{"id":7602,"date":"2024-04-03T08:02:21","date_gmt":"2024-04-03T12:02:21","guid":{"rendered":"https:\/\/www.silvercentury.org\/?p=7602"},"modified":"2024-04-09T21:23:06","modified_gmt":"2024-04-10T01:23:06","slug":"should-older-people-take-the-new-weight-loss-drugs","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2024\/04\/should-older-people-take-the-new-weight-loss-drugs\/","title":{"rendered":"Should Older People Take the New Weight Loss Drugs?"},"content":{"rendered":"

The new drugs being used to help people lose weight seem like game changers, but the studies done on them haven\u2019t included enough older adults, which raises lots of questions. In this article, journalist Judith Graham explains what\u2019s making some doctors think twice before prescribing the new medications for their older patients. <\/span><\/i>KFF Health News<\/span><\/a> posted her article on July 25, 2023, and it also ran on the <\/span><\/i>Washington Post<\/span><\/a>. <\/span>Funding from the Silver Century Foundation helps <\/span><\/i>KFF Health News<\/span> develop articles (like this one) on longevity and related health and social issues.<\/span><\/i><\/p>\n

Corlee Morris has dieted throughout her adult life.<\/span><\/p>\n

After her weight began climbing in high school, she spent years losing 50 or 100 pounds then gaining it back. Morris, 78, was at her heaviest in her mid-40s, standing 5 feet 10\u00bd inches and weighing 310 pounds. The Pittsburgh resident has had diabetes for more than 40 years.<\/span><\/p>\n

Managing her weight was a losing battle until Morris\u2019 doctor prescribed a Type 2 diabetes medication, Ozempic, four months ago. It\u2019s one in a new category of medications changing how ordinary people as well as medical experts think about obesity, a condition that affects nearly four in 10 people 60 and older.<\/span><\/p>\n

The drugs include Ozempic\u2019s sister medication, Wegovy, a weight loss drug with identical ingredients, which the FDA approved in 2021, and Mounjaro, approved as a diabetes treatment in 2022. (Ozempic was approved for diabetes in 2017.) Several other drugs are in development.<\/span><\/p>\n

The medications reduce feelings of hunger, generate a sensation of fullness and have been shown to help people lose an average of 15 percent or more of their weight.<\/span><\/p>\n

\u201cIt takes your appetite right away. I wasn\u2019t hungry at all and I lost weight like mad,\u201d said Morris, who has shed 40 pounds.<\/span><\/p>\n

But how these medications will affect older adults in the long run isn\u2019t well understood. (Patients need to remain on the drugs permanently or risk regaining the weight they\u2019ve lost.)<\/span><\/p>\n

Will they help prevent cardiovascular disease and other chronic illnesses in obese older adults? Will they reduce rates of disability and improve people\u2019s ability to move and manage daily tasks? Will they enhance people\u2019s lives and alleviate symptoms associated with obesity-related chronic illnesses?<\/span><\/p>\n

Unfortunately, clinical trials of the medications haven\u2019t included significant numbers of people ages 65 and older, leaving gaps in the available data.<\/span><\/p>\n

Medicare doesn\u2019t cover weight-loss medications. If it did, and everyone who needs them took them, the cost would be in the billions. <\/b><\/p><\/blockquote>\n

While the drugs appear to be safe\u2014the most common side effects are nausea, diarrhea, vomiting, constipation and stomach pain\u2014\u201cthey\u2019ve only been on the market for a few years and caution is still needed,\u201d said Mitchell Lazar, MD, founding director of the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania Perelman School of Medicine.<\/span><\/p>\n

Given these uncertainties, how are experts approaching the use of the new obesity medications in older people? As might be expected, opinions and practices vary. But several themes emerged in nearly two dozen interviews.<\/span><\/p>\n

The first was frustration with limited access to the drugs. Because Medicare doesn\u2019t cover weight loss medications and they can cost more than $10,000 a year, seniors\u2019 ability to get the new drugs is restricted.<\/span><\/p>\n

There is an exception: Medicare will cover Ozempic and Mounjaro if an older adult has diabetes, because the insurance program pays for diabetes therapies.<\/span><\/p>\n

\u201cWe need Medicare to cover these drugs,\u201d said Shauna Matilda Assadzandi, MD, a geriatrician at the University of Pittsburgh who cares for Morris. Recently, she said, she tried to persuade a Medicare Advantage plan representative to authorize Wegovy for a patient with high blood pressure and cholesterol who was gaining weight rapidly.<\/span><\/p>\n

\u201cI\u2019m just waiting for this patient\u2019s blood sugar to rise to a level where diabetes can be diagnosed. Wouldn\u2019t it make sense to intervene now?\u201d she remembered saying. <\/span><\/p>\n

The representative\u2019s answer: \u201cNo. We have to follow the rules.\u201d<\/span><\/p>\n

Seeking to change that, a bipartisan group of lawmakers has reintroduced the Treat and Reduce Obesity Act, which would require Medicare to cover weight loss drugs. But the proposal, which had been considered previously, has languished amid concerns over enormous potential costs for Medicare.<\/span><\/p>\n

If all beneficiaries with an obesity diagnosis took brand-name semaglutide drugs (the new class of medications), annual costs <\/span>would top $13.5 billion<\/a>,<\/span> according to a recent analysis in the <\/span>New England Journal of Medicine<\/span><\/i>. If all older obese adults on Medicare\u2014a significantly larger population\u2014took them, the cost would exceed the total spent on Medicare\u2019s Part D drug program, which was $145 billion in 2019.<\/span><\/p>\n

The new drugs are generally recommended for people with a BMI (body mass index) that\u2019s over 30\u2014or over 26 if they have an obesity-related condition like diabetes. <\/b><\/p><\/blockquote>\n

Laurie Rich, 63, of Canton, MA, was caught off guard by Medicare\u2019s policies, which have applied to her since she qualified for Social Security Disability Insurance in December. Before that, Rich took Wegovy and another weight loss medication\u2014both covered by private insurance\u2014and she\u2019d lost nearly 42 pounds. Now, Rich can\u2019t get Wegovy and she\u2019s regained 14 pounds.<\/span><\/p>\n

\u201cI haven\u2019t changed my eating. The only thing that\u2019s different is that some signal in my brain is telling me I\u2019m hungry all the time,\u201d Rich told me. \u201cI feel horrible.\u201d She knows that if she gains more weight, her care will cost much more.<\/span><\/p>\n

While acknowledging difficult policy decisions that lie ahead, experts voiced considerable agreement on which older adults should take these drugs.<\/span><\/p>\n

Generally, the medications are recommended for people with a body mass index over 30 (the World Health Organization\u2019s <\/span>definition of obesity<\/span>) and those with a BMI of 27 or above and at least one obesity-related condition, such as diabetes, high blood pressure or high cholesterol. There are no guidelines for their use in people 65 and older. (BMI is calculated based on a person\u2019s weight and height.)<\/span><\/p>\n

But those recommendations are problematic because BMI can under- or overestimate older adults\u2019 body fat, the most problematic feature of obesity, noted Rodolfo Galindo, MD, director of the Comprehensive Diabetes Center at the University of Miami Health System.<\/span><\/p>\n

Dennis Kerrigan, PhD, director of weight management at Henry Ford Health in Michigan, a system with five hospitals, suggests physicians also examine waist circumference in older patients because abdominal fat puts them at higher risk than fat carried in the hips or buttocks. (For men, a waist over 40 inches is of concern; for women, 35 is the threshold.)<\/span><\/p>\n

Fatima Stanford, MD, an obesity medicine scientist at Massachusetts General Hospital, said the new drugs are \u201cbest suited for older patients who have clinical evidence of obesity,\u201d such as elevated cholesterol or blood sugar, and people with serious obesity-related conditions, such as osteoarthritis or heart disease.<\/span><\/p>\n

Since going on Mounjaro three months ago, Muriel Branch, 73, of Perryville, AR, has lost 40 pounds and stopped taking three medications as her health has improved. \u201cI feel real good about myself,\u201d she told me.<\/span><\/p>\n

While shedding pounds, older adults need to exercise, to avoid losing too much muscle mass.<\/b><\/p><\/blockquote>\n

When adults with obesity lose weight, their risk of dying is <\/span>reduced by up to 15 percent<\/a>,<\/span> according to Dinesh Edem, MD, Branch\u2019s doctor and the director of the medical weight management program at the University of Arkansas for Medical Sciences.<\/span><\/p>\n

Still, weight loss alone should not be recommended to older adults, because it entails the loss of muscle mass as well as fat, experts agree. And with aging, the shrinkage of muscle mass that starts earlier in life accelerates, contributing to falls, weakness, the loss of functioning and the onset of frailty.<\/span><\/p>\n

Between ages 60 and 70, about 12 percent of muscle mass falls away, researchers estimate; after 80, it <\/span>reaches 30 percent<\/a>.<\/span> <\/span><\/p>\n

To preserve muscle mass, seniors losing weight should be prescribed physical activity\u2014both aerobic exercise and strength training, experts agree.<\/span><\/p>\n

Also, as older adults taking weight loss drugs eat less, \u201cit\u2019s critically important that their diet includes adequate protein and calcium to preserve bone and muscle mass,\u201d said Anne Newman, MD, director of the Center for Aging and Population Health at the University of Pittsburgh.<\/span><\/p>\n

Ongoing monitoring of older adults having gastrointestinal side effects is needed to ensure they\u2019re getting enough food and water, said Jamy Ard, MD, co-director of Wake Forest Baptist Health Weight Management Center.<\/span><\/p>\n

Generally, the goal for older adults should be to lose one to two pounds a week, with attention to diet and exercise accompanying medication management.<\/span><\/p>\n

\u201cMy concern is, once we put patients on these obesity drugs, are we supporting lifestyle changes that will maintain their health? Medication alone won\u2019t be sufficient; we will still need to address behaviors,\u201d said Sukhpreet Singh, MD, system medical director at Henry Ford\u2019s weight management program.<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Corlee Morris has dieted throughout her adult life. <\/span>After her weight began climbing in high school, she spent years losing 50 or 100 pounds then gaining it back. <\/span><\/p>\n

Read more Should Older People Take the New Weight Loss Drugs?<\/span> ›<\/span><\/a><\/div>\n

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