Doctors wish more people over 65 took Ozempic

For older people, these medications can help in ways that go beyond losing weight, physicians say. Fewer pounds can lead to more mobility and better balance, allowing older people to become more active. That can boost mood, overall health, and sometimes makes the difference between walking freely or using a wheelchair or cane.

Doctors say they’re hearing more from older people who are interested in taking the drugs. However, seniors face insurance hurdles to get the drugs covered. And doctors note that older people need to be careful about losing muscle mass when on the drugs, as well as possible interactions with other medications.

Nine percent of people 65 and older reported taking GLP-1 medications, such as Ozempic, Wegovy and Zepbound, compared with 19% of people ages 50 to 64, according to a May KFF poll.

“These drugs would really benefit seniors but there’s always these additional worries," says Dr. Sun Kim, an associate professor in the division of endocrinology at Stanford University School of Medicine. “I think sometimes we prioritize the risk over benefit when people get older."

Concerns for seniors

Doctors say it’s important to counsel seniors that they can lose muscle, not just weight, on GLP-1 drugs, increasing their vulnerability to bone problems and injuries. Seniors already grapple with sarcopenia, age-related loss of muscle mass and strength.

The drugs can also be more complex to manage for older people taking multiple medications. Someone with high blood pressure may take a diuretic medication that makes them more prone to dehydration, for instance. And GLP-1s can reduce a person’s appetite for food and fluids, potentially increasing risk of dehydration.

Another significant hurdle for seniors: Medicare, the federal insurance program for people age 65 or older, doesn’t typically cover weight-loss medications—including GLP-1 drugs—if they are prescribed solely for weight loss. Medicare will cover the drugs if they are used to treat Type 2 diabetes, or for people who are overweight or obese and have a history of heart disease.

People who lose weight on the medications in their early 60s could find themselves in a tough spot when they turn 65. Many can’t afford the out-of-pocket cost, which is upward of $1,000 a month. They can try to keep weight off with diet and exercise, or with help from older weight-loss medications, but that approach isn’t always as effective.

Most people on GLP-1 drugs who lose coverage at age 65 end up gaining weight back, says Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston.

Dr. Amanda Velazquez, director of obesity medicine at Cedars-Sinai Center for Weight Management and Metabolic Health in Los Angeles, says when patients are in their early 60s, she explains that they may not have coverage of the drugs once they hit age 65. But she doesn’t discourage them from trying the treatment.

“If we can allow you to improve your health for a period of your life—three, four, five years—that’s better than no improvement of your health for that duration of time," she says.

Precautions and benefits

Extra steps—such as strength training, eating more protein, and losing weight slowly—can counter some of the concerns about muscle loss and weakness, says Dr. Katherine H. Saunders, an obesity medicine physician at Weill Cornell Medicine and co-founder of FlyteHealth, a medical obesity-treatment company.

Dr. Jaime Almandoz, medical director of the Weight Wellness Program and associate professor of internal medicine at UT Southwestern in Dallas, says that when he treats older patients for weight loss, he has them see a dietitian as well. If he’s concerned about balance and falls, he refers them to a physical medicine or rehabilitation program to help them learn how to safely be more active or do resistance training.

He may also increase the dose of GLP-1s more slowly in older people, because many take other medications like blood-pressure or thyroid medications, whose doses may need to change when weight fluctuates.

He says he has seen big improvements in his elderly patients after they lose significant weight, including people who no longer have to use a wheelchair or walking cane, and can walk into his office unassisted.

Every pound someone loses takes 2 to 4 pounds off each joint, says Saunders, so weight loss can help older adults become more mobile, alleviate joint pain and start exercising again. “If somebody loses 25 pounds that’s up to 100 pounds taken off their joints," she says.

Losing weight can also help seniors who are likely to need a joint replacement surgery with the procedure and recovery, says Stanford’s Kim. One of her wheelchair-using patients wanted to lose weight to reduce the burden on her partner who had to frequently lift her up.

“If you’re no longer carrying around an extra 30 to 50 pounds, there’s so much more that people can do," Almandoz says. “Their physical activity increases, which improves their health and their minds."

Taking GLP-1 drugs helped George Barlow, a 78-year-old retired lawyer in Fort Worth, Texas, get down to about 245 pounds from 290. Medicare helped cover the cost because he had prediabetes and a history of heart disease, he says.

Losing weight has helped him in big ways and small, he says. He can more easily get up and out of a chair. He walks on a treadmill twice a week and goes to regular golf games with his friends. “It maintains my ability to get out and socialize," he says.

Write to Sumathi Reddy at Sumathi.Reddy@wsj.com