More than one in 10 Americans take a GLP-1 drug to lose weight. As more people take a GLP-1, or glucagon-like peptide 1, receptor agonist such as Wegovy, so do older adults, and those numbers are expected to skyrocket.
Last week, the Trump administration launched the Medicare GLP-1 Transition Programa new initiative that would fix the cost of three weight-loss drugs— Wegovy, the KwikPen version of Zepbound (tirzepatide) and Foundayo (orforglipron)—at $50 a month. This may be good news for the estimated at 38.9 percent of adults aged 60 and older in the United States living with obesity. But it could also energize an ongoing and risky experiment in aging on weight loss medications.
For years, clinicians had few effective options to safely treat obesity in older adults. But while GLP-1long used to treat diabetes, are now approved for weight loss, with limited evidence supporting their use in the population aged 60 and older. A person in their 60s may benefit as much from weight loss as someone in their 30s, but they may react very differently to the side effects of these medications; we simply don’t yet have enough evidence to draw informed conclusions, experts advise.
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“Eligibility does not automatically mean benefit,” says Ruchi Gaba, associate professor of endocrinology at Baylor College of Medicine. “We have to individualize.” And within the 60-and-older group, there’s a lot of variety: A healthy, active 68-year-old with obesity and sleep apnea is a very different patient than an 88-year-old who is frail, has a poor appetite and is at risk of falling, Gaba says.
Older adults are underrepresented in clinical trials of GLP-1 drugs. Despite the high prevalence of obesity in this age group, only about one in 10 participants In the first trials of GLP-1, it was 65 years or older, says Alissa Chen, a primary care physician and researcher at the Yale School of Medicine who specializes in obesity. Older people are more heterogeneous than younger people in terms of chronic conditions and multiple medications, Chen says, which can pose problems in terms of prescriptions and side effects.
“We need to be more critical about who we start taking these medications, and think about all these chronic illnesses and think about these medications, think about the benefits we can get from them,” she says. “We need to think about the question: ‘What does weight loss bring us in this age group?’ » »
GLP-1 drugs work by mimicking the glucagon-like peptide 1 hormonewhich the body naturally releases after eating to signal satiety. The hormone stimulates insulin secretion, suppresses glucagon (preventing it from causing the liver to release too much sugar into the bloodstream), and slows gastric emptying. These effects create a prolonged feeling of fullness which leads to weight loss.
GLP-1s don’t tend to interact directly with other drugs, but their effects can create cascading risks, Gaba says. Slow gastric emptying can make constipation worse. common complaint in the elderly. This can also cause nausea and vomitingwhich can lead to dehydration. In turn, dehydration can cause orthostatic hypotension and falls in people who also take blood pressure medications. Diabetic patients taking a sulfonylureaa class of drugs that lower blood sugar, have an increased risk of hypoglycemia with GLP-1, says Gaba.
Losing lean muscle mass is another well-known side effect GLP-1. This could put older adults at increased risk of serious injury if they fall. At the same time, older patients may react differently to medications than their younger counterparts due to their body composition and reduced liver and kidney function.
Functional capacity, rather than a number on a scale, should be the determining factor in whether or not to prescribe a GLP-1, Chen says. “For an older person, success might mean being able to walk longer distances without knee pain or get down on the ground to play with your grandchildren,” she says. “If an older person loses weight but also loses significant muscle mass, is the treatment really successful?
GLP-1s are intended for indefinite use, otherwise the weight returns. The Trump administration’s new Medicare program is temporary; it currently only lasts 18 months. But once a person starts taking one of these medications, stopping them is far from ideal, Chen says. “These are medications that must be taken long term. »
If a person already eats well and exercises, Chen says, they are often reluctant to prescribe a medication that will make them lose more weight. “We know that exercise is very effective in keeping people healthy, helping them live long and improving their cardiovascular fitness,” she says.
The goal of weight loss is to do the same thing. But if a patient is already making choices that improve these things, “I wonder how much further weight loss will help,” Chen adds.
For patients with other underlying conditions, there is evidence that GLP1s can improve lifespan, which in turn can affect lifespan. However, in people over 65 years old, lifestyle interventions remain the first line of obesity management.
Although GLP-1 drugs are often used as long-term maintenance therapy because stopping them usually leads to weight gainthere is still little data on their effects over the entire lifespan in older people, particularly in frail older people. Analysis to date show that, in older adults, GLP-1 medications are associated with fewer cardiovascular events and, in some studies, lower all-cause mortality. But there is no direct evidence that they extend lifespan.
Chen’s research shows that side effects can affect up to 40 percent of people taking weight-loss medications. Older people tend to drop out of treatment due to these effects. And when they do, they gain back the weight they lost, which can worsen underlying health conditions like cardiovascular disease or type 2 diabetes.
Resistance exercise and a higher protein intake could ensure that some of the weight regained is in the form of muscle and not fat. But “if you don’t do these things, you might have higher adiposity after than before you started treatment,” Chen says.
