GLP-1 drugs such as Ozempic are now associated with better blood sugar management, heart health, and weight loss. While a lifeline for many, these medications aren’t for everyone. In particular, people ages 65 and older may be susceptible to distinct risks, including muscle mass loss, when taking GLP-1s and similar drugs. Here’s what older adults and their loved ones need to know about the potential advantages and drawbacks of GLP-1s.
Why Ozempic Is Risky for Older Adults General Risks Originally designed to treat type 2 diabetes, GLP-1 drugs work by mimicking the hormone glucagon-like peptide 1, which prompts the pancreas to make more insulin after meals. The extra insulin helps regulate blood sugar , but the drugs can also reduce appetite and slow the movement of food from the stomach to the small intestine, helping people feel full faster and thus promoting weight loss. Weight loss is associated with a reduced risk of health conditions such as type 2 diabetes and heart disease, which disproportionately affect older adults. e60dc2a1-f33c-4a05-9b50-8e3e8e5976299b67453e-09ad-4073-b6ca-c0eca62ce0d2 But one thing to keep in mind with weight loss is muscle and bone also decrease, says John Batsis, MD , an associate professor of medicine in the department of geriatric medicine at the University of North Carolina in Chapel Hill and an American Board of Obesity Medicine (ABOM) diplomate. Strength training and a protein-rich diet can help to attenuate loss of muscle and bone, but shedding pounds rapidly — as most do on GLP-1s — may inhibit the body’s ability to compensate. Batsis says the same phenomenon happens with bariatric surgery. That’s particularly problematic for older adults, who naturally have less bone and muscle mass than younger people due to age-related degradation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b0798046-ee60-4e99-98f5-3aaa4095ac67 By reducing bone density and strength, weight loss may increase the risk of falls and fractures, to which older adults are already more vulnerable.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299f42195a-0d4d-42c9-81b1-443e653239fb One study found people who participated in a weight loss program for more than 10 years had a 39 percent greater risk of hip, shoulder, upper arm, and pelvis fractures. Participants, all of whom had type 2 diabetes, were ages 45 to 76. About 60 percent were women, while 40 percent were men.e60dc2a1-f33c-4a05-9b50-8e3e8e59762983151f9a-d86b-45df-85de-6f83c01589b7 Other research has found similar results in people who have undergone bariatric surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299cbef2ad-05c7-48db-882e-0d5f625a67b4 Meanwhile, muscle loss can impede older adults’ physical function and ability to live independently, Batsis says. Diminished strength can also raise the risk of potentially fatal falls, according to a study in the I nternational Journal of Environmental Research and Public Health .e60dc2a1-f33c-4a05-9b50-8e3e8e59762930639e2a-c0c7-426d-8ed0-99b1a3c23edc “Both muscle mass and strength impact muscle quality, which is key to ensuring individuals can conduct their daily activities,” he says. “Losing muscle mass and strength can lead to sarcopenia, which increases the risk for functional decline, disability, nursing home placement, and death.” Sarcopenia involves age-related, involuntary loss of muscle mass, strength, and function.e60dc2a1-f33c-4a05-9b50-8e3e8e597629068e3ded-efa2-4baa-9624-df094032410c Everyone gradually begins to lose muscle around age 30, but sarcopenia accelerates this process and can be dangerous.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a6131433-a16c-4b67-b3ce-ef0c43d170b5 Although age is the predominant risk factor, physical inactivity and certain health conditions, including obesity, malnutrition, rheumatoid arthritis , insulin resistance, and chronic illnesses such as HIV, cancer, and diabetes, may also contribute, according to the Cleveland Clinic.e60dc2a1-f33c-4a05-9b50-8e3e8e59762943b90862-4f89-43b3-b0b0-38c281f0ea1a Some studies have also linked GLP-1 agonists to conditions such as pancreatitis, gastroparesis — a condition that prevents the stomach from emptying properly — and thyroid cancer in patients of all ages.e60dc2a1-f33c-4a05-9b50-8e3e8e597629321039cb-f71c-463a-a98d-0954f58f9622e60dc2a1-f33c-4a05-9b50-8e3e8e597629b35af6b7-dc10-4d5e-bbcf-0427a5ab3ab6 Yet these complications are rare, and other research has found no significant increase in the risk of pancreatitis or thyroid cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b079184b-ebd9-4355-ae52-0dd57f063dc7e60dc2a1-f33c-4a05-9b50-8e3e8e597629fac1a364-903b-41a6-9a02-aecfa78848a9 Nonetheless, people who have a personal or family history of pancreatitis , medullary thyroid cancer, or multiple endocrine neoplasia are advised not to take them. Hypoglycemia, or low blood sugar, is another risk. However, this is usually only an issue for patients taking certain types of medications to lower blood sugar, such as insulin or sulfonylureas.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fc49e836-4681-48df-8a95-6935e57e18f2 Of course, obesity can also hinder older adults’ health and quality of life — including raising the risk of certain cancers,e60dc2a1-f33c-4a05-9b50-8e3e8e5976292a137687-e282-4ea7-a040-56fbc05dadc9 pancreatitis,e60dc2a1-f33c-4a05-9b50-8e3e8e5976295d735e28-43f6-4147-b398-31f4803f7d89 fatty liver disease, kidney disease, diabetes, and sarcopenia.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fa009ee4-4276-45ca-af01-7e3b8bd22642 But Batsis says there’s a “fine balance” to strike when it comes to weight loss. Further research on the effects of GLP-1s on older adults could help healthcare providers and patients achieve that balance more effectively. Few studies have evaluated newer GLP-1 medications, and, to Batsis’ knowledge, none have focused explicitly on adults ages 65 and older. Some trials have a mean age of around 65, meaning some participants are older and some younger, Batsis says, but most data comes from younger populations. “Older adults are medically and biologically complex and different. Their physiology is different,” Batsis says. “So, applying data that isn’t tested on the same at-risk population is problematic. Simply put, more research is needed.”
Side Effects of Ozempic May Also Pose Health Dangers for Older Adults GLP-1 Side Effects Common GLP-1 side effects include abdominal pain, nausea, vomiting, and diarrhea.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ace8a7db-919c-4baf-9186-a91d8e35e286e60dc2a1-f33c-4a05-9b50-8e3e8e597629dcea4b74-7412-46d8-b679-ad7165cf2d16 These usually dissipate after a few days or weeks, but they can still be problematic, especially for older adults. Some studies demonstrate these side effects — which happen because of the impact GLP-1s have on the gut and brain — are worse in older adults and lead to higher discontinuation rates, Batsis says. That’s primarily because the gastrointestinal system changes and becomes less efficient with age, he explains. “Severe gastrointestinal side effects from these drugs may lead to dehydration, which can lead to falls,” Batsis says. “When a person becomes dehydrated, they are more inclined to become dizzy or feel faint and fall. It’s important to monitor older people taking weight loss medications to ensure they get enough food and water.”
Safer Ways for Older Adults to Lose Weight Losing Weight Safely Obesity affects about 42 percent of adults in the United States, including about 41.5 percent of those 60 and older.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b42d0203-8479-42c6-a0aa-6fb9c15bb8eee60dc2a1-f33c-4a05-9b50-8e3e8e597629374f4058-b738-448d-b871-2b4edaf59900 Along with losing muscle mass, people tend to gain fat with aging up to the eighth or ninth decade of life, Batsis says. That’s due to factors like changes in metabolism, physical activity levels, and how the body absorbs and processes food (such as the inability to make protein and increased protein breakdown), Batsis says. Studies demonstrate that a body mass index (BMI) of 25 to 30 may be optimal for older adults, Batsis says.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290341962e-4660-4d56-8cb0-fc5697f3bc9a He adds that because BMI doesn’t accurately account for the amount of fat and muscle a person has, it isn’t the best indicator. “That said, the data on older adults with obesity (BMI >30) is clearer and associated with functional decline, disability, and death,” he says. While GLP-1s and similar medications can be effective tools to help people manage type 2 diabetes and obesity, they’re not enough on their own, nor are they one-size-fits-all, says Kristen Smith, RDN , a spokesperson for the Academy of Nutrition and Dietetics, who is based in Atlanta, and Shayna Oshita, PhD, RD, CDCES , a dietitian and diabetes educator at the University of Illinois in Chicago. They say that patients must also adopt healthy habits, including eating a balanced diet and staying physically active, to ensure healthful, sustainable results. Dana Angelo White, RDN , a dietitian, certified athletic trainer and member of the National Athletic Trainers’ Association , who is based in Norwalk, Connecticut, agrees. “There is no magic pill for weight loss, and without proper education on practical lifestyle modifications, patients on these medications will not be successful long term,” Angelo White says. “Weight loss is not just about the number on the scale — the type of weight lost and the nutrient deficiencies that may occur as a result of appetite suppression can pose serious health risks.” Smith says that working closely with a healthcare team is essential for people who use the medications to ensure safety and efficacy. Additionally, Oshita, Angelo White, and Smith say the following tips may help older adults lose weight safely and keep it off, whether they’re on GLP-1s or not: Eat quality protein. Examples include whole eggs , low-fat Greek yogurt, tofu, seitan, nuts, beans, or fish at every meal. Smith says you can also take a protein supplement if you’re struggling with low appetite. Research suggests that older adults need about 1–1.2 grams of protein per kilogram (or 2.2 pounds) of body weight daily.e60dc2a1-f33c-4a05-9b50-8e3e8e597629509cb624-eed4-485d-b976-b73caecddafc Protein is crucial for various body functions and can help build lean muscle mass and reduce appetite.e60dc2a1-f33c-4a05-9b50-8e3e8e597629708e1b24-36ba-4e43-ba76-369db1b36948 Don’t skimp on fruits and veggies. Incorporate a variety of produce into meals and snacks throughout the day to ensure you’re getting enough fiber , vitamins, minerals, and antioxidants.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296540c175-ea7f-4f42-9bed-2da222914022 Make sure you’re getting enough calories. Appetite tends to decrease with age, and GLP-1s can compound that. While that’s not necessarily a bad thing, it can be. “Weight loss requires a calorie deficit, but it must be a sensible and sustainable reduction to prevent muscle loss, nutrient deficiencies, and hunger,” Angelo White says. “Starvation will not work for the long haul.” Prioritize sleep. Getting enough quality z’s is important for regulating hunger and metabolism.e60dc2a1-f33c-4a05-9b50-8e3e8e59762949d41f6b-d850-4d76-8e60-a36548d8a816 Include fiber-rich foods. That includes whole-grain rice, oatmeal , beans, and broccoli. Smith says these may help regulate bowel movements and make you feel fuller for longer because, like protein, these foods take relatively longer to digest. Choose physical activities you enjoy. Consider water aerobics, walking , weight lifting, chair yoga, or a dance class. “Too many older adults force themselves to do exercise they don’t really like, and that makes it so much harder to commit to a consistent exercise routine to prevent injury,” Angelo White says. Set SMART (specific, measurable, achievable, realistic, and timely) goals. “For example, I am going to add a half cup (measurable) of a fruit or a vegetable (specific) to my dinner at least three days a week (timely). The small step of this goal makes it realistic and achievable,” Oshita explains.
How Older Adults Can Support Muscle Mass During Weight Loss Supporting Muscle Mass Although shedding excess fat may enhance older adults’ health and quality of life, maintaining muscle is equally important for mobility, vitality, and overall well-being. Besides sarcopenia, older adults face some distinct challenges when it comes to maintaining muscle mass, say Angelo White, Sabrena Jo, PhD , the senior director of science and research at the American Council on Exercise (ACE), who is based in Lawrence, Kansas, and Holly Lookabaugh-Deur, DSc, a physical therapist and educator at the Academy of Aquatic Physical Therapy , who is based in Muskegon Michigan. These include: A drop in production of certain hormones , such as testosterone, estrogen, and growth hormone, which are essential for muscle growth and repair. A higher risk for chronic health conditions like arthritis and cardiovascular disease can make exercise more challenging. A greater likelihood of nutrient deficiencies , such as inadequate protein intake caused by reduced appetite and decreased nutrient absorption. A combination of diet and exercise can help overcome some of these hurdles. Regarding diet, Angelo White, Smith and Oshita say eating adequate protein is crucial for muscle building and repair. They recommend having a little bit with every meal and snack rather than a large amount at once. “A piece of chicken or fish the size of your palm is great for a meal,” Oshita says. “A fourth cup of your favorite nuts or seeds mixed with dried or fresh fruit is a great snack option.” As for exercise, Angelo White, Jo, and Lookabaugh-Deur recommend moving daily and incorporating various activities, including resistance, or strength, training , into a weekly routine. “Resistance exercise at a minimum of twice weekly is one of the first recommendations towards maintaining and building strength in older adults,” Lookabaugh-Deur says.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ecd5412a-39a6-4376-9961-cddd2981c7af She recommends beginners do strength training three times a week, with at least one day between sessions. During each or most workouts, aim for about 8 to 12 repetitions of five to seven different exercises involving each major muscle group: the core, arms/upper body, and legs/lower body, Lookabaugh-Deur continues. “The key is making sure that there is enough mechanical stress on the muscle to create ‘microtrauma’ to the muscle fibers. This sounds dangerous, but it isn’t,” she says. “The muscle cell won’t change without enough tension and metabolic effort. A good rule of thumb to know if you are exercising at the right intensity is that you should be sufficiently fatigued after eight to 12 repetitions.” She explains you can tell your muscle is fatigued if it quivers or the force behind the movement becomes weaker. If you can continue doing the exercise with ease, gradually add more weight. Weightlifting is the most obvious form of resistance training, but exercise band and body weight workouts are great, too, Lookabaugh-Deur, Jo, and Angelo White say. Some examples of the latter include squats, lunges, yoga, barre, Pilates, TRX, stair climbing, and push-ups. Lookabaugh-Deur also recommends the following for older adults: Sit to stand: Sit in a chair and stand up without using your arms. Try to complete as many as you can in 30 seconds. Rest, then try again. Planks: Lie on the floor face down and hold yourself in a flat position on your toes and hands. Start by holding the position for 3–5 seconds and slowly increase the time. Use your forearms to hold the position if it’s too hard on your wrists and hands. Triceps lift: Hold a heavy ball or other object in both hands. Lift the object towards the ceiling, then bend and straighten at the elbow only. Shoulder circles: With your arms out to your sides in a cross position, start with small circles and work into larger circles. Begin with 10–15 seconds and work up to 1 continuous minute. Change directions and repeat. Heel raises: Standing near a wall for balance, shift your weight and lift your heels off the floor while keeping your knees straight. Try 8 to 12 reps with one leg, then the other. Hip windshield wipers: Standing sideways near a wall for balance, lift your entire leg out the side as far as you can without turning your foot. If it is too easy to complete 12, add exercise bands above both knees for more resistance.
