Think about an older man goes in to see his physician. He’s 72 years previous and reasonably obese: 5-foot-10, 190 kilos. His blood assessments present excessive ranges of triglycerides. Given his BMI—27.3—the person qualifies for taking semaglutide or tirzepatide, two of the wildly standard injectable medication for diabetes and weight problems which have produced dramatic weight reduction in scientific trials. So he asks for a prescription, as a result of his fiftieth faculty reunion is approaching and he’d wish to get again to his freshman-year weight.
He actually might use these medication to shed extra pounds, says Thomas Wadden, a scientific psychologist and weight problems researcher on the College of Pennsylvania, who not too long ago laid out this hypothetical in a tutorial paper. However ought to he? And what in regards to the tens of tens of millions of Individuals 65 and older who aren’t merely making an attempt to slim down for a cocktail celebration, however dwell with diagnosable weight problems? Ought to they be on Wegovy or Zepbound?
Already, seniors make up 26.6 p.c of the individuals who have been prescribed these and different GLP-1 agonists, together with Ozempic, since 2018, in keeping with a report from Truveta, which pulls knowledge from a big community of health-care methods. Within the coming years, that proportion might rise even greater: The bipartisan Deal with and Cut back Weight problems Act, introduced in Congress final July, would permit Medicare to cowl drug remedies for weight problems amongst its roughly 50 million Half D enrollees above the age of 65; in precept, about two-fifths of that quantity would qualify as sufferers. Even when this regulation doesn’t go (and it’s been launched half a dozen occasions since 2012), America’s retirees will proceed to be prescribed these medication for diabetes in monumental numbers, and so they’ll be dropping pounds on them as nicely. A technique or one other, the Boomers shall be giving form to our Ozempic Age.
Economists say the fee to Medicare of giving new medication for weight problems to only a fraction of this ageing era could be staggering—$13.6 billion a yr, in keeping with an estimate revealed in The New England Journal of Medication final March. However the well being results of such a program may also be unsettling. Till not too long ago, the very notion of prescribing any type of weight reduction by any means to an aged affected person—i.e., somebody 65 or older—was thought of suspect, even harmful. “Advising weight reduction in overweight older adults remains to be shunned within the medical neighborhood,” the geriatric endocrinologist Dennis Villareal and his co-authors wrote in a 2013 “evaluation of the controversy” for a medical journal. Greater than a decade later, clinicians are nonetheless struggling to succeed in consensus on security, Villareal instructed me.
Ample analysis reveals that interventions for seniors with weight problems can resolve related problems. Wadden helped run a years-long, randomized trial of dramatic calorie discount—utilizing liquid meal replacements, partly—and stringent train recommendation for 1000’s of obese adults with sort 2 diabetes. “Clearly the individuals who had been older did have advantages when it comes to improved glycemic management and blood-pressure management,” he instructed me. Different, smaller research led by Villareal discover that older individuals who succeed at dropping pounds by way of weight loss plan and train find yourself feeling more robust.
Such outcomes are important on their very own phrases, says John Batsis, who treats and research geriatric weight problems on the UNC College of Medication. “After we discuss older adults, we actually have to be eager about what’s necessary to older adults,” he instructed me. “It’s for them to have the ability to get on the ground and play with their grandchildren, or to have the ability to stroll down the hallway with out being utterly exhausted.” However weight reduction also can have opposed results. When an individual addresses their weight problems by way of weight-reduction plan alone, as a lot as 25 p.c of the burden they lose derives from lack of muscle, bone, and different fat-free tissue. For seniors who, by way of pure ageing, are already close to the brink of creating a purposeful impairment, a sudden drop like this might be enfeebling. Wadden’s trial discovered that, among the many individuals who had been on the weight-loss program for greater than a decade, their threat of fracture to the hip, shoulder, higher arm, or pelvis elevated by 39 percent. A similar increase has turned up in research of sufferers who endure bariatric surgical procedure, Batsis instructed me.
The impact of weight-reduction plan on muscle and bone could be attenuated, however not prevented, by way of resistance coaching. And weight problems itself—which is related to greater bone density, however maybe additionally diminished bone high quality—could pose its personal fracture dangers, Batsis mentioned. However even when a weight-loss remedy advantages an older affected person, what occurs when it ends? Folks are likely to regain fats, however they don’t get well bone and muscle, Debra Waters, the director of gerontology analysis on the College of Otago, in New Zealand, instructed me. That makes the long-term results of those interventions for older adults very murky. “What occurs once they’re 80? Are they going to have actually poor bone high quality, and be at greater threat of fracture? We don’t know,” Waters mentioned. “It’s a fairly large gamble to take, for my part.”
Villareal instructed me that medical doctors ought to apply “the final precept of beginning sluggish and going sluggish” when their older sufferers try to shed extra pounds. However that method doesn’t essentially sq. with the fast and memorable weight reduction seen in sufferers who’re taking semaglutide or tirzepatide, which can produce a higher proportional lack of muscle and bone. (For semaglutide, it seems to be about 40 p.c.)
Then once more, when given to laboratory animals, GLP-1 medication appear to tamp down irritation within the mind; and so they’re now in scientific trials to see whether or not they would possibly slow the progression of Alzheimer’s illness and dementia. Their a number of established advantages might additionally assist seniors handle a number of persistent issues—diabetes, weight problems, fatty liver disease, and kidney disease, as an illustration—suddenly. “Such a ‘one-stop store’ method can result in discount of remedy burden, opposed drug occasions, hypoglycemic episodes, remedy prices, and remedy nonadherence,” one group of geriatricians proposed in 2019.
General, Batsis stays optimistic. “As a clinician, I’m very enthusiastic about these drugs,” he instructed me. As a scientist, although, he’s inclined to attend and see. It’s certainly true that some diploma of weight reduction is a superb concept for some older sufferers. “However the million-dollar query is: What’s the candy spot? How a lot weight is de facto sufficient? Is it 5 to 10 p.c? Or is it 25 p.c? We don’t know.” Waters mentioned that if Medicare goes to pay for folks’s Wegovy, then it also needs to cowl scans of their physique composition, to assist predict how weight reduction would possibly have an effect on their muscle tissues and bones. Wadden mentioned he thinks that remedies ought to be restricted to individuals who have particular, weight-related problems. For everybody else—as for the hypothetical 72-year-old man who’s prepping for his faculty reunion—he counsels prudence.
To some extent, such recommendation is inappropriate. Older individuals are already on Ozempic, and so they’re already on Trulicity, and a few of them are already taking GLP-1 medication as a remedy for weight problems. Truveta reported that the sufferers in its member health-care methods who’re over 65 have acquired 281,000 prescriptions for GLP-1 medication throughout the previous 5 years. Given the community’s measurement, one can assume that no less than 1 million seniors, total, have already tried these drugs. Hundreds of thousands extra will strive them within the years to come back. If we nonetheless have questions on their use, mass expertise will begin offering solutions.
