Adults 65 and older taking GLP-1 medications for weight loss or type 2 diabetes face a higher risk of malnutrition, dehydration, and loss of muscle mass than people using other treatments, according to a new report urging greater medical oversight for this age group.
The report was produced by nference, an artificial intelligence platform that collects data for healthcare research. It has not yet been published in a peer-reviewed scientific journal and is currently under peer review. Researchers examined health records from three large groups. One cohort included 30,000 U.S. adults age 65 and older who were prescribed Zepbound for obesity. A second group contained nearly 19,000 older adults receiving non-GLP-1 drugs for type 2 diabetes. A third group included nearly 6,000 participants who had undergone weight-loss surgery.
Across all groups, the rates of serious complications were low. Less than 1% experienced declines in muscle mass and function. Less than 2% developed malnutrition. About 3% experienced dehydration, and almost 5% reported a loss of appetite. But the risks were significantly higher among participants taking Zepbound, the brand name for tirzepatide used to treat obesity.
The death risk numbers were striking. Zepbound users who developed malnutrition had a 25-fold higher risk of related death compared to tirzepatide users who did not develop malnutrition during an 18-month follow-up period. By comparison, the risk was 7-fold for people on other diabetes treatments and 2-fold for those who had weight-loss surgery. Zepbound users who experienced dehydration had a 6-fold higher death risk, compared to a 4-fold higher risk among people using other diabetes treatments.
Researchers were careful to note that frailty-associated conditions remain uncommon with GLP-1 use and that the findings should not discourage appropriate prescribing of these medications. The report called instead for closer follow-up with older patients already on these drugs.
According to Healthline, Mir Ali, MD, a bariatric medicine specialist and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California, addressed the findings directly. "These conditions are rare occurrences, and we should just be more aware of the issues for older adults," he said. "By no means does it mean we should not prescribe these medications to people over 65."
GLP-1 drugs containing tirzepatide, including Zepbound and Mounjaro, have been shown to support weight management, blood sugar regulation, heart health, and treatment of sleep apnea. The researchers acknowledged those benefits and said the decision to prescribe should weigh both the risks and benefits for each individual patient.
