How to strengthen the long-term value of GLP-1 weight loss programs

For employers and health plans, GLP-1 medications such as semaglutide have changed the conversation around obesity care. These treatments offer a way to reduce chronic disease risk, improve metabolic markers, and support meaningful weight loss.¹

GLP-1s are also widely known by brand names such as Ozempic, Wegovy, Saxenda, Mounjaro, and Rybelsus. Their short-term results can be striking. But without structured support, many members struggle to sustain those gains over time.² ³ From lean-mass loss and metabolic rebound to re-prescription pressure and downstream musculoskeletal risk, a pattern is emerging that can undercut long-term ROI.

GLP-1 programs work better when they are paired with structured support across movement, nutrition guidance, and long-term habit formation.

The weight-regain problem: short-term wins, longer-term cost pressure

One of the biggest concerns with GLP-1 use is sustainability. Many patients regain weight after stopping treatment. The research suggests that:

• up to 70% of users discontinue GLP-1 medications within one year²
• as much as two-thirds of lost weight may be regained after discontinuation³

This rebound effect is not simply about willpower. It reflects a structural gap in how GLP-1 strategies are designed. Weight can come off quickly, but without structured support, the daily habits that sustain long-term results often do not change.

Lean mass can also decline. Research suggests that up to 39% of weight lost during GLP-1 use may come from lean mass, not just fat.⁴ That means weight loss is not always equivalent to healthier body composition.

Lean-mass loss can weaken metabolism, physical function, and long-term resilience. When treatment ends or changes, members may be more likely to regain weight, need repeat support, or develop downstream musculoskeletal issues that were not visible in the first phase of care. This is a significant threat to the ROI of GLP-1 health plan spend.

Why muscle loss can threathen GLP-1 ROI

During weight loss, it is not just fat that is lost. Lean mass matters because it supports:

• resting metabolism and energy use⁵
• mobility and physical resilience⁶
• fall-risk reduction and stability⁷
• insulin sensitivity and glucose regulation⁵

When lean mass declines during weight-loss programs, especially if fat returns after discontinuation, members can end up with worse body composition and higher health risk than where they started.⁴ For employers and health plans, that can mean rising downstream exposure across musculoskeletal care, repeat treatment, and longer-term utilization.

Weight regain also creates re-prescription pressure. Without support that helps preserve lean mass and build sustainable habits, weight-loss programs may generate more repeat cost than expected.² ³

Why inactivity is the silent threat to GLP-1 ROI

Most GLP-1 users begin treatment from a low-activity baseline. Only about 1 in 4 U.S. adults regularly meet recommended physical activity targets, which means many members start treatment from a place of limited movement and lower physical resilience.⁸

That matters because low baseline activity makes lean-mass loss harder to prevent. When members lose weight through medication but do not build strength or movement habits, they may lose more than fat. They may lose functional reserve.

Lean-mass loss also rarely appears directly in claims data. But the downstream effects can emerge later through:

• higher musculoskeletal utilization
• more chronic pain, falls, and disability risk⁶ ⁷ ⁹
• absenteeism and productivity loss¹⁰

These are the hidden costs that erode ROI over time.

The business case to support GLP-1 users with structured lifestyle care plans

GLP-1s are expensive. WTW has estimated that GLP-1 medications can cost employers up to $10,000 per member annually.¹ These medications are starting to account for a meaningful share of total medical spend in plans with broad uptake.¹ Now layer in the quieter costs:

• sarcopenia is associated with nearly $900 in excess healthcare costs per employee annually⁹
• physical inactivity contributes meaningfully to medical spend across working populations¹⁰

If members on GLP-1s are inactive and losing lean mass, employers face the risk of absorbing hidden downstream costs across musculoskeletal care, pain, productivity loss, re-treatment, and long-term disability. That is what makes support strategy so important. The goal is not just early weight loss. It is better long-term value.

Sword Pulse is designed to support lifestyle change for GLP-1 users

Pulse, the cardiometabolic pillar of the AI Care Platform, is designed to support people managing blood pressure, blood sugar, cholesterol, weight, and GLP-1 use through continuous lifestyle support.

For people using GLP-1 medications, Pulse is built to address what medication alone does not: lean-mass preservation, strength-building support, nutrition guidance, and the daily habits that help results last.

Pulse combines Phoenix, Sword Health’s AI Care Specialist, with guidance from a Health Specialist and connected devices that bring objective health data into each interaction. Members receive support across movement, blood pressure, nutrition, and daily habits, with guidance that adapts over time to what is actually working for them.

Advice alone rarely creates durable behavior change at scale. To better protect lean mass during weight loss, plans need structured support that begins early and continues consistently.

What progress can look like with Pulse

Pulse supports GLP-1 users with continuous lifestyle support built around movement, nutrition guidance, and daily habits. In Pulse:

• 83% of members report feeling better or much better¹¹
• 51% of members with low physical activity at baseline reached the World Health Organization recommended activity threshold after 27 days of Pulse sessions¹²

These signals do not prove every downstream financial outcome on their own. But they do show the kind of sustained engagement plans need if they want weight-loss programs to produce more durable value over time.

A stronger model for sustained GLP-1 ROI

What does it take to improve return on investment in weight-loss treatment? GLP-1s are an effective intervention, but better strategy design can strengthen long-term value.

3 clear steps to help employers and health plans reverse the rising cost of GLP-1 investment:

1. Audit outcomes beyond weight loss: Track adherence, discontinuation, and re-prescription patterns. Compare them with musculoskeletal utilization, pain diagnoses, and functional signals where possible.
2. Build structured support before, during, and after prescription: Introduce support early to strengthen readiness. Reinforce movement, nutrition guidance, and daily habits during treatment. Continue support after discontinuation to reduce rebound risk.
3. Incentivize outcomes, not access: Choose partners with outcomes-based pricing and visibility into meaningful member improvement over time.

Do not offer weight-loss treatment in isolation. Build structured support around GLP-1 use to help protect lean mass, reinforce healthier habits, and improve the odds of lasting outcomes.