Your GLP-1 side effect management strategy: Prevent muscle loss and MSK costs

GLP-1 medications have transformed the landscape of obesity care. For benefits leaders and health plans, they offer a rare promise: a clinically proven intervention that can deliver meaningful weight loss across at-risk populations.

But that weight loss comes at a hidden cost. A cost that doesn’t show up on prescription data. This cost does show up in MSK claims, though

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

Muscle is essential for metabolism, movement, and protection against injury. Lean mass lost during GLP-1 use increases the likelihood of pain, fall risk, and disability, and can drive a second wave of claims³⁺. This downstream effect can erode the ROI of healthcare spend on GLP-1 weight loss treatment⁵.

Before analyzing how to prevent lean muscle loss in detail, let’s first cover the range of potential side effects of GLP-1 medication.

What are the side effects of GLP-1s?

GLP-1 receptor agonists, including semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), are commonly prescribed for weight loss. The most well-known side effects include:

• Nausea, vomiting, diarrhea, constipation⁺
• Appetite suppression leading to low nutrient intake⁺
• Headaches, fatigue, dizziness⁺
• Gallbladder issues, pancreatitis (in rare cases)⁺
• Injection site reactions⁺

These effects often show up early in treatment and may fade over time. But that one dangerous side effect grows more severe the longer it goes unaddressed: loss of lean muscle mass.

How soon do GLP-1 side effects start?

Muscle loss is unique among GLP-1 side effects because it builds slowly and silently. Unlike gastrointestinal symptoms that present quickly and fade, muscle deterioration progresses without overt symptoms. But over weeks and months, this lean tissue loss accumulates⁺.

Those impacted by lean muscle loss experience a decline in strength, a slower metabolism, and a significantly higher risk of falls³. This process all tends to happen without a diagnostic code or a pharmacy alert. By the time pain or instability prompts a claim, the damage is already done.

• Gastrointestinal issues can appear within hours or days
• Appetite suppression can lead to fatigue within weeks
• Muscle loss builds silently, especially in sedentary members

Muscle loss does not trigger a pharmacy flag or diagnostic code, so it often goes unnoticed. But its impact shows up later in the form of back pain, falls, joint instability, or disability claims. These events can lead to costly MSK care or surgical intervention.

Muscle loss is the GLP-1 side effect you can’t afford to ignore

Prescribing GLP-1s without movement support leaves patients at high risk of muscle loss. This muscle loss often escapes detection in pharmacy records but is reflected in a surge of downstream MSK-related claims and healthcare utilization costs.⁵

To manage GLP-1 side effects effectively, health plans and employers need a strategy to preserve lean muscle mass. Structured movement programs provide scalable protection and help generate sustainable ROI.

Benefits of lean muscle mass

• Protects the joints and spine by absorbing impact and stabilizing movement
• Reduces fall risk by supporting balance and coordination
• Injury prevention through balance and joint stabilization
• Fuel metabolisms by burning energy even at rest
• Prevents functional decline and supports everyday activities

Without strength-building movement, GLP-1 users risk losing a significant proportion of their lean muscle mass, which can accelerate decline in function and drive musculoskeletal claims₁.

To manage GLP-1 side effects effectively, health plans and employers need a clear strategy to preserve lean muscle mass. 

Offering structured movement programs as a support to GLP-1 prescriptions is the scalable way to reduce risk and generate sustainable ROI.

Lean muscle retention is the best defense against MSK risk

When members lose weight through appetite suppression alone, the body sheds both fat and muscle. Without strength-building movement, GLP-1 users risk losing high proportions of lean muscle mass₁. 

During GLP-1-induced weight loss, Up to 39% of lean body mass is lost during GLP-1 usage, especially in inactive users₁. Losing this tissue slows metabolism, which means fat returns more quickly if the member discontinues the medication₁.

That muscle isn’t easy to regain and the results are dangerous for patients and insurers alike:

• Metabolism slows → weight rebound risk increases
• Fall risk increases → MSK claims rise
• Strength drops → injury risk increases
• Functional impairments → long-term disability risk²

This isn’t hypothetical. Sarcopenia (progressive loss of muscle tissue) doesn’t often show up as a line item on a claim. But its consequences do. These effects are well-documented in clinical literature₁

• Sarcopenia contributes to 33% of chronic pain in older adults³
• It increases fall risk by 60%⁴
• In people with sarcopenic obesity (low muscle, high fat), disability risk jumps 2.5x⁵

GLP-1s accelerate sarcopenia without a plan to prevent muscle loss, employers are setting themselves up for a second wave of downstream claims and costs.

Sarcopenia adds nearly $900 in excess healthcare costs per member per year₆.

When lean muscle is lost during GLP-1 therapy, the consequences don’t end with strength and mobility decline. The broader financial exposure includes chronic pain, increased ER visits, and even surgical interventions₆. This is where the risk becomes most acute: among members who were already inactive or physically limited before treatment began.

Inactive members face the greatest risk

This low baseline is important context for understanding risk across the broader GLP-1 eligible population. The average GLP-1 user is not starting from a place of metabolic or physical resilience. In fact, Sword Move participant demographics are reflective of many in this cohort:

• 77% are overweight or obese
• 64% have chronic conditions like diabetes or high cholesterol
• 55% report difficulty with basic physical activity₆

This population is particularly vulnerable to muscle loss when using GLP-1s. However, while muscle loss is a dangerous side effect of GLP-1s, it’s also one of the most preventable.

The solution is straightforward.

Structured movement plans should be built into all GLP-1 treatment programs to encourage positive behaviour change, develop physical activity habits, and prevent muscle loss.

Movement is great medicine for managing GLP-1 side effects

GLP-1s suppress appetite, but they don’t help patients retain muscle when weight is lost.

Movement isn’t just a helpful adjunct to medication. For GLP-1 users, physical activity is a protection mechanism.

Structured movement programs:

• Preserve lean muscle mass to support metabolism
• Reduce fall and injury risk by strengthening stabilizing muscles
• Builds habits that help members transition successfully after discontinuing medication

Healthcare providers can proactively embed movement into a GLP-1 weight loss care model to prevent the dangerous side effect of lean muscle loss before it becomes a downstream cost driver.

Add Move to GLP-1 treatment for sustainable weight loss

Sword Move solves the GLP-1 muscle loss problem at scale.

Move’s digitally delivered physical therapy program allows patients to complete their exercises at a time and place that suits their life. 

What does Move provide for GLP-1 patients?

• Personalized strength-building movement plans
• Expert clinical guidance and support
• Real-time tracking via the Move wearable or a patient’s own smart device
• Ongoing plan adjustments based on member progress

What improvements does Move deliver?

• 69% of “inactive” and “insufficiently active” members reach “active or healthy active” status within 10 weeks₇
• 4.5 sessions/week completed on average₈
• Sedentary time reduced by 1 hour 22 minutes per day for previously “inactive” or “insufficiently active” members₉
• 91% report feeling moderately or much better₊

These improvements protect against GLP-1 muscle loss and build resilience that scales.

Move helps members build strength, retain muscle, and increase resilience, while allowing employers to track outcomes, reduce MSK claims, and protect GLP-1 ROI.

GLP-1 preauthorization of movement plans: drive sustainable weight loss

Many providers use Move as a preauthorization mechanism for a period of 8-10 weeks to help their members develop regular physical activity habits. 

With that support, some members can:

• Build enough metabolic and physical progress to delay GLP-1 initiation, or in some cases, enable members to pursue weight loss without pharmacologic intervention₆
• Better prepare for the demands of GLP-1 treatment
• Develop foundational movement habits to retain muscle and support long-term health

This is the core value of preauthorized movement plans: they screen for readiness, create behavior change, and protect against the significant risk of downstream musculoskeletal conditions and costly medical interventions.

The smarter GLP-1 side effect management strategy

Effective GLP-1 benefit design requires a prevention-first approach. Here’s what leading plans are implementing now to protect spend, improve healthcare outcomes, and optimize ROI:

1. Audit MSK and fall-related claims

Look 6 to 12 months post-GLP-1 initiation to identify pain, physical therapy, and fall-related ER visits.

2. Flag at-risk members

Watch for signs of rapid weight loss with low activity, poor refill adherence, and new MSK complaints.

3. Require structured movement alongside medication

Prescribing GLP-1s without movement is like cutting calories without nutrients. The plan is incomplete and the longer-term results can be damaging and costly.

4. Choose vendors who track real outcomes

Work with partners who provide reporting on:

• Activity level improvement
• Functional change
• Sedentary time
• Member-reported well-being

Only then can you turn side effect management from a cost center into a measurable ROI engine.

Sword Move is the movement multiplier your GLP-1 program needs

GLP-1s suppress appetite, but they aren’t designed to retain muscle mass. 

Movement protects against the common risk of lean muscle loss, helping patients to retain and build strength. 

Sword’s Move closes the clinical gap left by GLP-1s, giving members structured movement programs to retain strength and lean muscle mass. Move is the ideal support to a GLP-1 prescription as patients will build new physical activity habits to protect long term health outcomes.

Employers and health insurers alike can maximize GLP-1 investment with speed and scale by combining Move with all GLP-1 prescriptions. 

FAQ: Managing the side effects of GLP-1 medications

Is muscle loss really that common on GLP-1s? Yes. Clinical data shows up to 39% of lean body mass is lost during GLP-1 usage, particularly in inactive individuals⁸.

Can structured movement really offset the risk? Yes. Clinical and real-world data support movement as a lean mass preservation strategy. It also builds daily behavior change that protects long-term outcomes.