Obesity is becoming an increasingly serious health problem around the world, especially among older adults.
As people age, carrying excess body weight can place extra strain on the heart, joints, blood vessels, lungs, and many other organs.
Obesity in older age is linked to high blood pressure, heart disease, sleep problems, diabetes, reduced movement, disability, and lower quality of life.
For many years, doctors were cautious about aggressive weight-loss treatment in older adults because older people are often more medically fragile.
Some elderly individuals already live with several chronic diseases, reduced muscle strength, balance problems, or frailty. Rapid weight loss could sometimes worsen weakness or increase the risk of falls.
However, obesity itself can also seriously damage health and independence. Scientists have therefore been searching for safer and more effective ways to help older adults manage excess weight.
Now, researchers from the University of Padova in Italy and collaborators from Novo Nordisk have reported encouraging results for semaglutide, one of the world’s most talked-about obesity drugs.
The findings came from a large analysis of clinical trials known as the STEP program. The study examined whether semaglutide works safely and effectively in adults aged 65 years and older.
Semaglutide belongs to a group of medicines called GLP-1 receptor agonists. These drugs were first developed to help treat type 2 diabetes because they improve blood sugar control. Later, researchers discovered that they also strongly reduce appetite and help many people lose weight.
Semaglutide works partly by slowing how quickly food leaves the stomach and by affecting areas of the brain linked to hunger and fullness. Many patients feel satisfied after eating smaller amounts of food, which helps reduce calorie intake over time.
In recent years, semaglutide has gained worldwide attention because studies showed very large amounts of weight loss in many adults with obesity. However, researchers still needed more information about whether the drug works equally well in older adults.
The new analysis combined data from several STEP trials, including STEP 1, 3, 4, 5, 8, and 9. The researchers focused only on adults with obesity or overweight who did not have diabetes because weight loss results in diabetes patients are usually different.
Participants either had obesity, defined as a body mass index of 30 or higher, or were overweight with at least one obesity-related health condition.
The participants were randomly assigned to receive either weekly injections of semaglutide at a dose of 2.4 milligrams or a placebo treatment. Everyone also received lifestyle advice, including guidance on healthy eating and physical activity. One study also included intensive behavioral therapy.
Researchers followed participants for 68 weeks, which is about one year and four months.
Out of more than 4,500 total participants in the STEP trials, 358 people were aged 65 or older and included in this analysis. Most were between 65 and 74 years old, while a smaller group was older than 75.
At the beginning of the study, the average participant weighed about 99 kilograms and had a body mass index of 36.6, which falls within the obesity range. Most participants were women.
The results were striking.
Older adults taking semaglutide lost an average of 15.4% of their body weight over 68 weeks. By comparison, participants receiving placebo lost only 5.1% on average.
Waist circumference also improved significantly. Participants taking semaglutide reduced their waist size by an average of 14.3 centimeters, compared with 6 centimeters in the placebo group.
The researchers also looked at how many participants achieved major weight-loss goals.
About 66.5% of people taking semaglutide lost at least 10% of their body weight. Nearly half lost at least 15%, and more than one-quarter lost at least 20%. These levels of weight loss are considered medically important because they may improve many obesity-related diseases.
The placebo group showed much smaller improvements.
The study also found better results for many measures linked to heart and metabolic health. Participants taking semaglutide showed improvements in blood pressure, cholesterol, blood fats, inflammation markers, and blood sugar control.
Researchers also found that more participants reached healthier body weight categories after treatment. About 27% of semaglutide users achieved a body mass index below 27, compared with only 5.5% in the placebo group.
The safety findings were also closely examined because older adults may be more sensitive to medication side effects.
Overall side effects were common in both groups, but most were not severe. Constipation and dizziness occurred more often in the semaglutide group, which matches previous studies of GLP-1 drugs.
Serious adverse events occurred somewhat more often in the semaglutide group compared with placebo. However, fractures and dangerously low blood sugar events remained rare in both groups.
Professor Luca Busetto explained that obesity is extremely common among adults over 65 in many wealthy countries and contributes greatly to disability and poor quality of life.
The researchers believe these findings support semaglutide as a useful treatment option for carefully selected older adults with obesity.
Still, experts caution that the medication is not suitable for everyone. Doctors need to monitor patients carefully because older adults may be at higher risk for dehydration, muscle loss, weakness, or digestive side effects during weight-loss treatment.
The study is important because obesity in older adults has often received less attention than obesity in younger people. Many doctors previously worried that encouraging weight loss in older patients could do more harm than good.
This new evidence suggests that properly supervised treatment may help many older adults improve both body weight and overall health.
The findings were based on the STEP clinical trial program and published by researchers from the University of Padova and Novo Nordisk.
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