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What seniors should know about Ozempic and new weight loss drugs

Corlee Morris has dieted throughout her adult life.

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.

Managing her weight was a losing battle until Morris’s doctor prescribed the Type 2 diabetes medication Ozempic four months ago. It’s one in a new category of medications changing how ordinary people as well as medical experts think about obesity, which affects more than 4 in 10 people 60 and older. Ozempic and similar drugs target receptors in the brain to reduce feelings of hunger and generate a sensation of fullness; they have been shown to help people lose an average of 15 percent or more of their weight.

“It takes your appetite right away. I wasn’t hungry at all, and I lost weight like mad,” said Morris, who has shed 40 pounds.

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.

Will Medicare pay for Ozempic?

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.

In the near term, because Medicare doesn’t cover weight-loss medications and these new drugs can cost more than $10,000 a year, seniors’ ability to get the medications is restricted.

There is an exception: Medicare will cover Ozempic and Mounjaro if an older adult has diabetes, because the insurance program pays for diabetes therapies.

“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.

“I’m just waiting for this patient’s blood sugar to rise to a level where diabetes can be diagnosed. Wouldn’t it make sense to intervene now?” she remembered saying. The representative’s answer: “No. We have to follow the rules.”

Seeking to change that, a bipartisan group of lawmakers introduced the Treat and Reduce Obesity Act, which would require Medicare to cover weight-loss drugs. But the proposal has languished amid concerns over enormous potential costs for Medicare.

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.

Which seniors should take weight-loss drugs?

While acknowledging difficult policy decisions lie ahead, experts voiced considerable agreement on which older adults should take the drugs.

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.)

But those recommendations are problematic because BMI can under- or overestimate older adults’ body fat, the most problematic feature of obesity, noted Rodolfo Galindo, director of the Comprehensive Diabetes Center at the University of Miami Health System.

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.

Since going on Mounjaro three months ago, Muriel Branch, 73, of Perryville, Ark., has lost 40 pounds and stopped taking three medications as her health has improved. “I feel real good about myself,” she told me.

When adults with obesity lose weight, their risk of dying is reduced by up to 15 percent, according to Dinesh Edem, Branch’s doctor and the director of the medical weight management program at the University of Arkansas for Medical Sciences.

Why weight loss is different for seniors

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.

Between ages 60 and 70, about 12 percent of muscle mass falls away, researchers estimate; after 80, it reaches 30 percent.

To preserve muscle mass, seniors losing weight should be prescribed physical activity — both aerobic exercise and strength training, experts agree.

Also, as older adults taking weight loss drugs eat less, “it’s critically important that their diet includes adequate protein and calcium to preserve bone and muscle mass,” said Anne Newman, director of the Center for Aging and Population Health at the University of Pittsburgh.

Ongoing monitoring of older adults having gastrointestinal side effects is needed to ensure they are getting enough food and water, said Jamy Ard, co-director of Wake Forest Baptist Health Weight Management Center.

Generally, the goal for older adults should be to lose 1 to 2 pounds a week, with attention to diet and exercise accompanying medication management.

“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.

KFF Health News, formerly known as Kaiser Health News or KHN, is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.

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