Are Weight Loss Drugs Risky for Older Adults?

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.

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.

“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.