Are there age restrictions on GLP-1s?

In this article:

• Are GLP-1 drugs safe for children and adolescents?
• GLP-1 use in older adults
• Ozempic
• Wegovy
• Mounjaro
• The bottom line

In this article

• Are GLP-1 drugs safe for children and adolescents?
• GLP-1 use in older adults
• Ozempic
• Wegovy
• Mounjaro
• The bottom line

In the last few years, pharmaceutical advancements have led to a new class of drugs that treat Type 2 diabetes and obesity. Known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs or GLP-1s), these medications are incredibly effective for blood sugar control and weight loss. Most GLP-1s are only FDA-approved for use in adults. However, four injectable GLP-1 drugs, Saxenda (liraglutide), Wegovy (semaglutide), Bydureon BCISE (exenatide), and Trulicity (dulaglutide), have been approved for use in younger age groups.

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Are GLP-1 drugs safe for children and adolescents?

The Food and Drug Administration (FDA) has approved two GLP-1 weight loss drugs for pediatric patients ages 12 to 17 with obesity: Saxenda and Wegovy. The FDA has also approved two GLP-1 diabetes drugs, Bydureon BCISE and Trulicity, for patients 10 y age and older. However, that doesn’t mean every young person who wants a GLP-1 gets a prescription, especially when the drug is used for weight loss.

“GLP-1 medications like Wegovy aren’t a first step,” says Heather Gosnell, MD, a pediatrician and plant-based health coach in Phoenix, Arizona. “They’re for teens who have struggled to improve their health with lifestyle changes alone.” She says clinicians must consider each patient’s body mass index (BMI), blood lab results, and whether lifestyle modifications have been tried before prescribing Saxenda or Wegovy to a child, adolescent, or adult.

Benefits of GLP-1 use in children and adolescents

“Wegovy offers significant benefits for teens with obesity, including a 16% drop in BMI and improvements in metabolic health, which may lower long-term disease risk,” says Dr. Gosnell. 

In other words, treating an adolescent’s obesity can improve their overall health now and in the future because obesity increases the risk of serious health problems, including cardiovascular disease, hypertension (high blood pressure), diabetes mellitus, and certain types of cancer. 

Risk of GLP-1 use in children and adolescents

GLP-1s work by suppressing appetite, which can be problematic for adolescents whose bodies are still growing. Research shows that nutrition is critical to healthy development during puberty. Dr.Gosnell says it’s essential for prescribers to monitor growth and nutrition in adolescents on these medications carefully.

Another potential problem? Disordered eating. When it comes to adolescents, treating obesity without first completing a psychiatric evaluation “can sometimes cause more harm than good,” says Sid Khurana, MD, DFAPA, DFAACAP, a board-certified psychiatrist, clinical assistant professor at the University of Nevada, Las Vegas School of Medicine, and medical director of Nevada Mental Health. “It can potentially worsen weight obsession and risk in folks with anorexia,” he adds.” 

GLP-1 use in older adults

There is “no absolute cutoff” when it comes to GLP-1 use in older adults, and these medications are generally considered “safe in seniors,” according to Mir Ali, MD, a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California. Overall, GLP-1 use poses the same benefits for older adults as younger adults: Blood sugar control and weight management. That said, there are a few aging-related risks to understand before starting weight loss medications like Wegovy or Zepbound, including:

• Fall risk due to lost muscle mass
• Underdiagnosed hypoglycemia
• Nutritional deficiencies 

“One of the biggest risks of GLP-1 agonist medications in the elderly population is loss of muscle mass because any weight loss will lead to loss of muscle mass,” says Cynthia Odogwu, MD, a family and lifestyle medicine physician in Maryland. Dr. Ali agrees: “Loss of muscle and bone loss can make someone more prone to falls.” Falls are a major health concern for adults 65 and older, causing about 1 million hospitalizations per year, according to the Centers for Disease Control and Prevention. So while weight loss from GLP-1s can be a huge benefit for older adults with obesity, it’s important to know that losing weight without adding exercise or resistance training to your routine can increase the risk of dangerous falls.

Hypoglycemia is a serious potential side effect for anyone on a GLP-1. But research suggests that hypoglycemia is underreported in older adults because symptoms like confusion and fatigue are nonspecific or misinterpreted as dementia-related. Given that, though the risk of low blood sugar is not higher in older adults, the risk of complications is greater unless those patients commit to carefully monitoring blood sugar levels.

Finally, there is a risk of malnutrition for older adults on GLP-1s. “As we age, we experience a decline in appetite,” says Dr. Odogwu. “One of the successes of GLP-1 agonist medications is their ability to effectively suppress appetite. An elderly person who is treated with a GLP-1 agonist may then end up with significantly decreased food intake, which predisposes them to deficiency of important vitamins and minerals.”

Bottom line: It’s important to discuss the benefits versus risks of GLP-1s with a healthcare provider before starting any new medication. Only a prescriber who understands a patient’s medical history, health conditions, and other medications can determine whether a GLP-1 is the best medication for an older adult with diabetes or obesity.

Ozempic age limit 

The lower age limit for Ozempic (semaglutide) use is 18 because, according to Novo Nordisk, the manufacturer of Ozempic, it is “not known” whether Ozempic is safe and effective in children. There is no upper age limit associated with this drug. 

Wegovy age limit

Wegovy (semaglutide) is approved for use in adolescents aged 12 and older and adults of all ages. There is no upper age limit for Wegovy use, but it’s still important for older adults to talk to their healthcare providers about the risks of muscle loss and nutritional deficiencies while on this weight loss medication.

Mounjaro age limit

Like Ozempic, Mounjaro (tirzepatide) is indicated for use in adults aged 18 and older. There is no definitive upper age limit for Mounjaro. In all cases, it’s important to discuss age-specific health conditions and concerns with a healthcare professional before starting Mounjaro is important.

RELATED: Are there generic GLP-1 drugs?

The bottom line

GLP-1s represent a new era of blood sugar management and weight loss benefits. Ongoing research suggests that GLP-1s may expand into treatments for neurodegenerative conditions, gastrointestinal diseases, liver problems, kidney disease, and more. That said, GLP-1s are not right for everyone. Their appetite suppression effects can be risky for adolescents who need extra nourishment during puberty and older adults who might already have diminished appetites. 

Currently, only four brand-name GLP-1s are approved for use in pediatric and adolescent populations. All are approved for use in adult populations, with no set upper age limit. Research is ongoing, and access to GLP-1s may be expanding, so it’s vital for patients to consult a healthcare provider who knows their medical history when determining whether a GLP-1 is right for them.