Who Qualifies for GLP-1 Weight-Loss Medication? The FDA Label Criteria

You generally qualify for a GLP-1 weight-loss medication if you are an adult with obesity, or an adult with overweight plus at least one weight-related health condition such as high blood pressure, high cholesterol, type 2 diabetes, or sleep apnea. That is the wording on the FDA labels for Wegovy, Zepbound, Saxenda, and Foundayo, and the labels give no BMI numbers in that wording^[1][2][3][4]. The numbers come from standard clinical definitions: the CDC defines adult obesity as a BMI of 30 or greater and overweight as 25 to under 30^[5]. For the overweight group, the trials behind these approvals set the entry bar at a BMI of 27 or higher with a weight-related condition^{[4][8][9][14]}. Two products are also approved for teens 12 and older, and some have uses beyond weight loss: heart-risk reduction and a fatty-liver disease called MASH (Wegovy), and obstructive sleep apnea (Zepbound). Meeting the label is the first step. It does not guarantee your insurance will pay, and it does not override the medical reasons someone should not take these drugs.

The short answer

• Adults with obesity qualify. All four weight-management labels cover adults with obesity^[1][2][3][4]. The CDC defines adult obesity as a BMI of 30 or greater^[5].
• Adults with overweight qualify only with a weight-related condition. The labels require “at least one weight-related comorbid condition.” The trials enrolled people with a BMI of 27 to under 30 who had conditions such as dyslipidemia (high cholesterol or triglycerides), hypertension, obstructive sleep apnea, or cardiovascular disease^[2][8][9].
• Teens 12 and older can qualify for two products. Wegovy injection is approved for patients 12 and older with obesity, and Saxenda for patients 12 and older with obesity who weigh more than 60 kg (about 132 lb)^[1][3]. Zepbound and Foundayo are not approved for anyone under 18^[2][4].
• Some uses go beyond weight. Wegovy is approved to lower the risk of heart attack, stroke, and cardiovascular death in adults with established cardiovascular disease (such as a prior heart attack or stroke) and obesity or overweight, and to treat MASH with moderate to advanced liver scarring. Zepbound is approved for moderate to severe obstructive sleep apnea in adults with obesity^[1][2].
• Qualifying is not the same as being covered, or being safe for you. Insurers set their own rules, and the labels list conditions that rule a person out entirely. See what disqualifies you from semaglutide and what disqualifies you from tirzepatide.

Where the “BMI 30, or 27 with a condition” rule comes from

If you read the current labels, you will notice something surprising: the “Indications and Usage” sections do not print a BMI number. The Zepbound label, for example, says it is indicated “to reduce excess body weight and maintain weight reduction long term in adults with obesity or adults with overweight in the presence of at least one weight-related comorbid condition”^[2]. Foundayo uses nearly identical wording^[4].

The numbers come from two places. The CDC's standard adult definitions put obesity at a BMI of 30 or greater and overweight at 25 to under 30^[5]. The 27 cutoff comes from the trials that proved the drugs work, which are described in each label's clinical studies section. STEP 1, the main Wegovy trial, enrolled adults “with a body-mass index … of 30 or greater (≥27 in persons with ≥1 weight-related coexisting condition)” who did not have diabetes^[8]. SURMOUNT-1 for Zepbound used the same cutoffs^[9], as did the SCALE trial for Saxenda^[14] and the main Foundayo trial described in its label^[4]. Separate trials enrolled adults with type 2 diabetes and a BMI of 27 or higher^[1][2]. So the practical rule beginners hear, “BMI 30, or 27 with a health condition,” is the clinical definition of obesity plus the overweight threshold each drug was tested in. It is a standard, not label text, and a prescriber applies it to your full history.

Foundayo is the newest product on this list. It is a once-daily pill from Eli Lilly and is listed on DailyMed with the same adult weight-management indication as Zepbound^[4]. In its main trial, ATTAIN-1, adults with obesity lost an average of 11.2% of their body weight at the highest dose studied, versus 2.1% on placebo, over 72 weeks^[16]. For background on the approval, see our Foundayo approval explainer.

How to calculate your BMI

Body mass index (BMI) is your weight in kilograms divided by the square of your height in meters: BMI = kg ÷ m²^[7]. If you use pounds and inches, multiply your weight in pounds by 703, then divide by your height in inches squared. A quick worked example: someone who is 5 feet 9 inches (69 inches) and weighs 203 pounds has a BMI of 203 × 703 ÷ (69 × 69), or about 30.0. In metric units, someone who weighs 92 kg and is 1.75 m tall has a BMI of 92 ÷ (1.75 × 1.75), also about 30.0.

That matches the CDC's own example for a 5-foot-9 adult: 169 to 202 pounds falls in the overweight range, and 203 pounds or more falls in the obesity range^[5]. The CDC's adult categories are: under 18.5 underweight, 18.5 to under 25 healthy weight, 25 to under 30 overweight, and 30 or greater obesity^[5]. You can skip the math with our GLP-1 BMI calculator, which shows where you land against the 30 and 27 thresholds.

Teens: how the percentile rules work

Children and teens are still growing, so their BMI is compared with other young people of the same age and sex. The result is a BMI-for-age percentile. For ages 2 through 19, the CDC defines overweight as the 85th percentile to under the 95th, and obesity as the 95th percentile or greater^[6].

• Wegovy injection (12+). The teen indication is for obesity. The supporting trial enrolled 201 patients 12 and older with a BMI at or above the 95th percentile for age and sex^[1]. In that trial, STEP TEENS, BMI fell by an average of 16.1% on semaglutide versus a 0.6% increase on placebo over 68 weeks^[10]. Wegovy tablets are not approved for anyone under 18^[1].
• Saxenda (12+). Approved for patients 12 and older who weigh more than 60 kg and have an initial BMI that corresponds to 30 or greater for adults, using international cutoffs^[3]. In the adolescent trial, 43.3% of teens on liraglutide reduced their BMI by at least 5%, versus 18.7% on placebo^[15]. The label tells prescribers to stop Saxenda in a teen whose BMI has not dropped by at least 1% after 12 weeks on the maintenance dose^[3].
• Zepbound and Foundayo. Safety and effectiveness have not been established in pediatric patients^[2][4].

For parents, our Wegovy for teenagers guide and the GLP-1 evidence review for ages 12 to 17 go deeper.

The approvals that are not about the scale

Wegovy for heart-risk reduction

Wegovy is approved “to reduce the risk of major adverse cardiovascular (CV) events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CV disease and either obesity or overweight”^[1]. The approval rests on SELECT, which enrolled 17,604 people aged 45 or older with existing cardiovascular disease and a BMI of 27 or higher but no diabetes. A major cardiovascular event occurred in 6.5% of the semaglutide group versus 8.0% of the placebo group (hazard ratio 0.80)^[11]. More detail: the SELECT trial explained.

Wegovy for MASH (fatty liver disease with scarring)

Wegovy injection is also approved for adults with noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis, stages F2 to F3. This use is under accelerated approval, meaning continued approval may depend on a confirmatory trial^[1]. In the ESSENCE trial's 72-week analysis, the liver inflammation of MASH resolved without worsening fibrosis in 62.9% of patients on semaglutide versus 34.3% on placebo^[12]. In the trial, every patient's MASH and fibrosis stage was confirmed by liver biopsy^[1], so this path starts with a liver diagnosis rather than a BMI check. See our Wegovy MASH review.

Zepbound for obstructive sleep apnea

Zepbound is approved “to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity”^[2]. The supporting trials enrolled people with an apnea-hypopnea index of 15 or more and a BMI of 30 or more^[2]. In SURMOUNT-OSA trial 1, breathing interruptions fell by 25.3 events per hour on tirzepatide versus 5.3 on placebo after 52 weeks^[13]. The apnea-hypopnea index counts breathing pauses per hour of sleep^[13], so this path starts with a sleep apnea diagnosis rather than a BMI check alone. See our SURMOUNT-OSA deep dive.

Why insurance criteria are different from label criteria

The FDA label decides what a drug is approved for. Your health plan decides what it will pay for, and those are separate questions. A plan can require more than the label does, such as prior authorization or documentation, or it can exclude weight-loss drugs altogether.

Public programs are shaped by federal law. The Medicaid drug statute lists classes that “may be excluded from coverage or otherwise restricted,” and the first item is “agents when used for anorexia, weight loss, or weight gain”^[18]. The Medicare Part D statute carries that exclusion into its own definition of a covered drug^[17]. That is why the reason a prescription is written for, such as weight management versus cardiovascular risk or sleep apnea, can matter as much as your BMI. For how this plays out across Medicare, Medicaid, and employer plans, read GLP-1 insurance coverage explained. The only authoritative source for your situation is your own plan's coverage policy.

What a telehealth intake checks

A legitimate online prescriber has to answer two questions before writing a prescription: do you meet the label, and is there a reason you should not take the drug? The labels and their patient Medication Guides spell out what the clinician needs to know^[1][2][4]. Expect questions about:

• Height, weight, and health conditions, to calculate BMI and identify any weight-related condition.
• Thyroid cancer history. Any personal or family history of medullary thyroid carcinoma (MTC), or an endocrine condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), rules out every product in this class^[1][2][3][4].
• Allergies, including any prior serious reaction to the drug or its ingredients^[1][2][3][4].
• Pancreas or kidney problems, and severe stomach problems such as gastroparesis (very slow stomach emptying)^[1][2][4].
• Diabetic eye disease (retinopathy), if you have type 2 diabetes^[1][2].
• Pregnancy, pregnancy plans, and breastfeeding^[1][2].
• Upcoming surgery or sedation, because these drugs slow stomach emptying^[1][2].
• Every medication you take, especially insulin or a sulfonylurea (low blood sugar risk), oral birth control pills (on Zepbound or Foundayo), and any other GLP-1 such as Ozempic or Mounjaro, which should not be combined with these products^[1][2][4].

If you have diabetes, the labels also tell prescribers to check your blood sugar before you start and during treatment^[1][2]. A service that prescribes without asking about these things is skipping safeguards the FDA label builds in. Our guide to how to get a GLP-1 prescription walks through the process step by step.

When you do not qualify

• Your BMI is under 25, or 25 to under 30 with no weight-related condition. That is outside the label wording. A BMI of 25 to under 27 with a condition fits the label's “overweight” wording but falls below the 27 cutoff the weight-management trials required, so it is a judgment call for your prescriber^[5][8][9].
• You or a family member has had medullary thyroid carcinoma, or you have MEN 2. This is a contraindication on every label^[1][2][3][4].
• You have had a serious allergic reaction to the drug or one of its ingredients^[1][2][3][4].
• You are pregnant. The labels say weight loss offers no benefit during pregnancy and may cause fetal harm, and for weight management they tell patients to stop when a pregnancy is recognized^[1][2][3][4].
• Your age is outside the label. No product here is approved under 12, and Zepbound, Foundayo, and Wegovy tablets are adult-only^[1][2][4].
• You are already taking another GLP-1 medicine. The labels say these products should not be combined with other GLP-1 receptor agonists^[1][2][3][4].

Eligibility can also end after you start. The Saxenda label tells prescribers to stop the drug in an adult who has not lost at least 4% of starting body weight after 16 weeks^[3]. The full list of absolute contraindications and the warnings that call for extra caution is in our guides to what disqualifies you from semaglutide (Wegovy) and what disqualifies you from tirzepatide (Zepbound).

Bottom line

If you are an adult with a BMI of 30 or higher, or 27 or higher with a condition like high blood pressure, high cholesterol, type 2 diabetes, or sleep apnea, you likely fit the FDA label for at least one GLP-1 weight-loss medication^[1][2][8][9]. Teens 12 and older with obesity have two approved options^[1][3]. Start by calculating your BMI, check the semaglutide and tirzepatide disqualification guides, then talk with a clinician. Coverage is a separate step that depends on your plan.