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Who Qualifies for Medical Weight Loss? BMI and FDA Criteria

FDA criteria for Wegovy and Zepbound (BMI 30+, or 27+ with a condition), BMI limits, what an evaluation covers, and who should not use them.

Tape measure, BMI band chart and clipboard checklist on a clinician desk, illustrating evaluation beyond BMI

By the Healthy Weight Loss 4 U Clinical Content Team · Published October 8, 2026 · Updated October 8, 2026 · 10 min read

In short

Adults generally qualify for FDA-approved weight-management medicines such as Wegovy (semaglutide) and Zepbound (tirzepatide) with a BMI of 30 or higher, or 27 or higher with at least one weight-related condition such as high blood pressure, type 2 diabetes or high cholesterol, used with a reduced-calorie diet and increased physical activity [2][3]. BMI is only one indicator, so clinicians also consider waist circumference, body composition, health history and medicines [1][6][7]. Personal or family history of medullary thyroid carcinoma or MEN 2 is a contraindication [4][5].

Key takeaways

  • FDA-announced criteria: BMI 30 or higher, or 27 or higher with at least one weight-related condition such as high blood pressure, type 2 diabetes or high cholesterol [2][3].
  • CDC defines adult obesity as BMI 30 or higher and calls BMI one potential health indicator to be considered with other factors [1].
  • The AMA policy says BMI loses predictability at the individual level and should be used with other measures such as waist circumference and body composition [6].
  • Contraindications for Wegovy and Zepbound include personal or family history of medullary thyroid carcinoma or MEN 2, and serious hypersensitivity to the drug [4][5].
  • Pregnancy, severe gastroparesis, and use of another GLP-1 medicine are additional reasons labels advise against treatment [2][4][5].
  • CDC survey data for 2025 show adult obesity prevalence of 30.0% in Florida and 25.7% in Colorado [13].

What are the FDA criteria for Wegovy and Zepbound?

The FDA-announced criteria for adults are a BMI of 30 kg/m2 or higher (obesity), or a BMI of 27 kg/m2 or higher (overweight) together with at least one weight-related condition. In announcing the approval of Zepbound, the FDA gave high blood pressure, type 2 diabetes and high cholesterol as examples of weight-related conditions, and the medicine is used alongside a reduced-calorie diet and increased physical activity [2]. The original 2021 Wegovy label used the same two thresholds [3].

Current prescribing information describes the population by category rather than by number. The Wegovy label lists adults and children 12 years and older with obesity, and adults with overweight in the presence of at least one weight-related comorbid condition, and the Zepbound label lists adults with obesity, or with overweight plus at least one weight-related comorbid condition [4][5]. The numeric BMI cutoffs appear in the pivotal trials: STEP 1 and SURMOUNT-1 enrolled adults without diabetes with a BMI of 30 or higher, or 27 or higher with a weight-related complication [8][9]. Wegovy also carries indications for cardiovascular risk reduction in adults with established cardiovascular disease and obesity or overweight, and Zepbound for moderate to severe obstructive sleep apnea in adults with obesity [4][5].

These are label criteria for the medicines, not a guarantee of treatment or coverage. A licensed clinician decides whether a medicine is appropriate after an evaluation.

How BMI maps to the FDA-announced criteria for adults (kg/m2)
BMICDC categoryWithin FDA-announced criteria for Wegovy or Zepbound?
Below 18.5UnderweightNo
18.5 to below 25Healthy weightNo
25 to below 27OverweightNo
27 to below 30OverweightOnly with at least one weight-related condition
30 to below 35Obesity, class 1Yes
35 to below 40Obesity, class 2Yes
40 or higherObesity, class 3 (severe)Yes
Adult obesity prevalence, 2025 (CDC BRFSS)

Source: [13][17][18] CDC data.cdc.gov, dataset hn4x-zwk7

How is BMI defined, and what do the categories mean?

BMI is weight in kilograms divided by height in meters squared. CDC categories for adults 20 and older are: underweight below 18.5, healthy weight 18.5 to below 25, overweight 25 to below 30, and obesity 30 or higher, subdivided into class 1 (30 to below 35), class 2 (35 to below 40) and class 3 or severe obesity (40 or higher) [1].

CDC describes BMI as one potential health indicator that should be considered with other factors when assessing an individual's health [1]. National survey data show how common the upper categories are: CDC reports adult obesity prevalence of 41.9% in 2017 to March 2020 and severe obesity of 9.2% [12].

Why is BMI not the whole story?

BMI estimates body size, not body fat or where it sits. The American Medical Association adopted a policy stating that BMI does not account for differences across race and ethnicity, sex, gender and age, is based primarily on data from earlier generations of non-Hispanic white populations, and loses predictability when applied to an individual [6]. The AMA says BMI should be used in conjunction with other valid measures of risk, listing visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic and metabolic factors, and that it should not be the sole criterion for denying insurance reimbursement [6].

Waist circumference is the most accessible complement. The National Heart, Lung, and Blood Institute states that a waist of more than 35 inches for women or more than 40 inches for men increases risk, because fat concentrated around the waist raises the risk of heart disease and type 2 diabetes [7]. Measurement is taken just above the hipbones after breathing out [7].

Specialist bodies have refined the picture. A 2025 Lancet Diabetes and Endocrinology Commission of 58 experts recommended BMI as a surrogate for screening at the population level, with confirmation of excess adiposity using at least one anthropometric measure such as waist circumference, waist-to-hip or waist-to-height ratio, or direct measures such as DXA, and with no extra measure needed above a BMI of 40 [10]. This is a secondary summary of the Commission's report, which also proposes classifying obesity as pre-clinical or clinical based on organ function [10]. The Obesity Society welcomed the work but notes that BMI is still an appropriate and inexpensive screening tool and that, used alone, it does not define the disease or replace clinical judgment [11]. A Guideline Central summary of the 2025 AACE algorithm likewise describes pairing anthropometric measures, including ethnic-specific BMI and adipose distribution cutoffs, with a clinical stage [14].

Do you have to try diet and exercise first?

The labels frame these medicines as an addition to lifestyle change, not a replacement. Wegovy and Zepbound are used with a reduced-calorie diet and increased physical activity [2][3]. The 2015 Endocrine Society guideline recommends diet, exercise and behavior change for all patients with a BMI of 25 or higher, describes medication and surgery as adjuncts to behavior change, and identifies as candidates patients with a BMI above 30, or 27 or higher with a comorbidity, who have repeatedly failed to lose and maintain weight and who meet the drug's label indications [15].

The same guideline suggests continuing a medicine if weight loss is at least 5% at 3 months and the medicine is safe, and stopping it if loss is under 5% or safety or tolerability problems arise [15]. That guideline predates the current generation of medicines, so treat it as a framework for how criteria and follow-up are structured, not as a statement about semaglutide or tirzepatide specifically. Your clinician applies current prescribing information to your case.

What does a medical weight-loss evaluation include?

An evaluation connects the numbers to your health. Published guidance and prescribing information describe several components; the exact workup is the clinician's judgment.

  • Measurements: BMI plus waist circumference or a body composition measure, because BMI alone can misclassify individuals [1][6][7].
  • Clinical evaluation and basic laboratory testing: a Guideline Central summary of the 2025 AACE algorithm says screening and diagnosis require clinical evaluation and basic laboratory testing, with staging of clinical severity [14].
  • Weight-related conditions: blood pressure, glucose, cholesterol and sleep apnea are the conditions named in FDA announcements and labels [2][4][5].
  • Medication review: the Endocrine Society guideline advises shared decision-making about weight-gaining medicines such as antidepressants, antipsychotics and antiepileptics, and preferring alternatives to corticosteroids where possible [15].
  • Screening for contraindications: personal or family history of medullary thyroid carcinoma or MEN 2, prior serious hypersensitivity, pregnancy plans, and gastrointestinal and gallbladder history [4][5].
  • A monitoring plan: the Endocrine Society guideline suggests assessing efficacy and safety at least monthly for 3 months and then at least every 3 months, and labels advise monitoring kidney function in patients with vomiting or diarrhea and blood glucose in patients with diabetes [4][15].

Who generally should not use GLP-1 weight-loss medicines?

The labels list firm contraindications and several situations where treatment is not recommended or has not been studied. Both Wegovy and Zepbound are contraindicated with a personal or family history of medullary thyroid carcinoma or in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2), and with a prior serious hypersensitivity reaction to the medicine or its ingredients [4][5]. The FDA notes that Zepbound causes thyroid C-cell tumors in rats and that it is unknown whether it does so in humans, and both labels carry a warning on thyroid C-cell tumor risk [2][4][5].

  • Pregnancy: the Zepbound label states that weight loss offers no benefit to a pregnant patient and may cause fetal harm [5]. The Wegovy label directs discontinuation when pregnancy is recognized and at least 2 months before a planned pregnancy [4].
  • Severe gastroparesis: both labels state the medicine is not recommended [4][5].
  • Other GLP-1 products: coadministration with other semaglutide or tirzepatide products or any other GLP-1 receptor agonist is not recommended [3][5].
  • History of pancreatitis: the original Wegovy label states it has not been studied in patients with a history of pancreatitis, and the FDA noted the same for Zepbound along with severe gastrointestinal disease [2][3].
  • Oral contraceptives: the Zepbound label advises people using oral hormonal contraceptives to switch to a non-oral method or add a barrier method around initiation and each dose increase [5].
  • Type 2 diabetes: low blood sugar can occur, especially with insulin or insulin-stimulating drugs, and diabetic retinopathy complications are a labeled warning [2][4][5].
  • Eating disorders and antidepressant use: the 2025 joint advisory states that effects of GLP-1 medicines on eating disorders are not well established and that their use with antidepressants requires more study [16].

What this means in practice

Meeting a BMI threshold is a starting point. A clinician still has to confirm that the medicine fits your health history, other medicines and plans, which is why an evaluation comes first. If your BMI is near a cutoff, other measures such as waist circumference and body composition, plus any weight-related conditions, can change the picture [6][7][14].

At Healthy Weight Loss 4 U, every program begins with a clinician evaluation at the Lighthouse Point, FL and Highlands Ranch, CO clinics, where semaglutide and tirzepatide programs, body composition analysis, counseling, meal replacements and maintenance care are offered. Financing is available through CareCredit and in-house plans. No outcome is guaranteed, and eligibility is determined by the evaluating clinician.

When should you talk to a clinician?

Consider scheduling an evaluation, or tell your current clinician, in these situations:

  • Your BMI is 30 or higher, or 27 or higher and you have high blood pressure, type 2 diabetes, high cholesterol or sleep apnea [2][5].
  • You are pregnant, planning a pregnancy, or using oral hormonal contraceptives [4][5].
  • You or a close relative has had medullary thyroid carcinoma or MEN 2 [4][5].
  • You have had pancreatitis, gallbladder disease, severe stomach emptying problems or an eating disorder [2][3][16].
  • You take insulin or other diabetes medicines, or medicines that may affect weight [2][15].

What this means in Florida and Colorado

State survey data from the CDC (Behavioral Risk Factor Surveillance System, a telephone survey system) show adult obesity prevalence of 30.0% in Florida (95% confidence interval 28.4% to 31.6%) and 25.7% in Colorado (24.6% to 26.7%) in 2025, compared with 33.5% nationally (318,092 respondents) [13][17][18]. BRFSS is a system of health-related telephone surveys [19]. These are state-level estimates and differ from the national figure of 41.9% (NHANES, 2017 to March 2020) cited above because they come from a different survey, so the two should not be compared directly [12][13]. They describe populations, not any individual's eligibility, and they say nothing about a specific city or county [13].

Frequently asked questions

What BMI do you need for Wegovy or Zepbound?
The FDA-announced criteria are a BMI of 30 or higher, or 27 or higher with at least one weight-related condition such as high blood pressure, type 2 diabetes or high cholesterol, along with a reduced-calorie diet and increased physical activity [2][3]. A clinician decides whether a medicine is appropriate for you after an evaluation.
Can you qualify with a BMI of 27 to 30?
Yes, if you also have at least one weight-related condition. FDA examples include high blood pressure, type 2 diabetes and high cholesterol [2]. At a BMI of 27 to below 30 without such a condition, you fall outside the labeled criteria. The final decision rests with the evaluating clinician.
Is BMI an accurate measure of whether I need treatment?
BMI is one indicator, not a diagnosis. The AMA states it loses predictability for individuals and should be used with other measures such as waist circumference and body composition [6]. CDC says it should be considered with other factors [1]. Your clinician combines BMI, measurements, history and labs.
What waist size increases health risk?
The National Heart, Lung, and Blood Institute states that a waist circumference of more than 35 inches for women or more than 40 inches for men increases risk [7]. Fat concentrated around the waist is linked to higher risk of heart disease and type 2 diabetes [7]. A clinician interprets this alongside BMI.
Who should not take semaglutide or tirzepatide?
Labels contraindicate use with a personal or family history of medullary thyroid carcinoma or MEN 2, and with prior serious hypersensitivity to the medicine [4][5]. Pregnancy, severe gastroparesis and concurrent GLP-1 products are further concerns [3][4][5]. Your clinician reviews your full history before prescribing.
What is the adult obesity rate in Florida and Colorado?
CDC survey data show adult obesity prevalence of 30.0% in Florida (95% confidence interval 28.4% to 31.6%) and 25.7% in Colorado (24.6% to 26.7%) in 2025, versus 33.5% nationally [13][17][18]. These are state-level survey estimates of a population, not a measure of any individual's eligibility, which a clinician determines.

Sources

  1. Adult BMI Categories. Centers for Disease Control and Prevention, accessed 2026. cdc.gov/bmi/adult-calculator/bmi-categories.html
  2. FDA Approves New Medication for Chronic Weight Management (Zepbound, November 8, 2023). U.S. Food and Drug Administration, 2023. fda.gov/news-events/press-announcements/fda-approves-new-medication-ch
  3. WEGOVY (semaglutide) injection: Prescribing Information, original approval label (2021). U.S. Food and Drug Administration (Drugs@FDA), 2021. accessdata.fda.gov/drugsatfda_docs/label/2021/215256s000lbl.pdf
  4. WEGOVY (semaglutide) injection and tablets: Prescribing Information (revised 06/2026). Novo Nordisk, 2026. novo-pi.com/wegovy.pdf
  5. ZEPBOUND (tirzepatide) injection: Prescribing Information (revised 08/2026). Eli Lilly and Company, 2026. pi.lilly.com/us/zepbound-uspi.pdf
  6. AMA Adopts New Policy Clarifying Role of BMI as a Measure in Medicine. American Medical Association, n.d. (page undated). ama-assn.org/press-center/press-releases/ama-adopts-new-policy-clarify
  7. Assessing Your Weight and Health Risk. National Heart, Lung, and Blood Institute (NIH), accessed 2026. nhlbi.nih.gov/health/educational/lose_wt/risk.htm
  8. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). N Engl J Med 384:989-1002 (Wilding et al.), 2021. doi.org/10.1056/NEJMoa2032183
  9. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). N Engl J Med 387:205-216 (Jastreboff et al.), 2022. doi.org/10.1056/NEJMoa2206038
  10. Distilled: Lancet Diabetes & Endocrinology Commission on the definition and diagnostic criteria of clinical obesity (secondary summary of Rubino et al., Lancet Diabetes Endocrinol 2025;13(3):221-262, DOI 10.1016/S2213-8587(24)00316-4). Diabetes on the Net, 2025. diabetesonthenet.com/wp-content/uploads/3.-Distilled_LDE-Commission-ob
  11. The Obesity Society Applauds the Work of The Lancet Diabetes & Endocrinology Commission on Diagnostic Criteria of Clinical Obesity. The Obesity Society, 2025. obesity.org/the-obesity-society-applauds-the-work-of-the-lancet-diabet
  12. Adult Obesity Facts. Centers for Disease Control and Prevention, accessed 2026. cdc.gov/obesity/adult-obesity-facts/index.html
  13. Nutrition, Physical Activity, and Obesity: Behavioral Risk Factor Surveillance System (obesity indicator, state totals, 2025; data.cdc.gov dataset hn4x-zwk7). Centers for Disease Control and Prevention, 2026. data.cdc.gov/resource/hn4x-zwk7.json?$where=questionid%3D%27Q036%27%20
  14. Guideline Central summary of: Nadolsky K, Garvey WT, Agarwal M, et al. AACE Consensus Statement: Algorithm for the Evaluation and Treatment of Adults with Obesity/Adiposity-Based Chronic Disease, 2025 Update (Endocrine Practice, 2025; DOI 10.1016/j.eprac.2025.07.017). Guideline Central (summarizing AACE), 2025. guidelinecentral.com/insights/dec-2025-aace-obesityabcd-guideline-spot
  15. Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 100(2):342-362 (Apovian CM et al.), 2015. doi.org/10.1210/jc.2014-3415
  16. Nutritional Priorities to Support GLP-1 Therapy for Obesity: A Joint Advisory From the ACLM, ASN, OMA and The Obesity Society. American Journal of Lifestyle Medicine (Mozaffarian et al.), 2025. pmc.ncbi.nlm.nih.gov/articles/PMC12125019/
  17. Nutrition, Physical Activity, and Obesity: BRFSS (Colorado totals, data.cdc.gov dataset hn4x-zwk7). Centers for Disease Control and Prevention, 2026. data.cdc.gov/resource/hn4x-zwk7.json?$where=questionid%3D%27Q036%27%20
  18. Nutrition, Physical Activity, and Obesity: BRFSS (US totals, data.cdc.gov dataset hn4x-zwk7). Centers for Disease Control and Prevention, 2026. data.cdc.gov/resource/hn4x-zwk7.json?$where=questionid%3D%27Q036%27%20
  19. About BRFSS (Behavioral Risk Factor Surveillance System). Centers for Disease Control and Prevention, accessed 2026. cdc.gov/brfss/about/index.htm
General information, not medical advice. Results vary and treatment depends on evaluation by a licensed clinician. This article was prepared by the Healthy Weight Loss 4 U Clinical Content Team from the published sources listed above. Nothing here is a recommendation for a specific person, and no treatment is started without an evaluation by a licensed clinician.

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