Corlee Morris has dieted all through her grownup life.
After her weight started climbing in highschool, she spent years shedding 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 shedding battle till Morris’ physician prescribed a Type 2 diabetes remedy, Ozempic, 4 months in the past. It’s one in a brand new class of medicines altering how extraordinary folks in addition to medical specialists take into consideration weight problems, a situation that impacts almost 4 in 10 folks 60 and older.
The medicine embrace Ozempic’s sister remedy, Wegovy, a weight reduction drug with similar components, which the FDA accredited in 2021, and Mounjaro, accredited as a diabetes remedy in 2022. (Ozempic was accredited for diabetes in 2017.) Several different medicine are in growth.
The medicines scale back emotions of starvation, generate a sensation of fullness, and have been proven to assist folks lose a mean of 15% or extra of their weight.
“It takes your appetite right away. I wasn’t hungry at all and I lost weight like mad,” mentioned Morris, who has shed 40 kilos.
But how these medicines will have an effect on older adults in the long term isn’t effectively understood. (Patients want to stay on the medicine completely or threat regaining the burden they’ve misplaced.)
Will they assist forestall heart problems and different continual sicknesses in overweight older adults? Will they scale back charges of incapacity and enhance folks’s skill to maneuver and handle every day duties? Will they improve folks’s lives and alleviate signs related to obesity-related continual sicknesses?
Unfortunately, medical trials of the medicines haven’t included vital numbers of individuals ages 65 and older, leaving gaps within the out there information.
While the medicine look like protected — the commonest negative effects are nausea, diarrhea, vomiting, constipation, and abdomen ache — “they’ve only been on the market for a few years and caution is still needed,” mentioned Mitchell Lazar, founding director of the Institute for Diabetes, Obesity and Metabolism on the University of Pennsylvania Perelman School of Medicine.
Given these uncertainties, how are specialists approaching using the brand new weight problems medicines in older folks? As is likely to be anticipated, opinions and practices fluctuate. But a number of themes emerged in almost two dozen interviews.
The first was frustration with restricted entry to the medicine. Because Medicare doesn’t cowl weight reduction medicines and so they can price greater than $10,000 a 12 months, seniors’ skill to get the brand new medicine is restricted.
There is 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 need Medicare to cover these drugs,” mentioned Shauna Matilda Assadzandi, a geriatrician on the University of Pittsburgh who cares for Morris. Recently, she mentioned, she tried to steer a Medicare Advantage plan consultant to authorize Wegovy for a affected person with hypertension and ldl cholesterol who was gaining weight quickly.
“I’m just waiting for this patient’s blood sugar to rise to a level where diabetes can be diagnosed. Wouldn’t it make sense to intervene now?” she remembered saying. The consultant’s reply: “No. We have to follow the rules.”
Seeking to vary that, a bipartisan group of lawmakers launched the Treat and Reduce Obesity Act, which might require Medicare to cowl weight reduction medicine. But the proposal has languished amid issues over huge potential prices for Medicare.
If all beneficiaries with an weight problems analysis took brand-name semaglutide medicine (the brand new class of medicines), annual prices would prime $13.5 billion, based on a current evaluation in The New England Journal of Medicine. If all older overweight adults on Medicare — a considerably bigger inhabitants — took them, the associated fee would exceed the full spent on Medicare’s Part D drug program, which was $145 billion in 2019.
Laurie Rich, 63, of Canton, Massachusetts, was caught off guard by Medicare’s insurance policies, which have utilized to her since she certified for Social Security Disability Insurance in December. Before that, Rich took Wegovy and one other weight reduction remedy — each coated by personal insurance coverage — and he or she’d misplaced almost 42 kilos. Now, Rich can’t get Wegovy and he or she’s regained 14 kilos.
“I haven’t changed my eating. The only thing that’s different is that some signal in my brain is telling me I’m hungry all the time,” Rich instructed me. “I feel horrible.” She is aware of that if she positive aspects extra weight, her care will price far more.
While acknowledging tough coverage choices that lie forward, specialists voiced appreciable settlement on which older adults ought to take these medicine.
Generally, the medicines are advisable for folks with a physique mass index over 30 (the World Health Organization’s definition of weight problems) and people with a BMI of 27 or above and at the very least one obesity-related situation, akin to diabetes, hypertension, or excessive ldl cholesterol. There aren’t any tips for his or her use in folks 65 and older. (BMI is calculated based mostly on an individual’s weight and top.)
But these suggestions are problematic as a result of BMI can under- or overestimate older adults’ physique fats, essentially the most problematic function of weight problems, famous Rodolfo Galindo, director of the Comprehensive Diabetes Center on the University of Miami Health System.
Dennis Kerrigan, director of weight administration at Henry Ford Health 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 greater threat 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 General Hospital, mentioned the brand new medicine are “best suited for older patients who have clinical evidence of obesity,” akin to elevated ldl cholesterol or blood sugar, and folks with critical obesity-related circumstances akin to osteoarthritis or coronary heart illness.
Since occurring Mounjaro three months in the past, Muriel Branch, 73, of Perryville, Arkansas, has misplaced 40 kilos and stopped taking three medicines as her well being has improved. “I feel real good about myself,” she instructed me.
When adults with weight problems shed pounds, their threat of dying is decreased by as much as 15%, based on Dinesh Edem, Branch’s physician and the director of the medical weight administration program on the University of Arkansas for Medical Sciences.
Still, weight reduction alone shouldn’t be advisable to older adults, as a result of it entails the lack of muscle mass in addition to fats, specialists agree. And with growing old, the shrinkage of muscle mass that begins earlier in life accelerates, contributing to falls, weak spot, 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 shedding weight must be prescribed bodily exercise — each cardio train and energy coaching, specialists agree.
Also, as older adults taking weight reduction medicine eat much less, “it’s critically important that their diet includes adequate protein and calcium to preserve bone and muscle mass,” mentioned Anne Newman, director of the Center for Aging and Population Health on the University of Pittsburgh.
Ongoing monitoring of older adults having gastrointestinal negative effects is required to make sure they’re getting sufficient meals and water, mentioned Jamy Ard, co-director of Wake Forest Baptist Health’s Weight Management Center.
Generally, the aim for older adults must be to lose 1 to 2 kilos every week, with consideration to weight-reduction plan and train accompanying remedy administration.
“My concern is, once we put patients on these obesity drugs, are we supporting lifestyle changes that will maintain their health? Medication alone won’t be sufficient; we will still need to address behaviors,” mentioned Sukhpreet Singh, system medical director at Henry Ford’s weight administration program.
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