Who Qualifies for a GLP-1 — and Who Shouldn't Take One

"Am I a candidate for a GLP-1?" has a more precise answer than most marketing pages let on. The FDA-approved labels for Wegovy and Zepbound define specific eligibility criteria, and separately, a short list of conditions rule a person out entirely. Here is both lists, stated plainly.

Who the label says qualifies

Wegovy and Zepbound are indicated, alongside a reduced-calorie diet and increased physical activity, for adults who meet one of two thresholds: **obesity**, generally defined as a body mass index (BMI) of 30 kg/m² or higher, or **overweight** — a BMI of 27 kg/m² or higher — **in the presence of at least one weight-related comorbid condition**, such as high blood pressure, type 2 diabetes, or high cholesterol³⁴. Wegovy also carries an indication for adults with established cardiovascular disease and either obesity or overweight, to reduce the risk of major cardiac events, independent of the weight-loss indication³. Zepbound additionally carries an indication for moderate-to-severe obstructive sleep apnea in adults with obesity — see our dedicated breakdown of that approval if that applies to you. In short: this is not a drug for modest, cosmetic weight goals on the label's own terms — it is indicated for a specific, defined threshold of excess weight, with or without an accompanying health condition.

The absolute exclusions — hard no, not a discussion

Two conditions are outright contraindications on both labels, meaning the drugs must not be prescribed at all, not just "used with caution": a personal or family history of medullary thyroid carcinoma (MTC), or a diagnosis of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)³⁴. Both stem from the boxed warning for thyroid C-cell tumors observed in rodent studies — we cover the full evidence and reasoning behind that warning in the GLP-1 thyroid cancer boxed warning, explained. A known serious hypersensitivity reaction to semaglutide, tirzepatide, or any excipient in the specific product is the other absolute exclusion on both labels³⁴.

The precautions — not automatic exclusions, but real conversations your prescriber should have

Several other conditions do not rule you out outright but require real clinical judgment before starting, and a genuine intake should surface every one of them:

- **A personal history of pancreatitis or gallstones.** Both drugs carry warnings for acute pancreatitis and gallbladder disease. We cover the actual trial data on both in GLP-1s, your gallbladder, and your pancreas. - **Diabetic retinopathy**, particularly in people with type 2 diabetes — both labels note a numerically higher rate of retinopathy complications in trial participants with type 2 diabetes. - **A planned pregnancy or active breastfeeding.** See our full breakdown in GLP-1s, pregnancy, and breastfeeding — the guidance is more specific than a blanket "don't." - **Use of insulin or a sulfonylurea**, which raises hypoglycemia risk when combined with a GLP-1 — covered in GLP-1 drug interactions. - **Any upcoming surgery or procedure requiring general anesthesia or deep sedation.** Because GLP-1s delay gastric emptying, both labels warn of rare postmarketing reports of pulmonary aspiration in patients undergoing elective procedures who had residual stomach contents despite following standard preoperative fasting instructions³⁴. The FDA states the data are insufficient to give firm guidance on whether adjusting fasting time or pausing the drug beforehand reduces this risk — which is exactly why the label instructs patients to tell every surgical or anesthesia team they are taking a GLP-1 before any planned procedure, rather than leaving it to guesswork³⁴.

Why this list matters more than the marketing suggests

None of this is meant to talk anyone out of a legitimate, medically appropriate GLP-1 prescription — the efficacy data is real and substantial: roughly 15% mean weight loss for semaglutide in the STEP-1 trial and up to about 21% for tirzepatide at its top dose in SURMOUNT-1¹². The point is narrower: a legitimate program screens for this list before prescribing, and a provider that skips straight from a form to a prescription is skipping exactly the safety net this label exists to provide. That is the single biggest differentiator our provider checklist asks you to check for, and it is why prescriber access is weighted heavily in our Verdict Score methodology.

If you're not sure where you land

If you meet the BMI/comorbidity threshold and none of the exclusions apply, the practical next step is comparing providers on price honesty, formulary, and support — start with the ranked reviews. If you are unsure whether a precaution applies to you, that uncertainty is itself the reason to insist on a real clinician reviewing your full history rather than a form that approves almost everyone.

This is editorial information, not medical advice. Eligibility is a clinical determination made between you and a licensed prescriber based on your full medical history.