What Is the Impact of GLP-1s in Older Adults with Obesity?

Adults aged 65 and older's desire to lose weight is frequently centered around improving functional ability and health outcomes, which may differ from those of young adults, says Yale School of Medicine’s Alissa Chen, MD, MPH.

“Their goals are usually aimed at improving outcomes—like being able to walk longer distances without knee pain or getting on the floor to play with their grandchildren,” says Chen, instructor of medicine (general medicine). “They are also interested in weight loss drugs for the benefits of treating other conditions, such as heart problems or sleep apnea.”

Chen researches obesity in older adults and how medications can help individuals meet their individual goals. She is the first author of a systematic review that found a lack of research on the impact of obesity medications in those aged 65 and up.

In the review, the researchers discovered that older adults had a higher prevalence of gastrointestinal adverse events when taking anti-obesity medications. Another finding was that people discontinued taking the medication more often. Larger and more studies of the use of obesity medicines by older adults are needed to guide clinical care, the researchers determined.

“Our approach to the treatment of obesity in older adults should be inherently different given that they have different medical needs and goals,” Chen says. “If we can better understand those needs and goals, we can provide older adults with obesity with the care they need.”

Older adults may be prone to adverse events that may interact with other medications taken, which could result in a severe downstream effect, Chen adds. For example, there is a potential increased risk of falls among older adults taking glucagon-like peptide-1 receptor agonists (GLP-1s) due to dehydration.

“These medications are transforming obesity care, but we still don’t have clear evidence on how they perform in people over 65, who often have different risks and vulnerabilities,” says Kasia Lipska MD, MHS, associate professor of medicine (endocrinology), who is senior author of the study and Chen’s mentor. “Understanding safety in this group is essential before we scale up use.”

Putting older adults at the center of the story opens up a new frontier in obesity research, Lipska adds.

Obesity in older adults is shaped by decades of health history, social factors, and changes in muscle and metabolism, according to Lipska. “It deserves its own science rather than being treated as a simple extension of midlife obesity,” she says.

To obtain more data on how these medications affect this age group, Chen is leading two studies on veterans aged 65 and older using GLP-1 medications.

The purpose of the first study is to understand how GLP-1 agonists help individuals meet their goals. Chen will interview participants at the VA Connecticut Healthcare System (VACHS) before they begin the medication to collect information about their quality of life, including physical function, mood, pain, and expectations for the trial. The participants will then be surveyed again six months after starting the drug so researchers can learn about their experience.

In the second study, Chen will use national VA data to investigate the weight loss effect of GLP-1 agonists in older adults. Because real-world weight loss often differs from weight loss in a clinical trial, the study will provide better insight into what to expect when not in a controlled environment, she says.

“How much weight do we expect them to lose? Can it help them improve their function, or does it hinder their function? What are the unforeseen adverse effects that occur when older adults take these meds?”

Chen hopes these studies will answer these questions and further understanding of the important considerations for older adults who take GLP medications.