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Are Weight Loss Drugs Risky for Older Adults?

New anti-obesity medications may seem like a miracle, but for older Americans, their downsides can be serious


spinner image a stack of pills balanced end on end and casting a shadow shaped like a person holding out their pants waistband as if they have just lost a lot of weight
JUANJO GASULL

Oh, oh, oh, Ozempic …

If that jingle is caught in your head, you’re not alone. In 2022, health care professionals wrote more than 5 million weight-loss prescriptions for various versions of semaglutide — the generic name for the diabetes drug that’s become a fat-fighting sensation. The injectables Ozempic and Wegovy, as well as Rybelsus (a pill form), have become so popular that diabetes doctors have had to scramble to get alternative medications for their patients.

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But, to paraphrase the marketing lingo: Is Ozempic right for you?

There’s no doubt that the new anti-obesity drugs are effective at helping people shed pounds — a potential boon for the nearly 42 percent of people over 60 in the U.S. who are affected by obesity. “Many of them will benefit,” says John Batsis, M.D., associate professor in the division of geriatric medicine and the department of nutrition at the University of North Carolina at Chapel Hill. “But the older you are, the more reason you have to be cautious. Our bodies change with age, so the results in younger people don’t necessarily apply to those who are older.”

A new way to think about weight

Over the past 30 years, science has begun to pinpoint the biological underpinnings of obesity. “When you gain too much weight, the weight-regulating pathways between the intestine and the brain begin to malfunction, which makes you hungrier and prevents you from feeling full,” explains Louis Aronne, M.D., an obesity specialist at Weill Cornell Medicine’s Comprehensive Weight Control Center.

“What a relief it was when my doctor said, ‘Your weight is not your fault. This is a treatable medical condition,’ ” says Barbara Hiebel (not her real name), 65, of Chapel Hill, North Carolina. “I weighed 200 pounds and was prediabetic.”

As this new understanding of obesity as a disease began to emerge, researchers testing semaglutide — developed to help people with diabetes regulate blood sugar — noticed that many participants taking the drug were getting slimmer. Turns out, semaglutide mimics intestinal hormones, including glucagon-like peptide-1, or GLP-1, which slows digestion and tells your brain you’re full. The result: You eat less, according to the first study looking at semaglutide for weight loss. Published in 2021 in The New England Journal of Medicine, it found that half of participants lost 15 percent of their body weight in about 15 months.

The medicine has changed the lives of patients such as Hiebel. “I lost 60 pounds and have kept it off — for the first time ever.” In June 2021, the Food and Drug Administration approved semaglutide for the treatment of obesity, under the brand name Wegovy. And in November 2023, the FDA approved a similar diabetes drug, tirzepatide, for treating obesity under the brand name Zepbound.

How exactly do these drugs work?

Anti-obesity medications are FDA-approved for people with a body mass index (BMI) of 30 or more, and for those with a BMI of 27 or higher who have at least one weight-related health condition, such as heart disease or sleep apnea, says Caroline Apovian, M.D., codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital. “They aren’t intended for healthy people who want to lose a few pounds.”

They work not only by making people feel full longer, but also by making fatty, sugary foods and even alcohol less appealing.

Anti-obesity drugs may also reduce the risk of some health problems linked to weight. “Weight loss can help with sleep apnea, fatty liver disease, heart failure and diabetes,” says Eduardo Grunvald, M.D., medical director of the Center for Advanced Weight Management at the University of California, San Diego. In people with diabetes, these medications have been shown to have cardiovascular benefits — and new data suggests similar benefits for people with obesity who don’t have diabetes.

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Kimberly DelRosso, 57, a senior administrative assistant in Pembroke, Massachusetts, has reaped health benefits since starting Wegovy in February 2022. She has lost 50 pounds, a lot for her 5-foot-2-inch frame. “Plus, I no longer have sleep apnea, my A1c and blood pressure are normal, and my arthritis has improved. My intense cravings are gone. After 27 years of yo-yo dieting, this medication has finally helped me lose weight and get healthy.”

Although there are plenty of anecdotal stories of people shedding massive amounts of weight quickly, clinical trial results show more modest short-term results. In 2022, for instance, Mayo Clinic researchers found that after three months on semaglutide, patients had lost about 6 percent of their body weight — still significant but not necessarily dramatic. Longer term, the average weight loss is about 16 percent. It plateaus after one year and is maintained as long as the patient stays on the medication, Apovian says.

Potential risks in people over 60

Though the promise of a slimmer you is appealing, there are risks involved, especially for older adults.

  • Loss of muscle and bone. For every pound you lose, about 25 percent is muscle and bone — and older people typically have less of both to start with. “Excess abdominal fat promotes declines in muscle mass,” Batsis says. “The longer you’ve had obesity, the more it impacts your muscle.” Weight loss can cause additional bone deterioration, pushing people teetering on the brink of osteoporosis over the edge.
  • Nutrient deficiencies. Semaglutide and similar medications reduce appetite, making it easier to develop deficiencies in protein, vitamins and minerals, warns Diana Thiara, M.D., medical director of the University of California San Francisco Weight Management Program.
  • Unintended ongoing weight loss. A 16-year study followed people 45 to 76 years old who lost 6 percent of their body weight with diet and exercise. As the years went on, many participants started losing weight unintentionally.

“I’d be cautious in prescribing rapid weight loss, like that induced by semaglutide, for people in their 70s,” says Thomas Wadden, former director of the Center for Weight and Eating Disorders at the University of Pennsylvania.

Is thinner better? maybe not

“It’s sometimes healthier to weigh a little more as you get into your 60s and beyond,” says Anne Marie O’Melia, M.D., chief medical officer at Eating Recovery Center in Denver. Indeed, research suggests that those who are overweight (a BMI of 25 to 29.9) in midlife or later are more likely to live longer than those who weigh less.

And thinness isn’t always a blessing. Since starting Ozempic a year ago, Loriannie Wood (not her real name), 51, of Grand Island, Nebraska, has lost 126 pounds. But for Wood, it has come with a price.

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“I’ve lost so much weight, the skin hangs from my arms and legs, and my face looks like a skeleton. I feel like my bones aren’t strong enough to support my body,” Wood says. “It has taken a toll on me.”

Should you drop pounds with a drug?

Here are seven questions to ask yourself — before you ask your doctor for a weight-loss drug:

1. Am I willing to stay on this for life? In one study, participants regained two-thirds of the weight they had lost on the medication after just one year. “Anyone using these drugs temporarily for quick weight loss will be as disappointed as they are by any crash diet,” Apovian says.

2. Is it worth the potential risks? Pancreatitis, kidney injury, even vision changes are potential side effects. Doctors are just starting to see the long-term data, Thiara says. “So far, they seem reasonably safe. But we may not have the full picture for years.”

3. Is my mental state solid? If you have a history of depression or suicidal thoughts, tell your doctor before taking the drugs, Thiara advises. “Suicidal ideation and worsening depression have been reported by patients,” she says.

4. Do I have access to ongoing care? It’s important to start at a low dose and raise the dosage slowly to manage side effects including nausea, Apovian says. Thiara agrees: “Some people get the meds through an online portal, so they get no supervision. That can be risky.”

5. Am I willing to follow a strength-training routine? Every­one taking an anti-obesity drug needs to engage in strength training to protect bones and muscle — and that goes double for people over 50, says Fatima Cody Stanford, M.D., an obesity medicine physician at Massachusetts General Hospital. “Strength training can mean walk­ing up hills or lifting weights, starting with 3 to 5 pounds, but it’s a must,” she says.

6. Am I willing to eat plenty of protein? Older adults need about 1 gram for every 2.2 pounds of body weight. A 150-pound woman needs roughly 68 grams of protein a day; a 180-pound man needs about 82 grams, spread throughout the day.

7. Am I prepared for the financial commitment? At up to $1,500 a month, these medications are pricey, and at present, Medicare and most private insurers won’t cover them for weight loss.

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