About 40% of people aged 60 and older are obese. If you’re one of them, you probably know that weight loss isn’t just about diet, exercise, and willpower. It can be hard to lose weight – and even harder to keep it off. This was especially true during the pandemic: The average weight gain was almost 30 pounds!

Over the last couple of years, more and more doctors have started to prescribe weight loss drugs. More than five million prescriptions were written for them for weight management in 2022, compared to just 230,000 in 2019. One reason is that many doctors now recognize that being overweight may sometimes be something you just can’t control.

“It’s a brain disease,” Fatima Cody Stanford, MD, an obesity specialist at Massachusetts General Hospital, said on an episode of “60 Minutes” this past January. “And the brain tells us how much to eat and how much to store.”

Even some celebrities have jumped in on this trend. It’s rumored that they are flocking to semaglutide, an injectable drug that’s sold under the brand name Ozempic. Comedian Chelsea Handler has ‘fessed up to using it, as have Tik Tok celebrity Remi Bader and South African billionaire Elon Musk.

If you’ve struggled with your weight for a while, these drugs might sound tempting. After all, if groups like the American Academy of Pediatrics even recommend these drugs for kids as young as twelve, they have to work and be safe, right?

They are safe and effective, but they can also be expensive and not everyone can use them. Here’s what you should know.

What weight loss drugs are available?

Right now, there are five main weight loss drugs that have been shown to be safe and effective.

Orlistat (Xenical)

This prescription medication prevents your body from absorbing fat from food. If you eat too much fat while you use them, you can experience unpleasant side effects, such as diarrhea, stomach pain, loose oily bowel movements, and gas. You’ll also need to take a daily multivitamin. People who take this drug for a year lose up to 10% of their body weight. Orlistat is also available over the counter at a lower dose (Alli).

Phentermine-topiramate (Qsymia)

This is a combo of two drugs: the appetite suppressant phentermine and topiramate, which treats seizures and migraines. Qsymia makes you less hungry. Side effects include constipation, dizziness, dry mouth, taste changes, tingling of your hands and feet, and insomnia. You can’t take it if you have glaucoma or hyperthyroidism. You should also talk to your doctor about whether it’s safe to use if you have heart or kidney disease or mood problems. People who are on this drug for a year lose on average about 8-10% of their total body weight.

Naltrexone-bupropion (Contrave)

Contrave contains two drugs: naltrexone, used for drug and alcohol addiction, and bupropion, which treats depression. It works by reducing hunger. It can cause GI problems, dizziness, dry mouth, headache, trouble sleeping, and increased blood pressure and heart rate. You can’t take it if you have uncontrolled high blood pressure or a history of seizures. People who take Contrave lose an average of 6-9% of their body weight after a year.

Liraglutide (Saxenda) and semaglutide (Wegovy and Ozempic)

These drugs are given as injections, either daily (liraglutide) or weekly (semaglutide). They mimic a hormone called GLP-1 to make you less hungry. (In lower doses, they are used to treat type two diabetes.) They can cause gastrointestinal problems, headaches, and an increased heart rate. People on liraglutide for a year lose anywhere from 6-12% of their body weight. On semaglutide it’s even higher: up to 16%.

Another type two diabetes drug, tirzepatide, is being studied as a weight loss drug. Although it’s not approved for weight loss yet, some doctors prescribe it as part of “off-label” use. It may be even more effective than drugs that are already out there. Company data has found that almost two-thirds of people who use it lose at least 20% of their body weight! It’s given as a weekly injection.

There are also plenty of over-the-counter supplements available that claim to promote weight loss. You shouldn’t use them, especially without talking to your doctor. They’re not regulated by the FDA, which means you don’t know what’s in them. There’s no proof that they work. They may also contain ingredients that could be dangerous, especially if you have other health conditions, like high blood pressure.

Does Medicare cover weight loss drugs?

Right now, no. Medicare does not cover weight loss drugs. There’s a bill in Congress, the Treat & Reduce Obesity Act, that aims to change that, but it hasn’t been passed yet.

Medicare does have a program called Intensive Behavioral Therapy. You qualify if you have a body mass index (BMI) of 30 or higher. It includes:

●      A diet evaluation

●      Weight-loss counseling

If you are severely obese – a BMI of 35 or higher – Medicare may cover bariatric surgery. Some Medicare Advantage plans have extra coverage to support weight loss, like gym memberships and even short-term healthy home meal delivery.

Find a Medicare plan that best supports your weight loss goals with our easy-to-use Find a Plan tool.

When Should You Consider Weight Loss Drugs?

You shouldn’t just take weight loss drugs because you want to look better. They do carry risk, and you’ll probably have to pay for them out of pocket since they’re not covered by Medicare. You may want to consider them if you have a BMI over 30 and a health condition related to your weight, like high blood pressure or type two diabetes.

Even then, you’ll probably want to try diet and exercise first. If those don’t help, and if your doctor recommends it, prescription weight loss medications are very effective. However, you’ll probably need to stay on the drug long term. Research shows that if you go off of it, you’re likely to regain the weight.

If you do decide to take a weight loss drug, you’ll most likely have to pay for it yourself. Check with the drug manufacturer to see if they offer any savings coupons, and ask your doctor if they offer a payment plan.

Additionally, you can look for discounts using sites like GoodRx or SingleCare. You can find orlistat on GoodRX’s website, for example, for just $48.00. Other, newer drugs like Wegovy may be much more expensive out of pocket – around $1600 for a month’s supply of injections.