From the Guidelines
Metformin can help reduce abdominal fat in individuals with insulin resistance, type 2 diabetes, or polycystic ovary syndrome (PCOS), with a typical dosage starting at 500 mg once or twice daily with meals, potentially increasing to a maximum of 2000-2550 mg daily divided into two or three doses. The most recent and highest quality study, published in 2025 in the journal Diabetes Care 1, supports the use of metformin for weight management in individuals with type 2 diabetes, as it has multifaceted benefits, including improved glycemic management, reduction in hepatic steatosis, and improvement in cardiovascular risk factors. Metformin works primarily by decreasing glucose production in the liver, improving insulin sensitivity in muscle and fat tissues, and reducing intestinal absorption of glucose, which may contribute to decreased fat storage, particularly in the abdominal area. Common side effects include gastrointestinal issues like diarrhea, nausea, and abdominal discomfort, which can often be minimized by starting with a low dose and gradually increasing it, taking the medication with food, and using extended-release formulations. While metformin may support modest weight loss of 2-5% of body weight, it works best when combined with lifestyle modifications, including calorie-restricted diet and regular physical activity, rather than as a standalone treatment for abdominal fat reduction. Additionally, a study published in 2023 in the journal JAMA 1 found that metformin was associated with approximately 3% weight loss, and approximately 25% to 50% of participants achieved at least 5% weight loss, highlighting its potential benefits for weight management. However, it is essential to consider the potential risks and side effects of metformin, including the risk of lactic acidosis, particularly in individuals with renal impairment, and the association with vitamin B12 deficiency and worsening of symptoms of neuropathy, as reported in a study published in 2024 in the journal Diabetes Care 1. Overall, metformin can be a useful adjunct to lifestyle modifications for reducing abdominal fat in individuals with insulin resistance, type 2 diabetes, or PCOS, but its use should be carefully considered and monitored by a healthcare professional. Some key points to consider when using metformin for abdominal fat reduction include:
- Starting with a low dose and gradually increasing it to minimize side effects
- Taking the medication with food to reduce gastrointestinal side effects
- Using extended-release formulations to improve tolerability
- Combining metformin with lifestyle modifications, including calorie-restricted diet and regular physical activity, for optimal weight loss and abdominal fat reduction
- Monitoring for potential side effects, including lactic acidosis, vitamin B12 deficiency, and worsening of symptoms of neuropathy.
From the Research
Metformin and Abdominal Fat Reduction
- Metformin is known to have various effects on glucose metabolism and body composition, but its specific impact on abdominal fat reduction is not directly stated in all studies.
- A study from 2 suggests that metformin may contribute to some weight loss, especially in the visceral depot, which could imply a reduction in abdominal fat.
- Another study from 3 found that metformin caused a decline in BMI standard deviation score and a reduction in serum leptin in girls, indicating potential effects on body fat, including abdominal fat.
- However, a study from 4 found that waist circumference decreased in both the metformin and placebo groups, but the difference between the two groups was not significant, suggesting that metformin may not have a substantial impact on abdominal fat reduction in this specific context.
- It is essential to note that the effects of metformin on abdominal fat reduction may vary depending on the population, dosage, and duration of treatment, as well as individual responses to the medication.