What BMI criteria are required to prescribe Wegovy (semaglutide) or other prescription weight‑loss medications?

BMI Requirements for Wegovy and Weight Loss Medications

Adults with a BMI ≥30 kg/m² qualify for Wegovy (semaglutide 2.4 mg) or other prescription weight-loss medications without any additional requirements, while those with BMI ≥27 kg/m² qualify if they have at least one weight-related comorbidity such as hypertension, dyslipidemia, or type 2 diabetes. 1

Standard FDA-Approved BMI Criteria

The eligibility thresholds are consistent across all major anti-obesity medications, including Wegovy, tirzepatide (Zepbound/Mounjaro), and liraglutide (Saxenda):

• BMI ≥30 kg/m² (obesity): No additional comorbidities required 1, 2
• BMI ≥27 kg/m² (overweight): Requires at least one weight-related comorbid condition 1, 2

Qualifying Weight-Related Comorbidities for BMI ≥27 kg/m²

The following conditions satisfy the comorbidity requirement 1:

• Type 2 diabetes mellitus
• Hypertension
• Dyslipidemia (elevated cholesterol or triglycerides)
• Obstructive sleep apnea
• Cardiovascular disease

Special Population Considerations

Asian Americans

The same BMI thresholds (≥30 or ≥27 with comorbidities) apply for pharmacotherapy, though metabolic surgery recommendations use lower cutoffs (≥27.5 kg/m² with comorbidities) in this population 2

Patients with Type 2 Diabetes

When GLP-1 receptor agonists are prescribed specifically for diabetes management (rather than weight loss), no minimum BMI threshold is required, though these medications are particularly beneficial for patients with BMI >35 kg/m² due to superior weight loss effects 2

Patients with Cardiovascular Disease

For overweight patients (BMI ≥27 kg/m²) with established cardiovascular disease, semaglutide 2.4 mg should be strongly considered to reduce cardiovascular mortality, myocardial infarction, or stroke, even in the absence of diabetes 2

Absolute Contraindications (Regardless of BMI)

Do not prescribe GLP-1 receptor agonists to patients with 1, 2:

• Personal or family history of medullary thyroid cancer
• Multiple endocrine neoplasia syndrome type 2 (MEN2)
• Pregnancy or breastfeeding 3

Treatment Discontinuation Criteria

Discontinue therapy if 1, 2:

• Weight loss is <5% after 3 months at therapeutic dose
• Significant safety or tolerability issues emerge at any time

Required Lifestyle Interventions

All anti-obesity medications must be combined with 1, 2:

• Reduced-calorie diet (typically 500-kcal deficit below daily requirements)
• Minimum 150 minutes per week of physical activity
• Behavioral counseling and lifestyle modification support

Common Clinical Pitfalls

Avoid these mistakes:

• Waiting for multiple failed diet attempts before prescribing—early intervention in appropriate candidates leads to better outcomes 2
• Ignoring cardiovascular disease status—semaglutide 2.4 mg provides proven cardiovascular benefit (20% risk reduction) in patients with established CVD and should be prioritized 2
• Prescribing to patients with contraindications—always screen for personal/family history of medullary thyroid cancer or MEN2 before initiating therapy 1, 2