A working group of the American Geriatrics Society has published a framework for prescribing obesity medications, including GLP-1 drugs, to older adults, with muscle protection at its center. The AGS Healthy Aging Special Interest Group wrote it, and News-Medical reported the release on October 29, 2026. The paper applies the Geriatrics 5Ms, an organizing model made of Mind, Mobility, Medications, Multicomplexity and Matters Most, to incretin therapy.
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Before a first dose, the framework asks clinicians to assess functional status, nutritional adequacy and cognitive impairment. It names sarcopenia and frailty, the risk of lean muscle loss, malnutrition and dehydration as the hazards to weigh in this age group. No new trial results are reported; the paper is organized around a series of cases and offers a practical approach to prescribing.
The muscle problem behind the framework
The society’s group states that older adults are under-represented in clinical trials of these medications, according to the News-Medical summary, which is the main account of the release. The full paper carries the identifier 10.1111/jgs.70769. The summary does not list individual authors, so the paper itself is the place to check who wrote which section.
The same concern appeared in the society’s January 2025 comments on Medicare coverage of obesity drugs, signed by president Mark Supiano and chief executive Nancy Lundebjerg. The letter defined sarcopenia as the age-related loss of muscle mass and strength, said few obesity-drug trials include older adults and noted that recent heart failure trials had a mean age near 65 with few or no participants over 75. It also said losing weight is not always the best option for an older patient, urging attention to overall health, physical function and quality of life.
Evidence on muscle itself is thinner than the worry suggests. A narrative review in the International Journal of Obesity by Alex Henney, John Wilding, Uazman Alam and Daniel Cuthbertson found that intentional weight loss tends to preserve muscle mass while unintentional loss reduces it. In one prospective study of adults with a mean age of 68, liraglutide at 3 milligrams daily for 24 weeks improved body composition and left muscular performance intact. The review reported no drug-specific lean-mass results for semaglutide or tirzepatide, and it called for randomized trials that measure body composition and function in older adults.
The 5Ms structure gives the framework its shape. In the standard geriatrics model, Mind covers cognition and mood, Mobility covers function and fall risk, Medications covers prescribing burden, Multicomplexity covers the interaction of several conditions, and Matters Most covers the goals of the patient. News-Medical lists the five components but does not explain how the paper applies each to incretin therapy, so the detail on dosing decisions, monitoring and stopping rules sits in the full text rather than in the summary, and readers who want those specifics can start from the paper’s identifier cited earlier in this article. The summary also gives no figures on how many older adults currently take these drugs.
The pretreatment checklist is where the muscle concern becomes practical. A patient with weak grip, slow walking or poor appetite starts from a different place than a robust 66-year-old, and the pretreatment assessment of function, nutrition and cognition gives clinicians a baseline against which later change can be judged.
Resistance training, protein and a care team
The framework pairs drug treatment with co-interventions, naming resistance training and adequate dietary protein intake. For some older adults it suggests a team-based approach that could include a registered dietitian, a physical therapist, a fitness trainer and a behavioral health professional. The list reads as a response to the risks flagged earlier: nutrition guards against malnutrition and dehydration, training works against sarcopenia, and the cognitive assessment bears on whether a patient can follow a regimen.
The Henney review reaches a similar conclusion from the trial literature. Its authors argue that maintaining muscle strength, and not muscle mass alone, is key to preventing functional decline, and they recommend resistance training and combining energy restriction with high protein intake and physical activity.
Redefining Weight Wisdom and the society’s training sessions
The 5Ms framing is not new to the society’s obesity work. Its meeting program lists a plenary symposium, Redefining Weight Wisdom, moderated by John Batsis, MD, who also presents on judicious prescribing of incretin mimetics in older adults. Julianna Marwell, MD, speaks on applying the 5Ms to obesity assessment, and the page says weight loss in older adults with obesity has been shown to improve function and mobility.
That balance, with function gains on one side and muscle risk on the other, is what the new framework tries to manage. What it cannot yet show is that its package works: the summary reports no statistics, and the framework is guidance built from cases rather than outcome data. Whether pairing a GLP-1 drug with resistance training and protein actually preserves lean mass in people over 75 is the question the review authors say randomized trials still need to answer.
This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.
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