Understanding BMI Requirements

For the weight-management-approved medications (Wegovy and Zepbound), the FDA requires a BMI of 30 or higher for straightforward eligibility. A BMI of 27 or higher also qualifies if you have at least one weight-related comorbidity.

This lower threshold of 27 is clinically significant because it recognizes that the health risks of excess weight don't begin at a specific BMI cutoff — conditions like high blood pressure, sleep apnea, and type 2 diabetes can develop at lower BMI values, especially in certain ethnic groups. Use our BMI Eligibility Checker to calculate your BMI and see which criteria you meet.

BMI limitations: BMI is a screening tool, not a perfect measure of health or body fat. It doesn't account for muscle mass, bone density, or fat distribution. Asian populations, for example, face higher metabolic risks at lower BMI values. Many clinicians now supplement BMI with waist circumference measurements and other metabolic markers when assessing eligibility.

Weight-Related Conditions That Qualify

If your BMI is between 27 and 29.9, you can still qualify for Wegovy or Zepbound if you have at least one of the following conditions:

  • Hypertension (high blood pressure) — even if controlled with medication
  • Type 2 diabetes or prediabetes
  • Dyslipidemia (high LDL cholesterol or low HDL cholesterol)
  • Obstructive sleep apnea
  • Cardiovascular disease (history of heart attack, stroke, or peripheral artery disease)

For Ozempic and Mounjaro, the primary qualifying condition is type 2 diabetes — no BMI requirement applies for on-label use.

Who Should NOT Take GLP-1 Medications

Several medical conditions are contraindications — meaning GLP-1 medications should not be used:

  • Personal or family history of medullary thyroid carcinoma (MTC) — GLP-1 receptors are expressed in thyroid tissue, and animal studies showed thyroid tumors at high doses (though this hasn't been confirmed in humans)
  • Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • Pregnancy — these medications should be discontinued at least 2 months before a planned pregnancy
  • Breastfeeding
  • History of pancreatitis — use with caution; acute pancreatitis has been reported
  • Severe kidney disease — dose adjustment may be needed
  • Severe gastrointestinal disease including gastroparesis
Important: This list is not exhaustive. Many other medications and health conditions may affect GLP-1 suitability. Always provide your complete medication list and medical history to your prescriber before starting these medications.

Insurance Requirements vs FDA Criteria

The FDA eligibility criteria described above are the minimum medical requirements. Insurance coverage often adds additional hurdles — and this is where many patients get frustrated.

Common insurance requirements beyond FDA criteria include:

  • Prior authorization: Your doctor must submit documentation justifying the prescription before the insurer will approve it
  • Step therapy: Some plans require you to try and "fail" other weight loss interventions (typically diet programs, sometimes other medications) before approving GLP-1 drugs
  • Documented BMI history: Some plans want to see BMI documented over time, not just a single measurement
  • Exclusion for weight loss: Many plans explicitly exclude weight loss medications — even if you meet FDA criteria for Wegovy or Zepbound

See our detailed Cost & Insurance Guide for strategies on navigating prior authorization, appealing denials, and reducing out-of-pocket costs.

How to Get a Prescription

Getting a GLP-1 prescription requires a licensed healthcare provider — you cannot buy these medications over the counter. Here are your options:

Primary Care Physician

Your regular doctor is often the easiest starting point. Many PCPs are comfortable prescribing GLP-1 medications for qualifying patients. Come prepared with your weight history, any relevant lab work (HbA1c if diabetic, lipid panel, blood pressure readings), and documentation of any weight-related conditions.

Endocrinologist or Obesity Medicine Specialist

If your PCP isn't comfortable prescribing or if your situation is complex, an endocrinologist or obesity medicine specialist has the most expertise. They're also often more successful at navigating insurance prior authorizations.

Telehealth Platforms

Several telehealth services offer GLP-1 prescriptions through online consultations with licensed physicians. You still need a real medical evaluation — these platforms screen for eligibility and contraindications. This can be faster and more convenient than in-person visits, though availability varies by state and insurance coverage may be more limited.