GLP-1 Eligibility: Do You Qualify for Semaglutide or Tirzepatide?

The Quick Answer

You likely qualify for a GLP-1 program if any of the following apply:

• Your BMI is 30 or higher (obesity threshold), OR
• Your BMI is between 27 and 29.9 AND you have at least one weight-related health condition like high blood pressure, type 2 diabetes, high cholesterol, sleep apnea, or cardiovascular disease

Even if you meet the BMI threshold, an independent licensed provider will review your full medical history, current medications, and health conditions before determining whether a prescription is appropriate. Not all patients will qualify.

What Is BMI, and Why Does It Matter?

Your Body Mass Index (BMI) is calculated from your weight and height. It is a screening tool that providers use alongside other clinical information to assess whether GLP-1 medications are medically appropriate for you.

BMI = weight in pounds / (height in inches squared) x 703

You can calculate your BMI using any online calculator. The threshold for obesity – which is the main clinical criterion for GLP-1 eligibility – is a BMI of 30 or above.

The BMI 30+ Rule (Obesity)

If your BMI is 30 or higher, you meet the basic BMI threshold for eligibility. This is the obesity category by medical definition^[1]. You do not need any additional health conditions to qualify.

However, a BMI of 30+ alone does not guarantee a prescription. The reviewing provider will still evaluate:

• Your complete medical history
• Current medications and any potential interactions
• Any absolute contraindications (see below)
• Your weight loss goals and your ability to follow a medically supervised program
• Overall clinical appropriateness

Most adults with BMI 30 or above and no absolute contraindications will be eligible pending full provider review.

The BMI 27-29.9 Rule (Overweight With a Condition)

If your BMI falls between 27 and 29.9, you are in the overweight category. You can qualify for a GLP-1 program if you have at least one weight-related health condition.

Qualifying Weight-Related Health Conditions

These conditions, alongside a BMI of 27-29.9, support GLP-1 eligibility:

• High blood pressure (hypertension) – Diagnosed and documented by your provider or from your health records
• Type 2 diabetes or pre-diabetes – Including gestational diabetes in your history
• High cholesterol (hyperlipidemia) – Elevated LDL, low HDL, or elevated triglycerides
• Sleep apnea (diagnosed) – Obstructive sleep apnea (OSA) with a formal diagnosis
• Cardiovascular disease – History of heart attack, stroke, or documented coronary artery disease
• Metabolic syndrome – A cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol
• Non-alcoholic fatty liver disease (MASLD/NAFLD) – Imaging or lab evidence of fat accumulation in the liver
• Other obesity-related comorbidities – Such as osteoarthritis, gout, or PCOS with metabolic complications

One condition is sufficient. You do not need multiple conditions to qualify at BMI 27-29.9. However, the provider will verify the condition during their review of your intake information.

Clinical Criteria for Each Qualifying Condition

When you report a health condition during your intake, the provider uses specific clinical thresholds to verify whether that condition genuinely qualifies you. These thresholds come from standard medical definitions and are consistent across the field. Here is what those thresholds are so you understand what the provider is evaluating.

Hypertension (High Blood Pressure)

Clinical threshold: Blood pressure of 130/80 mmHg or higher on at least two separate occasions, OR currently taking blood pressure medication.

The American College of Cardiology and American Heart Association (2017 guidelines) define hypertension as a systolic blood pressure (the top number) of 130 mmHg or higher, or a diastolic (bottom number) of 80 mmHg or higher, or use of antihypertensive medication^[1].

If you report high blood pressure, the provider will look for:

• A record of elevated BP readings from your provider or a recent check
• A current prescription for a blood pressure medication
• A documented hypertension diagnosis in your medical history

Type 2 Diabetes or Prediabetes

Clinical threshold for type 2 diabetes: HbA1c of 6.5% or higher, or fasting glucose of 126 mg/dL or higher on repeat testing.

Clinical threshold for prediabetes: HbA1c between 5.7% and 6.4%, or fasting glucose between 100-125 mg/dL, or 2-hour glucose of 140-199 mg/dL on an oral glucose tolerance test.

The American Diabetes Association uses these cutoffs to define diabetes and prediabetes^[2]. If you report diabetes or prediabetes, the provider will ask for recent lab work (typically within the last 6 months) showing your HbA1c or fasting glucose level. This confirms the diagnosis.

Dyslipidemia (High Cholesterol or Abnormal Lipids)

Clinical thresholds:

• LDL (“bad” cholesterol) 130 mg/dL or higher
• Triglycerides 150 mg/dL or higher
• HDL (“good” cholesterol) less than 40 mg/dL in men, or less than 50 mg/dL in women
• Currently taking statin or other cholesterol medication

These thresholds come from the National Institutes of Health guidelines for cholesterol management^[3]. If you report high cholesterol, the provider will review recent lipid panel results to verify at least one abnormal value.

Sleep Apnea (Obstructive Sleep Apnea)

Clinical threshold: Diagnosed by a sleep study showing an Apnea-Hypopnea Index (AHI) of 5 or greater, OR clinical symptoms (loud snoring, witnessed apneas, daytime sleepiness) plus a BMI of 30 or higher.

Sleep apnea requires either a formal sleep study diagnosis or strong clinical suspicion based on symptoms and BMI. If you report sleep apnea, the provider will look for:

• A sleep study report documenting the diagnosis
• A CPAP prescription or use
• Clinical documentation of the condition

Polycystic Ovary Syndrome (PCOS)

Clinical threshold: PCOS is diagnosed using the Rotterdam criteria, which require two of the following three findings:

1. Irregular or absent menstrual periods (ovulatory dysfunction)
2. Elevated androgens (high testosterone or free testosterone, or clinical signs like excess facial/body hair)
3. Multiple small cysts on ovarian ultrasound (polycystic ovaries)

PCOS itself is not explicitly listed in GLP-1 labeling as a weight-loss indication, but PCOS patients often have associated metabolic conditions (insulin resistance, high blood pressure, abnormal lipids) that qualify them. The provider will evaluate whether the associated metabolic complications support GLP-1 eligibility^[4].

Cardiovascular Disease

Clinical threshold: Any documented history of:

• Myocardial infarction (heart attack)
• Ischemic stroke or transient ischemic attack (TIA)
• Heart failure
• Atherosclerotic disease (including peripheral artery disease or documented coronary artery disease)

If you report cardiovascular disease, the provider will request documentation (hospital records, previous test results, or a letter from your cardiologist) confirming the diagnosis and date of the event.

Additional Metabolic Conditions

Other conditions may qualify depending on their clinical significance:

• Metabolic syndrome: A cluster of three or more of the following: elevated blood pressure, elevated fasting glucose, elevated triglycerides, low HDL, increased waist circumference.
• Non-alcoholic fatty liver disease (NAFLD/MASLD): Documented by imaging or liver function tests.
• Osteoarthritis, gout: Weight-related joint conditions that benefit from weight loss.

Important Note on Clinical Judgment

These are the clinical thresholds used in practice, but individual providers use clinical judgment. If your condition falls near a threshold (for example, a blood pressure of 128/79 mmHg, which is just below the 130/80 cutoff), the provider may still consider you eligible based on the overall clinical picture. Conversely, meeting one threshold does not guarantee eligibility if there are other medical factors at play.

The thresholds provide a framework, but the provider’s evaluation is always individualized.

Type 2 Diabetes Patients: Especially Strong Candidates

If you have type 2 diabetes and a BMI of 27 or above, you are an especially strong candidate for a GLP-1 program. GLP-1 medications are FDA-approved for type 2 diabetes management^[2], so patients with diabetes benefit from both the weight loss and glucose control effects of the medication.

Clinical Evaluation Is Always Required

Even if you meet the BMI and health condition criteria, you still need an independent provider review before a prescription can be issued. This is not a rubber-stamp approval process.

When you complete the online assessment, the reviewing provider will evaluate:

• Full medical history – All conditions, treatments, and surgeries
• Current medications and supplements – To check for interactions or contraindications with GLP-1 medications
• Medication allergies and adverse reactions – Your history with other drugs and treatments
• Contraindications – Absolute and relative reasons the medication may not be appropriate for you (see “Who Does Not Qualify” below)
• Weight loss goals and realistic expectations – What outcomes are reasonable for your situation
• Ability to participate in the program – Willingness to engage with coaching and follow-up visits

The provider’s job is to match the right patient with the right treatment. Not every patient with a qualifying BMI is appropriate for a GLP-1 program, and the provider evaluation is designed to identify those situations.

Who Does NOT Qualify

You will not be eligible for a GLP-1 program if any of the following apply.

Absolute Contraindications (Automatic Disqualification)

• Personal or family history of medullary thyroid carcinoma (MTC) – Patients with a personal history of MTC cannot take GLP-1 medications. This is a black-box warning^[3]. Neither semaglutide nor tirzepatide is appropriate.
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) – Family history of MEN 2 is also a contraindication for the same reason (MTC risk).
• Current pregnancy or planning pregnancy within 2 months – GLP-1 medications should not be used during pregnancy. If you are pregnant or planning pregnancy in the near term, your provider will defer treatment.
• Known allergy to semaglutide or tirzepatide – Severe allergic reactions to the specific medication or any component of the injection.
• Severe gastroparesis (stomach paralysis) – GLP-1 medications slow digestion, which can worsen severe gastroparesis. This is a contraindication.

Relative Contraindications (Likely Disqualification)

Your provider may determine you do not qualify if you have:

• History of pancreatitis (inflammation of the pancreas) – GLP-1 medications carry a risk of pancreatitis; history increases the risk.
• Current or recent thyroid nodules or elevated calcitonin – Requires further evaluation before GLP-1 use.
• Retinopathy (diabetic eye disease) – GLP-1 medications may affect vision in patients with existing diabetic retinopathy.
• Kidney disease (eGFR below 15) – Severe kidney disease may contraindicate the medication.
• Severe dehydration or acute illness – Temporary contraindications that may resolve.
• Diabetic ketoacidosis history – GLP-1 use requires careful monitoring in patients with this history.

Medication Interactions

Some medications create significant drug interaction concerns with GLP-1s. Your provider will review all current medications and supplements. Common interactions include:

• Insulin or other diabetes medications (may require dose adjustment, not disqualification)
• Certain heart medications
• Blood pressure medications (may require adjustment)
• Medications that slow digestion

Medication interactions do not automatically disqualify you – they often just require dose adjustments or monitoring. Your provider will determine whether the risks are manageable.

State-Specific Requirements

If you live in one of these states, you are required by state law to complete a live video consultation with the provider before a prescription can be written. The online assessment is still the first step, but a real-time video visit with the provider is mandatory:

• Arkansas (AR)
• District of Columbia (DC)
• Delaware (DE)
• Mississippi (MS)
• New Mexico (NM)
• Rhode Island (RI)
• West Virginia (WV)

For all other states, the provider review can be completed asynchronously after your online intake is submitted, typically within 24-48 hours.

What Happens During the Online Assessment

The assessment takes about 10 minutes and covers:

• Basic demographics – Name, date of birth, contact information
• Height and weight – Used to calculate your BMI
• Current health conditions – Diabetes, high blood pressure, heart disease, sleep apnea, high cholesterol, and others
• Medications and supplements – Everything you are currently taking, including doses
• Medication and food allergies – Anything you have had an allergic reaction to
• Surgical history – Any major surgeries or procedures
• Weight loss history – Previous attempts, what worked or didn’t work, current goals
• Lifestyle information – Exercise habits, diet, stress level, sleep quality
• Thyroid history – Any family history of thyroid cancer (MTC) or MEN 2
• Pregnancy status – Whether you are pregnant, breastfeeding, or planning pregnancy

All of this information is reviewed by the independent provider to determine eligibility and appropriateness.

The Decision Timeline

Here is what to expect after you complete your assessment:

1. Immediate after submission – You will receive confirmation that your assessment was received.
2. Provider review – Within 24-48 hours, an independent licensed provider reviews your complete health history and assessment information.
3. Decision notification – You will be notified via email whether you have been approved or not approved. If approved, you will also receive information about your prescription and next steps.
4. If approved – Your prescription is sent to a licensed US compounding pharmacy, which prepares your medication and ships it to your address. Typical delivery is within a few business days.
5. If not approved – You will receive an explanation of why the provider determined the program is not appropriate for your situation. There is no charge for the assessment or the provider review if you do not qualify.

Am I Likely to Qualify? A Practical Assessment

Use this guide to get a rough sense of whether you are likely to qualify:

Likely to qualify:

• BMI 30 or higher with no absolute contraindications
• BMI 27-29.9 with at least one weight-related health condition and no absolute contraindications
• Type 2 diabetes with BMI 27 or above
• PCOS with elevated BMI and metabolic complications
• Hypertension or high cholesterol with BMI 27 or above
• Cardiovascular disease with BMI 27 or above

Less likely to qualify:

• BMI under 27 without weight-related health conditions
• Recent pancreatitis or ongoing GI issues
• Current pregnancy or planning pregnancy within 2 months
• History of medullary thyroid carcinoma or family history of MEN 2
• Severe kidney disease

Not eligible:

• Personal history of medullary thyroid carcinoma (absolute contraindication)
• Family history of MEN 2 (absolute contraindication)
• Known allergy to semaglutide or tirzepatide
• Current pregnancy or planning pregnancy within 2 months

Key Points to Remember

1. BMI is a starting point, not the whole story. Your BMI determines whether you meet the threshold, but the provider’s clinical judgment determines whether the medication is appropriate for you.

2. No guarantees. Even if your BMI meets criteria, the provider may determine that GLP-1 medication is not medically appropriate based on your full health history, medications, or other factors. This is not a failure on your part – it is the provider being appropriately cautious.

3. The assessment is free. If you do not qualify, there is no charge for the assessment or the provider review. You will receive an explanation of the provider’s decision.

4. You are not alone. The majority of adults seeking weight management support have already tried multiple approaches. This evaluation is designed to determine whether medication is a medically appropriate next step for your specific situation.

5. Results vary by individual. Even if you qualify and start the program, your weight loss will depend on your adherence to medication, nutrition guidance, exercise, and other lifestyle factors. The provider and coaching team will support you throughout.

Next Steps

The best way to know whether you qualify is to complete the free online assessment. It takes about 10 minutes and provides you with a definitive answer from an independent, licensed provider.

If you have specific questions about your eligibility before starting the assessment – such as concerns about a particular health condition or medication – you can reach out to our team at 904-257-3027 or [email protected]. We can help you understand whether the program might be a fit before you invest time in the full assessment.

Citations

[1] CDC/NCHS. “BMI Categories and Health Risk.” CDC Obesity and Health. https://www.cdc.gov/obesity/basics/

[2] FDA. “Diabetes Medications (GLP-1 Receptor Agonists).” https://www.fda.gov/drugs/

[3] FDA. “Prescribing Information for semaglutide for chronic weight management.” 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215256s000lbl.pdf

[1] American College of Cardiology and American Heart Association. “2017 ACC/AHA Guidelines on Hypertension.” https://www.ahajournals.org/doi/10.1161/hyp.0000000000000065

[2] American Diabetes Association. “Standards of Care in Diabetes – Diagnosis and Classification.” https://diabetesjournals.org/care/article/46/Supplement_1/S19/138063/Standards-of-Care-in-Diabetes-2023

[3] National Institutes of Health. “NIH Cholesterol Guidelines.” https://www.nhlbi.nih.gov/science/heart-and-vascular-diseases

[4] Rotterdam ESHRE/ASRM Consensus on PCOS. “Revised 2003 Consensus Definition.” https://academic.oup.com/humrep/article/19/1/41/2356101