Obesity affects nearly 40% of Americans age 65 and over, leading to an increased occurrence of heart disease, arthritis, high blood pressure, and impaired mobility among many weight-related diseases and complications.
Though using a GLP-1 medication in this age group is an effective treatment for weight reduction, these drugs can also cause reduced muscle mass potentially leading to reduced strength and mobility and increased risk of falls and fractures.
It has been reported that 8% of older adults have taken a GLP-1 but 45-65% discontinue its use within 1 year, leading to weight cycling, and in some individuals, sarcopenic obesity.
It’s important to note that less than 10% of participants in the GLP-1 medication clinical trials were age 65 or older.
I recently participated in a program, Beyond GLP-1’s: Comprehensive Obesity Care to Improve Healthy Aging sponsored by the Abbott Nutrition Health Institute where we reviewed the benefits and concerns about using these highly effective medications in aging adults.
Based on best practices, here are some key takeaways to support optimal health in older adults considering GLP-1 therapy:
1-Identify a Clear Treatment Goal Beyond Weight Loss
Gaining health rather than losing weight is the primary goal of obesity care.
This is particularly true when we choose to treat older adults.
Although the medical problems among middle age and older adults living with obesity may overlap, such as diabetes, heart failure, hypertension and arthritis, the number of complications that an individual acquires increases with age.
These obesity-related complications lead to increased morbidity, polypharmacy, and reduced quality of life and health-span (number of years living a healthy life) in aging adults.
Prescribing a GLP-1 medication can help treat the multitude of weight-related diseases and complications that are common in this age group.
2-Be Cautious when Monitoring
The most common side effects of GLP-1 medications are GI related and occur during the initial months of dose escalation.
Elderly individuals may be more susceptible to the effects of diarrhea and vomiting leading to dehydration, low blood pressure, and acute kidney injury.
An aging individual may also be more responsive to the medication at lower doses and not tolerate a standard dose recommended by the manufacturer.
Prescribing a higher dose may lead to excessive weight loss accompanied by fatigue, weakness and frailty.
Close monitoring with special attention to tolerance and effectiveness of the medication is critical in this population.
3-Focus on Physical Function, Exercise, and Healthy Diet
GLP-1s should never be prescribed without also counseling on lifestyle management.
GLP-1s are effective in reducing the quantity of food but do not ensure diet quality.
Similarly, the medications do not compel an individual to become more physically active or engage in aerobic and resistance exercise – healthy behaviors that are predictive of healthy aging.
When used with diligence and supervision that includes lifestyle modification counseling, GLP-1 medications hold promise for the aging adult.
RK
Robert Kushner, MD
