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 remedy, Ozempic, 4 months in the past. It is one in a brand new class of medicines altering how unusual folks in addition to medical specialists take into consideration weight problems, a situation that impacts practically 4 in 10 folks 60 and older.
The medicine embody Ozempic’s sister remedy, Wegovy, a weight reduction drug with similar substances, which the FDA authorized in 2021, and Mounjaro, authorized as a diabetes remedy in 2022. (Ozempic was authorized for diabetes in 2017.) A number of different medicine are in growth.
The drugs 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 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 is not effectively understood. (Sufferers want to stay on the medicine completely or danger regaining the burden they’ve misplaced.)
Will they assist stop heart problems and different continual diseases in overweight older adults? Will they scale back charges of incapacity and enhance folks’s potential to maneuver and handle every day duties? Will they improve folks’s lives and alleviate signs related to obesity-related continual diseases?
Sadly, medical trials of the drugs have not included important numbers of individuals ages 65 and older, leaving gaps within the accessible knowledge.
Whereas the medicine look like secure — the commonest unwanted side effects are nausea, diarrhea, vomiting, constipation, and abdomen ache — “they’ve solely been in the marketplace for just a few 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 specialists approaching the usage of the brand new weight problems drugs in older folks? As could be anticipated, opinions and practices differ. However a number of themes emerged in practically two dozen interviews.
The primary was frustration with restricted entry to the medicine. As a result of Medicare does not cowl weight reduction drugs they usually can price greater than $10,000 a 12 months, seniors’ potential to get the brand new medicine is restricted.
There may be 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 medicine,” stated Shauna Matilda Assadzandi, a geriatrician on the College of Pittsburgh who cares for Morris. Not too long ago, she stated, she tried to influence a Medicare Benefit plan consultant to authorize Wegovy for a affected person with hypertension and ldl cholesterol who was gaining weight quickly.
“I am simply ready for this affected person’s blood sugar to rise to a stage the place diabetes could be identified. Would not it make sense to intervene now?” she remembered saying. The consultant’s reply: “No. We now have to comply with 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 medicine. 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 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 Drugs. If all older overweight adults on Medicare — a considerably bigger inhabitants — took them, the fee would exceed the entire 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 remedy — each lined by non-public insurance coverage — and she or he’d misplaced practically 42 kilos. Now, Wealthy cannot get Wegovy and she or he’s regained 14 kilos.
“I have not modified my consuming. The one factor that is totally different is that some sign in my mind is telling me I am hungry on a regular basis,” Wealthy instructed me. “I really feel horrible.” She is aware of that if she features extra weight, her care will price way more.
Whereas acknowledging troublesome coverage selections that lie forward, specialists voiced appreciable settlement on which older adults ought to take these medicine.
Typically, the drugs are really helpful for folks 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 not less than one obesity-related situation, comparable to diabetes, hypertension, or excessive ldl cholesterol. There are not any tips for his or her use in folks 65 and older. (BMI is calculated based mostly on an individual’s weight and top.)
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 Heart 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 stomach 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 ladies, 35 is the brink.)
Fatima Stanford, an weight problems drugs scientist at Massachusetts Basic Hospital, stated the brand new medicine are “greatest suited to older sufferers who’ve medical proof of weight problems,” comparable to elevated ldl cholesterol or blood sugar, and other people with critical obesity-related circumstances comparable 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 instructed me.
When adults with weight problems reduce weight, their danger of dying is diminished 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 really helpful 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 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 losing a few pounds must be prescribed bodily exercise — each cardio train and power coaching, specialists agree.
Additionally, as older adults taking weight reduction medicine eat much less, “it is critically vital that their weight loss program contains satisfactory protein and calcium to protect bone and muscle mass,” stated Anne Newman, director of the Heart for Getting older and Inhabitants Well being on the College of Pittsburgh.
Ongoing monitoring of older adults having gastrointestinal unwanted 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 Heart.
Typically, the purpose for older adults must be to lose 1 to 2 kilos per week, with consideration to weight loss program and train accompanying remedy administration.
“My concern is, as soon as we put sufferers on these weight problems medicine, are we supporting way of life modifications that may keep their well being? Remedy alone will not be enough; we are going to nonetheless want to deal with behaviors,” stated Sukhpreet Singh, system medical director at Henry Ford’s weight administration program.
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