Am I eligible for a GLP-1? BMI thresholds, qualifying conditions and who is screened out

For the FDA-approved weight-management GLP-1s, the starting point is a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related health condition such as high blood pressure, type 2 diabetes or high cholesterol. Meeting those numbers makes you a candidate for evaluation. It doesn't mean the medication is right for you, and some people are screened out for safety reasons.

This article explains the criteria in plain terms. It doesn't replace an evaluation, and an online BMI calculator can't tell you whether a GLP-1 is safe for you.

The BMI thresholds

Body mass index is weight in kilograms divided by height in meters squared. The thresholds in the prescribing information for weight-management GLP-1s are:

• BMI 30 or higher (obesity), with no other condition required.
• BMI 27 to 29.9 (overweight) with at least one weight-related condition.

As a rough example, for someone 5 feet 6 inches tall, a BMI of 27 is about 167 pounds and a BMI of 30 is about 186 pounds. For someone 5 feet 10 inches tall, those figures are about 188 and 209 pounds. These are approximations; your clinician will calculate yours from measured height and weight.

Which conditions count

The labels refer to weight-related comorbid conditions. Commonly accepted examples include:

• High blood pressure
• Type 2 diabetes or prediabetes
• High cholesterol or triglycerides
• Obstructive sleep apnea
• Cardiovascular disease
• Fatty liver disease (MASLD or MASH)
• Osteoarthritis of weight-bearing joints

Insurers often have their own, sometimes narrower, list. Our article on insurance coverage for weight loss medication covers how plans apply these rules.

BMI has limits

BMI is a screening tool, not a full measure of health. It doesn't distinguish between muscle and fat or show where fat is carried. Some people of Asian descent develop metabolic problems at lower BMIs, and the American Diabetes Association uses a lower BMI cutoff when screening Asian Americans for diabetes. Very muscular people may have a high BMI without excess fat. A clinician will consider waist circumference, lab results and your overall health alongside BMI. The FDA-approved labels still use the standard thresholds, though, and insurers usually do too.

Condition-based approvals

Some GLP-1 approvals depend on a specific diagnosis as well as weight:

• Cardiovascular risk reduction: Wegovy is approved to reduce the risk of heart attack, stroke and cardiovascular death in adults with established cardiovascular disease and either obesity or overweight. This was based on the SELECT trial (NEJM, 2023), which found a 20% relative reduction in major cardiovascular events compared with placebo.
• Obstructive sleep apnea: Zepbound is approved for moderate to severe obstructive sleep apnea in adults with obesity, based on the SURMOUNT-OSA trials. A sleep study is typically required to confirm severity.
• Liver disease: Wegovy received accelerated approval in August 2025 for adults with MASH (metabolic dysfunction-associated steatohepatitis) with moderate to advanced liver scarring, but without cirrhosis.

Age

Wegovy is approved for adolescents 12 and older with obesity, defined as a BMI at or above the 95th percentile for age and sex, based on the STEP TEENS trial. Zepbound is approved for adults. Teenagers are best evaluated by a pediatric specialist.

For older adults, there is no upper age limit in the labels, but loss of muscle and bone matter more with age. See our article on muscle loss on a GLP-1.

Who is screened out

Contraindications in the labels

The prescribing information for Wegovy and Zepbound lists these as reasons not to use the drugs:

• A personal or family history of medullary thyroid carcinoma (MTC).
• Multiple endocrine neoplasia syndrome type 2 (MEN2).
• A prior serious allergic reaction to the drug or its ingredients.

Both labels carry a boxed warning about thyroid C-cell tumors, which were seen in rodent studies. It is not known whether these drugs cause such tumors in people. Pregnancy is also a reason not to use them, and they should be stopped before a planned pregnancy.

Conditions that need careful review

These may not rule you out, but they change the conversation:

• Prior pancreatitis
• Gallbladder disease or gallstones
• Severe gastrointestinal disease, including gastroparesis
• Diabetic retinopathy, since rapid improvement in blood sugar has been linked to worsening in some patients
• Kidney disease, because dehydration from side effects can strain the kidneys
• A history of depression or suicidal thoughts; both labels advise monitoring
• A current or past eating disorder
• Type 1 diabetes, for which these drugs are not approved
• Upcoming surgery, since slowed stomach emptying can raise the risk of aspiration during anesthesia

We cover these in more depth in our article on who should not take a GLP-1.

What an evaluation usually includes

• Measured height, weight and BMI, and often waist circumference.
• Your medical history, including weight history and prior weight-loss attempts.
• Family history, especially thyroid cancer.
• A review of current medications, some of which can cause weight gain or interact.
• Lab work, which may include blood sugar or A1C, kidney and liver function, and cholesterol.
• A discussion of goals, side effects, costs and what long-term treatment involves.

If you are just under the threshold

If your BMI is 25 to 26.9, or 27 to 29.9 with no weight-related condition, the approved GLP-1s are not indicated for you. Some online services may still offer them. That is a sign the evaluation isn't being taken seriously; see how to spot a prescription mill. Other approaches, including nutrition, activity and treatment of conditions such as sleep problems, may fit better.

If you think you may qualify, a clinician can confirm it and screen for anything that makes a GLP-1 unsafe. Our weight management program explains how the evaluation works. Meeting the criteria makes you eligible to be considered; it does not mean you will be prescribed one.

Questions patients ask us

What BMI do I need to qualify for Wegovy or Zepbound?

The prescribing information covers adults with a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related condition such as high blood pressure, type 2 diabetes or high cholesterol. Meeting the threshold makes you a candidate for evaluation, not automatically a good fit for the medication.

Which weight-related conditions count with a BMI of 27?

Commonly accepted conditions include high blood pressure, type 2 diabetes or prediabetes, high cholesterol or triglycerides, obstructive sleep apnea, cardiovascular disease, fatty liver disease and osteoarthritis of weight-bearing joints. Insurers may use a narrower list for coverage, so a condition that satisfies the label may not always satisfy your plan.

Can I get a GLP-1 if my BMI is 25 or 26?

The FDA-approved weight-management GLP-1s are not indicated at that BMI. A service that prescribes them anyway is not following the labeling, and that is worth noticing. Other approaches, such as nutrition support, activity and treating related conditions, may fit better. A clinician can review your full picture.

Does a family history of thyroid cancer rule out a GLP-1?

A personal or family history of medullary thyroid carcinoma, a specific and uncommon type, is a contraindication in the Wegovy and Zepbound labels, as is MEN2 syndrome. Other thyroid cancers, such as papillary thyroid cancer, are not listed the same way, but tell your clinician about any thyroid history so it can be reviewed properly.

Can I take a GLP-1 if I have had pancreatitis?

Prior pancreatitis is not a formal contraindication in the labels, but both warn about acute pancreatitis, and many clinicians avoid these drugs in people who have had it. The decision depends on the cause, how long ago it was and other options. It needs a careful conversation rather than a yes or no answer online.

Are GLP-1s approved for teenagers?

Wegovy is approved for adolescents 12 and older with a BMI at or above the 95th percentile for age and sex, based on the STEP TEENS trial. Zepbound is approved for adults. Teenagers are best evaluated by a pediatrician or pediatric obesity specialist who can involve the family and monitor growth.

Is there an upper age limit for GLP-1 medications?

The labels do not set an upper age limit for adults. Older adults may face more concern about muscle and bone loss, dehydration, and interactions with other medications, so a careful evaluation and attention to protein and strength training matter more. Age alone is not a reason to be excluded.

Is BMI a fair way to decide who qualifies?

BMI is a screening tool with real limits. It does not separate muscle from fat or show where fat is stored, and some people of Asian descent develop metabolic problems at lower BMIs. Clinicians consider waist size, labs and health history too. Still, the FDA labels and most insurers use the standard BMI thresholds.

Can I take a GLP-1 if I have type 1 diabetes?

GLP-1 weight-management drugs are not approved for type 1 diabetes. Some specialists use them off-label in selected patients, but the risk of low blood sugar and other complications means that decision belongs with an endocrinologist who manages your diabetes, not a general weight-loss program.

What should I bring to a GLP-1 eligibility evaluation?

Bring a complete list of medications and supplements, recent lab results if you have them, your weight history, details of any thyroid, pancreas, gallbladder or kidney problems, family history of thyroid cancer, and your pregnancy plans. Being complete helps the clinician screen for safety and avoids delays.