CACI for Weight Loss Medications – More than 70 percent of US adults are obese or overweight [1]. That fact alone makes weight control arguably the most common health-related concern in the nation, but excess body weight itself is only the tip of the iceberg. Being overweight or obese places you at risk for a wide range of health conditions including heart disease, diabetes, stroke, sleep apnea, and mental health conditions like depression and anxiety [2].

As serious as the health consequences of those conditions, each one also imparts significant challenges when it comes to qualifying for an FAA medical certificate. None of that is new information. 

However, the FAA has developed a new policy regarding the options pilots can use to keep their weight down to earth. 

New weight loss medications approved by the FAA

Before October 2023, orlistat – aka Alli or Xenical – was the only weight loss medication allowed by the FAA and even that required an observation period. That left a growing number of effective FDA-approved weight loss medications unavailable for pilots. Most notable among those were metformin, Ozempic/Wegovy (semaglutide), and Saxenda/Victoza (liraglutide) – drugs originally developed to treat diabetes, but increasingly prescribed for weight loss. 

After gradually expanding its list of allowable diabetes medications for years, the FAA’s new weight loss medication now allows pilots to take several of those same medications for weight loss. Even more, they allow AMEs to issue medical certificates to pilots taking those medications on the day of their medical certification exams. 

Now for the fine print

To take a weight loss medication other than orlistat, you must meet the following criteria:

• You must have a hemoglobin A1C lab result that is 6.4 mg/dL or less within 90 days preceding your AME appointment
• You can never, ever, in your life had a hemoglobin A1C lab result of 6.5 mg/dL or greater
• You must never have been diagnosed with diabetes
• You must not have had a history of substance use disorder, psychosis, suicidal ideation, or self-destructive ideations
• The medicine must be prescribed for weight loss and it must be taken for a minimum of two weeks without side effects
• You can take only one weight loss medication other than Orlistat

If you meet those criteria then taking metformin, liraglutide, or semaglutide should not affect your FAA medical certification. Your AME can issue your certificate on the day of your exam without any additional review by the FAA.  

Mounjaro (tirzepatide) and others still are not allowed 

For many pilots, this policy change means the answer to prayers. Others may feel it does not go far enough. In particular, Mounjaro/Zepbound (tirzepatide) has recently emerged as a very promising option. It has even been approved by the FAA for use by pilots with diabetes and – as of November 8, 2023 – it has been FDA-approved for use in weight loss [3]. However, at least for the time being, non-diabetic pilots cannot be approved via this CACI to use tirzepatide. 

Many other popular weight loss medications also remain on the FAA’s do not issue/do not fly list. Benzphetamine, diethylpropion, phendimetrazine, phentermine, topiramate, bupropion, naltrexone, locaserin, and fenfluramine, among others, will not be approved. 

Their policy is not likely to change for most of those medications, but tirzepatide might be an exception. The FAA has not signaled anything officially, but with its recent FDA approval for treating obesity there is a good chance tirzepatide could be added to the FAA’s list of acceptable weight loss medications if it continues to demonstrate an acceptable safety profile,  

Talking to your AME about weight loss

All medications have side effects and the best way to lasting weight loss, for those who can achieve it, remains healthy eating and daily exercise. However, weight loss medications can provide a safe means for many struggling toward that goal to accelerate their progress.         

As you approach your AME exam, be sure to recognize that the FAA has only recently released its weight loss medication policy. Not every AME will be familiar with it or comfortable with the finer points of applying it. 

It may be a good idea to schedule a consultation appointment with your AME before your appointment or find one that offers that option. You should always prepare for your medical certification exam like a check ride. That is especially true after a new medical diagnosis or starting a new medication.

No matter what, do not attend your AME appointment unless you know how all of your health conditions and medication will affect your FAA medical. Preparing for your exam the right way can reduce the time it takes to get your certificate by months.      

References

[1] “Overweight & Obesity Statistics – NIDDK,” National Institute of Diabetes and Digestive and Kidney Diseases. Accessed: Nov. 07, 2023. [Online]. Available: https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity

[2] CDC, “Effects of Overweight and Obesity,” Centers for Disease Control and Prevention. Accessed: Nov. 07, 2023. [Online]. Available: https://www.cdc.gov/healthyweight/effects/index.html

[3] O. of the Commissioner, “FDA Approves New Medication for Chronic Weight Management,” FDA. Accessed: Nov. 26, 2023. [Online]. Available: https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management

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