Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Mar;49(3):369-380.
doi: 10.1038/s41366-024-01529-z. Epub 2024 May 6.

Obesity pharmacotherapy in older adults: a narrative review of evidence

Alex E Henney  1   2   3 , John P H Wilding  4   5   6 , Uazman Alam  4   5   6 , Daniel J Cuthbertson  4   5   6
Affiliations
Review

Obesity pharmacotherapy in older adults: a narrative review of evidence

Alex E Henney et al. Int J Obes (Lond). 2025 Mar.

Abstract

The prevalence of obesity in older adults (people aged >60 years) is increasing in line with the demographic shift in global populations. Despite knowledge of obesity-related complications in younger adults (increased risk of type 2 diabetes, liver and cardiovascular disease and malignancy), these considerations may be outweighed, in older adults, by concerns regarding weight-loss induced reduction in skeletal muscle and bone mass, and the awareness of the 'obesity paradox'. Obesity in the elderly contributes to various obesity-related complications from cardiometabolic disease and cancer, to functional decline, worsening cognition, and quality of life, that will have already suffered an age-related decline. Lifestyle interventions remain the cornerstone of obesity management in older adults, with emphasis on resistance training for muscle strength and bone mineral density preservation. However, in older adults with obesity refractory to lifestyle strategies, pharmacotherapy, using anti-obesity medicines (AOMs), can be a useful adjunct. Recent evidence suggests that intentional weight loss in older adults with overweight and obesity is effective and safe, hence a diminishing reluctance to use AOMs in this more vulnerable population. Despite nine AOMs being currently approved for the treatment of obesity, limited clinical trial evidence in older adults predominantly focuses on incretin therapy with glucagon-like peptide-1 receptor agonists (liraglutide, semaglutide, and tirzepatide). AOMs enhance weight loss and reduce cardiometabolic events, while maintaining muscle mass. Future randomised controlled trials should specifically evaluate the effectiveness of novel AOMs for long-term weight management in older adults with obesity, carefully considering the impact on body composition and functional ability, as well as health economics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: DJC has received investigator-initiated grants from Astra Zeneca and Novo Nordisk, as well as speaker fees for lectures. UA has received investigator-led grant from Proctor and Gamble, as well as speaker fees for lectures. He has also received honoraria from Boehringer Ingelheim, Eli Lilly, Napp, Proctor and Gamble and Sanofi for educational meetings. JPHW consults widely for pharmaceutical companies in relation to obesity and diabetes (fees paid to the University of Liverpool) and via his institution has received research grants from industry. He is received lecture fees from commercial organisations including the pharmaceutical industry and has provided unpaid support to various charities in relation to his interest in obesity and diabetes. AEH has no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1. Venn diagram exploring the four body composite phenotypes in older adults (including healthy weight).
The triad of sarcopenia, as defined by The European Working Group on Sarcopenia in Older People (EWGSOP), is illustrated [35]. Co-morbid complications related to obesity include, but are not limited to, cardiovascular disease (CVD), metabolic dysfunction associated steatotic liver disease (MASLD), type 2 diabetes (T2D), hormone-dependant cancers, and musculoskeletal (MSK) issues such as osteoarthritis.
Fig. 2
Fig. 2. General algorithm for the management of obesity including lifestyle intervention, pharmacological therapy, and metabolic surgery.
BMI body mass index.
Fig. 3
Fig. 3. An updated algorithm for the medical management of obesity using approved pharmacological agents.
BMI body mass index. If in the USA, phentermine/topiramate could also be considered after semaglutide.
Fig. 4
Fig. 4
Radar plot demonstrating the percentage weight loss from baseline in the intervention arm of landmark randomised controlled trials of approved and novel anti-obesity medicines that have evidence for use in older adults.
See this image and copyright information in PMC

References

    1. NHS. Improving care for older people. 2023. https://www.england.nhs.uk/ourwork/clinical-policy/older-people/improvin....
    1. Arora S. Aging and non-communicable disease. In: Arora S, editor. The transitions of aging. Cham: Springer International Publishing; 2015. pp. 1–23.
    1. Al Snih S, Ottenbacher KJ, Markides KS, Kuo YF, Eschbach K, Goodwin JS. The effect of obesity on disability vs mortality in older Americans. Arch Intern Med. 2007;167:774–80. - PubMed
    1. Colin RS, Julia H-C, Aziz S. Trends in the epidemiology of smoking recorded in UK general practice. Br J Gen Pract. 2010;60:e121–7. - PMC - PubMed
    1. Peralta M, Ramos M, Lipert A, Martins J, Marques A. Prevalence and trends of overweight and obesity in older adults from 10 European countries from 2005 to 2013. Scand J Public Health. 2018;46:522–9. - PubMed

Substances

LinkOut - more resources