AGS Framework for Obesity Medications in Older Adults

The American Geriatrics Society (AGS) has released a clinical framework for prescribing obesity medications to older adults, published in the Journal of the American Geriatrics Society. The paper was developed by the AGS Healthy Aging Special Interest Group.

The framework addresses medications that act through gut-derived hormonal pathways, including glucagon-like peptide-1 (GLP-1) receptor agonists, dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists, and emerging triple GLP-1/GIP/glucagon receptor agonists. According to the authors, these agents are increasingly prescribed for weight management, glycemic control, and cardiometabolic and renal benefits, but older adults have been underrepresented in clinical trials, leaving the potential risks in this population poorly understood.

The authors noted that older adults face increased risks of sarcopenia and frailty and that evidence from major clinical trials suggests medication-associated weight loss may result in substantial loss of lean mass. Other adverse effects they described as potentially more consequential in older adults include dehydration, malnutrition, perioperative aspiration, and fat-predominant weight regain after discontinuation.

The framework draws on patient scenarios involving frailty, cognitive impairment, glucocorticoid use, and surgical planning, and integrates its recommendations within the Geriatrics 5Ms Framework (Mind, Mobility, Medications, Multicomplexity, and Matters Most). The authors wrote that safe prescribing requires pretreatment assessment of functional status, nutritional adequacy, and cognitive capacity, and that treatment should be paired with co-interventions such as resistance training and adequate dietary protein intake. For some patients, they suggested a team-based approach involving a registered dietitian, physical therapist, fitness trainer, and behavioral health professional. They also highlighted transitions of care, including the perioperative period and skilled nursing facility admission, noting that the medications may need to be held or discontinued based on a person’s health condition or significant changes in functional status.

The authors identified priority areas for future research, including age-stratified clinical trials and routine inclusion of body composition and physical function outcomes.

Sources: American Geriatrics Society. AGS releases new framework for safe and patient-centered prescribing of obesity medications in older adults. News release. American Geriatrics Society; October 29, 2026. Accessed October 29, 2026.

Wisdom EM, Goldlist K, Lieber SB, et al. Obesity medications in older adults: a Geriatrics 5Ms framework for safe and patient-centered prescribing. J Am Geriatr Soc. Published online October 29, 2026. Doi:10.1111/jgs.70769