What older adults should know before starting GLP-1s

Impact of GLP-1-associated weight loss on other medications

Older adults may take multiple medications for chronic conditions and should be monitored closely, as these medications may require adjustment during GLP-1 treatment. For example:

• Diabetes medications may need to be reduced to prevent low blood sugar.
• Blood pressure medications need to be monitored, as weight loss can lower blood pressure and increase the risk of dizziness, passing out and falls.
• People with heart failure may need closer monitoring, because eating and drinking less can affect hydration and kidney function.
• Thyroid medication doses may need to be adjusted with weight change.
• Doses of any medication that worked well before starting a GLP-1 may not be the right dose after significant weight loss.
• Weight loss can have positive impacts on mental health and negative ones when not done in a healthy way, leading to depression, anxiety and other issues related to maintaining mental health.

How weight loss from GLP-1s affects bone health

Bones need both nutritional support and resistance exercise such as strength training to maintain density. People losing weight quickly may not get enough nutrients to support healthy bones. Also, carrying less body weight puts less stress on bones, which reduces the signal that helps keep them dense and strong. Older adults with bone loss, such as osteopenia or osteoporosis, are at a higher risk of fractures from falls. Loss of muscle further increases this risk, as weaker muscles are linked to worse balance and a greater chance of falling.

How to preserve muscle and bone strength while losing weight on GLP-1s

Older adults should avoid aggressive calorie restriction and focus on adequate nutrition, including appropriate protein intake. Regular checkups are important to make sure weight loss is safe and healthy. Strength training is especially important, because it helps maintain muscle and bone strength. Older adults should aim for strength training 2-3 days per week that works on all major muscles. Regular aerobic activity, such as walking, cycling, swimming or other low-impact exercises, is also important for overall health and mobility.

Prescriptions for success: Nutrition, hydration and physical exercise

GLP-1s can reduce appetite and thirst, so people taking them should eat a balanced diet that includes protein at every meal, avoid skipping meals, and make it a habit to drink fluids throughout the day, even if they don’t feel thirsty. Working with a physician or dietitian can help ensure patients meet healthy intake and hydration goals. Exercise should progressively challenge muscles and be planned to target all major muscle groups, such as:

• Chair stands and wall push-ups
• Step-ups and sit-to-stand repetitions
• Resistance band exercises, light free weights and weight machines
• Regular aerobic activities such as walking, cycling and swimming

Physical therapy: An individualized GLP-1 plan

Because older adults are already at higher risk for age-related muscle loss, those who are frail; have a history of falls, balance problems, arthritis or low bone density; or who are recovering from injury may benefit from physical therapy. A physical therapist can develop an individualized program that combines resistance training, balance exercises and flexibility work that mimics everyday activities to improve mobility and independent movement.

When it’s time to wean off GLP-1s

Because prescription coverage or patient preferences may change, it’s important for patients to work with their physician on a long-term weight management plan. Clinicians can help patients explore non-GLP-1-based therapies and develop a step-down plan to reduce weight regain if they stop taking a GLP-1. Maintaining and maximizing healthy lifestyle habits can help preserve health benefits achieved during GLP-1 treatment. By planning ahead, patients and physicians can work together to make informed decisions about these powerful drugs.