Year after year, Mary Bucklew strategized with a nurse practitioner about losing weight. \u201cWe tried exercise,\u201d like walking 35 minutes a day, she recalled. \u201cAnd 39,000 different diets.\u201d<\/p>\n
But 5 pounds would come off and then invariably reappear, said Bucklew, 75, a public transit retiree in Ocean View, Delaware. Nothing seemed to make much difference \u2014 until 2023, when her body mass index slightly exceeded 40, the threshold for severe obesity.<\/p>\n
\u201cThere\u2019s this new drug I\u2019d like you to try, if your insurance will pay for it,\u201d the nurse practitioner advised. She was talking about Ozempic.<\/p>\n
Medicare covered it for treating Type 2 diabetes but not for weight loss, and it cost more than $1,000 a month out-of-pocket. But to Bucklew\u2019s surprise, her Medicare Advantage plan covered it even though she wasn\u2019t diabetic, charging just a $25 monthly copay.<\/p>\n
Pizza, pasta, and red wine suddenly became unappealing. The drug \u201cchanged what I wanted to eat,\u201d she said. As 25 pounds slid away over six months, she felt less tired and found herself walking and biking more.<\/p>\n
Then her Medicare plan notified her that it would no longer cover the drug. Calls and letters from her health care team, arguing that Ozempic was necessary for her health, had no effect.<\/p>\n
With coverage denied, Bucklew became part of an unsettlingly large group: older adults who begin taking GLP-1s and related drugs \u2014 highly effective for diabetes, obesity, and several other serious health problems \u2014 and then stop taking them within months.<\/p>\n
That usually means regaining weight and losing the associated health benefits, including lower blood pressure, cholesterol, and A1c, a measure of blood sugar levels over time.<\/p>\n
Widely portrayed as wonder drugs, semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Zepbound, Mounjaro), and related medications have transformed the treatment of diabetes and obesity.<\/p>\n
The FDA has approved several GLP-1s for additional uses, too \u2014 including to treat kidney disease<\/a> and sleep apnea<\/a>, and prevent heart attacks<\/a> and strokes.<\/p>\n \u201cThey\u2019re being studied for every purpose you can conceive of,\u201d said Timothy Anderson, a health services researcher at the University of Pittsburgh and author of a recent JAMA Internal Medicine editorial about anti-obesity medications<\/a>.<\/p>\n (Drug trials have found no impact on dementia<\/a>, however.)<\/p>\n People 65 and older represent prime targets for such medications. \u201cThe prevalence of obesity hovers around 40%\u201d in older adults, as measured by body mass index, said John Batsis, a geriatrician and obesity specialist at the University of North Carolina School of Medicine.<\/p>\n The proportion of people with Type 2 diabetes rises with age<\/a>, too, to nearly 30% at age 65 and older. Yet a recent JAMA Cardiology study found that among Americans 65 and up with diabetes, about 60% discontinued <\/a>semaglutide<\/a> within a year.<\/p>\n Another study of 125,474 people with obesity or who are overweight found that almost 47% of those with Type 2 diabetes and nearly 65% of those without diabetes stopped taking GLP-1s within a year \u2014 a high rate, said Ezekiel Emanuel, a health services researcher at the University of Pennsylvania and senior author of the study.<\/p>\n Patients 65 and older were 20% to 30% more likely than younger ones to discontinue<\/a> the drugs and less likely to return to them.<\/p>\n What explains this pattern? As many as 20% of patients may experience gastrointestinal problems<\/a>. \u201cNausea, sometimes vomiting, bloating, diarrhea,\u201d Anderson said, ticking off the most common side effects.<\/p>\n Linda Burghardt, a researcher in Great Neck, New York, started taking Wegovy because her doctor thought it might reduce arthritis pain in her knees and hips. \u201cIt was an experiment,\u201d said Burghardt, 79, who couldn\u2019t walk far and had stopped playing pickleball.<\/p>\n Within a month, she suffered several bouts of stomach upset that \u201cwent on for hours,\u201d she said. \u201cI was crying on the bathroom floor.\u201d She stopped the drug.<\/p>\n Some patients find that medication-induced weight loss lessens rather than improves fitness, because another side effect is muscle loss. Several trials have reported that 35% to 45% of GLP-1 weight loss is not fat<\/a>, but \u201clean mass\u201d including muscle and bone.<\/p>\n Bill Colbert\u2019s cherished hobby for 50 years, reenacting medieval combat, involves \u201cputting on 90 pounds of steel-plate armor and fighting with broadswords.\u201d A retired computer systems analyst in Churchill, Pennsylvania, he started on Mounjaro, successfully lowered his blood glucose, and lost 18 pounds in two months.<\/p>\n But \u201cyou could almost see the muscles melting away,\u201d he recalled. Feeling too weak to fight well at age 78, he also discontinued the drug and now relies on other diabetes medications.<\/p>\n \u201cDuring the aging process, we begin to lose muscle,\u201d typically half a percent to 1% of muscle weight per year, said Zhenqi Liu, an endocrinologist at the University of Virginia who studies the effects of weight loss drugs<\/a>. \u201cFor people on these medications, the process is much more accelerated.\u201d<\/p>\n Losing muscle can lead to frailty, falls, and fractures, so doctors advise GLP-1 users to exercise, including strength training, and to eat enough protein.<\/p>\n The high rate of GLP-1 discontinuation may also reflect shortages; from 2022 to 2024, these drugs temporarily became hard to find. Further, patients may not grasp that they will most likely need the medications indefinitely, even after they meet their blood glucose or weight goals.<\/p>\n Re-initiating treatment involves its own hazards, Batsis cautioned. \u201cIf weight goes up and down, up and down, metabolically it sets people up for functional decline down the road.\u201d<\/p>\n Of course, in considering why patients discontinue, \u201ca large part of it is money,\u201d Emanuel said. \u201cExpensive drugs, not necessarily covered\u201d by insurers. Indeed, in a Cleveland Clinic study<\/a> of patients who discontinued semaglutide or tirzepatide, nearly half cited cost or insurance issues as the reason.<\/p>\n Some moderation in price has already occurred. The Biden administration capped out-of-pocket payments for all prescriptions that a Medicare beneficiary receives ($2,100 is the 2026 limit), and authorized annual price negotiations with manufacturers.<\/p>\n The reductions include<\/a> Ozempic, Wegovy, and Rybelsus, though not until 2027. Medicare Part D drug plans will then pay $274, and since most beneficiaries pay 25% in coinsurance, their out-of-pocket monthly cost will sink to $68.50.<\/p>\n Perhaps even lower, if agreements announced in November between the Trump administration and drugmakers Eli Lilly and Novo Nordisk pan out.<\/p>\n The bigger question is whether Medicare will amend its original 2003 regulations, which prohibit Part D coverage for weight loss drugs. \u201cAn archaic policy,\u201d said Stacie Dusetzina, a health policy researcher at the Vanderbilt University School of Medicine.<\/p>\n The Trump administration\u2019s November announcement<\/a> would expand Medicare eligibility for GLP-1s and related medications to include obesity, perhaps as early as spring. But key details remain unclear, Dusetzina said.<\/p>\n Medicare should cover anti-obesity drugs, many doctors argue. Americans still tend to think that \u201cdiabetes is a disease and obesity is a personal problem,\u201d Emanuel said. \u201cWrong. Obesity is a disease, and it reduces life span and compromises health.\u201d<\/p>\n But given the expense to insurers, Dusetzina warned, \u201cif you expand the indications and extent of coverage, you\u2019ll see premiums go up.\u201d<\/p>\n For older patients, often underrepresented in clinical trials, questions about GLP-1s remain. Might a lower maintenance dose stabilize their weight? Can doses be spaced out? Could nutritional counseling and physical therapy offset muscle loss?<\/p>\n Bucklew, whose coverage was denied, would still like to resume Ozempic. But because of a recent sleep apnea diagnosis, she now qualifies for Zepbound with a $50 monthly copay.<\/p>\n She has seen no weight loss after three months. But as the dose increases, she said, \u201cI\u2019ll stay the course and give it a shot.\u201d<\/p>\n The New Old Age is produced through a partnership with\u00a0The New York Times<\/a>.<\/em><\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n