FDA labeling thresholds
Wegovy (semaglutide 2.4 mg) and Zepbound (tirzepatide) are FDA-approved for chronic weight management in adults with:
• BMI ≥ 30, OR • BMI ≥ 27 with at least one weight-related comorbidity (hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, cardiovascular disease)
Saxenda (liraglutide 3.0 mg) carries the same thresholds. The pediatric labels for Wegovy and Zepbound extend treatment eligibility to adolescents 12+ with BMI ≥ 95th percentile for age.
How clinicians apply them
Most telehealth and brick-and-mortar programs treat the FDA labels as floor criteria rather than ceiling criteria. Almost all reputable programs will treat at BMI ≥ 30 without further qualification, and at BMI ≥ 27 if a weight-related comorbidity is documented.
Some programs will treat at BMI 25–27 in the presence of strong metabolic features (impaired fasting glucose, high triglycerides, hepatic steatosis) — off-label but clinically defensible. Programs that treat freely at BMI < 25 are operating outside both label and clinical consensus, and warrant skepticism.
If you're close to a threshold
If your BMI is 26–27 without a comorbidity, the path to coverage is typically through documenting one of the qualifying conditions — most commonly prediabetes (HbA1c 5.7–6.4%), dyslipidemia, or hypertension. A baseline lab panel often surfaces qualifying findings.
If your BMI is 25–26 without comorbidities, GLP-1 therapy is harder to justify both clinically and from a payer perspective. Lifestyle-first approaches are typically more appropriate at this level.
BMI is a flawed but useful gate
BMI is a population-level screening tool, not an individual clinical measure of body composition. Muscular individuals may have BMI ≥ 30 without adverse metabolic features; thin individuals may have BMI < 25 with high visceral adiposity and metabolic dysfunction.
Clinicians vary in how strictly they apply BMI cutoffs. A program that lets you submit your own height/weight without any verification is operating at lower diligence; a program that requires a documented in-office measurement is operating at higher diligence.