PUMPING IRONY: Weighty Matters

For various reasons, we all tend to put on a little weight as we move through middle age and into our senior years. We become gradually more sedentary, our metabolic mechanism slows, and the extra pounds accumulate. By some estimates, four out of 10 Americans over the age of 60 fit the conventional definition of obese (a BMI of 30 or more). So, it’s not surprising that the recent headlines about weight-loss drugs have generated some interest among seniors — along with some warnings from physicians.

Results of a study published last month in the New England Journal of Medicine show that participants taking Eli Lilly’s experimental drug retatrutide lost an average of 24 percent of their body weight over a 48-week period. The findings were “mind-blowing,” Shauna Levy, MD, medical director of the Tulane Bariatric Center, told NBC News. Levy was not involved with the study.

It’s only the latest in a series of eye-opening developments from Big Pharma on the weight-loss front. The Food and Drug Administration in 2022 approved Eli Lilly’s Mounjaro, which has shown similar weight-loss results, to treat type 2 diabetes. That followed on the heels of the FDA’s approval of the type 2 diabetes/weight-loss drug Ozempic and Wegovy, a very similar injectable specifically prescribed to shed pounds.

“The drugs have been transformative to say the least,” Levy noted. “They’ve given so many people hope that felt sort of hopeless in this fight against obesity.”

These medications work by essentially telling your brain that you’re not hungry. “It takes your appetite right away,” Corlee Morris, 78, tells Judith Graham in the Washington Post after she lost 40 pounds in four months while taking Ozempic. “I wasn’t hungry at all, and I lost weight like mad.”

Studies suggest the side effects — stomach pain and other types of digestive discomfort — are mild, though some experts question the relevance of those findings for older adults, given the paucity of seniors included in the various trials. Weight loss, they argue, becomes more nuanced as we grow old.

There’s plenty of evidence to recommend maintaining a lean profile in our golden years, but shedding weight simply by curbing our appetite comes with complications. Those pounds we’re dropping may include both fat as well as the muscle mass we need to prevent frailty, falls, and a general erosion of functionality. Rather than focusing on calories alone, seniors need to include physical activity — both aerobic and strength training — as part of their weight-loss regimen.

And seniors opting for one of the new drugs to suppress their hunger should also be mindful of what they’re putting on their plates when they do sit down to eat, says Anne Newman, MD, MPH, director of the University of Pittsburgh Center for Aging and Population Health. “It’s critically important that their diet includes adequate protein and calcium to preserve bone and muscle mass.”

“My concern is, once we put patients on these obesity drugs, are we supporting lifestyle changes that will maintain their health?” Singh asks. “Medication alone won’t be sufficient; we will still need to address behaviors.”

It’s these sorts of issues that worry Sukhpreet Singh, MD, system medical director at Henry Ford Health’s weight management program. When a pill promises quick and painless results, after all, it’s easy to prolong habits that may be contributing to the problem. “My concern is, once we put patients on these obesity drugs, are we supporting lifestyle changes that will maintain their health?” Singh asks. “Medication alone won’t be sufficient; we will still need to address behaviors.”

That’s the grim reality Laurie Rich, 63, encountered when she shifted from private insurance to Social Security Disability Insurance late last year. Wegovy and another weight-loss medication had helped her shed more than 40 pounds before she discovered that the drugs weren’t covered by her government plan. Before long, she’d added 14 pounds. “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,” she tells Graham. “I feel horrible.”

Like any other weight-loss regimen, these drugs don’t guarantee you’ll be able to keep off the weight over the long term. And even if the data eventually shows that to be the case, the cost — more than $10,000 a year — may limit access for seniors unless Medicare coverage policies change. The agency, contemplating the enormous cost of covering millions of overweight seniors, currently reimburses only beneficiaries who are diagnosed with type 2 diabetes. And that’s creating a conundrum for physicians whose patients battling obesity could benefit from the drugs but don’t meet those guidelines.

“I’m just waiting for this patient’s blood sugar to rise to a level where diabetes can be diagnosed,” Shauna Matilda Assadzandi, MD, a geriatrician at the University of Pittsburgh, tells Graham of a patient with high blood pressure and elevated cholesterol who was gaining weight rapidly but had not yet reached the threshold requiring a type 2 diabetes diagnosis. “Wouldn’t it make sense to intervene now?”

As Big Pharma continues to churn out these wonder drugs and Medicare continues to blanch at the potential costs of covering seniors hoping to lighten their load, that’s a question Assadzandi and her peers will likely be asking for some time to come.