Dear NP

Dear NP,

“Are diabetes medications helpful for weight loss? Are there any bad side effects if I take these medications for weight loss and am not diabetic? What are the requirements to have them prescribed for me?”

Dear Reader,

Losing weight is a struggle for many people. Recently several medications that are used to treat diabetes have also been found to impact weight loss.

If you have diabetes and need to lose weight, trying one of these medications may be helpful, but what about people who don’t have diabetes? Can they take these medications strictly to help with weight loss?

There are two classes of diabetes medications that improve blood sugar control and influence weight loss. These are the glucagon-like peptide 1 (GLP-1) agonists and sodium-glucose cotransporter 2 (SGLT-2) inhibitors.

GLP-1 agonists mimic hormones in the gut that decrease appetite. These hormones impact insulin, how quickly the GI system empties and how full you feel after eating. Because of how these medications work, potential side effects include diarrhea, nausea and vomiting, especially after a larger meal.

SGLT-2 inhibitors cause sugar to be passed out through the urine. Rather than absorbing and storing the sugar, SGLT-2 inhibitors result in calorie loss.

You may eliminate as much as 60-100grams of glucose daily through the urine when taking an SGLT-2 inhibitor. Side effects of these medications include urinary tract infections, genital yeast infections, increased urination, nausea, thirst and flu-like symptoms.

So how much weight can you lose when taking these medications? Weight loss will depend on which drug you take and the dose of the medicine but on average GLP-1 medication can cause 3-9 lbs. of weight loss, and SGLT-2 inhibitors average about 6 lbs. of weight loss. Individuals who also add in diet modification and exercise will see even higher amounts of weight loss.

You may also want to remember that GLP-1 medications are given by injection, and SGLT-2 medications are taken orally.

Diabetic medications are currently FDA approved only for use for diabetes; however, some medicines have been authorized for use in obesity. They are essentially the same medications used for diabetes, but the dose may be slightly different, and they are rebranded with another name.

Wegovy and Saxenda are GLP-1 medications that have been FDA-approved for weight management alone. Candidates for treatment need to have a body mass index (BMI) more than 27 and at least one weight-related medical problem or a BMI more than 30 without medical problems. SGLT-2 inhibitors are not FDA-approved for weight loss alone.

Although traditional diabetes medications are not indicated for weight loss alone, healthcare providers may prescribe drugs “off-label.” The side effects are the same as for diabetic patients, with no additional risk to non-diabetics.

Some providers believe that since obesity is a predisposing factor for diabetes that treatment of obesity is essential in preventing future diabetic risk.

While medications can give you a boost in jump-starting weight loss, the actual amount of loss is modest. Doing the hard work of addressing diet and adding exercise along with any medical treatments will give you the best results.

If you are interested in exploring options for weight management, a discussion with your healthcare provider is the best place to start.

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]