What is the Body Mass Index (BMI) indication for Glucagon-like peptide-1 (GLP-1) agonist therapy?

From the Guidelines

GLP-1 agonists are typically indicated for adults with a BMI of 30 kg/m² or higher (obesity), or a BMI of 27 kg/m² or higher (overweight) with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia. These medications, including semaglutide (Wegovy, Ozempic), tirzepatide (Mounjaro, Zepbound), liraglutide (Saxenda), and dulaglutide (Trulicity), work by mimicking the incretin hormone GLP-1, which helps regulate blood sugar and appetite 1. They promote satiety, slow gastric emptying, and reduce hunger signals in the brain, leading to reduced caloric intake and weight loss. For patients with type 2 diabetes, these medications may be prescribed at lower BMI thresholds as they also improve glycemic control.

Key Points to Consider

• The FDA indication for all medications is BMI ≥ 30 kg/m² or BMI ≥ 27 kg/m² with significant complications 1.
• Treatment should be part of a comprehensive approach including diet and exercise.
• Patients should be monitored for side effects such as nausea, vomiting, and diarrhea, which typically improve over time.
• If a patient doesn't achieve at least 5% weight loss after 12 weeks on the maintenance dose, discontinuation may be considered as the benefit-risk ratio may not be favorable.

Important Considerations for GLP-1 Agonist Therapy

• Contraindications: Pregnancy and breastfeeding, personal or family history of medullary thyroid cancer or MEN2, pancreatitis 1.
• Cautions: Use caution in patients with history of pancreatitis, cholelithiasis, suicidal ideation and behavior, injection site reactions.
• Monitoring: Monitor for side effects, weight loss, and improvement in weight-related comorbidities.

The most recent and highest quality study 1 supports the use of GLP-1 agonists for weight management in adults with obesity or overweight with at least one weight-related comorbidity. The study highlights the importance of comprehensive treatment approaches, including diet and exercise, and monitoring for side effects.

From the Research

BMI Indication for GLP-1 Agonist Therapy

• The Body Mass Index (BMI) indication for Glucagon-like peptide-1 (GLP-1) agonist therapy, such as semaglutide, is a BMI of 30 or greater (≥27 in persons with ≥1 weight-related coexisting condition) 2.
• This indication is based on studies that have demonstrated the efficacy and safety of GLP-1 agonists, such as semaglutide, in achieving significant weight loss and improving cardiometabolic risk factors in adults with obesity 3, 2, 4.
• The use of GLP-1 agonists, such as semaglutide, has also been evaluated in adolescents with obesity, with a BMI in the 95th percentile or higher, or with overweight and at least one weight-related coexisting condition 5.
• A network meta-analysis of randomized clinical trials has compared the efficacy and safety of different GLP-1 agonists, including semaglutide, for the management of obesity in adults without diabetes, and found that they can lead to significant weight reduction, with varying degrees of efficacy and safety 6.

Key Findings

• Semaglutide 2.4 mg is indicated as an adjunct to a reduced-calorie diet and increased exercise for chronic weight management in adults with a BMI ≥30 kg/m2 or ≥27 kg/m2 with at least one weight-related comorbidity 2.
• GLP-1 agonists, such as semaglutide, have been shown to achieve substantial weight loss and improve cardiometabolic risk factors, with gastrointestinal symptoms being the most frequently encountered adverse events 3, 4.
• The use of GLP-1 agonists, such as semaglutide, in adolescents with obesity has been evaluated, with results showing a greater reduction in BMI compared to lifestyle intervention alone 5.