GLP-1 drugs, keto, and muscle loss: separating fact from TikTok

What did @susacharmd actually say?

The claim here is specific and a little eyebrow-raising. According to this video, if your insurance won't cover Saxenda (liraglutide) as a weight loss drug, you should know that the same molecule sold as Victoza is approved for type 2 diabetes. If you have prediabetes, defined as a hemoglobin A1C between 5.7 and 6.4, your doctor might be able to prescribe Victoza under the diabetes indication, which your insurance may cover even without obesity benefits.

The creator frames this as self-advocacy. The advice is to call your insurance company, understand your benefits, and have an informed conversation with your doctor. That framing matters when we start picking apart whether this guidance is sound, savvy, or something closer to gaming the system.

Does the science back this up?

The pharmacology is accurate. Saxenda and Victoza are both liraglutide. They are not the same product, but they share the same active molecule at different approved doses. Victoza is FDA-approved for type 2 diabetes management, and it does have a cardiovascular risk reduction indication. Saxenda is approved specifically for chronic weight management.

The A1C range cited (5.7 to 6.4) is consistent with the American Diabetes Association's current definition of prediabetes. That part checks out. Liraglutide has also been studied in prediabetes populations. The SCALE Obesity and Prediabetes trial (le Roux et al., 2017, New England Journal of Medicine) showed liraglutide significantly reduced progression from prediabetes to type 2 diabetes over three years. So there is a legitimate clinical rationale for prescribing liraglutide in someone who has prediabetes, not just a billing workaround.

However, the doses differ. Victoza is approved at up to 1.8 mg daily for diabetes. Saxenda goes up to 3.0 mg daily for weight loss. A doctor prescribing Victoza for a prediabetic patient is making a clinically defensible choice, but the dosing context is different.

What did they get wrong (or right)?

The creator gets the core pharmacology right: same molecule, two brand names, two different approved indications. That is accurate. The A1C range for prediabetes is correct. The general principle of knowing your insurance benefits and talking to your doctor is reasonable advice.

What deserves more scrutiny is the framing. The video says, essentially, that calling a weight loss drug by its diabetes name is a way to get coverage. That framing slides past some important nuances. Prescribing Victoza off-label or on-label to a prediabetic patient is a legitimate clinical decision. But deliberately relabeling a treatment primarily sought for weight loss as a diabetes medication, to secure insurance coverage, enters grayer territory around insurance coding and prior authorization practices. The creator does not tell viewers to misrepresent anything to their insurer, to be fair. But the nudge-nudge framing could encourage exactly that.

The claim that prediabetes automatically qualifies someone for Victoza coverage also overstates it. Insurance coverage depends on specific plan formularies, prior authorization criteria, and whether the prescriber documents a diabetes-related indication. There is no guarantee here, and presenting it as a reliable workaround sets up unrealistic expectations.

What should you actually know?

If you have prediabetes and your doctor believes liraglutide is clinically appropriate for you, prescribing Victoza under the diabetes indication is a legitimate medical decision, not a loophole. The SCALE trial data supports that liraglutide has real benefit for people with prediabetes. Talk to your doctor about your full metabolic picture, not just your weight goals.

What you should not do is call your insurer and describe your situation in ways that misrepresent your primary diagnosis or intent. Insurance fraud is a federal issue, and the advice to rebrand a drug by its other name, without that being driven by a genuine clinical indication, puts both patients and prescribers at risk.

Also worth knowing: Victoza and Saxenda are not interchangeable products. They come in different delivery devices, different approved doses, and are reviewed separately by the FDA. Compounded liraglutide is a separate matter entirely and is not equivalent to either brand-name product. If a telehealth platform is offering compounded liraglutide, that product has not gone through the same regulatory review as Victoza or Saxenda.

Finally, semaglutide-based medications like Ozempic and Wegovy have a similar dynamic. The same molecule, two indications, different approved doses. The same caveats apply.