- A new report states that older adults using GLP-1 drugs may have a higher risk of loss of muscle mass, malnutrition, and dehydration.
- However, the benefits of taking these drugs should be weighed against these risks when the medications are prescribed.
- The researchers say that GLP-1 drugs benefit older adults by promoting weight loss, lowering blood sugar levels, and improving heart health.
The authors of a new report are urging doctors to keep a closer watch on older adults taking GLP-1 medications for weight loss or type 2 diabetes.
The report states that adults ages 65 and older have a higher risk of malnutrition, dehydration, and loss of muscle mass while taking GLP-1 drugs containing the active ingredient tirzepatide.
However, the researchers noted that frailty-associated conditions are uncommon with GLP-1 use and should not discourage the appropriate use of this class of medications.
Instead, the researchers encouraged doctors to more closely follow up with older adults who are taking .
“These conditions are rare occurrences, and we should just be more aware of the issues for older adults,” said Mir Ali, MD, a bariatric medicine specialist and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California.
“By no means does it mean we should not prescribe these medications to people over 65,” he told Healthline.
The research was conducted by nference, an artificial intelligence platform that collects data for healthcare research. The study is currently under peer review and has not yet been published in a scientific journal.
One study cohort consisted of 30,000 U.S. adults age 65 and older who were prescribed Zepbound for obesity, Reuters reported.
Another group contained nearly 19,000 older adults receiving non-GLP-1 drugs for type 2 diabetes. The third cohort involved nearly 6,000 participants who had undergone weight-loss surgery.
The researchers reported that the health records of those subjects indicated that less than 1% overall experienced declines in muscle mass and function. Less than 2% overall developed malnutrition, and about 3% experienced dehydration. Almost 5% reported a loss of appetite.
However, the researchers reported that the risks associated with these conditions were significantly higher among participants taking Zepbound.
The researchers said Zepbound users who developed malnutrition had a 25-fold higher risk of related death than tirzepatide users who did not develop malnutrition during an 18-month follow-up period.
By comparison, the risk of death from malnutrition was only 7-fold for people prescribed other diabetes treatments and two-fold for those who had weight-loss surgery.
In addition, Zepbound users who experienced dehydration had a 6-fold higher death risk compared to a 4-fold higher risk among people given other treatments and a 2.5-fold higher risk for those who underwent surgery.
Zepbound users who experienced muscle mass loss had a 12-fold higher risk of death compared to 6-fold higher risk in people using other medications and a 2-fold higher risk among surgery patients.
The researchers noted that the frailty conditions tended to appear among the Zepbound group after 6 months of treatment, suggesting that close follow-up is important.
“[This was a] well-designed study showing concerns for frailty is important because frailty in older age is also predictive of mortality,” said Kristin Kirkpatrick, RD, president of KAK Consulting and a dietitian at the Cleveland Clinic’s Department of Wellness & Preventive Medicine.
“The study showed that risk was associated with level of weight loss while also highlighting other important factors such as malnutrition and dehydration. However, the paper did not show that tirzepatide was not safe and, as with many studies, limitations to the research did occur,” Kirkpatrick told Healthline.
Kirkpatrick said the findings provide some caution for medical professionals when prescribing GLP-1 medications to older adults.
“I think this depends on the individual… and healthcare providers must weigh the risk versus the benefits given the overall health, lab data, dietary history, and contraindications,” she explained.
The number of adults in the United States who are taking GLP-1 medications for weight loss has hit a record high of 11%, or around 40 million people.
Adults 65 years and older who take weight-loss drugs also appear to be on the rise.
For example, the number of Medicare Part D enrollees using Ozempic or Mounjaro rose from 200,000 in 2022 to 3 million in 2024.
That usage is expected to continue its upward trend with the introduction of a new federal program on July 1.
The Medicare GLP-1 Bridge pilot project allows some Medicare recipients to purchase a limited number of GLP-1 medications at a guaranteed price of $50 per month.
The Centers for Disease Control and Prevention (CDC)
Obesity is classified as a long-term chronic condition that can increase a person’s risk of type 2 diabetes, heart disease, high blood pressure, and cancer.
The Association of American Medical Colleges (AAMC) reports that GLP-1 drugs benefit older adults by promoting weight loss, lowering blood sugar levels, and reducing the risk of heart disease, dementia, and some kinds of cancer.
In addition, the AAMC states that GLP-1 drugs can reduce inflammation and improve brain health.
The side effects from GLP-1 medications in older adults are similar to those in younger adults.
Ali said the GLP-1 medications are useful for older adults because it is more difficult to lose weight as well as maintain muscle mass as you age.
“It is tougher as you age to lose weight and these medications are very effective,” he said.
There are various ways older adults can improve and maintain their health.
Kirkpatrick urges older patients to find a medical team that can tailor a diet and exercise program to their needs.
In particular, she said older adults should look for a diet that is nutrient-dense, contains adequate protein and calories, and ensures high antioxidant intake.
“If protein/calorie intake is already low, muscle loss is already significant from factors such as aging, then additional weight loss could lead to further frailty,” Kirkpatrick said.
She also encourages older adults to work with their doctor to develop an effective, safe exercise program.
Ali said the key to any weight management plan is to burn fat while maintaining muscle mass. He said a diet low in carbohydrates and sugars, while providing an adequate level of protein and vegetables, is ideal.
He added that a regular exercise program of at least 30 minutes a day, 5 days a week, is sufficient. He said a combination of aerobic and strength exercises is best.
Ali noted that older adults don’t necessarily need a strenuous exercise regimen, just one that is consistent. He said GLP-1 medications can help, but smart lifestyle choices are still required.
“You still have to make good food choices,” Ali said. “The medications can be used as a guide to get there.”
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