GLP-1 preauthorization: using movement plans for sustained weight loss

GLP-1 medications have redefined obesity care for employers and health plans. These powerful drugs support members at high metabolic risk with significant short-term weight loss. But without behavior change and muscle preservation, long-term success can become more elusive.

Many patients on GLP-1s experience weight regain after discontinuation, and research suggests some may also lose meaningful lean mass during treatment. Together, these patterns can increase downstream health and cost risk.¹ ³ Employers and health plans now have a treatment that can support significant short-term weight loss. But medication alone does not create the daily habits that make results more sustainable over time.

Clinical evidence suggests that structured support around movement, nutrition, and day-to-day habits can help strengthen long-term outcomes. Without that support, patients face a higher risk of weight regain, and employers face greater uncertainty around return on investment.

This guide outlines how employers, health plans, and care teams can build more sustainable GLP-1 strategies by supporting members with structured movement, nutrition guidance, and long-term behavior support.

Most GLP-1 candidates start from a deconditioned state

Many patients begin GLP-1 medication from a low-activity baseline. Without structured movement before and during treatment, they are more likely to lose lean muscle and regain fat².

Up to 39% of lean body mass is lost during GLP-1 usage¹.

Lean muscle plays a critical role in both short-term weight loss and long-term health. It is the body’s metabolic engine, helping regulate calorie burn, glucose sensitivity, and mobility. Muscle helps people stay active, pain-free, and physically resilient. Losing muscle, especially during rapid weight loss, slows metabolism and increases risk of injury, fatigue, and MSK conditions.

Lean muscle acts as the body’s metabolic engine. Without it, metabolism slows, mobility declines, and the risks of injury, fatigue, and MSK conditions climb (especially during rapid weight loss)¹. Pulse’s member population reflects the prevalence of this risk profile²

• 76% of Pulse members are overweight or obese
• 57% have an addressable health condition such as diabetes, high cholesterol, or a similar condition
• 46% had low physical activity at baseline

Starting GLP-1 treatment from this baseline can make it harder to preserve strength, function, and durable outcomes over time.

Why muscle retention matters more than weight loss alone

Not all weight loss is equal. Clinical studies show that much of the weight lost on GLP-1s is lean muscle, not fat. Unlike fat, lean muscle is metabolically protective. It supports:

• Strength and mobility
• Blood sugar regulation
• Resting metabolic rate (calorie burn at rest)

When lean muscle is lost, metabolism can slow, fall risk increases, and weight regain becomes more likely. This puts GLP-1 investment of employers and health plans at risk.

• Up to two-thirds of weight lost is regained within one year of stopping GLP-1s³.
• 70% of users discontinue GLP-1s within 12 months⁴.

This is why employers and health plans are looking beyond medication access alone. Structured support can help members build the strength, activity patterns, and routines that make results more sustainable over time.

Prescribing a structured movement program for potential GLP-1 users as a preauthorization is an effective strategic solution. If GLP-1 users build more consistent activity habits and receive the right support, they may be better positioned to preserve lean mass and sustain results over time.

Movement-first models reduce cost, risk, and re-prescription

GLP-1s reduce appetite. But they don’t build the healthy behaviors required to sustain results. That’s why so many users regain weight and return to the drug. This is costly and clinically inefficient. Building structured support into the GLP-1 strategy can:

• Improve readiness for lifestyle change
• Strengthen engagement over time
• Help employers better target support around long-term outcomes

Movement-first strategies will help protect investment into GLP-1 treatment plans

• GLP-1s can cost employers up to $10,000 per member annually⁵.
• Sarcopenia adds nearly $900 in excess healthcare costs annually per employee⁶.
• Physical inactivity contributes meaningfully to medical spend across working populations⁷.

Structured support helps address these risks by giving members more than a prescription alone. For some organizations, that support may begin before medication. For others, it may be embedded alongside treatment from day one.

The idea of prehabilitation (preparing the body before medical intervention) is not new. It’s common in orthopedic surgery and cancer care, where clinicians build strength and resilience before a procedure to improve recovery. GLP-1 treatment should follow the same approach.

Structured movement is part of the GLP-1 prescribing guidance

Supporting GLP-1 treatment with movement and lifestyle change is not just good practice. It is built into the prescribing context for these medications.

GLP-1 medications like semaglutide are indicated for weight management as an adjunct to a reduced-calorie diet and increased physical activity⁸. That means lifestyle support is part of the intended treatment context, not a separate add-on.

Still, many members start GLP-1s without structured exercise support. That undermines the treatment intent and puts GLP-1 investment at risk.

Sword Pulse helps close that gap with continuous lifestyle support designed to reinforce the behaviors medication alone does not create.

Muscle retention > habit formation > better outcomes

What progress can look like with Pulse

Pulse provides continuous lifestyle support built around movement, nutrition guidance, and daily habits. In Pulse:

• 83% of members report feeling better or much better²
• 51% of members with low physical activity at baseline reached the World Health Organization recommended activity threshold after 27 days of Pulse sessions²

These signals do not prove every downstream financial outcome on their own. But they do show the kind of sustained engagement employers need if they want GLP-1 strategies to deliver more durable results over time.

Some employers are exploring whether structured support should begin before or alongside GLP-1 treatment, especially for populations starting from low activity levels. That approach can:

• Support readiness for change
• Build more sustainable behavior patterns
• Create a stronger foundation for long-term outcomes

A stronger GLP-1 strategy gives members support before, during, or alongside treatment, helping them build a baseline of strength, activity, and daily habits that support more sustainable outcomes.

This kind of structured support can improve readiness for weight loss, reinforce long-term habits, and help reduce the risk that lean-mass loss, pain, or functional decline undermine results over time.

Future-proof obesity care with structured GLP-1 support

Obesity care is evolving. But medications alone won’t create long-term success. Movement-first authorization models help employers and health plans future-proof GLP-1 strategy by ensuring the most impactful care is delivered at the right time. Starting with structured support helps members build strength, improve readiness, and strengthen the odds of long-term success.

Follow this 4-step approach to GLP-1 treatment for sustained positive outcomes

1. Audit GLP-1 utilization
2. Build structured support into the care strategy
3. Use outcomes-based vendors
4. Educate stakeholders on cost and care impact

GLP-1s have real clinical value. But only when paired with sustained behavior change.

Building structured support around GLP-1 use can help employers strengthen long-term outcomes and improve visibility into the value of their investment. Start improving your GLP-1 strategy by embedding movement, nutrition guidance, and long-term support from the beginning.