What the label actually requires
The FDA labels for chronic weight-management GLP-1s — Wegovy (semaglutide) and Zepbound (tirzepatide) — set the same starting threshold: a body mass index of 30 or more, or 27 or more if you also have at least one weight-related conditionsuch as high blood pressure, type 2 diabetes, prediabetes, high cholesterol, or obstructive sleep apnea. That single “27-with-a-condition” rule is why an honest answer needs to know about your health, not just your weight.
It is worth separating two things people blur together. The weight drugs (Wegovy, Zepbound) are approved on the BMI criteria above. The diabetes versions of the same molecules — Ozempic and Mounjaro — are approved for blood-sugar control in type 2 diabetes and are prescribed on different grounds entirely. Meeting or missing the weight threshold does not settle whether a diabetes indication applies.
Meeting the threshold is not the same as being covered
This is the trap that costs people the most time. You can clear the BMI bar and still be denied — or, more finally, excluded — by an insurer whose plan does not cover weight-management drugs at all. Coverage turns on the indication and your specific plan, not on your body. Before you get attached to a number here, run the Cost & Coverage Estimator and read how GLP-1 coverage works, Medicaid coverage by state, and whether Medicare covers them.
If you might become pregnant, read this first
Two facts matter enormously for women and are easy to miss. GLP-1s are not recommended in pregnancy, and the labels advise stopping before a planned pregnancy. And tirzepatide can reduce the effectiveness of the pill, which — combined with the way these drugs can restore fertility — is exactly how unexpected pregnancies happen on them (see GLP-1s, fertility and pregnancy). None of that rules a GLP-1 out; it just needs to be part of the conversation from day one.
The cautions the tool flags
A personal or family history of medullary thyroid cancer or MEN 2 is a contraindication to these drugs, and a history of pancreatitis needs individual assessment — those are label warnings, not our opinion. The point of surfacing them here is not to alarm you but to make sure they reach a prescriber, because they change the decision more than your BMI does.
Where to go next
Curious what the medicines actually do and how much weight the trials showed? See the weight-loss projector, GLP-1s explained, and — if midlife weight is your reason — GLP-1s for menopause weight gain.