In the early days of Mobility Management — the Complex Rehab Technology (CRT) publication I’ve edited since its 2002 founding — I wrote a bariatric mobility story that discussed conjecture that the rising popularity of gastric bypass surgery could reduce the need for such equipment.
That didn’t happen, for multiple reasons. Gastric bypass surgery is a major procedure with serious risks and side effects, including potential damage to the stomach, spleen and other organs. Gastric bypass patients additionally need to make major, permanent lifestyle changes for the surgery to ultimately succeed.
Even with the rise of adjustable gastric band procedures — marketed as less dangerous and easier to reverse — the demand for bariatric mobility equipment didn’t plummet.
The rapid rise of GLP-1 medications to treat type 2 diabetes and obesity the last few years has felt like deja vu, as we heard that the need for sleep apnea treatment and diabetes treatment — two conditions linked with obesity — could significantly decline.
But recent studies are now showing pushback from GLP-1 patients, particularly older ones.
“Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among U.S. Adults with Overweight or Obesity,” published by JAMA Network Open in January, reported that the medical records of more than 125,000 patients taking GLP-1 medications showed 46.5% of patients with type 2 diabetes stopped taking the drugs within a year. Of those, less than half — 47.3% — restarted treatment within one year.
“Weight loss, income and adverse events were significantly associated with discontinuation, while weight regain was significantly associated with reinitiation,” study authors noted.
A Dec. 21 New York Times article referenced a November JAMA Cardiology study that said about 60% of Americans older than 65 and diagnosed with diabetes stopped taking semaglutide [GLP-1] medications within a year of starting.
“Patients over age 65 were 20 to 30% more likely than younger ones to discontinue the drugs and less likely to return to them,” the New York Times article said. One reason: Up to 20% of GLP-1 patients experience gastrointestinal side effects, which can severely impact quality of life.
And an October 2024 study published by the American Heart Association — “Muscle Mass and Glucagon-Like Peptide-1 Receptor Agonists: Adaptive or Maladaptive Response to Weight Loss?” — questioned whether weight loss tied to GLP-1 usage “may be maladaptive” because it can impact muscle health or function.
“Several trials have reported that 35 to 45% of GLP-1 weight loss is not fat, but ‘lean mass’ including muscle and bone,” the Times article said. Muscle loss can raise the risk of falling and fractures.
And for many patients, the costs of the drugs — which in most cases need to be continued even after weight loss or blood glucose goals are achieved — are prohibitive.
Last month, the Trump administration announced reduced Medicare pricing for GLP-1s, including Ozempic, Wegovy, Mounjaro and Zepbound, while adding, “State Medicaid programs will also have access to these medications at these prices. These low prices will enable Medicare to cover Wegovy and Zepbound for patients with obesity and related comorbidities for the first time.”
Making these drugs more accessible to patients who want and need them is a good thing.
But in listening to conversations about how GLP-1s could lower sales of diabetic supplies and sleep apnea equipment, and then also reading about patients quitting GLP-1s in very significant numbers, I’m reminded of those conversations about gastric bypass surgery and bariatric equipment two decades ago.
While CRT professionals are well known for saying that no single seating or mobility system works for every CRT client, I’m now thinking that mindset is true for all patients, regardless of diagnosis.
We humans are complicated beings. We can have the same diagnoses, but we live in different environments with unique challenges and goals. Even effective medical treatments aren’t completely without risks and side effects, and we react to and tolerate those differently.
So, access to GLP-1s is good. But so is access to continuous glucose monitors, diabetic supplies, sleep apnea systems and supplies, and yes, bariatric mobility devices. The more tools that health care professionals and patients have, the greater the opportunity to find the combination of technology, treatment and support that will work best for each person.
Here’s to all those options that embrace us in our unique, quirky, individualized glory.
