Ozempic, Wegovy, and Mounjaro: It’s hard to miss the amazing success stories about these new anti-obesity medications that sound like they melt the pounds right off. But what’s the real story behind these new-generation drugs and are they right for you? Bottom Line Health talked to Amanda Velazquez, MD, DABOM, to learn more.

Are these medications safe for people over age 65?

The semaglutide trials looked at people who were, on average, age 46 plus or minus 13 years, but they didn’t specifically look at people over age 65. However, pooled data suggest these medications are safe for older people. The GLP-agonists like semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro) are very safe. There are very few reasons that a patient can’t be on them. Unlike some former medications, they can even be taken by people with cardiovascular disease.

People ages 65 and older should lose weight slowly—just one to two pounds a week—to preserve muscle mass and maintain gait stability and strength.

What other benefits do these medications provide?

In addition to improvement with weight loss, GLP-agonists help with insulin sensitivity, blood sugar control, and heart health. A recent trial called SELECT showed that semaglutide can actually reduce the risk of major adverse cardiovascular events. The study looked at more than 17,000 people in 41 countries with an average age over 45. I suspect that the cause is twofold: from the weight loss and the anti-inflammatory effects of the medication. It has been shown that on a cellular level, these drugs reduce inflammation in blood vessels.

Can someone take these drugs to lose a small amount of weight?

No, these medications are for individuals living with overweight and obesity that is impacting their health. In an ideal world, this medication would be used for the entire spectrum of people affected by obesity, but because of the challenges of cost, access, and insurance, for now, it’s a priority for those who have significant weight-related diseases.

How do these drugs change how we understand obesity?

Because they’ve caught mainstream attention, they’re changing the cultural perception of obesity. Among professionals, we have known for decades that this is a chronic disease. In society at large, obesity has been considered a problem that a patient should have to face on their own because it’s their fault that they’re at a higher weight. But obesity is like any other health condition.

Can you take these medications short-term?

A study found that when people stopped taking the medication after 68 weeks, even if they continued with lifestyle changes, two-thirds of the weight was regained within one year. This shows the biological pressure for the body to want to return to its set point.

Lifestyle alone is not a strong enough tool for many patients. That’s why we have an obesity epidemic. It’s not the failure to do the right diet or exercise plan. For now, our understanding is that these medications need to be taken for life.

A Pricey Solution

  • Ozempic costs five times more in the U.S. ($936) than it does in Japan ($169). Wegovy is nearly four times as expensive in the U.S. ($1,349) as it is in Germany ($328).
  • Medicare coverage of obesity services and treatments currently includes obesity screening, behavioral counseling, and bariatric surgery, but not anti-obesity medications.
  • Drug manufacturers are lobbying for a change in the law to allow coverage under Medicare.
  • A bipartisan group of lawmakers has reintroduced the Treat and Reduce Obesity Act (H.R. 4818/S. 2407), which would authorize Part D coverage of medications when used for the treatment of obesity or weight-loss management in overweight individuals with related comorbidities.

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