The American Geriatrics Society (AGS), a professional group for doctors who care for older people, has released a framework to help clinicians prescribe obesity medicines to older adults more safely1. The paper covers drugs that include GLP-1 medicines, which act through hormone signals that start in the gut1. Its main message is that age changes the questions a doctor should ask before and during treatment: Is this person losing muscle? Are they frail? Are they eating and drinking enough? And what do they actually want from treatment?1
What happened
The framework was published in the Journal of the American Geriatrics Society under the title “Obesity Medications in Older Adults: A Geriatrics 5Ms Framework for Safe and Patient-Centered Prescribing,” with Elias M. Wisdom listed as first author1. It was developed by the society’s Healthy Aging Special Interest Group1.
Instead of a list of rules, the paper is organized around a series of patient cases, meant to give doctors a practical way to think through these prescriptions1. The society says the medicines offer promising benefits for weight management, blood sugar control and other health conditions, but that older adults are underrepresented in the clinical trials behind them1. In other words, doctors are prescribing to a group the main studies did not include in large numbers.
What the framework advises
The paper uses a tool geriatric doctors already know, the Geriatrics 5Ms, and applies it to incretin therapy, the medical term for the drug family that includes GLP-1 medicines1. The five Ms are Mind, Mobility, Medications, Multicomplexity and Matters Most1. Put simply, these ask about a person’s thinking and memory, how well they move, what other drugs they take, how many health problems they are juggling at once, and what matters most to them.
According to the society’s summary, the authors say safe prescribing requires an assessment before treatment begins of three things1:
- Functional status: how well a person manages daily life on their own.
- Nutritional adequacy: whether they are getting enough food and nutrients.
- Cognitive impairment: any problems with memory or thinking.
The summary also says treatment should line up with the patient’s own priorities1. That reflects the “Matters Most” part of the framework: losing weight may be one goal among several, and the drug plan is meant to fit the person rather than the other way round.
Muscle, frailty and food
The framework puts age-related risks at the center. It says clinicians should carefully consider sarcopenia (the loss of muscle mass and strength that comes with age), frailty, the risk of losing lean muscle during weight loss, malnutrition and dehydration1.
To address these risks, the authors recommend pairing the drugs with two “co-interventions”: resistance training, meaning exercise that makes muscles work against a load, and enough protein in the diet1. The summary does not give specific amounts of exercise or protein, and Biohack has not seen the full paper’s details on this.
The paper also says that for some older adults, a team approach may be most appropriate1. The team it describes includes a registered dietitian, a physical therapist, a fitness trainer and a behavioral health professional1.
What it does not show yet
This is expert guidance, not a new study. The society’s announcement does not report new measurements in patients, and it does not say how many people, if any, were studied to build the cases. It does not show whether following the framework leads to better results, such as fewer falls or less muscle loss, than usual care.
The framework’s starting point is itself a gap in the evidence: the society notes that older adults are underrepresented in the trials of these medicines1. Guidance written in that situation reflects expert judgment about how to weigh risks, rather than direct proof from large trials in older people.
The public summary also leaves some questions open. It does not name specific drugs or brands, does not set an age cutoff for “older adults,” and does not say when, if ever, the authors think a drug should be avoided or stopped. Those details may be in the full journal paper, which Biohack has not reviewed.
Who is behind it
The framework comes from the American Geriatrics Society through its Healthy Aging Special Interest Group, and the news summary was provided by the society itself1. The announcement does not list funding for the paper or any ties between the authors and drugmakers. Readers should treat it as the society’s own description of its work until the full paper’s disclosures can be checked.
The society has long published advice on medicines for older people. Its best-known tool is the Beers Criteria, a list of medicines that may be inappropriate for adults aged 65 and older because the risk of side effects is higher in that age group2. The list was first developed by Dr. Mark Beers in 1991, first updated by the society in 2011, and most recently updated in 20233.
How it fits the field
The new framework is separate from the Beers Criteria, but it shares the same general approach the society has described for that list. The 2023 Beers update stresses individualized care and weighing benefits against risks, particularly in vulnerable groups2. The society’s guidance on using the Beers list also says a “potentially inappropriate” medicine is not automatically off limits, that clinical judgment matters, and that non-drug steps such as counseling and lifestyle changes help make medicine use safer3. It adds that the list should not be used to limit patients’ access to medicines through insurance rules3.
The obesity framework follows a similar pattern. It does not tell doctors to avoid weight-loss drugs in older adults. It tells them to check function, nutrition and thinking first, to watch for muscle loss and frailty, and to add exercise, protein and, where needed, a wider care team1. For readers who follow how older adults keep muscle and strength, the focus on resistance training and protein links this guidance to a broader concern about sarcopenia.
What to watch next
- Trials that include more older people. The society’s main concern is that older adults are underrepresented in the trials of these drugs1. Studies that enroll more of them, and that measure muscle, strength and nutrition, would test the risks the framework highlights.
- How doctors use it. The framework is built around cases for day-to-day practice1. Whether clinics adopt pretreatment checks and team-based care will shape its real effect.
- Further guidance from the society. The AGS updates its medicine advice over time, as it has with the Beers Criteria3. Biohack will follow this thread if the society or other groups add more specific recommendations.
This article is news, not medical advice. Anyone weighing a weight-loss medicine should talk it through with their own clinician.
