Older Adults Abandon Weight-Loss Medications in Large Numbers
The Rise and Challenges of GLP-1 Drugs in Treating Obesity
For years, Mary Bucklew, a 75-year-old public transit retiree from Ocean View, Delaware, struggled with weight loss. She tried numerous diets and exercises, but nothing seemed to work. It wasn’t until 2023 that she found a solution: Ozempic, a drug that helped her lose 25 pounds in six months. However, her journey with the medication was cut short when her Medicare plan stopped covering it.
Ozempic, along with other GLP-1 drugs like Wegovy, Rybelsus, and Zepbound, has revolutionized the treatment of obesity and diabetes. These medications are not only effective for managing blood sugar levels but also for reducing body weight and improving overall health. Despite their benefits, many older adults who start taking these drugs often discontinue them within months, leading to weight regain and the loss of health improvements.
Why Patients Discontinue GLP-1s
Several factors contribute to the high discontinuation rate of GLP-1 drugs. Gastrointestinal side effects such as nausea, vomiting, bloating, and diarrhea are common, affecting up to 20% of patients. Linda Burghardt, a 79-year-old researcher from Great Neck, New York, experienced severe stomach issues after starting Wegovy, leading her to stop the medication.
Another concern is muscle loss. Studies show that 35% to 45% of weight lost through GLP-1s is lean mass, including muscle and bone. Bill Colbert, a retired computer systems analyst, noticed his strength declining while on Mounjaro, forcing him to discontinue the drug. This muscle loss can lead to frailty, falls, and fractures, making it crucial for patients to maintain exercise and proper nutrition.
Shortages of these drugs from 2022 to 2024 also contributed to discontinuation. Additionally, many patients do not understand that they may need these medications indefinitely, even after reaching their goals.
Cost and Insurance Coverage
Cost is another significant barrier. While some insurance plans cover GLP-1s, others do not, especially for weight loss purposes. A Cleveland Clinic study found that nearly half of patients discontinued semaglutide or tirzepatide due to cost or insurance issues.
The Biden administration has taken steps to address this by capping out-of-pocket payments for Medicare beneficiaries and negotiating prices with manufacturers. Starting in 2027, Medicare Part D plans will pay $274 for Ozempic, Wegovy, and Rybelsus, reducing out-of-pocket costs to around $68.50 per month.
However, the long-term impact on insurance premiums remains a concern. Expanding coverage for anti-obesity drugs could lead to higher premiums, according to Stacie Dusetzina, a health policy researcher at Vanderbilt University School of Medicine.
The Future of GLP-1s in Medicare
Medicare’s 2003 regulations prohibit Part D coverage for weight loss drugs, a policy many consider outdated. The Trump administration’s November announcement aims to expand eligibility for GLP-1s to include obesity, potentially as early as spring. However, key details remain unclear.
Many doctors argue that obesity should be recognized as a disease, not just a personal issue. “Obesity reduces life span and compromises health,” said Ezekiel Emanuel, a health services researcher at the University of Pennsylvania. Yet, expanding coverage comes with financial challenges.
For older patients, questions about GLP-1s remain. Can lower maintenance doses stabilize weight? Can doses be spaced out? Could nutritional counseling and physical therapy offset muscle loss?
Mary Bucklew, whose coverage was denied, now takes Zepbound for her sleep apnea diagnosis. Though she hasn’t seen weight loss yet, she plans to continue the medication as the dose increases.
As the use of GLP-1s continues to grow, so do the complexities surrounding their long-term use, cost, and effectiveness. For many, these drugs offer hope, but the path to sustained health remains challenging.
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