Dr. Robert Sancetta is a former DC-10 captain with 11,000 flight hours. He has worked as a Senior AME since 1993 and is appointed as AME Consultant to the FAA Federal Air Surgeon.

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Robert Sancetta

In my August 2024 blog, I began a discussion of the FAA’s recent approval of a number of prescription weight loss medications. These medications can generally be used for pilots without necessitating a special issuance authorization to do so.
There are some restrictions, of course, but for the most part, the protocols are relatively straightforward and easy to comply with. Once initiating an acceptable medication, while the FAA typically requires a two-week stabilization period before a pilot resumes flight status or the AME issues a medical certificate, the good news is that there will be no extended period of grounding while an interminable wait for FAA review drags on.
As a quick review, the medical issues that can result from being overweight are many. These include heart disease, diabetes, hypertension, obstructive sleep apnea, high cholesterol, and arthritis, for example, along with the exacerbation of other medical conditions.
Additional factors for pilots to consider include simple things such as comfort when seated for a long period of time in the cockpit or deadheading in airliner seat 49R, with no recline, of course, as the seat is immediately adjacent to the lavatory (which will flush without interruption throughout the flight). As trivial as comfort might seem, considering the amount of time that pilots are stuffed into airplanes, it is actually quite significant.
There are also potential career impacts. No pilot enjoys being grounded while their diabetes or heart disease is being stabilized, and the special issuance process takes its time. Once approved under a special issuance for many conditions, ongoing data will be required at least annually. Sometimes this entire hassle can be avoided by simply losing some weight.
Did you catch that? I fell into my own trap by using the word “simply.” As I have discussed previously, there is nothing simple about losing weight. When I am asked by pilots for the secret to losing weight, I respond that if I knew that secret, we would not be having the conversation. I would be riding my G700 to Indonesia to go scuba diving, while the inquiring pilot was referred to one of my weight loss clinics.
Kidding aside, the medical and anecdotal data have consistently proven that weight loss is an elusive goal and a complicated and challenging subject. If we can transition our thinking to the fact that there are medical components to weight gain that are not simple for a pilot to control, then perhaps we can eliminate the stigma that there are now medical interventions that are not only effective but are in favor with the FAA.
A standard disclaimer before embarking on any medical treatment program is to carefully discuss all of the relevant risks and benefits with the healthcare provider. Yes, there are risks in using weight loss medications (usually, but not always, gastrointestinal). However, consider the many risks of remaining obese.
The FAA wants to ensure that a pilot is not using a weight loss medication as an end-run around the diabetes protocol (which is rather complicated). Diabetes is one of only 15 “specifically disqualifying” conditions in the Code of Federal Regulations. While it is not usually permanently disqualifying, a special issuance authorization is required for any pilot with that diagnosis.
As long as a Hemoglobin A1C blood test (a long-term glucose measurement) has never been 6.5% or higher, the weight loss medication protocol can apply. A 6.5% or higher is diagnostic of diabetes as per the American Diabetic Association guidelines.
The medications now being used most commonly for weight loss are, for the most part, new marketing strategies for medications indeed originally intended to treat diabetes. Many medications find a more marketable niche beyond what they were originally developed for.
Most of these medications are taken by injection approximately once weekly. There are usually quite simple auto-injectors that make the process essentially foolproof.
Most of these medications are glucagon-like peptide (GLP-1) agonists that mimic the native hormone itself. The result is better control of blood glucose and insulin (which can treat or prevent diabetes) and also an increased sensation of satiety (feeling full, which helps a person eat less and lose weight).
Some of the benefits being discovered with the weight loss medications are, in addition to weight loss, improvements in the risk profiles for heart disease and, of course, diabetes. This is not surprising and is likely multifactorial—weight loss and improved blood sugar control help ward off complications of ongoing obesity.
Some of the FAA-approved medications that we’ve all seen advertised include:
<ul>
<li>liraglutide (Victoza, Saxenda)</li>
<li>semaglutide (Ozempic, Wegovy)</li>
<li>tirzepatide (Mounjaro, Zepbound)</li>
</ul>
When any one of these medications is prescribed as a single agent, the AME can issue a pilot a medical certificate with a simple blood test (HbA1C) and a report from the treating physician that the pilot has no significant side effects and that the medication is being used for weight loss (and that there is no diagnosis of diabetes).
There are some additional cautions in the protocols that should be simple for the AME to determine. To amplify, there is some research in progress about the use of these medications in substance abuse. The AME must have confirmation that there is no history of such a disorder.
There is also the old tried and true medication of metformin (Glucophage). This oral medication has been used for years in diabetic management. It helps the pancreas’ native insulin production get into the cells of the body to better metabolize glucose, while at the same time decreasing glucose absorption from the gut.
On the occasions that a combination of weight loss medications is to be used, a formal special issuance authorization will usually be required. There are just a few exceptions that are beyond the scope of this article. Most commonly, however, weight loss medications are prescribed as a single agent, which facilitates the simplicity of the protocol.
All of the older amphetamine-like weight loss medications remain unacceptable for pilots.
There are finally relatively simple protocols for pilots to take a number of medications for weight loss. While these medications were intended to treat diabetes, they have found an important additional niche in the weight loss market. Their use seems to also reduce the risks of heart disease and diabetes. The benefits abound!
Remember, of course, that there is a risk/benefit ratio for any medical treatment plan. That said, this is now an exciting and effective option for pilots who have the goal of losing weight.

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