Corlee Morris has dieted all through her grownup life.
After her weight started climbing in highschool, she spent years dropping 50 or 100 kilos then gaining it again. Morris, 78, was at her heaviest in her mid-40s, standing 5 toes 10½ inches and weighing 310 kilos. The Pittsburgh resident has had diabetes for greater than 40 years.
Managing her weight was a dropping battle till Morris’ physician prescribed a Sort 2 diabetes medicine, Ozempic, 4 months in the past. It’s one in a brand new class of medicines altering how atypical individuals in addition to medical consultants take into consideration weight problems, a situation that impacts almost 4 in 10 individuals 60 and older.
The medication embrace Ozempic’s sister medicine, Wegovy, a weight reduction drug with similar components, which the FDA authorized in 2021, and Mounjaro, authorized as a diabetes therapy in 2022. (Ozempic was authorized for diabetes in 2017.) A number of different medication are in improvement.
The drugs cut back emotions of starvation, generate a sensation of fullness, and have been proven to assist individuals lose a median of 15% or extra of their weight.
“It takes your urge for food instantly. I wasn’t hungry in any respect and I misplaced weight like mad,” stated Morris, who has shed 40 kilos.
However how these drugs will have an effect on older adults in the long term isn’t nicely understood. (Sufferers want to stay on the medication completely or danger regaining the load they’ve misplaced.)
Will they assist stop heart problems and different power sicknesses in overweight older adults? Will they cut back charges of incapacity and enhance individuals’s capacity to maneuver and handle every day duties? Will they improve individuals’s lives and alleviate signs related to obesity-related power sicknesses?
Sadly, scientific trials of the drugs haven’t included important numbers of individuals ages 65 and older, leaving gaps within the out there knowledge.
Whereas the medication seem like protected — the most typical uncomfortable side effects are nausea, diarrhea, vomiting, constipation, and abdomen ache — “they’ve solely been in the marketplace for a number of years and warning remains to be wanted,” stated Mitchell Lazar, founding director of the Institute for Diabetes, Weight problems and Metabolism on the College of Pennsylvania Perelman Faculty of Drugs.
Given these uncertainties, how are consultants approaching the usage of the brand new weight problems drugs in older individuals? As could be anticipated, opinions and practices fluctuate. However a number of themes emerged in almost two dozen interviews.
The primary was frustration with restricted entry to the medication. As a result of Medicare doesn’t cowl weight reduction drugs they usually can value greater than $10,000 a 12 months, seniors’ capacity to get the brand new medication is restricted.
There’s an exception: Medicare will cowl Ozempic and Mounjaro if an older grownup has diabetes, as a result of the insurance coverage program pays for diabetes therapies.
“We want Medicare to cowl these medication,” stated Shauna Matilda Assadzandi, a geriatrician on the College of Pittsburgh who cares for Morris. Not too long ago, she stated, she tried to steer a Medicare Benefit plan consultant to authorize Wegovy for a affected person with hypertension and ldl cholesterol who was gaining weight quickly.
“I’m simply ready for this affected person’s blood sugar to rise to a stage the place diabetes could be identified. Wouldn’t it make sense to intervene now?” she remembered saying. The consultant’s reply: “No. We’ve got to observe the foundations.”
In search of to vary that, a bipartisan group of lawmakers launched the Deal with and Cut back Weight problems Act, which might require Medicare to cowl weight reduction medication. However the proposal has languished amid issues over huge potential prices for Medicare.
If all beneficiaries with an weight problems analysis took brand-name semaglutide medication (the brand new class of medicines), annual prices would high $13.5 billion, based on a current evaluation in The New England Journal of Drugs. If all older overweight adults on Medicare — a considerably bigger inhabitants — took them, the fee would exceed the overall spent on Medicare’s Half D drug program, which was $145 billion in 2019.
Laurie Wealthy, 63, of Canton, Massachusetts, was caught off guard by Medicare’s insurance policies, which have utilized to her since she certified for Social Safety Incapacity Insurance coverage in December. Earlier than that, Wealthy took Wegovy and one other weight reduction medicine — each lined by non-public insurance coverage — and he or she’d misplaced almost 42 kilos. Now, Wealthy can’t get Wegovy and he or she’s regained 14 kilos.
“I haven’t modified my consuming. The one factor that’s completely different is that some sign in my mind is telling me I’m hungry on a regular basis,” Wealthy advised me. “I really feel horrible.” She is aware of that if she beneficial properties extra weight, her care will value far more.
Whereas acknowledging tough coverage choices that lie forward, consultants voiced appreciable settlement on which older adults ought to take these medication.
Usually, the drugs are beneficial for individuals with a physique mass index over 30 (the World Well being Group’s definition of weight problems) and people with a BMI of 27 or above and at the least one obesity-related situation, similar to diabetes, hypertension, or excessive ldl cholesterol. There aren’t any pointers for his or her use in individuals 65 and older. (BMI is calculated primarily based on an individual’s weight and peak.)
However these suggestions are problematic as a result of BMI can under- or overestimate older adults’ physique fats, essentially the most problematic characteristic of weight problems, famous Rodolfo Galindo, director of the Complete Diabetes Middle on the College of Miami Well being System.
Dennis Kerrigan, director of weight administration at Henry Ford Well being in Michigan, a system with 5 hospitals, suggests physicians additionally look at waist circumference in older sufferers as a result of belly fats places them at larger danger than fats carried within the hips or buttocks. (For males, a waist over 40 inches is of concern; for girls, 35 is the brink.)
Fatima Stanford, an weight problems drugs scientist at Massachusetts Common Hospital, stated the brand new medication are “greatest fitted to older sufferers who’ve scientific proof of weight problems,” similar to elevated ldl cholesterol or blood sugar, and other people with severe obesity-related situations similar to osteoarthritis or coronary heart illness.
Since occurring Mounjaro three months in the past, Muriel Department, 73, of Perryville, Arkansas, has misplaced 40 kilos and stopped taking three drugs as her well being has improved. “I really feel actual good about myself,” she advised me.
When adults with weight problems drop some weight, their danger of dying is lowered by as much as 15%, based on Dinesh Edem, Department’s physician and the director of the medical weight administration program on the College of Arkansas for Medical Sciences.
Nonetheless, weight reduction alone shouldn’t be beneficial to older adults, as a result of it entails the lack of muscle mass in addition to fats, consultants agree. And with getting old, the shrinkage of muscle mass that begins earlier in life accelerates, contributing to falls, weak point, the lack of functioning, and the onset of frailty.
Between ages 60 and 70, about 12% of muscle mass falls away, researchers estimate; after 80, it reaches 30%.
To protect muscle mass, seniors dropping pounds ought to be prescribed bodily exercise — each cardio train and power coaching, consultants agree.
Additionally, as older adults taking weight reduction medication eat much less, “it’s critically essential that their eating regimen consists of sufficient protein and calcium to protect bone and muscle mass,” stated Anne Newman, director of the Middle for Getting old and Inhabitants Well being on the College of Pittsburgh.
Ongoing monitoring of older adults having gastrointestinal uncomfortable side effects is required to make sure they’re getting sufficient meals and water, stated Jamy Ard, co-director of Wake Forest Baptist Well being’s Weight Administration Middle.
Usually, the aim for older adults ought to be to lose 1 to 2 kilos per week, with consideration to eating regimen and train accompanying medicine administration.
“My concern is, as soon as we put sufferers on these weight problems medication, are we supporting life-style adjustments that can keep their well being? Remedy alone gained’t be adequate; we are going to nonetheless want to handle behaviors,” stated Sukhpreet Singh, system medical director at Henry Ford’s weight administration program.
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