Drugs like Wegovy promise dramatic weight loss--but muscle and bone are part of that weight lost.
In 2017, semaglutide–brand name Ozempic–debuted as a treatment for Type 2 diabetes. When semaglutide hit the weight loss market in 2021 as Wegovy, it was hailed as a miracle drug. Both semaglutide and tirzepatide (Zepbound) have the effect of making people feel more full with less food, and also tend to make fatty foods less appealing.
In the past several years, these drugs have changed the landscape of weight loss for doctors, patients, and drug makers. For some people who have long struggled with weight loss, it’s been life-changing. Kimberly DelRosso, 57 and just over 5 feet tall, told AARP that she lost 50 pounds on Wegovy. “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.”
At first glance, Ozempic and similar drugs present major potential health benefits for older Americans. About 39% of Americans over 60 fall into the medical category of “obese,” and about 29% of people over 65 have diabetes. And last March, semaglutide was approved as a preventive drug for people at risk of heart attack, after studies showed that it lowers some people’s risk of a cardiovascular event by up to 20%.
As more and more people over 60 are prescribed these drugs or seek them out, researchers are still working to understand the risks and benefits for older adults.
Special Considerations for Older People
Providers can prescribe Ozempic, Wegovy, and Zepbound to adults of any age. Older people will want to talk to their doctor about special concerns including muscle loss and adequate nutrition. Perhaps the biggest concern among doctors when prescribing these weight loss drugs to older adults is that muscle loss and fat loss go hand-in-hand.
When we lose weight, a portion of every pound we lose is muscle and bone–so everyone taking these drugs, but especially those at risk of osteoporosis, must incorporate strength training into their routine. Older people are already more susceptible to muscle loss, and a sudden drop in muscle strength could translate into a higher risk of falls.
Older adults also should be especially aware of taking in adequate nutrients while on these medications. Eating less will easily translate into taking in fewer vitamins and minerals, which could lead to nutrient deficiencies–to which older adults are also more susceptible than younger folks. It’s also important for all adults to increase protein intake while taking the drug.
A sudden loss of weight could also set up an older person with fewer reserves to weather a long-term illness.
All these considerations are in addition to the regular side effects of the drugs, which may include nausea, diarrhea, gastrointestinal discomfort, and vomiting. Unfortunately, these side effects appear to occur more severely in older adults. Gastrointestinal issues increase the importance of carefully monitoring nutrition. Some patients have also reported increased depression and suicidal ideation as side effects.
The Cost
A single injection of Ozempic or Wegovy costs upwards of $1,000 out of pocket. Since it must be taken weekly, that price tag puts the drug way out of reach for most Americans. Medicare Part D will cover the cost if the drug is prescribed for Type 2 diabetes or heart disease, but not to treat obesity alone. (In April, the CDC rejected a proposed change that would have allowed Medicare to cover these drugs solely for weight loss.) For those who take the drug for Type 2 diabetes or to prevent the risk of cardiovascular events, a Medicare copay will range from $0 to over $300 per dose until the deductible is met.
Just in the past few months, generic versions of semaglutide and tirzepatide have become less available. After a period of scarcity, the FDA determined that supplies of the drugs are stabilizing and ordered compounding pharmacies to stop making them. The decision is controversial: while some advocates say that many patients won’t be able to access the drugs under the new rules, the FDA and others contest that the ban is necessary to protect consumers from substandard products.
The Big Picture
There are many reasons to celebrate the advent of semaglutide: for those with Type 2 diabetes and cardiovascular risk, the benefits may easily outweigh the risks. And some older adults who have long struggled with health issues related to obesity are finally finding relief.
Just keep in mind that there’s no “miracle” here–during and after taking Wegovy for weight loss, nutrition and exercise will be as important as ever. According to one study, people who stopped using the drug regained two-thirds of the weight they lost in just one year. For older adults in particular, a careful nutrition plan and strength-training routine are absolutely essential to mitigating the side effects of anti-obesity drugs. As always, talk to your provider about the trade-offs when considering starting any medication for weight loss.
Additional sources:
