What Workforce Insights Into GLP-1s Tell Us About Clinical Oversight: Q&A with Dr. Nishu Uppal
Goodpath recently surveyed 1,049 employees to understand how people actually think about GLP-1 medications: what drives their interest, what holds them back, and how benefits design and coverage decisions shape the way they feel about their employer.
The findings are rich with learnings and signals for benefits leaders, but it’s critical to layer these learnings with clear clinical guidance.
We sat down with Dr. Nishu Uppal, Goodpath's Medical Director and a practicing internal medicine physician and health policy researcher, to dive into the clinical perspective behind what he believes are the most significant findings from the survey and what they mean for employers designing their GLP-1 coverage strategy.
More than half of employees say they'd consider a GLP-1 if their doctor said they were eligible. How should benefits leaders interpret that level of demand?
It’s important for benefits leaders to understand that demand doesn’t come with clinical readiness built in. Meaning, not everyone who is interested in GLP-1 medications for weight loss is a good candidate. Not everyone who is a candidate has been screened for the comorbidities that make sustained weight loss harder – common conditions like back or hip pain, metabolic dysfunction, depression, or sleep disorders. And every candidate needs education on benefits, risks, side effects, and prognosis while on a GLP-1 medication in order to make an informed decision with their prescribing provider on whether it may be right for them.
84% of US adults with obesity have at least one comorbid condition. If those conditions aren't identified and addressed alongside a GLP-1, the medication won't do what the patient expects it to, creating a cycle of frustration, discontinuation, and weight regain.
Employers can address these challenges amid a challenging GLP-1 coverage landscape by pairing GLP-1 medication access with dedicated weight management programs. This enables the infrastructure to ensure that employees who access these medications for weight loss are doing so with appropriate clinical guidance, including adjunctive care for comorbidities.
Without that infrastructure, demand doesn't disappear. It just moves to direct-to-consumer channels without the kind of clinical oversight or comorbidity care that drives sustainable results, which can have a cascading downstream impact on overall healthcare spend as people finance access without a guarantee of long-term weight loss and clinical outcomes.
The survey found that cost is employees' number one concern when it comes to GLP-1s. When employees can't access GLP-1s through a structured benefit and pursue them elsewhere, what happens clinically?
Cost pressures for employees can lead to inadequate adherence and discontinuation. Plus, when employees hit the affordability wall and look for alternatives, they often end up with less safe alternatives like compounded medications.
Traditional forms of access for GLP-1 medications prescribed for weight loss through brick-and-mortar and telehealth settings is often focused on the prescription itself with minimal time to comprehensively counsel people on nutrition and exercise, or to screen and co-manage comorbid chronic conditions.
That's the scenario most likely to produce the outcome employers fear most: an employee on an expensive medication who isn't losing weight, isn't building the habits that make weight loss sustainable, isn’t simultaneously addressing comorbid conditions, and eventually stops the medication and reverses any positive outcomes. This is where the right personalized, whole-person GLP-1 coverage strategy makes all the difference.
Side effects are also a significant concern, according to the survey — about a quarter of employees named them. How does clinical oversight change the side effect picture?
Side effects like nausea, fatigue, muscle loss, and gastrointestinal symptoms are real, and they're one of the primary reasons people stop these medications.
Fifty percent of patients using GLP-1 medications for weight loss discontinue the medication within one year. Another recent study found that 84% discontinued GLP-1 medications used for weight loss within two years. That suggests a failure of the traditional methods of care delivery.
One contributing factor is the prevalence of underlying comorbid digestive conditions like irritable bowel syndrome, that may increase the risk of side effects while on a GLP-1 medication for weight loss. Because GLP-1s slow digestion, pre-existing gastrointestinal (GI) sensitivities can amplify the most common side effects like nausea and diarrhea, and can increase the risk of more severe GI issues in rare cases.
Clinical guidance integrated in GLP-1 care is key to surfacing the existing conditions, health history, and personal factors that may make a patient more susceptible to certain side effects ahead of prescribing to weigh risks and set expectations with patients. It’s also critical for ongoing side effect management. Providers can connect the dots on symptoms, ensure patients are getting the lifestyle support that can help them manage side effects, and make dosage or titration changes when side effects become overwhelming for patients – all of which changes the narrative on discontinuation.
The survey found that nearly half of employees would be more likely to try a GLP-1 if it came with nutrition and exercise coaching. Clinically, how significant is that preference?
It’s encouraging to see this show up so clearly in the employee data.
Here's what the clinical evidence shows: in the pivotal trials for the GLP-1 medications we're using today (known as the STEP 1 Trial and Surmount-1 Trial), patients didn't just adhere to their prescribed dosage of the medication – they were required to adhere to a regimented nutrition and exercise program throughout the trials as well. That wraparound support likely contributes to the favorable trial results on weight loss.
What we're seeing in real-world use is that the robustness of exercise programming and nutrition counseling has diminished while increased focus has been placed on the medication itself. The medication gets prescribed, but the exercise and nutrition lifestyle program doesn't always follow.
This further emphasizes the value of personalized, whole-person programs for GLP-1 care. Take, for instance, someone who has existing musculoskeletal (MSK) issues like back pain or knee pain – which are common in people with obesity. A generic exercise program and instruction to “exercise more” isn’t going to work, and will likely only lead to frustration. You have to treat the pain and understand their mobility limitations to provide the level of personalized support they need to be successful.
The behavioral change component isn't supplementary to the clinical outcome; it's how the clinical outcome becomes sustainable. People who take GLP-1 medications and simultaneously build real nutritional habits, consistent physical activity routines, and strategies for managing stress-eating and food relationships have a fundamentally different trajectory than people who take the medication alone.
Nearly all of the employees surveyed (97%) have heard of GLP-1 medications. But about a quarter of them aren't confident they understand what these drugs actually do. From a clinical standpoint, what does that gap tell you?
It’s clear that employee perceptions of GLP-1s are being shaped almost entirely by media and advertising, not by clinical guidance. This isn’t surprising given the world we live in today. This poses a real challenge, though, not because employees are uninformed, but because the information landscape they're navigating is incomplete and often misleading.
The cultural conversation around GLP-1s has been heavily focused on weight loss as the outcome and on specific brands. Far too much of the emphasis is on the number on the scale. What's largely absent is clinical context, including:
- What these medications actually do
- How they were studied
- What's required for sustainable results
- Real perspectives on navigating side effects
- What happens when you stop taking these medications
When the dominant narrative comes from commercials or social media rather than clinicians, you end up with high awareness and low understanding. And, as our survey data shows, employees making treatment decisions or asking HR for coverage are often working from an incomplete picture.
This knowledge gap around GLP-1s is an opportunity for benefits leaders and employers. You have a direct channel to your workforce to deliver clear, evidence-backed information about GLP-1s and help answer common questions. Tap your benefits partners to share clinical expertise and content on FAQs like what GLP-1s treat, who they’re for, how they work best, and what to know before you start GLP-1s.
As you consider cost containment and sustainability for weight management and GLP-1 coverage, this internal communication component can add real value.
For the employees in the survey who weren't interested in GLP-1s but still expressed interest in employer weight management support, what's the clinical case for engaging them?
This is something I think gets lost in benefits conversations that are too focused on the medication and costs.
About 60 percent of people who come into Goodpath’s personalized weight management program do not receive a GLP-1 medication which means that they are managing their weight through nutrition counseling, exercise programming, health coaching, lifestyle support, and comorbidity treatment. And for a meaningful portion of those members, that's sufficient to drive results. In fact, 60-70% of Goodpath members with obesity lose weight within one year without GLP-1 medications.
What this survey data suggests to me is that the workforce population interested in structured weight management support is broader than the population interested in GLP-1 medications specifically, and employers who design their benefit as a prescription access program rather than a whole-person weight management program are leaving that population unserved.
If you could give benefits leaders one clinical principle to carry into their GLP-1 benefit design, what would it be?
Design the benefit around people, not the prescription.
A standalone GLP-1 prescription is not a weight management program. What we know from the clinical evidence is that the path to sustainable outcomes runs through the whole-person clinical picture.
I encourage benefits leaders to reframe the “how do we cover GLP-1s” question – which I know is extremely complex in-and-of itself. To deliver on cost savings and outcomes, start instead with this coverage design question: “How do we build a clinical, whole-person weight management program that not only incorporates GLP-1 medications where appropriate but also treats comorbidities, drives sustainable behavior and lifestyle change, and focuses on long-term outcomes?”
Dr. Nishu Uppal is the Medical Director at Goodpath, a health policy researcher, and a practicing internal medicine physician.