The label criteria
The FDA-approved indications for Wegovy and Zepbound in adults are chronic weight management alongside a reduced-calorie diet and increased physical activity, in people with an initial body mass index of 30 or greater, or 27 or greater in the presence of at least one weight-related comorbid condition.
Conditions that commonly qualify at the lower threshold include hypertension, type 2 diabetes, dyslipidaemia, obstructive sleep apnoea and established cardiovascular disease.
Indications have expanded over time — semaglutide has additional approvals relating to cardiovascular risk reduction and obstructive sleep apnoea — and these can matter a great deal for insurance coverage. Check the current labelling rather than relying on a summary.
Absolute contraindications
These rule out the medication entirely, and any service that prescribes through them is not screening properly.
- Personal or family history of medullary thyroid carcinoma
- Personal or family history of multiple endocrine neoplasia syndrome type 2
- Known serious hypersensitivity to the active ingredient or any excipient
- Pregnancy — these medications are not recommended, and effective contraception is generally advised during treatment
Histories that warrant a real conversation
None of these is an automatic exclusion, but each is a reason a competent prescriber should slow down and ask more questions. If your intake form did not raise any of them, that tells you about the quality of the screening.
- History of pancreatitis
- Gallbladder disease
- Severe gastrointestinal disease, including gastroparesis
- Diabetic retinopathy, particularly with type 2 diabetes
- Kidney impairment, given the dehydration risk from GI side effects
- Any history of an eating disorder
- Concurrent insulin or sulfonylurea use, because of hypoglycaemia risk
- A history of depression or suicidal ideation
What a good intake looks like
It asks for a full current medication list, not just a free-text box. It asks about family history specifically, not just your own. It asks about eating disorder history in a way that is hard to skip past. And where an answer raises a flag, a human follows up before anything is prescribed.
A published assessment of online GLP-1 sellers found that a simulated patient received prescriptions from the large majority of the sites they approached. Speed of approval is not a feature. It is the absence of the thing the medication's safety case depends on.
Adolescents
Semaglutide has an approved indication for chronic weight management in adolescents aged 12 and older meeting specific criteria, and paediatric obesity treatment is an area of active clinical guidance.
This is emphatically not a telehealth-intake decision. It belongs with a paediatrician or a paediatric obesity specialist who can assess growth, development and the whole family context.
If you are not eligible
Not qualifying for a GLP-1 is not a verdict on you, and it is not the end of the options. There are other approved anti-obesity medications with different mechanisms, and there are non-pharmacological approaches with real evidence behind them.
It is also worth knowing that some medications you may already be taking can contribute to weight gain, and that alternatives sometimes exist. That is a productive conversation to have with a prescriber, and one of the questions on our list of things worth asking at an appointment.