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Ozempic® vs. metformin: Which is the best choice for weight loss?

1 min Read

Reviewed by:

Dr Odhett Cojocaru, MD

Internist

Compare Ozempic® and Metformin for weight loss. Discover which medication is a better fit for your health goals. Learn more at Noom.

What you’ll learn:   

  • Ozempic® and metformin are medications that can support weight loss when prescribed off-label, but they work through different mechanisms.       
  • Ozempic® mimics a natural hormone to curb appetite and slow digestion, while Metformin improves how your body handles glucose.       
  • Both medications can help a person lose weight when combined with lifestyle changes.

We call managing weight a journey because it can involve ups and downs as you work to find an approach that works. For many, it’s about combining lifestyle changes with other methods that address unique needs. Medication can sometimes be the key to getting the scale moving in the right direction, but finding the right one can take time, as many options exist.

Two popular choices, Ozempic® and metformin, were both originally developed to manage type 2 diabetes but are often prescribed off-label to support weight loss. Understanding how these medications work, how effective they are, and key differences can help you have an informed conversation with your doctor. Could one be right for you? Let’s take a look at what they do.

Want to make it even easier to go through the options? If you qualify for Noom Med, our clinicians can guide you through all the medical options available, helping you choose the best fit for your lifestyle, biology, and budget. Let’s dive into how these medications work so you can take the next step. 

Metformin vs Ozempic®: How they work for weight loss

Both Ozempic® and metformin can help a person lose weight, but they work very differently and have different levels of effectiveness. Let’s look at what these medications are and how much weight you might expect to lose with both.

What is Ozempic?

Ozempic is the brand name for a medication containing semaglutide. It is part of the class of drugs called GLP-1 receptor agonists. 

  • How it works: Semaglutide, like other GLP-1 receptor agonists, mimics the hormone GLP-1, which regulates appetite, slows digestion, and stabilizes blood sugar. 
  • How to take it: Ozempic® is taken as a once-weekly injection.
  • Weight loss potential: After 16 months of treatment combined with lifestyle changes, people lost an average of 15% of their body weight. Between 69% and 79% lost at least 10% of their body weight.

What is metformin?

Metformin is a generic medication sold under various brand names, including Glucophage, Glucophage XR, Fortamet, Glumetza, and Riomet. 

  • How it works: It reduces glucose production in the liver and improves the body’s response to insulin. 
  • How to take it: Metformin comes as a pill that you take by mouth two to three times a day. 
  • Weight loss potential: Studies have shown that people can expect to lose an average of about 7% of their body weight.

Metformin vs Ozempic®: The bottom line on weight loss 

If weight loss is your prime motivation, Ozempic® has been found to be more effective in clinical trials than metformin. When combined with diet changes and exercise, the average weight loss is 15% for Ozempic® versus 7% for metformin. When choosing between these two, there are other factors to consider, including cost, which is drastically different if insurance doesn’t cover Ozempic®.

High-quality meds. Powerful psychology-based weight loss.

  • Starting at $149/month
  • Meds to your door in 7 days
  • 100% online access to coaches and doctors
  • Backed by Noom's award winning behavior change program

See if you qualify

Medications require consultation and prescription by clinician through Noom platform. Not all customers will qualify for prescription. Compounded semaglutide is produced in an FDA-registered facility but not reviewed by the FDA for safety, efficacy or quality.

Metformin vs Ozempic®: What do they cost?

Cost can be a big factor for many people. Ozempic® has a much higher list price than metformin, and without insurance, it can be out of reach. Here’s a look at what you might pay for either prescription.

Without insurance, Ozempic® costs about $935 per month. There are no generic versions of Ozempic because the company that produces it has an exclusive patent. Your price will vary depending on insurance and any patient assistance programs you qualify for. If you qualify for Noom Med, your clinician can assist you in coordinating coverage and finding the best deal and an alternative if needed. You will fill your prescription for Ozempic at your pharmacy of choice. As a Noom Med member, you’ll get a weight loss program designed just for you, access to your clinician, plus Noom’s tools and trackers to help get you to your goal.

Unlike Ozempic, metformin is a widely available generic medication, so it will cost significantly less even without insurance coverage. If you qualify for Noom Med, your clinician will determine if a prescription for metformin is right for you. If prescribed, you’ll pay $59 for the first month and $89 per month after that (billed in three-month increments), and the medication will be delivered to your door. This one price covers your medication, ongoing clinical support, and full access to Noom’s behavior change program and tools. Check your eligibility here

You can also ask your Noom Med clinician about compounded semaglutide* through Noom GLP-1Rx. It has the same active ingredient as Ozempic but at an accessible cost. If prescribed, you’ll pay $149 for the first month, and the medication will be delivered to your door in just seven days. 

*Compounded semaglutide available on the Noom platform is produced in an FDA-registered facility but not reviewed by the FDA for safety, efficacy, or quality.

Ozempic® vs Metformin: Who can take them?

Your clinician will decide whether medication is right for you depending on your health needs, medical history, weight management goals, and what you can afford. Here are some things they consider:

Who can take Ozempic® for weight loss?

Ozempic® is often prescribed off-label for weight loss in individuals who meet specific criteria. To qualify, you typically need:

  • A body mass index (BMI) of 30 or higher (considered obese).
  • A BMI of 27 or higher with at least one weight-related condition, such as high blood pressure or high cholesterol.

Who can’t take Ozempic®?

While Ozempic® can be effective for weight loss, it’s not suitable for everyone. You should not take Ozempic® if you:

  • Have a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2).
  • Are allergic to semaglutide or any of the ingredients in Ozempic®.
  • Have a history of pancreatitis, as the medication may increase the risk of this condition.
  • Are pregnant or planning to become pregnant, as Ozempic® may harm fetal development.
  • Are breastfeeding, as its safety during lactation is not established.

Who can take Metformin for weight loss?

Metformin can be prescribed off-label for weight loss, generally under the same conditions as Ozempic®. These include: 

  • A body mass index (BMI) of 30 or higher
  • A BMI of 27 or higher with at least one weight-related condition, such as high blood pressure or high cholesterol. 
  • Metformin can be prescribed to people with a lower BMI (≳ 25 in some cases).

Who should avoid taking metformin?

While metformin is considered safe and effective for many people, certain people should avoid taking it due to contraindications and potential risks. You should not take metformin if you:

  • Have severe kidney disease: Metformin is eliminated by the kidneys, and impaired kidney function increases the risk of lactic acidosis, a rare but serious side effect.
  • Have liver disease: Liver dysfunction can also heighten the risk of lactic acidosis.
  • Have a history of lactic acidosis: People who have experienced this condition in the past should avoid metformin.
  • Have significant heart or lung conditions: Conditions that reduce oxygen delivery to tissues, such as heart failure or chronic obstructive pulmonary disease (COPD), increase the risk of lactic acidosis when taking metformin.
  • Consume excessive alcohol: Heavy alcohol use can interfere with metformin metabolism and increase the risk of lactic acidosis.
  • Are pregnant or breastfeeding: Although metformin is sometimes used during pregnancy for specific conditions, its safety as a weight-loss aid during pregnancy and lactation is not well established.
  • Have a severe infection or are undergoing surgery: These conditions may temporarily impair kidney function and necessitate discontinuing metformin.

Metformin vs Ozempic®: Side effects and warnings

Most people find the side effects of Ozempic® and metformin to be manageable. Here’s everything you need to know, from the common issues to the rare but important risks.

Common side effects of Ozempic®:

  • Nausea, vomiting, diarrhea, constipation, abdominal discomfort, and fatigue can be common symptoms when first starting Ozempic®. However, for most people, these symptoms improve as their bodies get used to the medication.

Common side effects of Metformin:

  • Nausea, diarrhea, and stomach upset are common, especially in the first few weeks. 

Now that we’ve covered the more expected side effects, let’s discuss the less common ones. These are less likely to happen, but they’re still important to know.

Rare side effects and warnings of Ozempic®:

  • In very rare cases, Ozempic® can cause severe allergic reactions. If you notice swelling in your face, tongue, or throat, seek immediate medical attention.
  • Pancreatitis, or inflammation of the pancreas, can occur. If you experience severe abdominal pain, seek immediate medical attention.
  • Kidney problems are another rare but serious side effect. Symptoms to watch out for include changes in urination frequency or color, and swelling in the legs, ankles, or feet. You may also experience fatigue, weakness, or confusion. 
  • Gallbladder issues, such as gallstones, may also occur. Be alert to sudden, severe abdominal pain, nausea, vomiting, fever, chills, or yellowing of the skin or eyes. 
  • Hypoglycemia, or low blood sugar, is more likely when Ozempic® is taken alongside other diabetes medication. 
  • Thyroid cancer, particularly medullary thyroid carcinoma (MTC), is considered a possible side effect of Ozempic®. If you experience any signs of a lump or swelling in your neck, shortness of breath, or hoarseness, stop taking Ozempic® and contact your doctor immediately. Note: This connection has not been established in humans.

Rare side effects of Metformin:

  • Lactic acidosis is the big one here. While rare, it’s serious and can happen if you have kidney problems or certain other risk factors. Symptoms like unusual fatigue, muscle pain, or trouble breathing mean you should immediately seek medical attention.
  • Low blood sugar (hypoglycemia) is uncommon with Metformin alone but can happen if it’s combined with other diabetes meds.
  • Another potential issue is a vitamin B12 deficiency, which can develop into long-term use or in people with certain risk factors. Symptoms include fatigue, weakness, constipation, loss of appetite, numbness or tingly in the hands and feet, and yellowish skin. 

Millions of people use these medications safely every day. The key is open communication with your clinician and noticing anything unusual. Remember, the goal isn’t just weight loss—finding a solution that fits your body and life. Stay informed, stay proactive, and don’t hesitate to ask your healthcare provider questions!

Metformin vs Ozempic®: Which is better for weight loss?

As you can see, choosing between metformin and Ozempic® depends on your health goals and lifestyle. 

High-quality meds. Powerful psychology-based weight loss.

  • Starting at $149/month
  • Meds to your door in 7 days
  • 100% online access to coaches and doctors
  • Backed by Noom's award winning behavior change program

See if you qualify

Medications require consultation and prescription by clinician through Noom platform. Not all customers will qualify for prescription. Compounded semaglutide is produced in an FDA-registered facility but not reviewed by the FDA for safety, efficacy or quality.

People taking Ozempic® will likely lose more weight than those taking metformin. But, the price of Ozempic® can be a barrier. Some people might also be averse to giving themselves weekly injections. Remember that the needle is very small, and most report only mild discomfort. 

Not sure which is right for you? Be sure to consider Noom Med. Noom Med connects you with clinicians who can assess your needs and prescribe the best option if you qualify. Pairing medication with personalized guidance ensures you’re building habits that last. Ultimately, the right choice is the one that works for you, and Noom Med can help you find it!

Note: Ozempic® and metformin are not FDA-approved to treat obesity or for weight loss.