Healthy Business Podcast: Movement Capacity Is the Missing Variable in Your Metabolic Strategy

Speaker A: Most employers think metabolic risk is a chemistry problem. A1C levels, triglycerides, BMI, GLP1 utilization, pharmacy trends. And so they buy chemistry solutions. And to be clear, some of those solutions definitely work. Weights can drop, a 1C can improve, short term claims stabilize. But here's the question that almost no one is asking. Why? What happens if someone loses 30 or 40 pounds but never address the root behaviors and capacity limits that led to their obesity? What happens if glucose improves, but daily movement tolerance never does? Because metabolic dysfunction does not begin with a 1C. It begins when movement becomes expensive. When bending hurts, knees swell. When sleep disruption happens because of pain, recovery slows. And when someone quietly avoids activity because it costs too much. When movement declines, insulin sensitivity follows. If muscle isn't used, glucose regulation degrades. If movement is painful, muscle isn't used. If inflammation rises, pain worsens. And that's the loop. Pain reduces movement, reduced movement worsens metabolic stability. Metabolic stability increases inflammation. And if nutrition isn't addressed, inflammation compounds, inflammation worsens pain. And most employer strategies interrupt appetite. But they never repair the loop. Today I want to introduce a variable that almost never shows up in claims reporting, pharmacy dashboards or renewal decks. Movement capacity. Not steps, not gym reimbursements or participation rates. Movement capacity is the ability to move frequently without pain and stability and strength across your daily life. And if your metabolic strategy does not increase movement capacity, it is incomplete. If your intervention stops and risk rebounds, it is not a strategy. It is a temporary offset. Today we're going to break down why movement capacity is the missing variable in metabolic strategy, why it stays invisible in claims data, and how to evaluate any MSK or metabolic program through this lens. Because once you see healthcare as a capacity system instead of a chemistry system, you design things very differently. My name is Dr. Andrew Weitz. I am the CEO and founder of AlignWell, a national MSK and metabolic risk management company working with self funded employers. You are listening to the Healthy Business Matters podcast. The podcast for brokers, CFOs, HR leaders and operators who are tired of buying health programs that just don't move the risk. If you care about reducing risk instead of managing optics, you are definitely in the right place. So. So let's get into it. Let me give you a pattern that I see over and over again in the manufacturing, trucking and construction clients that we serve on, uh, a daily basis. Insert an employee. He's 42 years old and he has intermittent low back pain. He's had it for years, nothing dramatic. He hasn't had any Surgeries or a disability claim. But every few years, he does throw his back out. When that happens, he'll commonly get some rest. He might get some imaging done. He's probably done some PT and chiropractic. After a while it will calm down after everyone then moves on. But something subtle happens. He's gonna stop lifting outside of work. He's gonna stop playing basketball or walking or wrestling around with his kids. He's gonna stop moving in the evenings. Not because he's lazy, but because movement is now becoming expensive. It costs pain on a daily basis. The daily energy expenditure drops. Nothing drastic, but gradual. 500 fewer calories burned per day, then 800. Then activity compresses to only what is required for his job. Muscle mass will slowly decline, especially because he likely isn't eating. The best slee drops because discomfort wakes him. His recovery slows. Body composition slowly shifts. Fifteen pounds show up over the over three years, then 20. Then he's pre diabetic. His triglycerides climb. Nothing catastrophic, nothing urgent, Nothing that triggers a case management event. But the trajectory is now set. Insulin sensitivity is not primarily a lab problem. It is a muscle problem. Muscle is the largest site of glucose disposal in the entire body. If muscle is not used frequently, insulin resistance accelerates. And so when, so when pain limits movement, movement declines, muscle engagement declines, glucose regulation declines. And because this unfolds over years, it never shows up as a big event. It shows up as a diabetes diagnosis. So the system responds with a pharmaceutical intervention. But the original constraint was capacity. The body stopped tolerating movement well. And that's the beginning of a metabolic drift. Not the A1C, not the prescription and not the diagnosis code. The slow erosion of, uh, daily movement tolerance. And employers just simply do not see it because it doesn't generate a claim large enough to flag. It generates a pathway. And once that pathway is established, all of the downstream costs become very predictable. More imaging, more intermittent flares, more weight gain, more pharmacy. And eventually higher catastrophic probability. But the pivot point was small when movement became expensive. And to be clear, movement is not the only variable here. Nutrition matters massively. Often the employees that we work with are eating ultra processed foods, Excess refined carbohydrates, often a massive surplus in calories, alcohol, late night eating, all of that increases systemic inflammation. But here's the mistake that we make. We treat food as the only lever. Inflammation is not only about what you eat, but it is what your system can tolerate. Two employees can eat the exact same diet, but one moves daily, preserves muscle, and sleeps well. While the other movement. While the other avoids movement because of pain, the metabolic response will not be the same. Movement capacity determines whether dietary load becomes a metabolic dysfunction. So before we talk about solutions, we have to get precise about what we mean by movement capacity and why it's different from fitness steps or wellness engagement. Let's step out of the individual story and zoom back out to the plan level. If you're an employer, you are not managing health in theory. You are managing trend volatility, productivity renewal pressures, stop loss exposures. And here's the uncomfortable reality. Most metabolic strategies employers buy do not change moving capacity. They change biomarkers, they change appetite, they change medication utilization. But they do not change whether an employee can bend, lift, rotate, walk, train, recover and repeat it on a daily basis without friction. And if daily movement tolerance does not improve, long term risk remains structurally unstable. So here's the lens shift. Movement capacity is not a clinical concept. It's a risk stabilization variable. If you increase movement capacity across your population, daily energy expenditure rises organically, muscle mass stabilizes or improves. Insulin sensitivity improves through use, not suppression. Inflammation load decreases, your MSK flare frequency is going to drop, your short term disability likelihood drops, catastrophic MSK events are going to become much less probable. That is what I would call durability. Now let's contrast it. If you reduce appetite through, let's say, GLP1s, but you're not improving movement, weights may drop, labs may improve, pharmacy spend may look efficient, but again, muscle mass may decline, strength may decline, baseline metabolic resilience will remain, weak pain patterns remain, and then your risks are going to rebound when the intervention stops. That is fragile. So if I'm a CFO or a broker, I would ask yourself, when this intervention stops, what will remain? Does an employee have a greater capacity than they did before? Or are they likely to return to baseline behaviors with suppressed appetite removed? If it's B, you did not build capacity. You just simply subsidized suppression. In a very different risk posture, employers unintentionally buy short term optics. You have a 12 month plan, year stop loss renewals, immediate A1C movements, and quarterly reporting. But movement capacity compounds slowly. But so does catastrophic stability. If you only optimize for what moves in a year, you will ignore what stabilizes over 5. That is not a moral failure. It's an incentive structure. But once you see it, you cannot unsee it. So let's ask the uncomfortable question. If moving capacity is foundational, why doesn't it show up in renewal? Because employers don't measure friction they measure events, claims, data shows diagnosis, will show your diagnosis, your diagnoses, your procedures, your prescriptions, your imaging and admissions. But it doesn't show the uh, behaviors that were avoided, the fear of bending, the sleep disruption from pain, the gradual strength decline or the loss of movement confidence. Movement erosion does not generate a claim, but it does generate a pathway. And again, pathways are often invisible until they mature into a big cost. And that's a blind spot in these plans. When a CFO reviews a dashboard, they're going to see your diabetic prevalence, your GLP1 utilization, your MSK spend by total, your high cost claimants and your trend versus the prior year. But what you're not going to see are how many employees can no longer tolerate daily movement without compensation. There's no column for it. There's often not a great way to measure it. No KPI for functional resilience, no early warning indicator for inflammation low driven by movement avoidance. So what gets managed, what's visible. And what's visible is always downstream. It's always a lagging indicator. So employers end up intervening after A1C has crossed the threshold or pain becomes acute, driving high cost claims. Imaging gets ordered pharmacy starts and your stop loss flags because you hit spec. That is all a reactive architecture. Employer employers manage what is visible, but risk accumulates where it is invisible. So let's talk about why most wellness programs miss this stuff. Wellness programs often track participation, steps, logins, coaching calls or challenges completed. But none of those measure whether someone can move without pain. An employee could easily log 8,000 steps in a day and still have dysfunctional movement patterns that can trigger flare up cycles. And an employee can tolerate. And an employee can complete a biometric screening and still avoid resistance training because their back is unstable. Activity does not equate to capacity, participation does not equate to tolerance. And employers often confuse these two. Constantly moving capacities upstream of both musculoskeletal claims and metabolic claims. If the moving capacity degrades, both cost categories are going to drift. If it improves, both categories will stabilize. But because it doesn't sit cleanly inside of a CPT code or an RX category, it lives in kind of a no man's land. It's what we often talk about when we come on site to do our discovery process with our mobile X ray is we often say that we're going to expose a lot of blind spots because again, these issues often sit in this no man's land because there hasn't been a claim yet. Which means that no one Owns it. And when no one owns it, no one manages it. That's the structural problem. So if moving capacity is invisible in traditional reporting, the next question becomes what breaks when you design a metabolic strategy without accounting for it? That's where durability versus fragility shows up. So let's assume you're an employer and you're considering building a metabolic strategy that's going to expand your GLP1 coverage and nutritional coaching at biometric screenings and encourage weight loss. You're likely going to see weights improve, you'll likely see a 1C improve. Trend stabilizes for a year or two on uh, paper looks like a smashing success. But if movement capacity never improved, what can break? Muscle erodes quietly. If appetite is suppressed but resistance stimulus does not increase, your lean muscle mass inside of your population will decline. Their strength will decline. Their basal metabolic rate, which is your base rate of uh, metabolism and horizontal how many calories you need to maintain your muscle mass will decline. You now have a lighter employee with the same structural instabilities. That's not resilience, that's cosmetic improvements over functional fragility. Muscle is metabolic infrastructure. If you don't preserve or build it long term glucose handling capacity does not improve durably. Inflammation will persist. If movement mechanics are dysfunctional, joints are going to erode over time. Low grade inflammation signaling persists, pain cycles persist, Weight may improve, but mechanical friction remains. Inflammation is not only biochemical, it's mechanical. If someone cannot hinge, rotate, stabilize well, inflammation inputs continue and inflammation load feeds your metabolic instability. You will never close the loop unless you address these issues. Dependency risks will increase. If the intervention works only while the intervention is active, you create a dependency. What happens when your coverage changes? Cost shares increase, stop loss, pressure shift, the employer discontinues the medication. If the answer is well, the risk is going to rebound, then the system did not become stronger, it just became managed. And those are not the same thing. Managed risk are fragile. Strengthened systems are durable. Catastrophic risk remains structurally elevated. And if you are not addressing the movement, uh, capacity patterns never improve. MSK flare up, probabilities remain, Surgical probabilities remain high. Disability exposure remains fall risks remain work. Comp interactions in your mod will still be affected. Weight reduction without affecting your movement capacity within your population will not materially reduce mechanical injury probability. You reduced your mass, you reduced the weights, you did not increase tolerance. It's a different variable. And catastrophic claims often begin mechanically. And again. Lastly, your behavior is going to the behaviors are going to revert. If appetite suppression is the primary Driver of weight loss. When the suppression lifts, the appetite will return. If the employee never rebuilt strength or movement confidence, training habits, recovery patterns, the environment pulls back, pulls them back to their baseline. That's not a character issue, it's just a system design issue. The behavior sticks when capacity supports it. Without capacity, behavior is effort dependent. And effort dependent systems collapse under stress. So before you approve any metabolic initiative, the government's question should be, does this increase daily movement tolerance? Does this preserve or build muscle? Does this reduce mechanical inflammation load? And when the intervention stops, is the employee stronger than before? Because if the answer is no, you may have improved optics and may have improved some benchmark and markers, but you did not improve resilience. So let's simplify this. I am talking to employers on a daily basis when we're looking to implement new programming when it comes to their MSK and their metabolic concerns. And so you're likely listening to this, wrestling with the same things that many of our customers are around. Whether or not to approve or expand coverage for GOP1s and how, how to address your metabolic concerns. So before you approve or expand any metabolic or MSK initiative, let's run it through four questions. First, one, does this increase daily movement tolerance? So again, not participation, not engagement, not logins. Does the employee leave this intervention more capable of bending, lifting, rotating, exercising, training, recovering without pain or fear? If daily movement capacity does not improve, metabolic durability will not improve either. Full stop. Question two, does this preserve or build muscle? Muscle is a metabolic infrastructure. It's not just cosmetic. It is the largest glucose disposal organ in the entire body. If lean muscle mass declines while weight declines, you may be improving numbers while weakening structure. Ask this directly, is this intervention strengthening the metabolic engine or simply reducing the the metabolic load through appetite suppression? Because reducing the load will certainly help. But strengthening the structure stabilizes this process and those are different outcomes. Question three, does this reduce mechanical inflammatory input? Inflammation is not only dietary, it is mechanical. If joints have instability, poor movement mechanics and flare cycles persist. Inflammatory signaling will also persist. You cannot supplement your way out of mechanical irritation. So ask these questions. Are we addressing the mechanical drivers of inflammation or only the biochemical ones through a, uh, pharmaceutical intervention? Because if the mechanical friction remains, metabolic fragility remains. Last question. What happens when this intervention stops? This is your durability test. If you're going to invest in something like this. If you don't have some sort of long term roi, then again, I would argue that's probably not a worthwhile investment. This is the true DURABILITY test when coverage changes, when budgets tighten, when the the employee discontinues, is the employee stronger, more capable, more metabolically stable, or do they return to baseline because if risk rebounds when the intervention stops, it was never a strategy, it was only a subsidy. Metabolic dysfunction is not a chemistry problem, it is a capacity problem. Nutrition matters, behavior matters. Medications have a role, but without moving capacity, those interventions become fragile. If you want durable outcomes, you have to restore the body's ability to move, not temporarily, but structurally. If you take anything from this episode today, let it be this if risks rebound when intervention stops, you didn't fix it, you simply financed it. Uh, this is Dr. Andrew White and I want to thank you for listening to the Healthy Business Matters podcast. If this episode sharpens your thinking, share it with a broker, CFO or HR leader you know who needs a clear framework. Healthy Business Matters is built for people who make real decisions. This is not a simple passive listening podcast. If you haven't already, please follow, subscribe wherever you listen to these podcasts on Apple or Spotify so you don't miss future episodes. And if you have a topic that you want us to unpack, or a guest that you would like us to interview, or a question that you're wrestling with inside of your own health plan, please reach out to us directly at hellolineco Life. The goal of this show is simple, clear thinking, better decisions, healthier businesses. I'll see you next week.