You do not need a BMI of 40, and you do not need diabetes. The FDA-approved weight-management GLP-1s, Wegovy (semaglutide) and Zepbound (tirzepatide), are approved for adults with obesity, or adults with overweight plus at least one weight-related health condition. Their main trials put numbers on that: a BMI of 30 or more, or 27 or more with a condition such as high blood pressure, high cholesterol or sleep apnea.
The BMI number gets you into the conversation. What decides the answer is a doctor’s review of your health history, your current medications and the conditions that make these medicines unsafe. Here is how each part works.
The BMI rule, and where it comes from
The labels themselves use the words obesity and overweight. Wegovy’s label covers weight reduction “in adults with obesity, or in adults with overweight in the presence of at least one weight-related comorbid condition,” and Zepbound’s uses almost the same wording. Both are approved for use alongside a reduced-calorie diet and more physical activity.
The BMI cut-offs come from how the main trials chose who could take part: 30 or more on its own, or 27 or more with a weight-related condition. That is the line doctors work from.
To find your BMI, divide your weight in pounds by your height in inches squared, then multiply by 703. A 5‘6” adult crosses 27 at about 167 pounds and 30 at about 186 pounds.
Which health conditions count at a BMI of 27 to 29.9
“Weight-related condition” means a health problem that excess weight causes or worsens. The trials described in the Wegovy and Zepbound labels give these examples:
- high blood pressure
- high cholesterol or other blood-lipid problems
- obstructive sleep apnea
- heart disease
Separate trials enrolled adults with type 2 diabetes at a BMI of 27 or more. At our intake, polycystic ovary syndrome (PCOS) and sleep apnea also count as weight-related conditions that the doctor weighs at a BMI of 27 or more.
Approvals beyond weight loss
Some of these medicines are approved for more than weight:
- Zepbound is also approved to treat moderate to severe obstructive sleep apnea in adults with obesity.
- Wegovy is also approved to lower the risk of heart attack, stroke and cardiovascular death in adults with established heart disease and either obesity or overweight. The weekly injection (not the daily tablet) is approved for weight management from age 12.
- Ozempic and Mounjaro contain the same medicines as Wegovy and Zepbound but are approved only for type 2 diabetes, which is why insurance treats them differently. What to do when insurance will not cover weight-loss medication covers that side.
What rules a GLP-1 out
The labels carry a boxed warning about thyroid C-cell tumors seen in rodent studies, and they say not to use these medicines if you or a family member has had medullary thyroid carcinoma, or if you have multiple endocrine neoplasia syndrome type 2 (MEN2). Pregnancy is the other hard stop: the labels say these medicines may harm a fetus.
Our intake does not accept anyone with:
- a personal or family history of medullary thyroid carcinoma or MEN2
- a history of pancreatitis
- type 1 diabetes
- severe gastroparesis
- a known allergy to GLP-1 medications
- pregnancy, trying to conceive, or breastfeeding (you can come back once that changes)
Some conditions are not automatic blocks but get a closer look from the doctor before anything is prescribed: kidney or liver disease, gallbladder or thyroid disease, a history of an eating disorder, and severe psychiatric illness. Already taking another GLP-1 is not a block either; the doctor reviews it as a transfer of care.
What the doctor actually checks
A real screening is more than a BMI calculator. Before prescribing, the doctor looks at:
- your height and weight, and so your BMI
- your health history, including the conditions above
- every medicine you take, because some interact (insulin and sulfonylureas, for example, raise the risk of low blood sugar alongside a GLP-1)
- any personal or family history of medullary thyroid cancer or MEN2
- labs, when the doctor needs them to decide; if you already have recent results, they review those
Sometimes the answer is no, or “not yet.” That is the point of a screening. The FDA lists a seller that “does not require a screening and prescription by a licensed doctor” as a red flag, and how to verify an online semaglutide provider covers what else to check.
How it works with us
You must be 18 or older. The online intake takes a couple of minutes and tells you straight away if one of the conditions above rules you out. A licensed physician then reviews it: by written review in most of the states we serve, or by video visit where the state requires one or you ask for one (the state-by-state breakdown explains why). The intake and that first review are free, and nothing is charged unless you choose to start.
We prescribe compounded semaglutide and tirzepatide as weekly injections. Compounded medications are not FDA-approved, and they are not generic versions of Wegovy or Zepbound. Our doctor also prescribes the brand-name medicines Zepbound, Wegovy and Foundayo, using the same intake and review: you pay us $28/month for the doctor’s care and buy the medicine separately through LillyDirect or NovoCare. How to get Wegovy and how to get tirzepatide walk through the brand routes.
Frequently asked questions
What BMI do you need to get a GLP-1? The main trials behind Wegovy and Zepbound enrolled adults with a BMI of 30 or more, or 27 or more with a weight-related condition such as high blood pressure, high cholesterol or sleep apnea. You do not need a BMI of 40. Whether you qualify is your doctor’s decision.
Do I need diabetes to qualify? No. Wegovy and Zepbound are approved for weight management without diabetes. Ozempic and Mounjaro contain the same medicines but are approved only for type 2 diabetes.
Who should not take a GLP-1? Anyone with a personal or family history of medullary thyroid carcinoma or MEN2, and anyone who is pregnant. Our intake also does not accept a history of pancreatitis, type 1 diabetes, severe gastroparesis, a GLP-1 allergy, trying to conceive, or breastfeeding.
Will I need blood work? Only if the doctor needs it to decide. If you already have recent lab results, the doctor reviews those.
Can I qualify at a BMI of 27 without another condition? Not under the trial criteria the labels are based on. At a BMI of 27 to 29.9, the doctor looks for a weight-related condition such as high blood pressure, high cholesterol, type 2 diabetes, sleep apnea or PCOS.
Dr. James Simmons, MD