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4 ways to pair behavioral support and GLP-1 medications for better outcomes

As GLP-1 use surges, payers and employers can benefit from behavioral support, deprescription planning and long-term care to sustain outcomes.

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GLP-1 medications like semaglutide and tirzepatide are revolutionizing diabetes and obesity care — and for good reason. Originally developed to treat type 2 diabetes, these drugs are now delivering widespread, dramatic benefits: double-digit weight loss, improved cardiovascular outcomes and promising impacts on conditions as varied as sleep apnea1 and Alzheimer’s disease.2 

As a result, GLP-1 coverage is expanding quickly. Roughly 40% of large employers now offer GLP-1 coverage for obesity, and prescription rates have jumped more than 2,000% since 2019.3 Member interest is also accelerating as obesity evolves from being seen as primarily a lifestyle issue to a chronic condition that requires long-term, comprehensive care. 

The cost curve, however, is steep. Some payers have seen their spend double or quadruple in a single year.4 Meanwhile, annual per-member costs for GLP-1s can exceed $16,000 before rebates.5 Without a smart benefit strategy in place, employers, payers and members risk facing unsustainable costs and inconsistent outcomes. 

And the stakes are too high to ignore. Today, over 42%6 of U.S. adults are obese, a number expected to reach 50% by 20307. Obesity is a driver of chronic disease and ballooning costs. A comprehensive report found that obesity costs U.S. employers and employees more than $400 billion a year in higher medical expenses, absenteeism, disability and workers’ compensation.8 

For employers and payers balancing tighter budgets and increasingly complex member needs, weight management is now both a clinical imperative and a financial one. 

Why GLP-1s need to be part of benefit strategies

Yet despite their powerful potential, GLP-1s are not a cure-all. Without the right support for behavior change, medication adherence and care continuity, members can struggle to stay on track due to:  

  • High quit rates. Roughly 50–75% of patients stop treatment within a year, often without guidance for how to maintain their weight loss.9
  • Major costs. More than half (53%) of insured adults using GLP-1s say the cost is difficult to afford.10
  • Desire for alternatives. Nearly 70% of members say they’d prefer to lose weight without medication if given the right tools and support.11

GLP-1s work best as part of a broader benefit strategy rather than in isolation. Employers and payers must move toward a proactive plan that combines behavioral support, clinical guardrails and long-term care planning. Here’s how.  

1. Pair GLP-1 medication with whole-person, behavioral support 

GLP-1s can help members lose weight, but they don’t teach healthy habits, address stress or tackle all the root causes that can contribute to obesity. More than half of users stop taking GLP-1s within a year12, and many regain weight shortly after stopping.13 

Behavioral support changes the story. In a large-scale study, when GLP-1s were combined with coaching, behavior change and nutrition therapy, the mean weight loss for participants was an impressive 16%.14 

What employers and payers can do: 

  • Cover access to dietitians and mental health providers. Obesity rarely occurs alone. Depression, for example, is common in people with obesity and if left unaddressed, can undercut obesity treatment success.15
  • Integrate care. Consider using Optum Hub to source trusted vendors for digital coaching, nutrition therapy and clinical monitoring through a single gateway.  
  • Address social drivers of health. Members facing challenges like mobility limitations or chronic stress may benefit from wraparound services such as stress management or specialty exercise programs that meet their complex needs.  

2. Plan for deprescribing from the start 

Most GLP-1 users stop treatment within 12 months16 yet few benefit programs offer a clear off-ramp. That’s a missed opportunity: Abrupt discontinuation can lead to weight regain, lost progress and diminished ROI.17

Deprescription plans help members gradually transition off medication while maintaining results. A recent study found that participants who were gradually tapered off GLP-1s while still receiving nutrition and behavioral support maintained their weight loss a year later.18 

What employers and payers can do: 

  • Include deprescription plans in benefit design. This should include tapering protocols, timeline expectations and clear pathways for continued support. 
  • Fund transitional services. Combining GLP-1 treatment with coaching improves therapy adherence and promotes lasting behavior change.19
  • Track deprescribing outcomes. Use biometric and claims analytics to monitor deprescription progress. 

3.  Guide benefit use with smarter benefit design 

GLP-1s are powerful tools, but they’re not right for everyone. Some members, for example, may be better served with lifestyle-first approaches. Without clear clinical criteria, plans risk off-label or cosmetic use, which drives up cost without improving health. That’s why some employers and payers are leaning on benefit designs that connect GLP-1 access to clinical need and participation in metabolic or behavioral health programs.20

Step therapy is another available cost containment lever, while outcome-based contracts could also help employers protect outcomes and budget.21

What employers and payers can do: 

  • Work with PBMs to implement guardrails. Adherence monitoring, deprescription alerts and risk-based escalation protocols can help drive adherence and align benefits to outcomes like sustained weight loss. 
  • Incentivize participation in lifestyle programs. Financial incentives can boost program engagement by up to 44%.22
  • Offer HSA/FSA flexibility. Allow members to use tax-advantaged dollars toward GLP-1 prescriptions. 

4. Improve access and personalization in every phase 

Obesity is not a one-size-fits-all condition. Members have different risks, needs and lived experiences, and their benefits should reflect that. 

A young, metabolically healthy member may thrive with lifestyle support alone. A member with type 2 diabetes and cardiovascular risk, meanwhile, may benefit most from GLP-1s. Using predictive analytics, payers and employers can stratify members by risk and readiness, ensuring that high-touch care is reserved for those most likely to benefit.  

Improved access must also be part of the equation. For example, nearly 57% of Black women in the U.S. are obese, the highest of any race, yet they often face steep systemic barriers to treatment.23 

What employers and payers can do: 

  • Use multilingual, low-literacy materials. Support informed decision-making by tailoring content for limited-English or low-literacy members.  
  • Offer culturally responsive coaching and support. As an example, one study found that culturally responsive coaching helped improve weight outcomes for Black women in comparison to standard weight loss programs.24 
  • Integrate social risk screening into all metabolic pathways. Research shows that social risk factors such as financial strain and housing insecurity negatively impact medication adherence and other health outcomes.25
  • Track access metrics. Employers and health plans can use data to uncover disparities in GLP-1 access and close access gaps. 

A 360-degree view of GLP-1s pays off 

GLP-1s have transformed expectations for obesity treatment. But they’ve also exposed a need for more resilient benefit strategies — ones that integrate medication with lifestyle and mental health support.  

Employers and payers who center whole-person care, deprescription planning, personalized pathways and equitable access will be best positioned to control spending and support meaningful member outcomes. 

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Optum provides health and well-being information and support as part of a patient’s health plan. It does not provide medical advice or other health services and is not a substitute for a doctor’s care.

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