Maintaining a healthy weight and preventing or managing diabetes are important health goals no matter how old you are, but they take on increased importance with every birthday.
As you age, obesity and diabetes increase your risk for heart disease, stroke, kidney disease, dementia and cancer.
To reduce these risks, many people are turning to GLP-1 medications including semaglutide (brand name Ozempic and Wegovy) and tirzepatide (brand name Mounjaro and Zepbound).
If you’re 65 or older and considering a GLP-1, know that there are special considerations older adults should be aware of, says UNC Health geriatrician John Batsis, MD.
“The promise of these medications is great, but when it comes to older adults, we still need more data and research for this specific population,” Dr. Batsis says.
Read on for his advice for older adults starting a GLP-1.
Benefits and Risks of GLP-1s in People Older than 65
When GLP-1s were in development, they were tested mostly on adults who were younger than 65, Dr. Batsis says.
“It’s important to note that we do not have any guidelines specific to older adults and how we should approach using these medications with them,” Dr. Batsis says. “Ask different experts, you might get different opinions.”
The potential benefits of these medications—weight loss or better controlled blood sugar levels—remain the same despite your age, but the risks are different.
GLP-1s are known for causing gastrointestinal side effects such as nausea, constipation and decreased appetite. These side effects can be especially problematic for older adults.
“You’re already more susceptible to dehydration and constipation as you age, and then if those are increasing on these medications, you really need to push fluid intake and monitor bowel movements,” Dr. Batsis says.
Weight loss can result in loss of muscle and bone mass, a process which is already happening in older age, particularly if you are not active. This additional muscle and bone loss could have more serious consequences, including osteoporosis, frailty, increased risk of falls and permanent disability. These risks become more serious if the weight loss happens rapidly due to medication.
“It’s really important to focus on building muscle strength and muscle quality, especially when you’re losing weight,” Dr. Batsis says.
Recommendations for Older Adults Starting a GLP-1
If you are 65 or older, Dr. Batsis has a few recommendations for starting a GLP-1:
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Focus on a balanced diet, regular exercise and hydration.
Anyone who is starting a GLP-1 needs to make sure they’re focusing on healthy habits, such as increasing protein and fiber, eating a well-balanced diet, drinking plenty of water and engaging in regular physical activity, including strength training. That’s especially true if you’re over 65.
“Ideally, starting on a GLP-1 is a team-based effort, and you’re working with your doctor, a dietitian and an exercise specialist, whether that’s a personal trainer or a physical therapist,” Dr. Batsis says. “When someone has been engaging in all of those lifestyle interventions and still can’t lose weight, then they might be a good candidate for a GLP-1.”
If you’re not getting the recommended 150 minutes of moderate cardio exercise (plus 60 minutes of strength training) per week, start by doing what you can.
“Something is always better than nothing,” Dr. Batsis says. “It’s OK to start with 10 minutes of movement a day.”
These habits help the GLP-1 work effectively while minimizing side effects.
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Think about functional goals, not weight loss goals.
You’ve probably seen people boasting of major weight loss on a GLP-1, but Dr. Batsis prefers to focus on what you want to do that you can’t do right now rather than setting a specific goal around weight.
“For many people, that might be getting down on the floor with grandkids or being able to enjoy walking around their block,” he says.
Losing 10 to 15 percent of your weight over time has been shown to lower high blood pressure and high blood sugar while minimizing loss of muscle mass, Dr. Batsis says. Particularly in older adults, it’s focusing on what matters most, and that often is about quality of life and physical function.
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Go “low and slow” on dosing.
Typically, these medications have five or six dosing levels, with people starting at a low dose so that their body can adjust and then gradually moving up. It can take months to reach the full dose.
You might need to go even slower if you’re over 65, and you may not ever need the full dose to meet your goals.
“I like to start low and go slow,” Dr. Batsis says. “Rapid weight loss is not good for anyone because of the risk of muscle loss.”
Starting at a low dose gives your body more time to adjust to side effects, and it allows you to continue working with your care team on nutrition and exercise.
Going slow also allows your doctor to monitor how your body is responding to the GLP-1 so adjustments can be made as needed. That’s why it’s important to see your doctor rather than turning to the internet.
“I strongly advise against the compounded medications available online,” Dr. Batsis says. “For safety, you should be under clinical supervision.”
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Pay attention to how you feel.
Dr. Batsis says he’s seeing older patients who lost large amounts of weight with medication but suffered in function from loss of muscle; one prominent example, he says, is a patient in his 80s who lost 50 pounds in six months, improving his diabetes but affecting his mobility.
“In six months, he’d barely been able to play golf and had to start using a walker,” Dr. Batsis says. “If function is declining like that, we need to adjust the dosing or you may need a different medication. Once we decreased his dosing, his function improved.”
As you age, what you can do and how you do it will change. It can be hard to distinguish something that might be a part of aging from a side effect from your medication. That’s why it’s so important to stay connected to your care team and let them know what you’re experiencing on these medications.
“Communication is so important,” Dr. Batsis says. “One-size-fits-all is not how we should approach these medications. It really needs to be individualized so that it’s right for you.”
Questions about managing obesity or diabetes? Talk to your doctor or find one near you.