Older Americans are quitting weight loss drugs in droves

KFF Health News — Every year, Mary Bucklew strategizes weight loss with her nurses. “We tried exercise, like walking 35 minutes a day,” she recalls. “And 39,000 different diets.”

But Bucklew, 75, a public transit retiree who lives in Ocean View, Del., said every time she loses 5 pounds, it always comes back. There didn't seem to be much of a difference until 2023, when her BMI rose just above 40, the threshold for severe obesity.

“If your insurance covers it, there's a new drug you should try,'' the nurse advised. She was talking about Ozempic.

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

Pizza, pasta and red wine suddenly lost their appeal. The drug has “changed what I want to eat,” she says. After losing 25 pounds over six months, she felt less tired and started walking and riding her bike more.

She was then informed that her Medicare plan would no longer cover the drug. She received phone calls and letters from her medical team claiming Ozempic was necessary for her health, but it had no effect.

By denying coverage, Mr. Bucklew became part of a disturbingly large group. That group is older people who start taking GLP-1 and related drugs, which are highly effective against diabetes, obesity, and several other serious health problems, and then stop taking them within a few months.

This usually means you'll gain weight back and lose the associated health benefits, such as lowering your A1c, a long-term measure of blood pressure, cholesterol, and blood sugar levels.

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

Americans still tend to think that diabetes is a disease and obesity is a personal problem…which is incorrect. Obesity is a disease that shortens lifespan and impairs health.

The FDA has approved several GLP-1s for additional uses, including therapeutic purposes. kidney disease and sleep apnea syndromeand prevent heart attack And stroke.

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

(The drug test revealed that No effect on dementiabut. )

People over the age of 65 are the main targets for such drugs. John Batsis, a geriatrician and obesity expert at the University of North Carolina School of Medicine, said that “the prevalence of obesity, as measured by body mass index (BMI), is hovering around 40%” among older adults.

percentage of people with Type 2 diabetes increases with agereaching nearly 30% even among people aged 65 and over. However, a recent JAMA Cardiology study found that among Americans 65 and older with diabetes, 60% discontinuation of semaglutide within a year.

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

20-30% of patients were over 65 years old. more likely to discontinue than younger people You will be less dependent on drugs and less likely to return to them.

What explains this pattern? As many as 20% of patients may experience it gastrointestinal problems. “Nausea, sometimes vomiting, bloating, diarrhea,” Anderson said, listing the most common side effects.

Linda Burkhardt, a researcher from Great Neck, New York, started taking Wigovy because her doctor thought it might reduce the pain of arthritis in her knees and hips. “It was an experiment,” said Burghardt, 79, who stopped playing pickleball because he couldn't walk far.

Within a month, she had several stomach upsets that “lasted hours”. “I was crying on the bathroom floor.'' She stopped taking the drug.

Some patients find that the drug reduces their weight loss rather than increasing their fitness, as another side effect is muscle loss. Some trials have reported that 35% up to 45% GLP-1 reduction This refers to lean body mass, which includes muscle and bones, not fat.

Bill Colbert's cherished hobby for 50 years has been reenacting medieval combat, which involves “wearing 90 pounds of plate steel armor and fighting with broadswords.” The former computer systems analyst, who lives in Churchill, Pennsylvania, started using Maunjaro to lower his blood sugar levels and lost 18 pounds in two months.

But “I could almost see the muscles melting away,” he recalls. The 78-year-old felt too weak to fight properly, so he stopped taking that medication and now relies on other diabetes medications.

“As we age, we start to lose muscle,” said endocrinologist Jianqi Liu of the University of Virginia, who typically loses 0.5% to 1% of muscle mass per year. Researching the effects of weight loss drugs. “For people taking these drugs, the process is even more accelerated.”

Muscle loss can lead to weakness, falls, and fractures, so doctors advise GLP-1 users to exercise, including strength training, and eat enough protein.

The high discontinuation rate of GLP-1 may also reflect a shortage. From 2022 to 2024, these drugs were temporarily unavailable. Additionally, patients may not understand that even after they reach their blood sugar and weight goals, they will likely need the medication indefinitely.

Batsis warned that resuming treatment comes with its own risks. “When you go up and down, or go up and down, weight can lead to poorer functioning in the future, metabolically.”

Of course, when you think about why patients discontinue treatment, “a big part of it is money,” Emanuel says. “Expensive medicines, not always covered” by insurance companies. surely, cleveland clinic research Among patients who discontinued semaglutide or tirzepatide, nearly half cited cost or insurance issues as the reason.

Some moderation in prices is already occurring. The Biden administration capped out-of-pocket costs for all prescriptions received by Medicare beneficiaries (up to $2,100 in 2026) and authorized annual price negotiations with manufacturers.

The cuts also include Ozempic, Wigoby and Libersus, but not until 2027. A Medicare Part D drug plan would pay $274, and most beneficiaries would pay a 25% coinsurance, lowering their monthly out-of-pocket cost to $68.50.

It will likely fall further if the agreement announced in November between the Trump administration and drug companies Eli Lilly and Novo Nordisk goes well.

The bigger question is whether Medicare will revise its original 2003 regulation banning Part D coverage of weight loss drugs. “It's an outdated policy,” said Stacey Dusetsyna, a health policy researcher at Vanderbilt University School of Medicine.

of the trump administration November announcement Medicare eligibility for GLP-1 and related drugs will be expanded to include obesity, perhaps as early as this spring. But important details remain unclear, Dusetsyna said.

Many doctors argue that Medicare should cover anti-obesity drugs. Americans still tend to think of diabetes as a disease and obesity as a personal problem, Emanuel said. “No. Obesity is a disease that shortens your lifespan and impairs your health.”

However, considering the burden on insurance companies, “if we expand indications and coverage, premiums will go up,” Dusetsyna warned.

Questions remain regarding GLP-1 in elderly patients, who are often underrepresented in clinical trials. Will lower maintenance doses stabilize weight? Can doses be spaced apart? Can nutritional counseling and physical therapy compensate for muscle loss?

Bucklew, who declined to be interviewed, still hopes Ozempic will be restarted. However, because she was recently diagnosed with sleep apnea, she was able to qualify for Zepbound for a monthly copay of $50.

She showed no weight loss after 3 months. But even with the increased dosage, she said, “I'm going to stay the course and give it a try.”

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