title: Metformin as treatment for overweight and obese adults: a systematic review.
abstract: OBJECTIVE
  We wanted to determine whether metformin is an effective medication for treatment of overweight or obese adults who do not have diabetes mellitus or polycystic ovary syndrome (PCOS).
  
  
  METHODS
  We searched MEDLINE (1966-2003), EMBASE (1986-2003), Allied and Complementary Medicine Database (1985-2003), International Pharmaceutical Abstracts (1970-2003), the Cochrane Library, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Controlled Trials Register, MEDLINE In-Process & Other Non-Indexed Citations, reference lists of retrieved articles, and articles by selected authors and pharmaceutical manufacturers. Inclusion criteria were being obese or overweight determined by a BMI of 25 kg/m2 or greater or waist-to-hip ratio (WHR) of more than 0.8, metformin use, and aged 18 years or older. Exclusion criteria were a diagnosis of diabetes mellitus, polycystic ovarian syndrome or descriptors of polycystic ovarian syndrome, human immunodeficiency virus infection, and concomitant antipsychotic medications. Trials were graded on an 11-point Jadad scale. Only randomized controlled and blinded trials were accepted. Two reviewers independently extracted data from each trial. Primary outcomes measured were changes in BMI, WHR, and weight.
  
  
  RESULTS
  Fifty-seven potentially relevant studies were initially identified; 48 were excluded because of lack of randomization, lack of blinding, failure to meet inclusion or exclusion criteria, inaccessible outcomes, or improper study design. Nine clinical trials met criteria for validity assessment. Four studies used the parameter of waist-to-hip ratio, 3 studies included BMI, and 8 used weight. Two of the 9 studies showed a small reduction in WHR.
  
  
  CONCLUSIONS
  Insufficient evidence exists for the use of metformin as treatment of overweight or obese adults who do not have diabetes mellitus or polycystic ovary syndrome. Further studies are needed to answer this clinical question.
authors.affiliation: University of Pittsburgh Medical Center St. Margaret, Pittsburgh, PA 15201, USA. kl55882@aol.com
authors.forename: Kara M
authors.initials: KM
authors.lastname: Levri
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Slaymaker
authors.forename: Allen
authors.initials: A
authors.lastname: Last
authors.forename: Julie
authors.initials: J
authors.lastname: Yeh
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ference
authors.forename: Frank
authors.initials: F
authors.lastname: D'Amico
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wilson
mesh_terms: D000328:Adult; D006801:Humans; D008687:Metformin / Q000627:therapeutic use*; D009765:Obesity / Q000188:drug therapy*; D050177:Overweight; D016032:Randomized Controlled Trials as Topic
chemical_list: D008687:Metformin