What seniors should know before trying Ozempic, new weight-loss drugs – The Washington Post

Her weight began climbing in high school, and she spent years losing dozens of pounds, then gaining them back. Morris, 78, was at her heaviest in her mid-40s — at 5 feet 10½ inches tall, she weighed 310 pounds. The Pittsburgh resident also has had diabetes for more than 40 years.

But how these medications will affect older adults in the long run isn’t well understood because clinical trials of the medications haven’t included significant numbers of people ages 65 and older, leaving gaps in the available data. Beyond that, how seniors will pay for these expensive drugs is another big question.

Given these uncertainties, how are experts approaching the use of the new obesity medications in older people? Although opinions and practices vary, several themes emerged in nearly two dozen interviews.

The Food and Drug Administration approved Ozempic, an injectable semaglutide, to treat diabetes in 2017. Wegovy, a weight-loss drug with identical ingredients to Ozempic, was approved by the FDA in 2021. Mounjaro, whose key ingredient is tirzepatide, was approved as a diabetes treatment in 2022. Several other drugs are in development.

While the drugs appear to be safe — the most common side effects are nausea, diarrhea, vomiting, constipation and stomach pain — “they’ve only been on the market for a few years and caution is still needed,” said Mitchell Lazar, founding director of the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania Perelman School of Medicine.

“We need Medicare to cover these drugs,” said Shauna Matilda Assadzandi, 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.

If all beneficiaries with an obesity diagnosis took brand-name semaglutide drugs, annual costs would top $13.5 billion, according to a recent analysis in the New England Journal of Medicine. If all older obese adults on Medicare — a significantly larger population — took them, the cost would exceed the total spent on Medicare’s Part D drug program, which was $145 billion in 2019.

Laurie Rich, 63, of Canton, Mass., was caught off guard by Medicare’s 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 — both covered by private insurance — and she had lost nearly 42 pounds. Now, Rich can’t get Wegovy, and she has regained 14 pounds.

“I haven’t changed my eating. The only thing that’s different is that some signal in my brain is telling me I’m hungry all the time,” Rich said. “I feel horrible.” If she gains more weight, she said, her care will cost much more.

Generally, the medications are recommended for people with a body mass index over 30 (the World Health Organization’s definition of “obese”) 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’s weight and height.)

Dennis Kerrigan, director of weight management at Henry Ford Health in Michigan, 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.

Fatima Stanford, an obesity medicine scientist at Massachusetts General Hospital, said the new drugs are “best suited for older patients who have clinical evidence of obesity,” such as elevated cholesterol or blood sugar, and people with serious obesity-related conditions such as osteoarthritis or heart disease.

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.

“My concern is, once we put patients on these obesity drugs, are we supporting lifestyle changes that will maintain their health? Medication alone won’t be sufficient; we will still need to address behaviors,” said Sukhpreet Singh, system medical director at Henry Ford’s weight management program.

This content was originally published here.

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