Can GLP-1s Break the Vicious Cycle of Mental Health, MSK Pain, and Obesity?

The glucagon-like peptide-1 agonist (GLP-1) craze has brought to light an alarming trend that is often overshadowed by a tunnel vision-like focus on weight management. Time and time again, we see that obesity rarely exists alone. When a person is obese, they are far more likely to suffer from comorbid health conditions, such as chronic musculoskeletal (MSK) pain and depression, which are often exacerbated by obesity—and vice versa.  

This vicious cycle not only drastically impairs an individual’s quality of life, but it can also easily consume the majority of healthcare spending for employers and payers. Altogether, these three conditions total $920 billion annually nationwide (Dieleman, 2020; White House, 2022; Cawley, 2021). With promises of up to a 15 percent reduction in body weight, glucagon-like peptide-1 agonists  (GLP-1s) such as Ozempic, Wegovy, and Mounjaro have quickly made headlines as the premier treatment to improve outcomes and curb these astronomical costs (Wilding, 2021). However, given the many well-known downsides of these medications—which range from hefty price tags to a high likelihood of non-adherence to an increased risk of lean muscle mass loss—using GLP-1s as a standalone solution to treat obesity and its comorbid conditions fails to truly drive value and move the needle on holistic health.  

Together, obesity, chronic musculoskeletal (MSK) pain, and depression total $920 billion in annual spending for employers and payers nationwide.

Unraveling a three-way, cyclical relationship

Obesity, chronic back and joint pain, and depression often coexist in a complex web of cause and effect. High body weight puts excessive strain on joints and muscles. Over time, this increased pressure can lead to chronic muscle and joint pain that can make it incredibly difficult for a person to move and carry out normal, day-to-day activities. As a result, obese individuals are prone to move less due to significant pain and discomfort. Gradually, this lack of healthy movement can wreak havoc on an individual’s mental health, leading to serious mental illnesses like depression and anxiety. The compounding effect of these conditions is strongly supported by research with studies indicating:

• A 142 percent higher risk of obesity in sedentary individuals (Cleven, 2020)

• More than 90 percent of individuals with a body mass index over 42 report MSK pain (Rosa, 2021).

• Up to 85 percent of individuals with MSK pain report depression (Melkevik, 2018)

• 43 percent of adults who have depression are also obese (NCHS, 2014)
  

With traditional care—which often treats pain, depression, and obesity as siloed entities—achieving healthy progress for individuals suffering from all three conditions can become close to impossible.

The role of GLP-1s in a holistic care program

Take Vori Health patient Anne C. as an example. Before coming to Vori Health, Anne was an insulin-dependent diabetic in her 60s who weighed more than 300 pounds. For 30 years, she had struggled with severe low back and neck pain, classifying it as an eight out of 10 on most days. Depression also chipped away at Anne’s daily quality of life.  

Given the complexity of Anne’s health, it’s not surprising that traditional obesity and musculoskeletal care was failing her. Her orthopedic surgeon had prescribed steroid injections, which provided little relief and instead caused her blood sugars to spike. Simply making it to a physical therapy appointment felt impossible due to her depression and mobility limitations. Her strength and balance began to deteriorate, contributing to two significant falls in one year. With her health rapidly declining, Anne’s primary care physician (PCP) prescribed her a GLP-1 for weight loss and her surgeon scheduled her for elective spine surgery to address her lower back pain.  

At around the same time, Anne learned about Vori Health through her health plan. Through one convenient video visit from the comfort of her home, Anne met with a Vori physician and physical therapist who diagnosed her with degenerative disc disease and spinal stenosis. Anne’s Vori care team—which consisted of a non-operative physician, physical therapist, health coach, and registered dietitian—worked with her PCP to integrate her GLP-1 medication into a full-spectrum MSK treatment plan to address her pain, weight, and mental health concerns. With AI-powered at-home exercises and easy follow-up video visits, Anne worked regularly with her holistic Vori care team to minimize her pain, recover her balance and mobility, combat GLP-1 related muscle loss with targeted strengthening and dietary recommendations, rebuild her healthy eating habits, improve her mood, and cultivate strategies for sustainable behavior change.

Anne's Vori Health care team worked with her PCP to integrate her GLP-1 medication into a full-spectrum MSK treatment plan to address her pain, weight, and mental health concerns.

With this surround-sound approach to care, Anne finally had access to the level and scope of care that she, like countless others, needed to find true, long-term relief. In just four and a half months, Anne lost more than 80 pounds. She was able to stop taking her insulin as she learned to balance her blood sugar with healthy meals and snacks. Her mobility has dramatically increased, she hasn’t suffered any more falls, and her pain is now a four out of ten. Anne’s depression also significantly improved and she reports being both surprised and thrilled by the amount of progress she was able to achieve. “It was really helpful to go from exercises for my back pain to exercises that burn more calories,” Anne said. “I couldn't have lost this much weight without my Vori care team.”

Anne cancelled her spine surgery, and has since jumped back into life, engaging in daily activities like grocery shopping, driving, and gym classes without any concern over her pain.  

So, are GLP-1s capable of breaking this vicious cycle? 

Yes! But not alone. When paired with an evidence-based, holistic care program that encourages sustainable behavior changes, GLP-1s can be an incredibly effective tool to kickstart a healthy lifestyle.  

Anne’s story is all too common in our traditional healthcare system. Driving value in the cost and quality of care means catching patients like Anne and redirecting them to appropriate evidence-based care. The introduction of GLP-1s into regular care protocols make this intervention even more crucial—while GLP-1s helped jumpstart Anne’s weight loss, her Vori Health care team was the reason she was able to make the most of her weight loss opportunity and get on a better path with healthy habits, ongoing exercise, balanced nutrition, and, ultimately, a life free from severe chronic pain.

Whether your members are already taking GLP-1s, or would benefit from a prescription given alongside comprehensive behavior and lifestyle support, Vori Health’s physician-led GLP-1 program ensures your population receives evidence-based obesity and MSK care designed for lasting results.

Reach out today to learn more about how Vori Health’s full-spectrum GLP-1 care can improve MSK, mental health, and obesity outcomes for your members.  

REFERENCES

• Cleven, 2020: Cleven L, Krell-Roesch J, Nigg CR, Woll A. The association between physical activity with incident obesity, coronary heart disease, diabetes and hypertension in adults: a systematic review of longitudinal studies published after 2012. BMC Public Health. 2020;20(1):726. 

• NCHS, 2014: Depression and Obesity in the U.S. Adult Household Population, 2005-2010. (October 2014). NCHS Data Brief No. 167.

• Melkevik, 2018: Melkevik O, Clausen T, Pedersen J, Garde AH, Holtermann A, Rugulies R. Comorbid symptoms of depression and musculoskeletal pain and risk of long term sickness absence. BMC Public Health. 2018;18(1):981.

• Dieleman, 2020: Dieleman JL, Cao J, Chapin A, Chen C, Li Z, Liu A, Horst C, Kaldjian A, Matyasz T, Scott KW, Bui AL, Campbell M, Duber HC, Dunn AC, Flaxman AD, Fitzmaurice C, Naghavi M, Sadat N, Shieh P, Squires E, Yeung K, Murray CJL. US Health Care Spending by Payer and Health Condition, 1996- 2016. JAMA 2020;323(9):863-884.

• White House, 2022: Reducing the Economic Burden of Unmet Mental Health Needs. (May 31, 2022). The White House.

• Cawley, 2021: Cawley J, Biener A, Meyerhoefer C, et al. Direct medical costs of obesity in the United States and the most populous states. J Manag Care Spec Pharm. 2021;27(3):354-366.

• Trilliant Health, 2023: 2023 Trends Shaping the Health Economy: Value for Money. Trilliant Health.

• Wilding, 2021: Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002.

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