But, to paraphrase the marketing lingo: Is Ozempic right for you?

There’s no doubt that the new anti-obesity drugs are effective at helping people shed pounds—a potential boon for the nearly 42 percent of people over 60 in the U.S. who are affected by obesity. “Many of them will benefit,” says John Batsis, M.D., associate professor in the division of geriatric medicine and the department of nutrition at the University of North Carolina at Chapel Hill. “But the older you are, the more reason you have to be cautious.”

Weight loss can be fraught with dangers for people 60 and older, and in the clinical trials for semaglutide that reported the breakdown of ages, just 3 to 10 percent of subjects were 75 or older. “Our bodies change with age, so the results in younger people don’t necessarily apply to those who are older,” Batsis says.

A New Way to Think About Weight

Over the past 30 years, science has begun to pinpoint the biological underpinnings of obesity. “We now know that when you gain too much weight, the weight-regulating pathways between the intestine and the brain begin to malfunction, which makes you hungrier and prevents you from feeling full,” explains Louis Aronne, M.D., an obesity specialist at Weill Cornell Medicine’s Comprehensive Weight Control Center.

For many patients, this new understanding is a game changer. “I can’t tell you what a relief it was when my doctor said, ‘Your weight is not your fault. This is a treatable medical condition,’ ” says Barbara Hiebel (not her real name), 65, of Chapel Hill, North Carolina. “I weighed 200 pounds and was prediabetic.”

As this new understanding of obesity as a disease began to emerge, researchers testing semaglutide—developed to help people with diabetes regulate blood sugar—noticed that many participants taking the drug were getting slimmer. Turns out, semaglutide mimics intestinal hormones, including glucagon-like peptide-1, or GLP-1, which slows digestion and tells your brain you’re full. The result: You eat less, according to the first study looking at semaglutide for weight loss. Published in 2021 in The New England Journal of Medicine, it found that 50 percent of participants lost 15 percent of their body weight in about 15 months.

The medicine has changed the lives of patients like Hiebel. “My doctor prescribed Ozempic, along with metformin, a diabetes drug, and Contrave, which helps prevent constant thoughts of food,” she says. “I lost 60 pounds and have kept it off—for the first time ever.” In June 2021, the FDA approved semaglutide for the treatment of obesity, under the brand name Wegovy.

How Exactly Do These Drugs Work?

Anti-obesity medications are FDA-approved for people with a body mass index (BMI) of 30 or more, and for those with a BMI of 27 or higher who have at least one weight-related health condition, like heart disease or sleep apnea, says Caroline Apovian, M.D., codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital. “They aren’t intended for healthy people who want to lose a few pounds.”

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 of the serious health problems linked to weight. “We know weight loss can help with hypertension, 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, he adds—and there’s new data suggesting 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.”

But while 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 50

While the promise of a slimmer, healthier you is appealing, there are serious 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. “People who have had obesity for years are at particular risk, because excess abdominal fat promotes declines in muscle mass,” Batsis says. “The longer you’ve had obesity, the more it impacts your muscle.” Meanwhile, half of women and a third of men 50 and older have osteopenia, or low bone mass. Since weight loss can cause additional bone deterioration, it could push people teetering on the brink of osteoporosis over the edge. 

“In clinical trials, participants were prescribed a healthy diet and exercise, along with the medication,” Batsis continues. “Those lifestyle habits are extremely important, especially for those over 50 or 60.”

• Nutrient deficiencies. Semaglutide and similar medications reduce appetite. DelRosso, for example, says she gets full after maybe a half dozen bites of food. One friend refuses to go out to dinner with her because she finds her small appetite irritating. A significantly reduced appetite makes it easier to develop deficiencies in protein, vitamins and minerals, warns Thiara. “It’s not healthy to live on a few bites of food per meal, especially for older people, who may be less likely to get enough nutrients to begin with,” she adds.

• Unintended ongoing weight loss. A seminal 16-year study followed people 45 to 76 years old who lost 6 percent of their body weight with diet and exercise alone. 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 and one of the study’s authors. “More research is needed to weigh the potential harms and benefits in this age group.”

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, a growing body of 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. “It’s ironic,” O’Melia says. “These medications are prescribed for people who have a BMI of 27 and at least one weight-related health consequence—but studies show that a BMI of 27 in later life is correlated with the longest life expectancy.”

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’m deficient in a number of nutrients, so my doctor has me taking vitamins and drinking protein shakes,” she says. “I’ve lost so much weight the skin hangs from my arms and legs, and my face looks like a Halloween skeleton. I feel like my bones aren’t strong enough to support my body,” Wood says. “It has taken a toll on me.”

Ginny Graves writes on health and psychology for Time, Vogue, Outside and other magazines.