Batsis said. But even when a weight-loss treatment benefits an older patient, what happens when it ends? People tend to regain fat, but they don’t recover bone and muscle,
This is false. People can regain muscle, such as after an injury or paralysis. Resistance training works at all ages.
Also one must take into the marginal utility of these drugs, which may not justify the cost if the result is only a little extra life expectancy.
Obesity does lower life expectancy by a lot, that is not 'the narrative'. The marginal utility of an anti-obesity drug goes beyond extending life expectancy into a huge number of areas that come together to increase quality of life, mobility, memory, and ability to live independently. With fewer young people to care for the rapidly aging population, making these people require less care overall is a necessity if we are going to ensure they live with dignity.
After the age of 50, there's a marked and steady yearly loss of muscle mass. This is a huge driver of morbidity in older folks. This has been studied extensively and isn't particularly controversial. [1]
I would expect the proportion of people > 50 that perform resistance based weight training to be small. Adding a drug that diminishes your muscle mass when you can least afford to lose it sounds like it could be terrible for that aging population.
> I would expect the proportion of people > 50 that perform resistance based weight training to be small. Adding a drug that diminishes your muscle mass when you can least afford to lose it sounds like it could be terrible for that aging population.
Then prescribe weight training in addition to it. This isn't rocket science. Older folks should be doing exercise to offset the potential loss in muscle and bone mass anyway. It works. We've proven it works. We've proven it improves health outcomes and quality of life long-term going into old age. This isn't just something that should be waved away with "ah, well, we've proven people lose muscle mass, nothing we can do about it".
At 63, I have gained about 4 kilos of muscle mass and lost about two kilos of abdominal fat in three months by doing more rucking (backpacking, up hills).
Older people need a high protein diet, but muscle gain isn't impossible, nor is muscle loss inevitable.
Absolutely. That’s my plan as well. I never said this was inevitable, but it is a well established pattern. Even with weight training, it’s harder than it would be when you’re younger to pack on the pounds of muscle.
It’s much harder to regain muscle, though. Especially as you’re older. And if weight loss drugs are done without regard for diet (ie you just eat chips… but fewer chips), then muscle loss would be expected.
The problem for old people is that it's hard to get bone and muscle, as most of them simple will not exercise.
Also stomach acid drops a lot in old people which makes protein digestion even harder.
In the ideal world, assuming GLP1 is not toxic long-term and that they can keep the weight off, people would exercise to regain muscle.
But if those people got obese in the 1st place, do you really think many of them will suddenly uptake exercise for more than a New Years resolution week or two?
It works on short timescales but discipline has almost zero correlation with long term (5+ years) weight loss.
Drugs, bariatric surgery, and even techniques / lifestyle change make a difference. Discipline alone gets eroded by various hormonal systems aiming to return lost weight.
You've cut the quote out of context and as such missed what is being said. It might help to rephrase the quoted sentence: when an older patient stops weight-loss treatment, on average they regained the fat, but didn't recover the bone and muscle. The point isn't about what's possible, it's about real outcomes that happened. The older you get, the less your body responds to resistance training.
As someone who’s been 150kg and 75kg, fat, fit and everything in between I can guarantee you fat and muscle/bone do not build or atrophy at the same rate, both volumetrically and temporally
Bones and joints are especially slow to adapt (in both directions). Even losing ~0.25kg/w for a year is sufficient to cause my shoulders to frequently sublux if I attempt to raise my arm above shoulder height
And trivially, gaining weight without proper training or too quickly can result in insufficient time for your bones and joints to adapt, placing them under potentially dangerous stress
The time scale the article is talking about does not follow the same trends as recovery from sudden and complete mobility cessation (injury/paralysis)
Resistance training does work at all ages, but the degree to which it is effective varies greatly, and its recommendation is potentially dangerous if applied bluntly to all people
This is false. People can regain muscle, such as after an injury or paralysis. Resistance training works at all ages.
Also one must take into the marginal utility of these drugs, which may not justify the cost if the result is only a little extra life expectancy.