Unpacking the Off-Label Weight Loss Medication Trend

Weight loss is a multi-billion dollar industry with no shortage of options, from diets and exercises to surgeries and pills. Some of these options include off-label prescriptions and supplements. While the efficacy and safety of these off-label weight loss medications is not fully established, many people opt for them as a potential solution to shedding extra pounds.

Celebrities like Elon Musk and Kim K. have been promoting some of the newer classes of these off-label drugs. Brands have been leveraging the PR and marketing directly to people on social media. Off-label weight loss medications are now a trend, and many people are trying to get on it without thinking about the possible impact on health.

For some people, weight loss is about health. While diet and exercise remain the gold standard for weight management, they often don’t yield results for everyone. Consequently, health care providers turn to off-label prescriptions for weight loss.

On the other hand, the narrative around weight loss has been highjacked by aesthetics, overshadowing its essential purpose — health. In our quest for Instagram-perfect bodies, the lines between wellness and appearance have been blurred, fueling a dangerous rise in off-label prescription weight loss medication.

When we prioritize “looking good” over “feeling good,” we enter a hazardous space where quick fixes seem more appealing than long-term health.

What Does Off-Label Mean?

“Off-label” is a term that refers to the practice of prescribing medication for purposes other than those approved by regulatory agencies like the U.S. Food and Drug Administration (FDA). While this may sound risky or unconventional, it’s important to note that off-label prescribing is entirely legal and often based on emerging scientific evidence, expert medical opinion, or anecdotal experiences that suggest a medication could be effective for a different condition than initially intended.

Obesity and overweight are now regarded as a global pandemic, affecting between 2.8 and 3.5 billion of the world’s population. Using targeted and off-label weight loss medication is supposedly an essential component of comprehensive therapy for what is now seen as a chronic disease.

Common Drugs and Supplements Used Off-Label for Weight Loss

You may recognize some of these drugs and supplements that treat various conditions ranging from depression to diabetes and are now being prescribed off-label for weight loss.

• Adderall: A medication primarily prescribed for attention-deficit/hyperactivity disorder (ADHD), some people use it off-label for weight loss due to its appetite-suppressing effects.
• Modafinil: Originally intended for treating sleep disorders like narcolepsy, some use it for its stimulant-like effects that can suppress appetite.
• Clenbuterol: A drug used to treat asthma in some countries, it has been used off-label for its fat-burning properties, although it can be dangerous.
• Topiramate: Primarily an anti-epileptic drug, it can cause weight loss as a side effect. Some people use it specifically for this reason.
• Zonisamide (Zonegran): This anti-seizure drug is another example that has been used off-label for its weight loss-inducing side effects.
• Tirzepatide: Though primarily developed for diabetes treatment, Tirzepatide has been found to aid in significant weight loss in some cases.
• Trulicity (dulaglutide): Originally designed to manage blood sugar levels in type 2 diabetes, Trulicity is often prescribed for its appetite-suppressing effects.
• Ozempic (semaglutide): Another diabetes medication, Ozempic has shown significant promise in reducing body weight, making it an option for off-label weight loss medication.
• Pramlintide (Symlin): Used to treat diabetes, Pramlintide has the side effect of suppressing appetite, which can aid in weight loss.
• Metformin: Used primarily to treat type 2 diabetes, it has been used off-label for weight loss, although the effects are generally modest.
• Thyroid Hormones: Some people misuse thyroid medication to boost metabolism and lose weight, leading to various health issues, including heart problems.
• Diuretics: Though intended for conditions like hypertension, some people misuse diuretics to lose “water weight,” which is ineffective for long-term weight loss and potentially dangerous.
• Nootropics: Sometimes called “smart drugs,” these are sometimes misused for their stimulant-like effects, including appetite suppression.
• Ephedra/Ephedrine: Once famous as a weight loss supplement, it’s banned in the U.S. for safety concerns, but is still available online and used off-label.
• Human Growth Hormone (HGH): Intended for specific medical conditions like growth hormone deficiency, some people use it off-label, hoping it will help burn fat and build muscle.
• Sibutramine: Though withdrawn from U.S. and European markets due to cardiovascular risks, it is sometimes used off-label or purchased online.
• Laxatives and Herbal Teas: Not drugs per se, but these are sometimes misused in an attempt to quickly lose weight, leading to dehydration and other health risks.

When considering using any of these drugs or supplements for weight loss, it is crucial to consult a health care provider for a proper diagnosis and appropriate treatment plan. Off-label prescriptions should be based on a comprehensive medical evaluation and consistent monitoring. Always prioritize safety and make informed decisions when it comes to your health.

Why Is Off-Label Weight Loss Trending?

The trend of using off-label medication for weight loss is rising due to media coverage, celebrity endorsements, social media buzz, new research findings, and public health concerns like rising obesity rates. Seasonal trends, like New Year’s resolutions or summer weight loss goals, may also influence this pattern. Legislative changes, health care trends, and global events like the COVID-19 pandemic can also impact people’s interest in off-label weight loss options.

Remember, trending does not equate to safety or efficacy. 

“It is important to remember that obesity is heterogenous, chronic and complex,” says Vijaya Surampudi, MD, physician nutrition specialist and assistant director of the UCLA Weight Management Program (RFO). “There is no cure for obesity. It requires lifelong treatment that’s not one size fits all.” – UCLA Health

Prescribing medication off-label for weight loss is gaining traction among health care providers for several reasons. While it may seem unconventional, this approach is often grounded in clinical evidence, patient needs, and the limitations of existing treatments. Here are some of the key reasons why we see an increase in off-label weight loss prescriptions:

• Clinical evidence supporting efficacy in some cases: Many off-label drugs prescribed for weight loss have shown promising results in clinical studies or smaller-scale trials, even if they haven’t been formally approved for this purpose by regulatory agencies.
• High demand for quick solutions: With obesity rates rising and societal pressures to achieve a certain body type, there’s a high demand for fast, effective weight loss solutions. Off-label drugs often promise quicker results than traditional methods like diet and exercise.
• Lack of effective weight loss treatments on the market: While there are FDA-approved medications for weight loss, they often come with limitations such as prohibitive costs, side effects, or modest efficacy. This scarcity of effective, well-tolerated options drives doctors to look elsewhere, opening the door for off-label prescriptions.
• Cost and accessibility of traditional treatments: Weight loss treatments can be expensive and not covered by insurance. Surgical interventions like gastric bypass or sleeve gastrectomy are costly, involve significant recovery time, and carry surgical risks. Off-label medications often present a more accessible and less expensive alternative.
• Social media influence: Platforms like Instagram perpetuate beauty standards prioritizing appearance over health, encouraging people to seek out any means of achieving rapid weight loss, including off-label drug use.
• Doctor endorsement: Some health care providers prescribe off-label medication for weight loss, lending a sense of legitimacy to their use. Patients may feel reassured when a trusted physician suggests it as an option.
• Anecdotal success: Word-of-mouth endorsements or testimonials about the effectiveness of these drugs for weight loss can make them seem like an attractive option, even if the scientific evidence is lacking.
• Desperation and last resort: For people who’ve tried multiple methods without success, off-label medications may seem like the last avenue for weight loss.
• Lack of awareness: Some people may not fully understand the risks involved in off-label weight loss medication, thinking that if a drug is effective for one condition, it may be equally effective and safe for another.
• Holistic patient care: Weight loss isn’t just a standalone issue. It is interconnected with other health conditions like hypertension, diabetes, and heart disease. Some off-label drugs can address multiple conditions simultaneously. For instance, Metformin can assist with blood sugar regulation and weight loss, offering a dual benefit.
• The placebo effect: Some people may believe so strongly in the efficacy of a particular off-label treatment that they experience real weight loss, reinforcing their belief and encouraging others to try it.
• Convenience: In a world where everyone is looking for quick fixes, taking a pill daily often seems more accessible than committing to a strict diet and exercise regimen.

While off-label prescribing for weight loss is not without controversy, it often arises from a complex interplay of factors, including clinical evidence, patient needs, and limitations in existing treatments. As always, the decision to go down this route should be a joint one between a health care provider and patient, taking into account the potential risks and benefits, and it should be accompanied by a comprehensive approach that includes diet, exercise, and lifestyle modification.

Potential Side Effects

Navigating the realm of off-label weight loss medication involves understanding the risks involved, which can vary widely depending on the type of medication being considered. Here are some specific side effects associated with different classes of drugs

1. Antidepressants and Antipsychotics

• Bupropion (Wellbutrin): Can cause insomnia, dry mouth, and increased risk of seizures.
• Trazodone: May lead to drowsiness, dry mouth, and, less commonly, cardiac arrhythmias.

2. Diabetes Medications

• Metformin: Common side effects include gastrointestinal issues like diarrhea and nausea.
• GLP-1 Agonists: May cause nausea, vomiting, and potential risk of thyroid tumors.

3. Anti-seizure Medications

• Topiramate (Topamax): Potential for drowsiness, mental fog, and tingling in the extremities.
• Zonisamide (Zonegran): May cause drowsiness, loss of appetite, and, rarely, metabolic acidosis.

4. Stimulants

• Adderall: Increased risk of dependency, insomnia, high blood pressure, and severe cardiovascular issues.

5. GLP-1 Agonists

• Ozempic/Wegovy: Severe vomiting, fatigue, headaches, diarrhea, and stomach cramps.

Weight gain is also listed as a side-effect of most of these drugs.

While this is not a comprehensive list of side-effects, it does paint a dark picture. Everybody’s biology is unique. There is no guarantee that these drugs will aid in weight loss, and even if they do, safety will be a huge concern.

The Long-Term Implications of Using Off-Label Medication for Weight Loss

Admittedly, there need to be more studies on this, and most data still needs to be more conclusive. This raises concerns for both health care providers and patients.

• Efficacy over time: Some medication may lose effectiveness over time, requiring either higher doses — which come with their risks — or cessation of the drug, which might lead to weight regain.
• Potential for unknown side effects: Prolonged use could reveal side effects not apparent in short-term studies or off-label usage.
• Risk of chronic conditions: Some medication, especially stimulants, may put you at risk for developing chronic conditions like hypertension or cardiovascular diseases when used long-term.

Impact on Diabetes Drug Supply

Diabetes drugs like Ozempic and Wegovy are gaining social media popularity, thanks to celebrities and billionaires touting about the weight loss benefits. As a result, people of all ages who have been looking to shed a few pounds all their lives are rushing to get a prescription. In 2022, this caused a shortage in supply impacting thousands of people living with diabetes across the world.

Who Qualifies for Prescription Weight Loss Drugs?

Whether you can get a prescription for a weight loss drug can depend on various factors including, but not limited to, the specific drug in question, the country’s medical guidelines, and the individual’s health status. Generally speaking, weight loss medications are often reserved for those who have:

1. A Body Mass Index (BMI) of 30 or higher.
2. A BMI of 27 or higher with associated health problems, such as hypertension, type 2 diabetes, or high cholesterol levels.
3. Demonstrated a sincere effort to lose weight through diet and exercise without significant success.

Additionally, medical history, other medication currently being taken, and overall health are usually taken into consideration. Doctors typically conduct a full medical evaluation, which may include blood tests, and discuss lifestyle habits and diet before prescribing a weight loss drug. Keep in mind that weight loss drugs are usually considered a last resort after lifestyle changes have failed, and they are often used in conjunction with dietary changes and physical activity.

It’s essential to consult a health care provider for a thorough evaluation to determine if you are a candidate for weight loss medication.

Tips for People Considering Off-Label Medication for Weight Loss

If you’re contemplating using off-label drugs for weight loss, it’s crucial to approach the decision with caution and due diligence. Informed decision-making is critical to minimizing risks and maximizing the chances of a successful outcome. Here are some essential tips to guide you through the process.

Questions to Ask Your Doctor

Before starting any medication, especially those prescribed off-label, it’s essential to have an open and frank discussion with your health care provider. Here are some questions you might consider asking:

• What is the expected benefit of this medication for weight loss?
• What are the potential side effects and long-term risks?
• Are there any interactions with the medication I’m currently taking?
• How long should I expect to be on this medication?
• Are there any alternatives, including approved medications or lifestyle changes, that could be effective?

These questions can help you better understand what to expect and make an informed decision based on the information provided.

Being Vigilant About Side Effects

Monitoring for side effects is crucial if you decide to proceed with an off-label weight loss medication. Given the lack of comprehensive clinical trials for this use:

• Keep a detailed log of any new symptoms or changes in existing conditions.
• Report any adverse effects to your health care provider immediately.
• Some side effects might not manifest immediately and could develop over time.

Your vigilance can help your health care provider make timely adjustments to your treatment plan, minimizing risks.

The Importance of Regular Check-Ups and Monitoring

Regular check-ups are essential for monitoring the efficacy and safety of the treatment:

• Expect frequent visits initially to gauge your response to the medication, both in terms of weight loss and any potential side effects.
• Frequent blood or other diagnostic tests to monitor for unforeseen complications.
• Your health care provider should also assess other health aspects impacted by weight, such as blood sugar levels, cholesterol, and blood pressure.
• Review your list of medications with a pharmacist every few months.

Regular monitoring is a safeguard that helps ensure you’re moving toward your health goals without compromising your well-being.

Seeking a Second Opinion if Unsure

Given the complex nature of off-label prescribing for weight loss:

• If you have reservations or uncertainties, seek a second opinion from another qualified health care provider.
• A second opinion can provide additional perspective on the risks, benefits, and possible alternatives and even confirm—or challenge—the initial diagnosis and treatment plan.

Getting another viewpoint can offer you additional peace of mind and may open up new avenues for treatment you hadn’t considered.

The Importance of a Comprehensive Approach

While the allure of a “magic bullet” in the form of off-label weight loss medication can be tempting, it’s crucial to understand that drugs alone are rarely a sustainable or comprehensive solution.

Achieving and maintaining weight loss is a multifaceted endeavor that demands dietary adjustments, regular physical activity, and behavioral changes for long-lasting results. Medication may offer a helping hand in this complex journey, but they are most effective when combined with lifestyle modifications.

By incorporating a balanced diet, regular exercise, and behavioral strategies like stress management and mindful eating, you can amplify the efficacy of pharmaceutical interventions and improve the likelihood of achieving sustainable weight loss. This comprehensive approach enhances the benefits of any medication and equips you with the skills and habits needed for lifelong health and well-being.