Off-Label Use of SGLT2 Inhibitors for Weight Loss— We Must Not Open That Pandora’s Box!

Abstract

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are increasingly discussed for weight management, yet their off-label use raises significant concerns. Evidence shows only modest weight loss, below clinically meaningful thresholds and likely overestimated in trial settings. Efficacy and safety data from populations living with diabetes, chronic kidney disease, or heart failure cannot be extrapolated to individuals with obesity alone. Off-label use may expose patients to avoidable risks, including infections and rare severe complications, while undermining pharmacovigilance. Ethical, social, and system-level consequences—including misuse, inequitable access, and drug shortages—further challenge justification.