Weight loss, GLP-1s and Sarcopenia: A Podcast with John Batsis, Shen Dewar, Aruna Josyula

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GeriPal - A Geriatrics and Palliative Medicine Podcast 46 min 2 speakers 4 chapters transcribed 10 hours ago

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What is the main topic discussed in this episode?

Eric Widera 0:00

This podcast is not C Me Eligible. If people do want to learn more about C Me Eligible Podcasts, Alex, what do they do?

Alex Smith 0:08

They can go to cherrypal.org backslash CME.

Eric Widera 0:12

And on to the show. Welcome to the JerryPal Podcast. This is Eric Guidara. This is Alex Smith. Alex, we got a great episode today. We're going to be talking about GLP1, sarcopenia, and obesity in older adults. Who do we have on the podcast with us? We

Alex Smith 0:28

are delighted to welcome John Batsis, who is a geriatrician researcher at the University of North Carolina. John, welcome to the JerryPal Podcast.

John Batsis 0:37

Thanks, Alex.

Alex Smith 0:38

Thanks, Eric.

John Batsis 0:39

Really uh excited

Alex Smith 0:40

to be here. And we're delighted to welcome Shen Dewar, who is a geriatrician and board certified in obesity medicine. And she's at the University of Michigan. Good Lex and

Shen Dewar 0:50

Eric. Happy to be here.

Alex Smith 0:52

Uh and we're delighted to welcome Aruna Josula, who is a geriatrician and directs the geriatrics fellowship at Texas AM and is chair of the American Geriatrics Society Ethics Committee. Aruna, welcome to the JerryPal podcast.

Aruna Josyula 1:08

Thank you, Alex. Thanks, Eric. So great to be here.

Eric Widera 1:11

All right, we got a lot to cover, a lot to talk about. GLP ones, weight loss, strength loss, muscle loss, all these potential things. But before we do, who has the song request? Is it Shen?

Shen Dewar 1:25

Yes. So Alex, uh wouldn't you play the weight by the band?

Eric Widera 1:30

Why did you choose this song?

Shen Dewar 1:33

Song guy walks into the town and everybody wants him to carry something different. And that's geriatric obesity in one song. Ten medications, five specialists, and one patient asking what matters to me? Back to you, Alex.

Alex Smith 1:49

Take a load off, Fanny. Yeah. The weight, great, great choice. Um, if you ever see me at a sing along um at one of these national meetings, this is one I love to do because we try and do the harmonies. Today you just got me, but dear listeners, uh hopefully we can harmonize to this one someday.

Unknown 2:25

Hold in Nazareth. I was feeling by half past dead. I just need some place. Where I can lay my hand Hey mister, can you tell me where a man might find it bed? It just screamed and shook my head and knows all he said. Seagalood offinning. Take a load for free. Jingle Fanny.

Unknown 3:09

Blow right on me.

Eric Widera 3:24

Oh, it's a great song. Awesome. Love it. Yeah, love it. Decision making. It could go oh the I love that those

Alex Smith 3:32

lyrics. Uh fun fact, Bob Dylan's backing band when he first went electric, for those of you who saw that Bob Dylan movie, that was the wait. Yeah. Mostly Canadian. Thank you. Great choice, Sean.

Eric Widera 3:45

So uh we got a lot to talk about today on GLP one sarcopenia and obesity. I want to just highlight that we have two articles and JAGs that cover this. One is just uh published now a month ago. We're actually recording this in July, but I think this is coming out in August. One size fits none, developing a person centered approach to weight management in older adults. Aruna, that was your article. Wonderful. Well And another combo article, Incretin-based therapeutics and older adults, information for clinicians and tip sheets for practice. I love this article because it has great cases in it. John, you were an author in this article. Just absolutely adored it. So well done. We'll have links to both of those.

Eric Widera 4:28

We're going to be talking about some of those topics during our talk today. I'm going to start us off with. Just big picture. What are some of the age-related changes that we see in weight and muscle? John, can you kinda give us a picture? Others feel free to chime in. You got

John Batsis 4:46

it. You know, this this comes up all the time. You know, think about When we age, we actually gain weight. Over the over the course of a lifespan.

Jarmo Kekalainen 4:56

I've

John Batsis 4:56

noticed that. Yep. And you know, I always like to say, Forget about being your college weight, you know. But let's think about beyond that. We've gained fat as we age, usually peaks around the seventh, eighth decade of life. And then subsequent to that You know, it kinda d it it fall it falls off a little bit. But here's here's where it gets really interesting. Brain. you build muscle uh muscle mass and muscle strength with age up until about the third to fourth decade of life.

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Chapters

4 chapters

1 What is the main topic discussed in this episode? 0:00–17:40 2 What are the age‑related changes in fat, muscle, and bone that affect older adults? 17:40–26:53 3 How is sarcopenia and sarcopenic obesity defined and why are they risky for independence? 26:53–33:41 4 What terminology should clinicians use when discussing obesity with older patients? 33:41–46:42

Speakers

2 identified

Eric Widera 9 min Alex Smith 2 min

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Topics in this episode

Alex 1 Alex Smith 1 University of Michigan 1 obesity 1 Texas A&M 1 University of North Carolina 1 Elizabeth Chung 1 Harry Hahn 1 Susan Nelson 1 sarcopenia 1 James Tulski 1 Asher Edwards 1

Source

Recorded03 Sep 2026

Publisherrss.libsyn.com ↗

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Show notes

GLP-1 receptor agonists (the "Ozempics of the world") have been a truly revolutionary pharmacological advance in modern medicine. In randomized controlled trials (RCTs), these agents have been shown to do much more than just reduce weight, including significantly reducing cardiovascular events, lowering all-cause mortality in patients with type 2 diabetes, and even slowing the progression of chronic kidney disease. But as we see their use rapidly expand among older adults, we have to ask: at what cost? In geriatrics, weight loss is rarely simple. In older bodies, GLP1s carry increased risks, including accelerated muscle loss, functional decline, and possibly decreased bone density. So are we just trading weight loss for frailty? To help us untangle this complex web, we sit down with three expert geriatricians in obesity: Dr. John Batsis, Dr. Shen Dewar, and Dr. Aruna Josyula. What We Discuss in This Episode: How age-related changes alter the distribution of fat and muscle, even when body weight stays exactly the same. What are sarcopenia (muscle loss) and sarcopenic obesity, and why are they so dangerous for independence? A discussion on what happens to fat, muscle, and bone during standard weight loss versus weight loss accelerated by GLP-1s. Whether GLP-1-induced muscle loss a direct biological side effect from suppressed muscle protein synthesis, or is it simply the indirect result of a massive caloric deficit and dropping protein intake? A broad, geriatric-focused approach to weight, including a vital review of common medications that might actually be causing weight gain in the first place. Practical, actionable strategies to protect muscle mass and function when prescribing GLP1s A discussion of red flags in older adults, where we should have major hesitation before ever writing a prescription for a GLP-1 We cover this and more in the podcast. There is a forthcoming article in JAGS that addresses this topic, and we will add the link here once published. If you want to take a deeper dive, take a look at some of the following references we discuss: Aruna's article in JAGS titled "One Size Fits None: Developing a Person-Centered Approach to Weight Management in Older Adults" John's Annal's article on the "Effect of Incretin-Based and Nonpharmacologic Weight Loss on Body Composition: A Systematic Review" John's article on the "Unintended risks of sarcopenic obesity during weight-loss interventions in older people" in Nature Med. An article titled "The Effects of Incretin Mimetic Therapies on Muscle and Bone Health in Older Adults" A systematic review of the effect of weight loss on muscle-based indices An article on "Treating Sarcopenic Obesity in the Era of Incretin Therapies: Perspectives and Challenges" Shen's article describing "The Optimal Health Weight and Lifestyle (OHWL) Clinic" Shen's article titled "A Geriatrician's Approach to Managing the Complex Older Adult with Obesity" Another JAGs article on "Older Adults with Obesity: The Need for a 4Ms Age-Friendly Approach to Care" Lastly, CMS's information on the GLP1 bridge program

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