Going Deeper Into HFA’s Ground-breaking GLP-1 White Paper

The Investment Frame

If there is a single phrase from Piccinini’s analysis that captures the white paper’s policy argument most economically, it is this: Structured exercise is an investment in health.

“The key message is that what our modeling shows is that incorporating structured exercise—and paying for structured exercise—has a positive return on investment,” she says. “It is an investment in health. It’s an investment in long-term better health outcomes that actually reaps a reward. We are finding that there is positive return on investment for the resources you put into funding structured exercise.”

The numbers behind that argument are hard to dismiss. In the United States, the model found that pairing structured exercise with GLP-1 therapy produced a 496% return on investment (ROI) over 10 years—meaning every dollar spent on a gym membership generated approximately five dollars in total societal value. Over 30 years, that figure reaches 1,572%. National net monetary benefit in the US alone was estimated at $120 billion over 10 years and $393 billion over 30.

Critically, those returns held across every country studied and across healthcare systems structured in fundamentally different ways. That consistency is not incidental; it is one of the research findings Piccinini finds most meaningful.

“I think the big takeaways are that on an individual patient level, there are significant benefits in terms of adverse outcomes that are prevented,” she says. “From a payer perspective, there are a lot of benefits in not having to have medical costs associated with those adverse outcomes.”

For instance, the research showed that adding structured exercise to GLP-1 therapy meaningfully reduced cardiovascular events and joint replacements. This led to a combined medical and societal cost savings over 10 years that reached roughly $28 billion in the US, A$143 million in Australia, CAD$2.1 billion in Canada, NZ$54 million in New Zealand, and £1 billion in the UK.

“It is reassuring that we found such positive results across all the countries that we studied—because that indicates that these clinical pathways that we’re modeling really will generate savings no matter how healthcare is organized or delivered across different countries.”

A Credibility Shift for the Fitness Sector

The research arrives at a moment when the fitness industry is actively working to reposition itself within the healthcare conversation—not as a wellness amenity but as a measurable contributor to preventive health and healthcare savings. The GLP-1 white paper provides something that public health messaging about exercise has rarely delivered: a specific, quantified economic argument tied to one of the most consequential healthcare developments of the decade.

Piccinini frames the study’s contribution this way: It takes the existing clinical research and applies the tools of health economics to assign value to what that evidence suggests. In doing so, it gives policymakers, payers, and employers a way to evaluate structured exercise using the same economic framework they apply to pharmaceutical interventions.

“I think that what our research really supports is the idea that GLP-1s with structured exercise is a really effective way to reduce the incidence of obesity and reduce the costs associated with that over time,” she says. “The value of our contribution is in taking the existing clinical research that’s out there and using our economist tools to think about how to put value on that as a way to understand what the gain [and] benefit from these treatments [are].”

For policymakers, the message offers clear policy recommendations:

• reimbursement for structured exercise programs;

• tax-preferred treatment of fitness expenses; and

• referral pathways that connect patients receiving GLP-1 prescriptions to qualified exercise professionals and fitness facilities.

These are not aspirational requests—they are proposals grounded in an ROI framework that healthcare economists, insurers, and government agencies are already equipped to evaluate.

The GLP-1 era has spent its first several years asking whether or how patients can access the drug. The research that HFA and Piccinini and her team produced suggests the next question is already overdue: Once they have it, what does the system do to make the results—and societal benefits—last?