Managing her weight was a dropping battle till Morris’s physician prescribed the Kind 2 diabetes medicine Ozempic 4 months in the past. It’s one in a brand new class of medicines altering how peculiar folks in addition to medical specialists take into consideration weight problems, which impacts greater than 4 in 10 folks 60 and older. Ozempic and related medication goal receptors within the mind to scale back emotions of starvation and generate a sensation of fullness; they’ve been proven to assist folks lose a median of 15 p.c 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 medicines will have an effect on older adults in the long term isn’t properly understood as a result of medical trials of the medicines haven’t included vital numbers of individuals ages 65 and older, leaving gaps within the out there knowledge. Past that, how seniors pays for these costly medication is one other massive query.
Given these uncertainties, how are specialists approaching the usage of the brand new weight problems medicines in older folks? Though opinions and practices fluctuate, a number of themes emerged in practically two dozen interviews.
Will Medicare pay for Ozempic?
The Meals and Drug Administration authorised Ozempic, an injectable semaglutide, to deal with diabetes in 2017. Wegovy, a weight-loss drug with an identical elements to Ozempic, was authorised by the FDA in 2021. Mounjaro, whose key ingredient is tirzepatide, was authorised as a diabetes therapy in 2022. A number of different medication are in growth.
Whereas the medication look like secure — the most typical unwanted effects are nausea, diarrhea, vomiting, constipation and abdomen ache — “they’ve solely been available on the market 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 College of Drugs.
Within the close to time period, as a result of Medicare doesn’t cowl weight-loss medicines and these new medication can value greater than $10,000 a yr, seniors’ potential to get the medicines 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’d like Medicare to cowl these medication,” 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’m simply ready for this affected person’s blood sugar to rise to a stage the place diabetes will be recognized. Wouldn’t it make sense to intervene now?” she remembered saying. The consultant’s reply: “No. We’ve to observe the principles.”
Searching for to vary that, a bipartisan group of lawmakers launched the Deal with and Scale back Weight problems Act, which might require Medicare to cowl weight-loss medication. 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 medication, annual prices would high $13.5 billion, based on a latest evaluation within the New England Journal of Drugs. If all older overweight adults on Medicare — a considerably bigger inhabitants — took them, the fee would exceed the overall spent on Medicare’s Half D drug program, which was $145 billion in 2019.
Laurie Wealthy, 63, of Canton, Mass., 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-loss medicine — each lined by personal insurance coverage — and he or she had misplaced practically 42 kilos. Now, Wealthy can’t get Wegovy, and he or she has regained 14 kilos.
“I haven’t modified my consuming. The one factor that’s completely different is that some sign in my mind is telling me I’m hungry on a regular basis,” Wealthy stated. “I really feel horrible.” If she positive factors extra weight, she stated, her care will value way more.
Which seniors ought to take weight-loss medication?
Whereas acknowledging tough coverage selections lie forward, specialists voiced appreciable settlement on which older adults ought to take the medication.
Typically, the medicines are really useful for folks with a physique mass index over 30 (the World Well being Group’s definition of “overweight”) and people with a BMI of 27 or above and at the least one obesity-related situation, equivalent to diabetes, hypertension or excessive ldl cholesterol. There are not any pointers for his or her use in folks 65 and older. (BMI is calculated primarily based on an individual’s weight and peak.)
However these suggestions are problematic as a result of BMI can under- or overestimate older adults’ physique fats, probably the most problematic characteristic of weight problems, famous Rodolfo Galindo, director of the Complete Diabetes Middle on the College of Miami Well being System.
Dennis Kerrigan, director of weight administration at Henry Ford Well being in Michigan, suggests physicians additionally look at waist circumference in older sufferers as a result of belly fats places them at larger 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 Normal Hospital, stated the brand new medication are “finest fitted to older sufferers who’ve medical proof of weight problems,” equivalent to elevated ldl cholesterol or blood sugar, and folks with critical obesity-related circumstances equivalent to osteoarthritis or coronary heart illness.
Since occurring Mounjaro three months in the past, Muriel Department, 73, of Perryville, Ark., has misplaced 40 kilos and stopped taking three medicines as her well being has improved. “I really feel actual good about myself,” she advised me.
When adults with weight problems reduce weight, their threat of dying is lowered by as much as 15 p.c, based on Dinesh Edem, Department’s physician and the director of the medical weight administration program on the College of Arkansas for Medical Sciences.
Why weight reduction is completely different for seniors
Nonetheless, weight reduction alone shouldn’t be really useful to older adults, as a result of it entails the lack of muscle mass in addition to fats, specialists agree. And with ageing, 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 p.c of muscle mass falls away, researchers estimate; after 80, it reaches 30 p.c.
To protect muscle mass, seniors reducing weight ought to be prescribed bodily exercise — each cardio train and power coaching, specialists agree.
Additionally, as older adults taking weight reduction medication eat much less, “it’s critically vital that their food regimen contains satisfactory protein and calcium to protect bone and muscle mass,” stated Anne Newman, director of the Middle for Growing old and Inhabitants Well being on the College of Pittsburgh.
Ongoing monitoring of older adults having gastrointestinal unwanted effects is required to make sure they’re getting sufficient meals and water, stated Jamy Ard, co-director of Wake Forest Baptist Well being Weight Administration Middle.
Typically, the objective for older adults ought to be to lose 1 to 2 kilos per week, with consideration to food regimen and train accompanying medicine administration.
“My concern is, as soon as we put sufferers on these weight problems medication, are we supporting life-style modifications that may keep their well being? Remedy alone gained’t be enough; we’ll nonetheless want to handle behaviors,” stated Sukhpreet Singh, system medical director at Henry Ford’s weight administration program.
KFF Well being Information, previously generally known as Kaiser Well being Information or KHN, is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF.
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