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Two numbers answer this. A BMI of 30 or higher qualifies you for a GLP-1 on its own. A BMI of 27–29.9 qualifies you if you also have at least one weight-related condition. Examples include high blood pressure, type 2 diabetes, high cholesterol, and sleep apnea. That’s the standard on the FDA labels for Wegovy (semaglutide) and Zepbound (tirzepatide). It’s also the framework Zappy’s clinicians use.
The rest of this page explains where those numbers come from, and what happens when your case isn’t clear-cut.
Where 30 and 27 come from
Regulators didn’t invent these cutoffs. The trials set them. STEP 1 (Wilding et al., NEJM 2021), which tested brand-name semaglutide (Wegovy), enrolled 1,961 adults using exactly this rule. They needed a BMI of 30 or more, or 27 or more with at least one weight-related condition, treated or untreated. SURMOUNT-1 (Jastreboff et al., NEJM 2022), which tested brand-name tirzepatide (Zepbound), used the same entry rule for its 2,539 participants. The FDA labels simply match the people who were studied.
So 30 and 27 don’t mean a BMI of 29.9 is fine and 30.0 isn’t. They mark the edge of the evidence. If you prescribe inside those lines, you’re prescribing where the trials actually looked. (What happened to the people in those trials, including results, side effects, and how the drugs work, is covered in the GLP-1 guide.)
The cutoffs in pounds
BMI is your weight in kilograms divided by your height in meters squared. In U.S. units, it’s 703 × pounds ÷ inches². Here’s what the two cutoffs look like at three heights:
- 5’4”: BMI 27 starts at 158 lb, and BMI 30 at 175 lb
- 5’8”: 178 lb and 198 lb
- 6’0”: 200 lb and 222 lb
Your own numbers take ten seconds with the BMI calculator.
What counts as a comorbidity
A comorbidity is a health condition that comes along with excess weight. The labels give examples: high blood pressure, type 2 diabetes, and dyslipidemia (high cholesterol or triglycerides). Zepbound’s label adds obstructive sleep apnea and cardiovascular disease. Notice the labels’ own wording: “e.g.” These are examples, and the list isn’t closed.
Two details matter in practice. First, the trials counted conditions whether they were treated or not. High blood pressure you haven’t seen a doctor about is still high blood pressure. Second, clinicians often consider conditions beyond the label’s short list, such as prediabetes, PCOS, and fatty liver disease. That second part is clinical judgment rather than trial evidence. It’s exactly the kind of call that belongs to your reviewing clinician instead of a checkbox.
BMI screens, but it doesn’t decide
BMI is just arithmetic using your height and weight. It can’t see body composition. A 5’10” weightlifter at 209 lb and a 5’10” desk worker at 209 lb both have a BMI of 30.0, with completely different amounts of body fat. BMI can’t see where your fat sits either. Visceral fat (the kind packed around your organs) drives metabolic risk more than the scale does. The standard cutoffs also fit some populations poorly. A WHO expert consultation (2004) set lower action points for Asian populations, at 23 and 27.5, because their risk of heart disease and diabetes starts climbing at a lower BMI.
The screen works the other way too. A qualifying BMI is necessary, but it isn’t enough. A personal or family history of medullary thyroid carcinoma (a rare thyroid cancer) or MEN 2 rules these drugs out at any BMI. That’s the boxed warning on both of them. Pregnancy, or trying to conceive, also rules them out. A history of pancreatitis calls for real caution. None of that shows up in a BMI calculator, which is why no careful prescriber stops there.
What the Zappy intake does with your number
The quiz collects the whole picture. It asks for your height and weight. It also asks about your conditions, medications, and the history that decides safety, including thyroid problems, pancreatitis, and pregnancy. A licensed clinician reviews every case within 24 hours. BMI opens the door, and your history decides what happens next. Sometimes that means a no.
If your BMI is 27 to 29.9, the clinician needs to be able to confirm your weight-related condition. A diagnosis, a prescription, or readings from your records help. A hunch alone isn’t enough. A condition that has never been treated still counts under the label, but it also needs care of its own. Say you have high blood pressure that no one is treating. Treating only your weight would leave the more immediate risk unaddressed, so a primary care visit may need to come first.
It works the other way too. A qualifying BMI doesn’t mean yes. Medullary thyroid carcinoma or MEN 2 in you or your family is an absolute stop at any BMI. So is pregnancy or actively trying to conceive.
And BMI can’t tell muscle from fat. A weightlifter with a BMI of 31, a normal waist, and normal metabolic labs may not have the problem the number describes. In that case, the honest answer is no prescription. That’s the reason a clinician reads your whole intake instead of stopping at the BMI field.
One thing you won’t face here is an insurer’s prior authorization checklist. By law, regular Medicare Part D can’t cover weight-loss drugs, apart from a temporary program for some brand-name GLP-1s. Commercial plans often exclude them or require documented diet programs first. Zappy is cash-pay and FSA/HSA eligible, so the only test is the label criteria plus clinical judgment.
The next step
Run your height and weight through the BMI calculator. At 30 or above, you clear the screen outright. At 27–29.9, list your diagnoses before you start the quiz. Include ones you suspect, and say which have been confirmed. The clinician reviewing your case can only weigh what you report.
