The use of glucagon-like peptide-1 agonists as a treatment for obesity in older people: risks and benefits

PURPOSE OF REVIEW: Obesity is an increasingly important health problem in older adults (≥65 years) and is associated with osteoarthritis, impaired mobility, reduced quality of life, cardiovascular disease, and other age-related comorbidities. This narrative review summarizes the current evidence regarding the benefits and risks of glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in older adults. RECENT FINDINGS: GLP-1 RAs, initially developed for the treatment of type 2 diabetes mellitus (T2DM), have emerged as effective pharmacological options for weight reduction and cardiovascular risk reduction. Studies suggest that GLP-1 RAs have clinically meaningful weight loss in older adults, with efficacy comparable to that observed in younger populations. In addition, selected GLP-1 RAs have demonstrated cardiovascular benefits, including reductions in major adverse cardiovascular events (MACE), which may be particularly relevant in older individuals with a high burden of cardiovascular disease. Nevertheless, several concerns should be considered before treatment initiation, including gastrointestinal intolerance, sarcopenia-related muscle loss, ophthalmologic complications, and hypoglycaemia when combined with insulin or sulfonylureas. Furthermore, polypharmacy and age-related physiological changes may increase the likelihood of clinically relevant drug interactions. SUMMARY: Current evidence indicates that GLP-1 RAs may represent a valuable therapeutic option for carefully selected older adults, particularly those with severe obesity and cardiometabolic comorbidities.