What Older Adults Need to Know Before Taking a GLP-1 Like Ozempic

While a lifeline for many, these medications aren’t for everyone. In particular, people age 65 and older may be susceptible to distinct risks — including muscle mass loss — when taking GLP-1s and similar drugs.

Here’s what older adults and their loved ones need to know about the potential advantages and drawbacks of GLP-1s.

Originally designed to treat type 2 diabetes, GLP-1 drugs work by mimicking the hormone glucagon-like peptide 1, which prompts the pancreas to make more insulin after meals. The extra insulin helps regulate blood sugar, but the drugs can also reduce appetite and slow the movement of food from the stomach to the small intestine, helping people feel full faster, which can promote weight loss.

But one thing to keep in mind is that losing weight, particularly in a rapid manner, can also lead to muscle and bone loss, says John Batsis, MD, an associate professor of medicine in the department of geriatric medicine at the University of North Carolina in Chapel Hill and an American Board of Obesity Medicine (ABOM) diplomate.

Muscle and bone loss can impede older adults’ physical function and ability to live independently, Dr. Batsis says.

“Both muscle mass and strength impact muscle quality, which is key to ensuring individuals can conduct their daily activities,” he says. “Losing muscle mass and strength can lead to sarcopenia [age-related involuntary muscle loss], which increases the risk for functional decline, disability, nursing home placement, and death.”

Strength training and a protein-rich diet can help reduce loss of muscle and bone, but shedding pounds quickly may inhibit the body’s ability to adjust, Batsis notes.

Of course, obesity can also hinder older adults’ health and quality of life, but Batsis says there’s a “fine balance” to strike when it comes to weight loss.

Further research on the effects of GLP-1s on older adults could help healthcare providers and patients achieve that balance more effectively.

“Severe gastrointestinal side effects from these drugs may lead to dehydration, which can lead to falls,” Batsis says. “When a person becomes dehydrated, they are more inclined to become dizzy or feel faint and fall.”

This is why it’s important to monitor older people taking weight loss medications to ensure they get enough food and water.

While GLP-1s and similar medications can be effective tools to help people manage type 2 diabetes and obesity, they’re not enough on their own, nor are they one-size-fits-all, says Kristen Smith, RDN, a spokesperson for the Academy of Nutrition and Dietetics, who is based in Atlanta.

In order to ensure healthful, sustainable results, it’s important to also adopt healthy habits, including eating a balanced diet and staying physically active, adds Shayna Oshita, PhD, RD, CDCES, a dietitian and diabetes educator at the University of Illinois in Chicago.

“There is no magic pill for weight loss, and without proper education on practical lifestyle modifications, patients on these medications will not be successful long term,” says Dana Angelo White, RDN, a dietitian and certified athletic trainer in private practice in Fairfield, Connecticut. “Weight loss is not just about the number on the scale — the type of weight lost and the nutrient deficiencies that may occur as a result of appetite suppression can pose serious health risks.”

Smith says that working closely with a healthcare team is essential for people who use the medications to ensure safety and efficacy.

Additionally, Oshita, Angelo White, and Smith say the following tips may help older adults lose weight safely and keep it off, whether they’re on GLP-1s or not:

• Don’t skimp on fruits and veggies. Incorporate a variety of produce into meals and snacks throughout the day to ensure you’re getting enough fiber, vitamins, minerals, and antioxidants.

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• Make sure you’re getting enough calories. Appetite tends to decrease with age, and GLP-1s can compound that. While that’s not necessarily a bad thing, it can be. “Weight loss requires a calorie deficit, but it must be a sensible and sustainable reduction to prevent muscle loss, nutrient deficiencies, and hunger,” Angelo White says. “Starvation will not work for the long haul.”
• Prioritize sleep. Getting enough quality z’s is important for regulating hunger and metabolism.

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• Include fiber-rich foods. That includes whole-grain rice, oatmeal, beans, and broccoli. Smith says these may help regulate bowel movements and make you feel fuller for longer because these foods take relatively longer to digest.
• Choose physical activities you enjoy. Consider water aerobics, walking, weight lifting, chair yoga, or a dance class. Physical activity helps increase calories burned throughout the day, and activities that strengthen muscles will help prevent weight-loss-related muscle loss, too (more on this below). “Too many older adults force themselves to do exercise they don’t really like, and that makes it so much harder to commit to a consistent exercise routine to prevent injury,” Angelo White says.
• Set SMART (specific, measurable, achievable, realistic, and timely) goals. “For example, I am going to add half a cup (measurable) of a fruit or a vegetable (specific) to my dinner at least three days a week (timely). The small step of this goal makes it realistic and achievable,” Oshita explains.

Although shedding excess fat may enhance older adults’ health and quality of life, maintaining muscle is equally important for mobility, vitality, and overall well-being.

Consuming adequate protein is crucial for muscle building and repair. Experts recommend having a little bit of protein with every meal and snack rather than a large amount at once.

“A piece of chicken or fish the size of your palm is great for a meal,” Oshita says. “A fourth cup of your favorite nuts or seeds mixed with dried or fresh fruit is a great snack option.”

During strength training workouts, Holly Lookabaugh-Deur, DSc, a physical therapist and educator at APTA Michigan, a component of the American Physical Therapy Association, recommends aiming for about 8 to 12 repetitions of five to seven different exercises involving each major muscle group: the core, arms and upper body, and legs and lower body.

“A good rule of thumb to know if you are exercising at the right intensity is that you should be sufficiently fatigued after 8 to 12 repetitions,” she says.

You can tell your muscle is fatigued if it quivers or the force behind the movement becomes weaker, Lookabaugh-Deur notes. If you can continue doing the exercise with ease, gradually add more weight.

Weight lifting is the most obvious form of resistance training, but exercise bands and body weight workouts are great, too, Angelo White says. Some examples of the latter include squats, lunges, yoga, barre, Pilates, stair climbing, and push-ups.

Lookabaugh-Deur also recommends the following for older adults:

• Sit to Stand Sit in a chair and stand up without using your arms. Try to complete as many as you can in 30 seconds. Rest, then try again.
• Planks Lie face down on the floor, push yourself up,  and hold yourself in a flat position on your toes and palms. Start by holding the position for 3 to 5 seconds, and gradually increase the time. Use your forearms to hold the position if it’s too hard on your wrists and hands.
• Triceps Lift Hold a heavy ball or other object in both hands. Lift the object toward the ceiling, then bend and straighten at the elbow only.
• Shoulder Circles With your arms out to your sides in a T position, start with small circles and work into larger circles. Begin with 10 to 15 seconds and work up to 60 continuous seconds. Change directions and repeat.
• Heel Raises Standing near a wall for balance, shift your weight, and lift your heels off the floor while keeping your knees straight. Try 8 to 12 reps with one leg, then repeat with the other leg.
• Hip Windshield Wipers Standing sideways near a wall for balance, lift your entire leg out the side as far as you can without turning your foot. If it is too easy to complete 12, add exercise bands above both knees for more resistance.

• GLP-1 medications are an effective way to manage blood sugar, improve heart health, and treat obesity, but there are certain considerations to take into account for older adults.
• Muscle and bone loss that can accompany rapid weight loss (as is common with GLP-1 use) can increase the risk of falls and fractures in older adults who are already at risk due to age-related deterioration.
• Focusing on a healthy diet, prioritizing sleep, eating adequate protein, and getting enough physical activity — including strength training — can help mitigate the risks of GLP-1 use in older adults.