Semaglutide and muscle loss: what health plans need to know

Semaglutide and muscle loss: what health plans need to know

Semaglutide has transformed the obesity treatment landscape. Originally approved as a diabetes drug, it’s now among the most widely prescribed GLP-1 medications for weight management, often more commonly known by brand names like Ozempic, Wegovy, and Rybelsus.

With outcomes that include 10%–15% total body weight loss and improved cardiometabolic markers¹, it’s no surprise health plans are rapidly expanding coverage. Semaglutide offers a powerful new lever to address obesity-related costs and long-term risk.

But there’s a less visible side effect emerging in the data, one that could undermine outcomes, increase musculoskeletal (MSK) costs, and reduce ROI for health plans:

• Up to 39% of lean muscle mass can be lost during semaglutide treatment

This isn’t a cosmetic issue. 

Muscle loss affects metabolism, injury risk, physical function, and long-term independence. And without a strategy to prevent it, health plans may find themselves covering a second wave of care: falls, joint pain, repeat prescribing, and downstream MSK claims.

How semaglutide causes muscle loss

Semaglutide mimics a hormone called GLP-1, which regulates appetite and digestion. It works by:

• Slowing gastric emptying
• Suppressing hunger
• Reducing overall food intake

This produces effective, sustained weight loss. But unless that weight loss is paired with movement or muscle-supportive nutrition, the body loses both fat and metabolically active tissue (lean muscle mass).²

In inactive members, that muscle loss accelerates.

And with fewer than 1 in 4 U.S. adults meeting CDC physical activity guidelines, most semaglutide users are already at risk.

Why lean muscle matters (and what happens when it’s lost)

Muscle is often misunderstood as optional. But in reality, it’s a critical driver of physical health and long-term function.

Muscle supports:

• Joint stability by reducing stress on knees, hips, and spine¹⁹
• Balance and coordination by protecting against falls and injury⁷
• Metabolic efficiency by burning energy even at rest²⁰
• Functional independence by allowing members to move confidently through daily life⁶

When lean muscle mass declines, members become more vulnerable to:

• Chronic pain⁶
• Balance issues and fall-related injuries⁷
• Slower recovery times⁶
• Functional decline, even as weight decreases⁶

This effect is even more pronounced in older adults, desk workers, and anyone managing chronic MSK or metabolic conditions. Many of these people are also GLP-1 candidates.

Why muscle loss doesn’t show up in your claims data

One of the biggest challenges in managing semaglutide side effects is visibility. Muscle loss isn’t coded as a diagnosis. There’s often no line item in a pharmacy claim or lab panel that tells you a member is physically weaker than before.

But the consequences are real and the downstream costs of lean muscle loss can be so expensive.

Clinical research shows that muscle loss (sarcopenia) is responsible for:

• 33% of chronic pain in older adults
• 60% increased risk of falls
• 2.5x higher risk of disability when combined with obesity

These outcomes don't appear immediately after starting semaglutide. They surface downstream, often months later, in the form of MSK-related health issues. This includes increased claims for fall-related injuries, joint pain, and referrals to physical therapy or orthopedics that correlate with the muscle degradation that began months earlier.

A recent study showed that up to two-thirds of weight lost on GLP-1s is regained within one year after discontinuation.⁹

Sarcopenia ​​adds nearly $900 in excess costs per employee annually.¹⁰

The short term benefit of weight loss is a hidden danger to any patient without regular physical activity. Subsequent muscle loss can significantly lower functional quality of life, leading to higher healthcare utilization and increased costs.¹⁰

The semaglutide cost curve doesn’t always end at the pharmacy

Most cost analyses of GLP-1 treatment focuses on pharmacy spend. A recent WTW 2024 Pulse Survey Report puts the average at $10,000 per member annually. But semaglutide’s real cost exposure expands if providers don’t support GLP-1 treatment with structured movement plans:

• Weight is lost, but so is functional resilience
• Members can become less physically capable with reduced muscle mass
• MSK issues emerge with the potential requirement for more costly intervention

Plans focused only on the initial ROI of weight loss risk miss out on the dangers of a second cost curve driven by MSK claims, pain, and diminished resilience.

How to protect lean mass during semaglutide treatment

Muscle loss is preventable and GLP-1s can be extremely effective over the long term with the addition of structured, clinically guided movement, introduced early in the GLP-1 care pathway.

Employers and health insurers should look for structured movement programs that provide:

• Pre-treatment movement readiness programs to build baseline strength
• Ongoing strength-focused activity support during medication use
• Post-discontinuation maintenance plans to preserve outcomes
• Real-time tracking of activity, function, and progress
• Reporting tied to member-level outcomes not just engagement

This wraparound support of a structured movement plan is a simple and cost-effective way  to improve the prospect of long term success.

Sword Move is the ideal solution to add to GLP-1 treatment programs for sustainable weight loss, even allowing health plan providers to use movement plans as a preauthorization tool.

Why Sword Move is the ideal support for GLP-1 patients

Weight loss plans and GLP-1 prescriptions should be accompanied by structured movement programs to help retain lean muscle and trigger positive behavior change.

Sword Move is built to close this clinical gap. 

What is Sword Move?

Move delivers whole-body, movement-first exercise programs to help members build sustainable activity habits, retain lean muscle, and reduce the risk of MSK conditions. Each Move member is assigned a Physical Health Specialist with a Doctor of Physical Therapy (PT). 

The personalised care plan is adapted as the patient progresses, with ongoing expert support from their assigned PT.

Members use wearable technology to provide real-time insights for the supporting Physical Health Specialists to tailor their movement plan.

• Personalized strength-building movement plans
• Supervision from dedicated Physical Health Specialists who hold a Doctor of Physical Therapy degree
• Real-time tracking via wearable 
• Ongoing adjustments based on progress, capacity, and risk

Move is designed to address pain, reduce injury risk, and increase activity levels, helping to avoid the costly consequences of muscle loss and chronic conditions that can develop. 

What results can you expect with Sword Move programs?

• 69% of “inactive” or “insufficiently active members” reached “healthy active” status within 10 weeks₉
• 4.5 sessions/week completed on average
• Sedentary time reduced by 1 hour 22 minutes per day for previously “inactive” or “insufficiently active” members
• 91% report feeling moderately or much better₁₂

These changes directly counteract the downstream risks of GLP-1 muscle loss.

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

Sword Move is proven to improve function and preserves strength

Sword Move delivers clinically guided, wearable-connected movement plans that help members retain muscle, improve adherence, and sustain weight loss outcomes.

Among members with GLP-1–relevant profiles:

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

These aren’t vanity metrics. These are the proven functional health indicators that reduce MSK risk and improve the durability of semaglutide success.

Future-proof your semaglutide outcomes with movement-first care

Semaglutide is a powerful tool in the fight against obesity, but it’s only one component of an effective GLP-1 treatment plan. 

Without structured movement support, weight loss can come at the cost of lean muscle, driving up MSK risk and leaving health plan providers with expensive downstream costs. 

Physical activity and structured movement programs can protect against the hidden cycle of pain, repeat prescribing, and reduced ROI for employers and health plans.

Sword Move closes the gap. 

With clinically-guided, personalized activity plans, Move helps members stay strong, preserve muscle mass, and build the habits that make semaglutide results sustainable. 

If you’re ready to protect outcomes, lower avoidable MSK spend, and see real, trackable results for your covered population, it’s time to make structured movement part of your GLP-1 strategy.

FAQ: What health plans need to know about semaglutide muscle loss

Is muscle loss more common with semaglutide than other weight loss methods? Muscle loss is common with any rapid weight loss but it’s especially likely when movement isn’t present. GLP-1s like semaglutide suppress appetite, which accelerates loss of both fat and lean tissue.

How can we measure muscle loss if it’s hard to find across claims? Look for proxies: pain complaints, therapy referrals, fall-related ER visits, or drop-offs in functional scores. Partners like Sword can report on function and physical activity directly to help analyze early indicators at scale. Sword’s Predict solution can even detect and engage your highest-risk members to reduce MSK costs before they occur. Note that sarcopenia can show up as a diagnosis but it's often after a fall or MSK issue has occurred, which means that damage has already been done..

Can structured movement really offset semaglutide side effects? Yes, research and real-world data show that consistent, guided physical activity is the best defense against muscle loss and MSK risk.