Phase 3 trials demonstrate that GLP-1 receptor agonists like semaglutide and tirzepatide produce sustained 10-20% weight loss in women aged 65 and older, alongside consistent improvements in cardiovascular and metabolic markers. This represents a significant therapeutic advance for a population where obesity compounds age-related health risks including frailty, osteoarthritis, and sleep disorders. However, the finding highlights a critical clinical paradox: these powerful weight-loss medications may accelerate sarcopenia, the age-related muscle loss that already affects this demographic. The muscle-wasting potential creates a delicate balancing act between achieving necessary weight reduction and preserving the lean mass essential for maintaining independence and preventing falls. This tension is particularly relevant given that muscle quality often matters more than total body weight in older adults. The research suggests combining GLP-1 therapy with resistance training and optimized protein intake, but real-world implementation remains challenging. While the 10-20% weight loss is clinically meaningful, the lack of long-term muscle preservation data in this age group represents a significant knowledge gap that could influence treatment outcomes and quality of life.