Should elderly use blockbuster weight loss drugs? A doctor explains what it does to muscle

For decades, her morning walk had been her trusted form of activity. But now, even that was becoming harder. Despite following several diets over the years, her weight hadn’t really changed and her doctors had told her that losing a few kilos might help ease the strain on her knees. Therefore, she wondered if she should try weight loss medication.

Should the elderly try weight loss medication?

She’s not alone. Doctors, including myself, are seeing a sharp rise in the number of people interested in weight loss medications — especially those in the GLP-1 receptor agonist and GLP-GIP categories (these mimic natural hormones to lower blood sugar and ensure weight loss). These are drugs approved for the treatment of obesity, and according to industry sources, several lakh people in India are already using them.

It’s not hard to see why. For the first time, we have medicines that help people lose weight — and that weight loss often brings real benefits, like lower risks of heart disease, snoring — to name a few. But it’s important to remember that these medications are just one part of the bigger picture. They’re a tool — not a magic fix. They should always be taken under medical supervision because, like all medicines, they can have side effects.

Muscle loss most pronounced side effect

One side effect that deserves special attention, especially in older adults, is the loss of muscle mass and strength. As we age, our muscles naturally weaken — a process called sarcopenia. When weight loss happens too quickly or without enough focus on nutrition and strength training, this muscle loss can become even more pronounced.

Therefore, when prescribing these medications for older adults, it’s important to also consider the risk of losing muscle mass and strength, and the health issues that can come with it.

If sarcopenia is not kept in check, it can make older adults more prone to falls, slower movement, and overall frailty. Added to this, any additional loss of muscle mass can tip the balance further, increasing the risk of falls, exhaustion, and reduced vitality.

Current research suggests that up to 15–40 per cent of total weight lost with these medications may come from muscle mass. The measurement of muscle mass through Body Composition Analysis (BCA) using bioimpedance techniques is not perfect but it’s the best available tool for general use at the moment. Readings can vary depending on factors such as hydration status, body fat levels and even calibration or standardization issues with the machine.

How to build muscle mass

As these medications become more popular, we need more research on how to assess muscle strength, function and physical performance — not just muscle mass alone. In the meantime, here are some helpful pointers, best followed under the guidance of a physician:

1) Ensure adequate protein intake (often ≥1.2 g/kg/day). This can come from any source — vegetarian, animal-based, or clean protein powders such as whey.

2) Follow a structured exercise programme that includes strength-building activities.

3) Track muscle health not only by body composition but also by body measurements, mobility and strength.

4) Personalise the approach: Medication selection and treatment plans should be individualised. Consider alternative therapies if the risks outweigh the benefits — especially in those with advanced frailty or disability.

(Dr Kucheria is a family physician and founder, DocGenie Telemedicine)