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Monday, March 4, 2024

Seniors and Weight-Loss Drugs

Finally, we have weight-loss drugs that really work. But should older adults be taking them?

Seniors hailed the recent introduction of effective weight-loss drugs to the market. Injectable semaglutide Ozempic was approved by the FDA for diabetes treatment in 2017. Weight-loss drug Wegovy, which is identical to Ozempic, was approved in 2021. Mounjaro, with active ingredient tirazepatide, got approval for diabetes in 2022. Other drugs are in development.

But are they safe for older adults? Reported side effects include nausea, diarrhea, vomiting, constipation, and stomach pain. The drugs are recommended for people with a body mass index (BMI) of 27 or more and at least one obesity-related condition like high blood pressure, high cholesterol, or diabetes. No guidelines exist for people 65 and up. 

Who Needs to Lose Weight?

BMI is calculated by weight and height – but it can either overestimate or underestimate actual fat percentage, the most problematic feature of obesity, according to Rodolfo Galindo, director of the Comprehensive Diabetes Center at the University of Miami Health System.

Is There a Generic Form of Semaglutide? 

Taking weight-loss drugs is expensive, so it’s no wonder people are asking when a generic version will become available. Novo Nordisk was the first drugmaker to patent semaglutide, and patents typically run for 20 years. Unfortunately, the earliest we can expect a generic is December 5, 2031 when their patent expires. 

Novo Nordisk may get marketing exclusivity, allowing them to extend the patent protection, usually for three to seven years. Competing pharmaceutical companies could challenge the patent, leading to earlier generic versions. However, the US Patent Office has not looked favorably on two recent claims, so optimism isn’t warranted.

What we really should be looking at in older people is waist circumference, suggests Dennis Kerrigan, director of weight management at Henry Ford Health in Michigan. It’s abdominal fat that carries more risk as you get older. He says that men should measure no more than 40 inches at the waist. For women, the number is 35 inches.

The drugs are “best suited for older patients who have clinical evidence of obesity,” according to Fatima Stanford, an obesity medicine scientist at Massachusetts General Hospital. This would include those with elevated cholesterol or high blood sugar, osteoarthritis, or heart disease. 

Cost of Weight-Loss Drugs

At about $1,000 per month, the drugs are not cheap. Medicare will not cover them unless a patient has diabetes. Some lawmakers have tried to change that, but it’s unlikely the Treat and Reduce Obesity Act has much of a chance of passing. The problem is, 42% of older adults are obese, according to the CDC. If all the clinically obese Medicare beneficiaries began taking semaglutide, the cost would exceed what Medicare spends on the Part D drug program, which amounted to $145 billion in 2019. 

But many wonder if that will change in the future, as the beneficial effects of the drugs on livers, hearts and more are beginning to be released. Could the cost saved on treatments for other diseases outweigh the cost of the drugs themselves at some point? 

Seniors At More Risk

The problem is that when people lose weight – and it doesn’t matter if the loss is from medication, dieting or bariatric surgery – they lose more than fat. Normally, about a quarter of the weight shed is from lean mass, such as muscle and bone. And older adults need all the muscle and bone they can get, since bones weaken and muscles shrink with age. 

Seniors must keep as much muscle mass as possible for strength and mobility. The loss of muscle strength in older adults is a leading factor in falls, according to the US Centers for Disease Control and Prevention. Waning bone strength puts seniors at risk of fractures. 

“While there may be many important benefits of weight loss metabolically, we need, particularly in older adults, to think about muscle and how important it is for the older adult population,” says John Batsis, a clinician and professor of geriatric medicine and nutrition at the University of North Carolina Chapel Hill. “Losing muscle mass and strength with aging is a natural phenomenon. Everyone, though, has a threshold where it causes a problem.”

More Research Needed

The problem is, not enough research has been done on the older population with these drugs to see if seniors may lose a greater proportion of fat and muscle than their younger cohorts. One study that looked at semaglutide use in older patients with diabetes found that they reported more side effects than younger patients. 

“My concern is that administering a medication without concurrent behavioral strategies may promote the development of loss of muscle mass and function,” says Batsis.

In the meantime, older adults should exercise caution when considering taking the drugs. Consult with your doctor about a concurrent exercise program to counter muscle loss. And check out the article in this month’s Senior Spirit about treatments for bone loss.