Not everyone who wants to lose weight is a candidate for semaglutide, and not everyone who is a candidate knows it yet. FDA candidacy criteria exist for a reason — they identify patients for whom the clinical benefit is most established and for whom the risk-benefit balance supports prescribing.
This guide walks through the candidacy criteria, the contraindications that disqualify patients, the lab work that informs the prescribing decision, and what to expect at a Vitality consultation. If you are wondering whether you qualify, the starting point is a free consultation and lab review at Vitality's medical weight loss program.
The FDA Candidacy Criteria for GLP-1 Weight Loss Therapy
The FDA-approved indication for Wegovy (semaglutide 2.4 mg weekly) for chronic weight management in adults covers two categories:
- BMI 30 or higher (obesity) — regardless of whether other weight-related conditions are present
- BMI 27 or higher (overweight) with at least one weight-related comorbidity
The weight-related comorbidities that qualify a patient with BMI 27+ include:
- Type 2 diabetes or prediabetes
- Hypertension (high blood pressure)
- Dyslipidemia (high cholesterol or triglycerides)
- Obstructive sleep apnea
- Cardiovascular disease (coronary artery disease, history of heart attack or stroke)
These criteria are the FDA-approved threshold — not a ceiling. Dr. Jaqua evaluates each patient's full clinical picture, including metabolic health markers that extend beyond BMI alone. BMI is an imperfect measure of metabolic health, and clinical judgment often identifies patients who benefit from treatment despite borderline BMI values.
Medical Contraindications — Who Should Not Use Semaglutide
Certain medical conditions disqualify a patient from semaglutide. These are evaluated at the Vitality consultation — they are not questions to self-assess based on this article alone:
- Personal or family history of medullary thyroid carcinoma (MTC) — this is a firm contraindication based on the mechanism of action and animal study data for GLP-1 receptor agonists
- Multiple Endocrine Neoplasia type 2 (MEN2) — a genetic syndrome associated with MTC; contraindicated for the same reasons
- Prior pancreatitis — patients with a history of pancreatitis are typically excluded due to the potential risk relationship between GLP-1 agonists and pancreatic inflammation
- Severe GI disease— gastroparesis or other conditions involving significantly impaired gastric motility may be worsened by semaglutide's gastric-slowing effects
- Pregnancy or planned pregnancy — semaglutide is not indicated during pregnancy; patients planning to conceive should not be on GLP-1 medications
- Severe kidney disease — advanced chronic kidney disease requires careful evaluation before prescribing
- Certain thyroid conditions — thyroid disease history beyond MTC requires evaluation; not all thyroid conditions are contraindications, but a full assessment is required
This list is not exhaustive. Physician evaluation is required to confirm candidacy — not self-screening.
What Labs Does Vitality Run Before Prescribing?
The lab panel before prescribing semaglutide is comprehensive. It serves two purposes: confirming candidacy and establishing baselines for ongoing monitoring. The standard Vitality panel includes:
- Fasting glucose and HbA1c — rules out uncontrolled diabetes; establishes baseline blood sugar status; identifies prediabetes that qualifies as a comorbidity under the BMI 27+ criteria
- Lipid panel — identifies dyslipidemia; establishes cardiovascular risk baseline; documents qualifying comorbidity if present
- Thyroid function (TSH, free T4) — identifies thyroid dysfunction that could contribute to weight gain or contraindicate treatment
- Basic metabolic panel — kidney and liver function; essential for establishing safety of prescribing
- Testosterone levels in men — low testosterone replacement therapy candidacy is frequently identified in men presenting for weight loss; low testosterone independently contributes to visceral fat accumulation and reduced response to weight loss treatment; identifying and addressing this alongside semaglutide treatment improves outcomes
- PSA (if applicable) — standard for men over 40; baseline established before any hormonal treatment
What If My BMI Is Under 27?
GLP-1 medications are currently not FDA-approved for weight loss in individuals with BMI under 27 without qualifying comorbidities. Off-label prescribing is a physician decision based on clinical merit.
Dr. Jaqua evaluates each patient on their full clinical picture — not BMI alone. Metabolic health markers including insulin resistance, HbA1c trend, visceral adiposity, blood pressure trajectory, and family history are all relevant. Patients with metabolic dysfunction at a BMI below 27 may have a clinical case for treatment — this is a physician conversation, not a self-determination.
Patients who do not currently meet the standard candidacy criteria may also benefit from a consultation to understand what options are available and what metabolic markers warrant monitoring.
The Vitality Consultation — What to Expect
The Vitality consultation process is designed to be low-pressure and clinically rigorous. There is no commitment before your labs are reviewed.
- Free initial consultation — Dr. Jaqua reviews your health history, current medications, weight history, and treatment goals. This is a clinical evaluation, not a sales conversation.
- On-site lab draw — blood is drawn on-site during the consultation appointment. Results are typically available the next day.
- Lab review appointment — Dr. Jaqua reviews your results, confirms candidacy, and discusses treatment options including medication choice (semaglutide vs. tirzepatide), dosing protocol, monitoring schedule, and program structure.
- No prescription without labs — the prescription decision is made after lab review. There is no Vitality protocol that prescribes before seeing your labs.
- Pricing reviewed at consultation — program costs are reviewed when treatment is discussed, so you have full transparency before making any decision.
The first step is booking that free consultation. Visit our GLP-1 weight loss program page for more information, or book directly to get your labs started.
Frequently Asked Questions
What BMI qualifies for semaglutide?
The FDA-approved indication for Wegovy (semaglutide 2.4 mg weekly for weight management) is a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related comorbidity (type 2 diabetes or prediabetes, hypertension, high cholesterol, obstructive sleep apnea, or cardiovascular disease). These are the standard qualifying criteria. BMI is one data point — Dr. Jaqua reviews the full clinical picture, including metabolic health markers, at the consultation.
Can I get semaglutide if I have type 2 diabetes?
Yes. Semaglutide (as Ozempic) was originally developed for type 2 diabetes management. For patients with type 2 diabetes who also have obesity or excess weight, semaglutide can address both conditions simultaneously. Dosing protocols and monitoring requirements differ slightly for diabetic patients — particularly if you are currently on other glucose-lowering medications — which is why physician evaluation before starting is essential. Dr. Jaqua reviews your current diabetes management before prescribing.
What happens at my first appointment?
Your first appointment at Vitality begins with a free consultation — no commitment required before your labs are reviewed. Dr. Jaqua reviews your health history, current medications, weight history, and goals. A blood draw is performed on-site, with results typically available the next day. At a follow-up appointment, Dr. Jaqua reviews your labs, confirms candidacy, and discusses your treatment options including medication choice, dosing, monitoring schedule, and program structure. No prescription is issued until after your labs are reviewed.
References
- FDA Prescribing Information — Wegovy (semaglutide) injection 2.4 mg. U.S. Food & Drug Administration. 2021.
- Wilding JPH, et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity.” New England Journal of Medicine. 2021;384:989–1002. (STEP 1 trial — inclusion criteria and patient population data)