Weight management was a losing battle for Morris until four months ago, when his doctor prescribed Ozempic for type 2 diabetes. It is one of a new category of medicines that is changing the way not only medical professionals but also the general public think about obesity. More than 4 in 10 people are over 60. Ozempic and similar drugs target receptors in the brain to reduce hunger and create a feeling of fullness. These have been shown to help you lose weight by an average of 15% or more.
“I lose my appetite very quickly. I wasn’t hungry at all and I lost like crazy,” said Morris, who lost 40 pounds.
However, clinical trials of these drugs have not included a significant number of people over the age of 65, leaving gaps in the available data, so it is unclear how long-term these drugs might affect the elderly. I don’t know how much impact it will have. Beyond that, how the elderly will pay for these expensive drugs is also a big problem.
Given these uncertainties, how are experts approaching the use of new obesity drugs in older adults? Opinions and practices vary, but a few themes emerge from nearly 20 interviews. became.
Will Medicare pay for Ozempic?
The Food and Drug Administration approved Ozempic, an injectable semaglutide, for the treatment of diabetes in 2017. we gobyMounjaro, a weight loss drug with the same ingredients as Ozempic, was approved by the FDA in 2021. Mounjaro, whose main ingredient is tirzepatide, was approved for the treatment of diabetes in 2022. Several other drugs are in development.
Although these drugs appear to be safe, the most common side effects are nausea, diarrhea, vomiting, constipation, and abdominal pain, but “it’s only been a few years on the market, so caution is still needed.” said founder Mitchell Lazar. Director of the Diabetes, Obesity and Metabolism Institute at the University of Pennsylvania Perelman School of Medicine.
In the short term, Medicare does not cover weight-loss drugs, and these new drugs can cost upwards of $10,000 a year, limiting drug availability for older people.
There are exceptions. Medicare covers Ozempis and Munjaro if older people have diabetes because the insurance program pays for diabetes treatment.
“You need Medicare to cover these drugs,” says Shauna Matilda Assandi, a geriatrician at the University of Pittsburgh who cares for Morris. Recently, she said, she tried to convince the people in charge of her Advantage Her Plan at Medicare to authorize her Wegovy for patients with hypertension and cholesterol spikes.
“I’m just waiting for this patient’s blood sugar to rise to diagnostic levels of diabetes. Wouldn’t it make sense to intervene now?” The representative’s answer is “No. We have to follow the rules.”
In an attempt to change this situation, a bipartisan group of lawmakers Obesity Treatment and Reduction Lawshould be covered by Medicare weight loss pills. But the proposal has stalled amid concerns over the potentially huge costs of Medicare.
Annual cost for all beneficiaries diagnosed with obesity taking brand name semaglutide drug will exceed $13.5 billion, according to a recent analysis in the New England Journal of Medicine. If all obese older people enrolled in Medicare (a much larger population) took these, the cost would exceed the total spent on Medicare’s Part D drug program ($145 billion in 2019). will exceed
Laurie Rich, 63, of Canton, Massachusetts, was caught off guard by the Medicare policies that have been in place for her since she qualified for Social Security Disability Insurance in December. Prior to that, Rich had been on Wegobee and another weight-loss drug (both covered by private insurance), and had lost nearly 42 pounds. Now Ms. Rich is unable to get Wigoby and her weight is 14 pounds back.
“I haven’t changed my diet. The only difference is that the signals in my brain are constantly telling me I’m hungry,” Rich said. “I feel horrible.” If she puts on more weight, she says, her treatment will cost even more.
Which older people should take weight loss medications?
While acknowledging the difficult policy decisions ahead, experts expressed considerable agreement about which older people should take the drugs.
In general, this drug is recommended for people with a BMI greater than 30 (the World Health Organization standard). Definition of “obesity””) and those with a BMI of 27 or greater and who have at least one obesity-related disease such as diabetes, hypertension, or high cholesterol.There are no guidelines for use in people over the age of 65. calculated based on.)
But Rodolfo Galindo, director of the University of Miami Health Systems Comprehensive Diabetes Center, said these recommendations were not supported because BMI can underestimate or overestimate body fat in older adults, the most problematic feature of obesity. pointed out there was a problem.
Dennis Kerrigan, director of weight management at Henry Ford Health in Michigan, suggests doctors also check the girth of older patients because abdominal fat poses a higher risk than fat in the hips and buttocks. . For men, waists greater than 40 inches are dangerous. Concern; 35 is the threshold for women.
Fatima Stanford, an obesity scientist at Massachusetts General Hospital, said the new drug could be used in “elderly patients with clinical evidence of obesity” such as elevated cholesterol and blood sugar levels, as well as in patients with serious obesity-related conditions such as osteoarthritis. said to be best suited for Or heart disease.
Muriel Branch, 73, of Perryville, Arkansas, has dropped 40 pounds and stopped taking three medications after starting the Munjaro regimen three months ago, and her health improved. “I’m really happy with myself,” she told me.
As obese adults lose weight, their risk of death increases Up to 15% reductionsaid Dinesh Edem, a branch physician and director of the medical weight management program at the Arkansas School of Medicine.
Why Older People Lose Weight Differently
Still, experts agree that weight loss alone should not be recommended for older people because weight loss alone can lead to loss of muscle mass as well as fat. And with age, the loss of muscle mass that begins early in life accelerates, leading to the development of falls, muscle weakness, loss of function, and frailty.
Researchers estimate that about 12 percent of muscle mass is lost between the ages of 60 and 70. After the age of 80, reach 30 percent.
To preserve muscle mass, experts agree that physical activity, both aerobic and strength training, should be prescribed for older people who are losing weight.
And because older people on weight-loss medications eat less, “it’s very important that your diet includes enough protein and calcium to help maintain bone and muscle mass,” says Pittsburgh. Ann Newman, director of the university’s Center for Aging and Population Health, said. .
Jamie Eard, co-director of the Wake Forest Baptist Center for Health and Weight Management, said older adults with gastrointestinal side effects need continued monitoring to make sure they are getting enough food and water. said there is.
In general, the goal for older adults is to lose 1 to 2 pounds per week while paying attention to diet and exercise along with medication management.
“My concern is, after giving patients these anti-obesity drugs, can we support them in making lifestyle changes to keep them healthy? No. The behavior still needs to be addressed,” said Sprout Singh, systems medical director for Henry Ford’s weight management program.
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