If you're a benefits leader, you've probably noticed the same trends I have. GLP-1 costs are through the roof. Musculoskeletal claims among women over 40 keep climbing. And despite all the wellness apps and step challenges, behavioral health spending isn't budging.
Most of these problems share a root cause our industry ignores: atrophy, the slow loss of muscle and bone density that begins for women around age 30. The fix is strength training, treated as a claims prevention strategy rather than a wellness perk.
What wellness programs miss
A typical benefits package includes a gym discount, maybe a yoga class, a step challenge, and a meditation app. Those are fine as far as they go, but they do not address what is driving costs for female employees.
The typical wellness model is passive. It waits for something to go wrong: a back injury, a diabetes diagnosis, a depressive episode. Then it reacts. It is like ignoring a slow leak in the roof until the ceiling caves in.
For women, the cost accumulates over years of muscle and bone loss. The numbers stack up:
- Women lose 3 to 8 percent of their muscle mass every decade after age 30.
- Bone loss accelerates in the years around menopause and continues through the rest of life.
- Women over 40 develop chronic back pain, knee osteoarthritis, and shoulder problems at higher rates than men, and the gap widens through midlife.
- Hip fractures cost the U.S. healthcare system an estimated $10 billion to $15 billion a year, and most occur in older women.
Classes like Zumba and most yoga provide movement, not the mechanical load that builds bone and muscle, and they will not reverse the losses listed above. Many women also avoid weights out of fear of bulking up, a result that requires far more training volume and hormonal support than a supervised beginner program produces.
Three places strength training moves the needle
1. Musculoskeletal claims
Chronic low back pain, knee osteoarthritis, and frozen shoulder are among the top MSK claims for women in their 40s and 50s. The standard treatment path is imaging, injections, physical therapy, sometimes surgery, often opioids.
A progressive resistance program (squats, deadlifts, rows, presses) improves bone mineral density at the spine and hip, and a network meta-analysis found moderate-intensity training three days a week produced the clearest gains in postmenopausal women. It strengthens the connective tissue around joints and rebuilds the structural resilience those tissues lost.
The employer case is strong, though the vendor-style ROI figures that circulate are mostly invented. MSDs are among the costliest conditions for employers, driving absenteeism, disability, and workers' compensation claims. A 2023 CDC systematic review of worksite physical-activity programs found muscle strength and musculoskeletal symptoms improved in every included study, while a 2025 scoping review found many MSD interventions claim a positive ROI in vendor analyses even when their actual risk reduction is unproven. The honest argument is physiological: supervised progressive training targets the tissue loss behind these claims, which a typical gym subsidy never does.
2. The GLP-1 connection
Wegovy, Ozempic, and Mounjaro are now mainstream. The part most employers miss is what the drugs do to muscle.
Without resistance training, a substantial share of the weight lost on these drugs is lean mass. In recent GLP-1 trials, lean tissue accounted for 26 to 40 percent of total weight loss. Patients end up lighter but weaker, with a lower metabolic rate, and many regain the weight after they stop the drug.
Pairing the prescription with structured strength training preserves lean muscle and keeps metabolic rate from dropping, which improves the odds the weight loss lasts. Structuring the benefit this way is medically sound, and it protects the return on your pharmacy spend.
3. The menopause gap
McKinsey's 2024 report with the World Economic Forum estimated that closing the women's health gap could add at least $1 trillion a year to the global economy by 2040, and it names menopause as one of the conditions driving lost productivity and workforce participation. Yet most benefits platforms have nothing for this population.
Strength training is one of the strongest non-hormonal interventions for perimenopause and menopause. A 15-week supervised program reduced moderate and severe hot flashes in a randomized trial, and a 2024 meta-analysis of five trials found resistance training cut both the frequency and severity of hot flashes. It also limits visceral fat gain, preserves joint health, and reduces depressive symptoms, with a moderate effect size in a meta-analysis of 33 randomized trials.
Personal training is not an HSA-eligible expense on its own. It generally requires a letter of medical necessity tied to a diagnosed condition. Your employees have no muscle mass account. They have a gym discount that does not fund the right kind of coaching.
I propose a Preventive Atrophy Rider: a carve-out benefit for women 40 and older that covers 80 to 100 percent of a certified strength coach for six months. It is a population health intervention, not a fitness perk.
Supervision and screening come first
The programs behind these results were not app-based self-serve workouts. The bone density trials used moderate-intensity, progressive resistance training two to three days a week, usually supervised. The hot-flash trial ran a structured 15-week program. That matters for the population you are targeting.
Women in their 40s and 50s with low bone density, metabolic syndrome, or chronic joint pain are often deconditioned. Standard osteoporosis exercise guidance recommends progressive resistance training and cautions against heavy spinal flexion or high-impact loading for people with confirmed low bone mass. A 58-year-old with osteopenia should not walk into a gym and start a deadlift program she found online. She needs a screen, a graduated plan, and a coach who can correct her form.
That is also why a blanket mandate is the wrong frame for the GLP-1 pairing. Make structured strength training the default with a strong incentive, and let a clinician adjust for each employee. The benefit only pays off if people start at a level they can handle and progress from there. Skip that step and a prevention program becomes its own source of MSK claims.
How to build this into your system
You do not have to redesign the whole benefits package. Fund a pilot by reallocating what you already spend on unused gym subsidies and wellness apps, then rewire a few pieces.
- Find the right population. Use claims data to identify women 40 and older with low bone density, chronic MSK issues, metabolic syndrome, or high GLP-1 spend. These are your highest-yield candidates.
- Choose the right partner. Not all platforms are equal. You need one that uses progressive overload: increasing weight or reps over time. That is the mechanism that builds bone and muscle. Digital MSK providers such as Hinge Health and Sword Health offer strength programs, and coaching platforms such as Future and Caliber pair members with human coaches who prescribe dumbbell-based routines.
- Rethink incentives. Reward completed strength sessions rather than gym visits. Offer a premium discount for women who finish a 12-week program, and create peer cohorts with live coaching calls. Community drives adherence.
- Track what matters. Measure session completion, strength progression (did weight or reps increase?), and downstream claims against a matched control group. Adherence and strength gains show up within the first program cycle; claims effects take longer.
What ignoring this costs
The benefits world has spent a decade on emotional wellness and mental health days while ignoring the physical modality that directly regulates mood, metabolism, and pain. That asymmetry is expensive.
Ignoring strength training for women 40 and older is a liability you are already paying for on the back end: surgery, medication, disability, and presenteeism. Prevention on the front end costs a fraction of that.
The next effective benefits tool is supervised, progressive resistance training, deployed as claims prevention. Build it into the plan, track the claims, and let the data settle the argument.