Older Americans Quit Weight-Loss Drugs in Droves

Year after year, Mary Bucklew developed a strategy with a nurse practitioner to lose weight. “We tried to exercise,” like walking 35 minutes a day, she recalls. “And 39,000 different diets.”

But 5 pounds would get lost and then invariably reappear, said Bucklew, 75, a retired transit worker in Ocean View, Delaware. Nothing seemed to make much of a difference – until 2023, when his body mass index slightly exceeded 40, the threshold for severe obesity.

“There’s this new medication I’d like you to try, if your insurance will pay for it,” the nurse practitioner advised. She was talking about Ozempic.

Medicare covered it for treatment of type 2 diabetes, but not for weight loss, and it cost more than $1,000 a month. But to Bucklew’s surprise, her Medicare Advantage plan covered her even though she didn’t have diabetes, charging only a $25 monthly copay.

Pizza, pasta and red wine suddenly became unappealing. The medication “changed what I wanted to eat,” she said. As 25 pounds disappeared in six months, she felt less tired and found herself walking and cycling more.

Then her Medicare plan let her know it would no longer cover the drug. Calls and letters from his healthcare team, saying Ozempic was necessary for his health, had no effect.

With coverage denied, Bucklew became part of a worryingly large group: older people who start taking GLP-1 and related drugs—highly effective for diabetes, obesity, and several other serious health problems—and then stop taking them after a few months.

This usually means gaining weight back and losing the health benefits that come with it, including lower blood pressure, cholesterol and HbA1c, a measure of blood sugar levels over time.

Widely described as wonder drugs, semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Zepbound, Mounjaro), and related drugs have transformed the treatment of diabetes and obesity.

The FDA has also approved several GLP-1s for additional uses, including to treat kidney disease and sleep apnea, as well as to prevent heart attacks and strokes.

“They’re being studied for every purpose imaginable,” said Timothy Anderson, a health services researcher at the University of Pittsburgh and author of a recent JAMA Internal Medicine editorial on anti-obesity drugs.

(However, drug trials have found no impact on dementia.)

People aged 65 and over represent prime targets for these drugs. “The prevalence of obesity hovers around 40 percent” among 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.

The proportion of people with type 2 diabetes also increases with age, reaching almost 30% at ages 65 and over. Yet a recent JAMA Cardiology study found that among Americans 65 and older with diabetes, about 60% stopped semaglutide within a year.

Another study of 125,474 obese or overweight people found that nearly 47% of people with type 2 diabetes and almost 65% of those without diabetes stopped taking GLP-1 within a year — a high rate, said Ezekiel Emanuel, a health services researcher at the University of Pennsylvania and lead author of the study.

Patients aged 65 and older were 20 to 30% more likely than younger patients to stop treatment and less likely to return.

What explains this pattern? Up to 20% of patients may suffer from gastrointestinal problems. “Nausea, sometimes vomiting, bloating, diarrhea,” Anderson said, listing the most common side effects.

Linda Burghardt, a researcher in Great Neck, New York, started taking Wegovy because her doctor thought it might reduce arthritic pain in her knees and hips. “It was an experience,” said Burghardt, 79, who couldn’t walk far and had stopped playing pickleball.

Over the course of a month, she suffered several stomach aches that “lasted for hours,” she said. “I was crying on the bathroom floor.” She stopped the medication.

Some patients find that medication-induced weight loss decreases rather than improves fitness, because another side effect is muscle loss. Several trials have reported that 35-45% of weight loss due to GLP-1 is not due to fat, but to “lean mass”, including muscle and bone.

Bill Colbert’s favorite pastime of 50 years, re-enacting medieval combat, involves “donning 90 pounds of steel plate armor and fighting with broadswords.” A retired computer systems analyst in Churchill, Pa., he started with Mounjaro, successfully lowered his blood sugar and lost 18 pounds in two months.

But “you could almost see the muscles melting,” he recalls. Feeling too weak to fight well at age 78, he also stopped taking the drug and now resorts to other diabetes medications.

“During the aging process, we start to lose muscle,” typically between 0.5 and 1 percent of our muscle weight per year, said Zhenqi Liu, an endocrinologist at the University of Virginia who studies the effects of weight-loss drugs. “For people taking these medications, the process is much more accelerated.”

Muscle loss can lead to frailty, falls and fractures. Doctors therefore advise GLP-1 users to exercise, including weight training, and eat enough protein.

The high GLP-1 discontinuation rate may also reflect shortages; From 2022 to 2024, these drugs have temporarily become difficult to find. Additionally, patients may not understand that they will likely need the medications indefinitely, even after reaching their blood sugar or weight goals.

Resuming treatment carries its own risks, Batsis warned. “If weight goes up and down, up and down, metabolically, that sets people up for functional decline later.”

Of course, when considering the reasons patients drop out, “a lot of it is money,” Emanuel said. “Expensive medications, not necessarily covered” by insurers. Indeed, in a Cleveland Clinic study of patients who stopped semaglutide or tirzepatide, nearly half cited cost or insurance concerns as the reason.

Some price moderation has already taken place. The Biden administration capped out-of-pocket payments for all prescriptions received by a Medicare beneficiary ($2,100 is the 2026 limit) and authorized annual price negotiations with manufacturers.

The reductions include Ozempic, Wegovy and Rybelsus, but not until 2027. Medicare Part D drug plans will then pay $274, and because most beneficiaries pay 25% in coinsurance, their monthly cost will drop to $68.50.

Perhaps even lower, if the deals announced in November between the Trump administration and drugmakers Eli Lilly and Novo Nordisk come to fruition.

The biggest question is whether Medicare will change its original 2003 regulations, which banned Part D coverage for weight-loss drugs. “An archaic policy,” said Stacie Dusetzina, a health policy researcher at Vanderbilt University School of Medicine.

The Trump administration’s November announcement would expand Medicare eligibility for GLP-1 and related drugs to include obesity, perhaps as early as spring. But key details remain unclear, Dusetzina said.

Medicare should cover anti-obesity drugs, many doctors say. Americans still tend to think of “diabetes as a disease and obesity as a personal problem,” Emanuel said. “False. Obesity is a disease, it shortens lifespan and compromises health.”

But given the expenses incurred by insurers, Dusetzina warned, “if you expand the guidance and the scope of coverage, you will see premiums increase.”

For older patients, often underrepresented in clinical trials, questions remain about GLP-1. Could a lower maintenance dose stabilize their weight? Can we space out the doses? Could nutritional advice and physiotherapy compensate for muscle loss?

Bucklew, who was denied coverage, would still like to take over Ozempic. But due to a recent sleep apnea diagnosis, she now qualifies for Zepbound with a monthly copay of $50.

She noticed no weight loss after three months. But as the dose increases, she said, “I’m going to stay the course and try.” »

The New Old Age is produced through a partnership with The New York Times.