What Airline Pilots Need to Know About Weight-Loss Medications

GLP-1 medications are a popular choice for weight loss, and multiple options are now available with a prescription from your physician. These drugs were initially developed in 2005 to help individuals with Type 2 diabetes, but, more recently, studies have demonstrated that these medications are also well suited to address excessive weight gain.

GLP-1, or glucagon-like peptide-1, duplicates a hormone the body naturally produces that helps regulate blood sugar and appetite. According to the Mayo Clinic, “People who take the medication will feel fuller after and between meals, have improved glucose levels, and experience reduced thoughts about food.”

Pilots in the United States

In a Pilot Minute video segment titled “Can I take a weight-loss drug and still fly?” Dr. Susan Northrup, the FAA federal air surgeon, said, “The FAA allows multiple medications for weight loss. These include some available over-the-counter and some categories of prescription diabetic drugs.”

If you’re a U.S. airline pilot taking over-the-counter medication, enter it into MedXpress and talk to your aviation medical examiner (AME). Over-the-counter drugs require an initial observation period of 48 hours to determine how they may affect you.

With GLP-1 medication, you must also confirm from the treating physician that there are no complications or side effects from the drug and ensure that your AME reviews the FAA’s Weight Loss Management Worksheet with you. In addition, you’ll need to be grounded for at least two weeks when initiating the treatment and an additional 72 hours following any dosage changes.

The FAA has outlined conditions that must be met and the required documentation needed if you wish to take GLP-1 drugs for weight loss and continue to fly. Under these constraints, the FAA will allow the use of semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), and tirzepatide (Zepbound, Mounjaro).

The use of these particular drugs falls under the CACI category—“Conditions AMEs Can Issue.” In addition, pilots using a single one of these GLP-1 medications (as opposed to a combination) are no longer required to possess a special-issuance authorization. Other medications for weight loss may be allowed but require a special-issuance medical certificate.

The terms for usage specify that the condition must be well controlled; the pilot’s A1C (a test that measures the average amount of sugar in your blood over the past few months) can’t surpass 6.4 (the percentage of hemoglobin in your blood saturated with sugar).

Pilots in Canada

In Canada, the policy isn’t quite as clear. Civil aviation medical examiners (CAMEs) are instructed to reference Appendix C of the Medications and Aviation Medical Certification guide, which provides a list of factors that can assist them in assessing applicants taking medication for compatibility with aviation, even when the drugs aren’t identified in any of the other annexes.

Be Cautious of Side Effects

Like all medications, this type of drug comes with potential side effects. The most common reactions are nausea, constipation, and fatigue. On rare occasions, the medicine can prompt mood changes or pancreatitis or gallbladder issues. It is not recommended for people with a personal or family history of medullary thyroid cancer.

Between 25 to 50 percent of total weight loss comes from a reduction of lean muscle mass. To counter this side effect, individuals on GLP-1 medications should engage in regular physical activity, especially resistance training, and increase their protein intake.

Be advised that certain weight-loss drugs remain disqualifying and must be avoided if you wish to fly. Examples include benzphetamine (Regimex), diethylpropion (Tempanil), and phendimetrazine (Bontril)—and there are others so proceed with caution.

Err on the side of caution when it comes to weight-loss medications. Make sure you understand how they’ll affect you. Most importantly, talk to your AME/CAME to ensure that you’re fit to fly and adhering to all policies and procedures.

Want More Information?

U.S. ALPA pilots with general health and medical certification questions are encouraged to contact the Aviation Medicine Advisory Service (AMAS), ALPA’s Aeromedical Office, Monday–Friday 8:30 a.m. to 4:00 p.m., mountain time at 866-237-6633. Additional information is available on the AMAS website.

ALPA members based in Canada should contact ALPA Canada’s Aeromedical consultant at 800-561-9576, ext. 8312.