Can Creatine Play a Positive Role in Obesity Treatment?

It’s been all over the popular media and social platforms lately: Recently released studies on creatine monohydrate’s potential to do everything from reducing cancer risk to boosting cognition in patients with Alzheimer’s have a lot of people talking. In fact, 1 million people per month search online for creatine, a statistic that’s rapidly increasing.

This supplement that used to fall strictly in the domain of athletes is no longer just for people who spend a lot of time at the gym — but does it have a role to play for patients dealing with obesity? Reviews are mixed.

How Creatine Figures Into Weight Loss and Muscle Quality

Obesity is often accompanied by poor muscular function, impaired metabolism, and reduced capacity for exercise — all factors that make sustained lifestyle change challenging. While creatine supplementation is traditionally associated with athletic performance, it has shown limited promise as a therapeutic tool for fat reduction, particularly when integrated with structured exercise programs.

This meta-analysis, first published in Nutrients in 2023, found that adults younger than 50 years who supplemented with creatine and participated in resistance exercise experienced a small but significant loss of body fat. While Matthew Fourman, MD, medical director and general surgeon at Ohio-based cosmetic surgery center pēkomd, believes in the benefits of creatine, he does not count fat reduction among its upsides.

“Creatine is one of the most studied supplements on the market. It has been shown to be very safe and effective in mostly two arenas — first, it does help with athletic performance and muscle structure and function, and then more recently, it has gained a lot of traction for its cognitive benefits, and there have been multiple studies showing that it could even be used in some cases of neurodegenerative disease,” Fourman said.

Creatine works by increasing phosphocreatine stores, which can boost energy during exercise and help increase strength and performance. Because of this, Fourman said, it can help people who are trying to lose weight make gains in their strength training routines.

Also, people with obesity might have a normal — or even a higher — total amount of muscle than average, but the muscle itself often isn’t as healthy or as strong as it needs to be. Issues with cellular energy production, inflammation, and insulin resistance can make it hard for patients’ bodies to use energy properly overall, resulting in fatigue and, in turn, decreased physical activity.

Creatine supports adenosine triphosphate regeneration in the muscles and may support the efficiency of the cells’ quick-start energy production powerhouse, resulting in improved muscular performance and staving off tiredness.

With respect to the makeup of musculature in patients undergoing weight-loss treatment, several clinicians noted that the supplement can be beneficial to patients taking GLP-1s.

“While creatine itself doesn’t cause weight loss, it may help preserve lean muscle mass during periods of rapid weight reduction, which is beneficial for metabolic health,” said Lisa Giffen, FNP-C, founder and owner of Giffen Aesthetics in Los Angeles.

Elizabeth Alexandra Zubowicz, MD, a general surgeon, advanced minimally invasive and bariatric surgeon at University of Virginia Health Haymarket Medical Center, Haymarket, Virginia, agreed.

“Creatine supplementation enables the preservation of lean muscle mass during weight loss, which is especially beneficial for obese individuals who are aiming to improve body composition,” Zubowicz said, expanding on Giffen’s comments on metabolic improvement. “It can also enhance exercise performance and support metabolic function, which promotes greater fat loss and long-term weight management.”

Zubowicz said she personally recommends creatine supplementation to her postsurgical patients, pointing to a 2021 meta-analysis in Nutrients that highlighted creatine’s role in preventing sarcopenia, which is common after bariatric surgery due to the rapid weight loss and reduced protein intake.

“I also recommend the same to those seeking to lose weight and/or increase muscle mass,” she said. “And I encourage everyone who engages in regular strength training to supplement with creatine, especially around andropause and menopause age.”

On the other side of the issue, board-certified dermatologic surgeon David Amron, MD, a recognized expert in lipedema, liposculpture, and revision liposuction, is not sold on the benefits of creatine.

“Creatine is formulated primarily for muscle building rather than addressing metabolic function or promoting weight loss,” he said. “Given that focus, it likely doesn’t offer significant benefit for bariatric patients, whose needs center more on metabolic support, fat reduction, and sustainable weight.”

Indirect Benefits Are Still Benefits

While doctors’ enthusiasm for creatine monohydrate supplementation in patients with obesity is mixed, in clinical settings where fatigue, reduced mobility, or muscle loss impede the progress of these patients, creatine may have promise as a low-risk intervention to support exercise capacity and body composition improvements. Though not a weight-loss agent, its role as a metabolic and functional enhancer complements clinical goals, and it may assist in managing obesity-related complications. Regardless, creatine is certain to remain in the public eye.

At the end of the day, studies suggest that creatine supplementation, particularly when combined with resistance or aerobic training, can enhance fat-free mass, increase strength, and improve exercise adherence. Some data indicate minor increases in resting energy expenditure, more than likely secondary to gains in lean tissue.

Related to the gains for those with Alzheimer’s disease as noted earlier, there is growing interest in creatine’s potential cognitive and mood-related benefits, which may indirectly support behavior change and physical activity adherence in patients with obesity, particularly those with comorbid depression or fatigue.

When creatine supplementation first came to public attention decades ago, word circulated about its potential impact on renal function. Those concerns have largely been debunked as laid out in this meta-analysis, but maintaining adequate water intake is critical when taking creatine.

“Hydration is really important to maximize the benefits of creatine, and bariatric patients often have struggles staying hydrated,” Fourman said. “I take great care to reinforce the need to be adequately hydrated if taking this supplement.”

“Creatine is generally safe and well-tolerated when used within recommended doses, typically 5 g/d. Hydration and kidney function should be monitored,” added Nathaniel L. Villanueva, MD, of the Plastic Surgery Institute in Beverly Hills, California. While on creatine, he said, some patients may see a small increase in weight associated with water.

Zubowicz said her patients don’t commonly come to her with negative side effects such as water retention, bloating, or mild gastrointestinal upset, and when they do, the impacts are minimal.

Just Take It

Of all the doctors queried for this article, pēkomd’s Fourman was the most enthusiastic about creatine supplementation — but not necessarily for any reason related to his work with bariatric patients.

“I truly think that just about everybody could benefit from creatine supplementation. I am a huge fan of it. I take it. I have my 75-year-old parents taking it for the cognitive benefits,” he said. “I think the long-term cognitive benefits are going to be evident as more and more data comes out.”

Fourman said that when it comes to bariatric patients, it doesn’t matter whether it’s presurgery or postsurgery, just get going, and that everyone else should consult with their physician before starting creatine or any other supplement.

“This is one of those supplements that I am bullish on, though, because there is an abundance of data and has been proven to be very safe and very effective,” he concluded.