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 rebound weight gain and muscle deterioration, which presents an increased risk of musculoskeletal conditions and downstream costs₁³.

Employers and health plans have a promising treatment that is effective in supporting fast weight loss. However, without positive behavior change to accompany a GLP-1 prescription, the healthy habit of regular physical activity is missing.

Clinical evidence and real-world outcomes show that movement plans offer vital support for these medications. Without this, patients risk relapse and employers risk their return on investment₉.

This guide outlines how prescribing structured movement programs as a GLP-1 preauthorization, care providers help GLP-1 patients build a foundation for sustainable weight loss and longer term positive health outcomes.

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.

Sword Move data reveals significant risk factors for the typical GLP-1 candidate:

• 77% of members are overweight or obese
• 64% of members have an addressable health condition (like diabetes and high cholesterol)
• 55% of members report experiencing some difficulty with basic physical activity₂

Starting GLP-1s from this baseline increases risk of MSK pain, falls, chronic fatigue, and eventual re-treatment₃.

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.

Reverse this trend and prevent the weight loss rebound. 

Prescribing a structured movement program for potential GLP-1 users as a preauthorization is an effective strategic solution.

If patients develop regular physical activity habits, they can prevent lean muscle loss and increase the likelihood of sustaining their weight loss.

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.

Using structured movement plans as a preauthorization mechanism before the prescription can:

• Improve readiness
• Strengthen adherence
• Delay or replace the need for medication

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 (progressive loss of muscle mass) adds nearly $900 in excess healthcare costs annually per employee₆.
• Physical inactivity contributes to 27% of total employee medical spend₇.

Preauthorized movement programs tackle all three costs. Smart healthcare providers introduce clinically guided physical activity plans before GLP-1 prescriptions are issued.

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

The suggestion of supporting GLP-1 treatment with prescribed movement plans isn’t just good practice. This is standard protocol.

GLP-1 medications like semaglutide are only approved for weight management as an adjunct to a reduced-calorie diet and increased physical activity. This is part of the actual prescribing indication₈, meaning that supporting GLP-1 prescriptions with structured physical activity plans is not optional, it’s advised by pharmaceutical manufacturers₈.

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

Sword Move helps close that gap with clinical-grade activity plans designed to support the success the prescription started.

Muscle retention > habit formation > better outcomes

Sword's Move program offers strong pre-prescription results

Employers and health insurers are starting to ask: If we use prehab for joint replacements, why not for metabolic care?

Sword Move provides structured, guided, and clinically supported activity plans that help members build strength, metabolic resilience, and readiness for change.

How Move improves health outcomes for low-activity members:

• 69% of “inactive” and “insufficiently active” members reach “active or healthy active” status within 10 weeks₉
• 4.5 movement sessions per member per week on average₁₀
• Sedentary time reduced by 1 hour 22 minutes per day for previously “inactive” or “insufficiently active” members₁₁
• 91% report feeling moderately or much better₁₂

Use Move as a GLP-1 preauthorization step

Progressive employers are implementing Move as a prerequisite for GLP-1 approval. Members complete 8–10 weeks of movement first. This:

• Supports readiness
• Screens for true clinical need
• Builds sustainable behavior change

34% of Move members are current, former, or potential GLP-1 users₂.

Smarter GLP-1 strategy: Add Move before the medication

Members begin with 8–10 weeks of personalized movement before any GLP-1 approval, creating a baseline of activity, reducing the need for medication, and supporting more sustainable outcomes.

This preauthorization model supports physical readiness for weight loss, aligns prescriptions of GLP-1s with true need, reinforces long-term movement habits, and helps to prevent the risk of lean muscle loss, pain, and injury developing after treatment 

Movement-first models create better value and better outcomes for these GLP-1 patients.

Future-proof obesity care with Move as a preauthorization step

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 movement builds strength, prevents overtreatment, and empowers long-term success.

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

1. Audit GLP-1 utilization
2. Add movement preauthorization
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.

Using Move as a prerequisite, co-requisite, or long-term companion to GLP-1s is a simple and cost-effective solution.

Start to improve prescription precision and control your pharmaceutical spend by embedding movement from the start.

FAQ Section: Movement and GLP-1 Preauthorization

What is GLP-1 preauthorization? It’s a clinical or administrative review to determine whether a member meets criteria for GLP-1 prescription. Employers and plans can set additional benchmarks (like required movement activity) before approval.

Why should movement be required before prescribing? Most GLP-1 users are inactive. Without movement, they risk losing muscle mass, rebounding after discontinuation, and driving up long-term costs.

Can physical activity alone deliver weight loss? In some cases, yes. Preauthorized movement may help certain members achieve their goals without medication, or make the medication more effective if it’s needed later.

How can employers implement this? With structured movement programs like Sword Move that provide wearable tracking, clinical support, and tailored plans. All outcomes are measurable.