this drug if you have obesity and are struggling to lose weight. But again, metformin isn’t a substitute for healthy eating and regular exercise, which are keys to sustainable weight loss. These habits also encourage weight loss if you have type 2 diabetes but can’t take metformin.
“Some people may not tolerate metformin, so it’s important to discuss options with your healthcare provider — medication is one tool to help manage blood sugars, but diet and lifestyle changes should be discussed first, because they can significantly lower blood sugars,” says Al Bochi.
As for what diet and lifestyle changes you should consider? “Diet modifications can include being mindful of your carbohydrate intake, eating enough protein and fat at meals, choosing high fiber foods, and decreasing intake of sugar-sweetened beverages,” says Al Bochi. She also recommends consulting with a registered dietitian for tailored nutrition recommendations. “Incorporating some type of movement, such as walking, weight training, or yoga on most days is also important for blood sugar management,” Al Bochi adds.
The Bottom Line on Metformin and Weight Loss
All things considered, in some people with and without diabetes, metformin can cause a modest reduction in weight. Nonetheless, scientists are still studying why the drug has this effect. Many factors — including appetite reduction because of the drug’s side effects — are likely in play.
Ultimately, metformin isn’t a silver bullet. The most important thing you can do to lose weight, whether to manage type 2 diabetes or for some other purpose, is to make changes to your diet and lifestyle. Think of metformin as the sidekick to those steps.
Also keep in mind that the FDA has currently approved metformin only for certain people with type 2 diabetes, not for those without the health condition. If you’re taking the drug to reduce your blood sugar in the case of diabetes, keep in mind that metformin comes with side effects you’ll want to discuss and manage with your healthcare team.
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