Before you start: the safety of SGLT2 inhibitors for anti-obesity treatment

Introduction: Obesity is one of the most common chronic conditions that raises the risk of cardiometabolic issues. Because of their ability to encourage weight loss through urine glucose excretion, sodium–glucose cotransporter 2 (SGLT2) inhibitors, which were first approved for the treatment of type 2 diabetes, have become a viable off-label option for managing obesity. Areas covered: This review examines the safety profile of SGLT2 inhibitors for weight reduction in non-diabetic, overweight/obese adults. A comprehensive search on PubMed, EMBASE, the Cochrane Library, and Scopus (January 2015–January 2025) for RCTs, systematic reviews, and meta-analyses was performed. It details the potential adverse effects of these medications, including euglycemic ketoacidosis, moderate hypotension, vaginal and urinary tract infections, and worries regarding lower limb amputations and renal function. There are still unknowns about the long-term impacts on cardiovascular outcomes, lipid profiles, and bone health, which emphasizes the need for further extensive, focused studies in non-diabetic individuals. Expert opinion: SGLT2 inhibitors offer a modest but clinically meaningful avenue for weight management in select individuals. Broader adoption in routine obesity care will likely require further research to clarify benefits versus risks, develop patient-specific treatment algorithms, and ensure robust monitoring of potential adverse events.