Should I consider a GLP-1 medicine? And when not to
Who the FDA labels cover, how insurance and Medicare decide, who should not take these medicines, and how to prepare for an honest talk with a doctor.
In the US, GLP-1 medicines are FDA-approved for type 2 diabetes, and for obesity or overweight that affects your health. Whether insurance or Medicare pays is a separate question, with its own, often stricter, rules. Meeting a number does not mean you should take one. Some people should not take them at all. Talk to a doctor before starting, stopping or changing any medicine.
Key facts
- Names you'll see
- Wegovy and Ozempic contain semaglutide. Zepbound and Mounjaro contain tirzepatide. Ozempic and Mounjaro are approved for type 2 diabetes, not weight loss.3,5,6,9
- The FDA label
- Adults with a BMI of 30 or more, or 27 to under 30 with at least one weight-related condition3,6
- Who pays
- Depends on your plan. Many employer plans don't cover them for weight; Medicare can't, except through a temporary $50 program10,11
- That is not a yes
- The labels say the medicine goes alongside a reduced-calorie diet and more activity, and a doctor weighs it up with you3,6
- Never take it if
- You or family had medullary thyroid cancer, you have MEN 2, you're allergic, or you're pregnant3
- Results vary
- In the main trials, 9 to 14 in 100 people lost less than 5% of their weight; about 31 in 100 if they had type 2 diabetes21,22,23
- When you stop
- Most of the weight lost tends to come back within a year24
On this page
- What do doctors look at?
- Who pays: insurance, Medicare and Medicaid
- Who should not take a GLP-1?
- What about pregnancy, PCOS and the pill?
- Teens, older adults, kidneys, liver, other medicines, surgery
- What if I only want to lose a few pounds?
- What results can I honestly expect?
- A way to think it through
- What to bring to the doctor
- What support comes with it?
- Questions people ask
What do doctors look at?
Doctors look at your weight, your health conditions, and what you've already tried. A BMI number alone does not decide it.
BMI (body mass index) compares your weight with your height. Two different sets of numbers get mixed up online. One set describes your weight. The other is where a doctor may start to think about medicine. They are not the same thing.
The CDC uses: healthy 18.5 to under 25, overweight 25 to under 30, obesity 30 or more.2 Some US guidance uses lower numbers for Asian Americans, such as diabetes screening from a BMI of 23.12 Waist size matters too. Guide 1 explains this.
Wegovy, Zepbound and Foundayo are approved for weight management in adults with a BMI of 30 or more. Or 27 to under 30 with at least one weight-related condition, like high blood pressure, type 2 diabetes or sleep apnea.3,6,7 The label numbers are the same for every ethnic background.3,6
Type 2 diabetes is a separate reason. Ozempic and Mounjaro are approved to control blood sugar in type 2 diabetes. Those approvals have no weight cut-off.5,9 The American Diabetes Association's 2026 Standards of Care say that for people with diabetes and overweight or obesity, the preferred medicine for weight is semaglutide or tirzepatide.20 Your doctor will look at your HbA1c (a blood test of your average sugar level over about 3 months) and your other medicines.
Other approved uses exist. Wegovy is approved to lower the risk of heart attack, stroke and heart-related death in adults with heart disease and obesity or overweight (since March 2024), and for a type of fatty liver disease with scarring (MASH, since August 2025). Zepbound is approved for moderate to severe sleep apnea in adults with obesity (since December 2024).18,3,19
Who can prescribe. Any prescriber licensed in your state with the authority to prescribe: a doctor, and in most states a nurse practitioner or physician assistant. Telehealth prescribers generally need a license in the state where you are when you get care.14 GLP-1 medicines are not controlled substances, so there's no federal rule that you must be seen in person first.15 Guide 6 explains the routes.
Who pays: insurance, Medicare and Medicaid
Far fewer people get coverage than the label covers. Each kind of plan has its own rules.
| Your coverage | What we found |
|---|---|
| Employer or other private plan | Coverage for weight loss is optional. In 2025, 19% of firms with 200 or more workers covered GLP-1s mainly for weight loss, rising to 43% of the largest firms (5,000 or more workers). Plans that cover them usually require prior authorization: your prescriber sends proof that you meet the plan's rules.10 Diabetes use is a different benefit. |
| Medicare | By law, Medicare drug plans can't cover medicines used for weight loss alone. They can cover GLP-1s for type 2 diabetes, heart protection, sleep apnea or MASH. From July 2026 to December 2027, the temporary Medicare GLP-1 Bridge covers Wegovy, Zepbound (KwikPen) and Foundayo for weight at a $50 monthly copay, for people who qualify: a BMI of 35 or more; or 30 or more with heart failure, uncontrolled high blood pressure or chronic kidney disease; or 27 or more with prediabetes, a past heart attack or stroke, or peripheral artery disease.11,16 |
| Medicaid | Each state decides. 13 state Medicaid programs covered GLP-1s for obesity in January 2026, usually with prior authorization; four states had recently ended coverage.17 |
| No coverage | The makers sell directly at self-pay prices. Guide 6 lists them. |
Coverage rules are changing fast. Checked Oct 12, 2026. Ask your plan, or call 1-800-MEDICARE, for your own rules.16
Who should not take a GLP-1?
Some people should never take these medicines. Others need extra care, and a doctor may decide it isn't safe for them.
The labels give two firm "do not take" groups. The first is anyone with a personal or family history of medullary thyroid cancer (MTC), or a rare inherited condition called MEN 2 (multiple endocrine neoplasia type 2).3,6 The second is anyone with a serious allergy to the medicine.3
The thyroid warning comes from animal studies. Semaglutide caused thyroid tumors in rodents. Nobody knows yet whether it does the same in people.3
The table below lists the main conditions. "Do not take" means the label lists it as a firm reason not to use the medicine. "Not recommended" means the label advises against it. "Caution" means a doctor may still prescribe, but watches you more closely.
| Condition | Why it matters | What it means |
|---|---|---|
| You or a close relative had medullary thyroid cancer, or you have MEN 2 | Thyroid tumors seen in animal studies; human risk unknown3 | Do not take Listed as a contraindication3,6 |
| Allergy to the medicine or its ingredients | Severe allergic reactions have been reported3 | Do not take3 |
| Pregnant, or trying to get pregnant | May harm the baby3,6 | Stop Stop Wegovy at least 2 months before trying3 |
| Breastfeeding | Not recommended with Wegovy tablets (US label); semaglutide should not be used (European label)3,4 | Ask first Discuss with your doctor3,4 |
| Past pancreatitis (swollen pancreas) | Pancreatitis, sometimes fatal, has happened on these medicines3 | Caution European label advises caution4 |
| Severe gastroparesis (very slow stomach) or bowel disease | Stomach side effects can be more severe3,4 | Not recommended if severe Caution with inflammatory bowel disease3,4 |
| Gallbladder problems | Gallstones are more common on these medicines3 | Tell your doctor Mention any past gallstones3 |
| Type 1 diabetes | Wegovy has not been studied in people with type 1 diabetes3,4 | Not recommended for weight (European label)4 |
| Severe kidney disease | Little experience; vomiting and diarrhea can dry you out and harm kidneys3,4 | Specialist decision See kidneys below |
| Severe liver disease | Little experience in severe liver impairment4 | Not recommended for weight (European label)4 |
| Diabetic eye disease (retinopathy) | Eye complications reported in people with type 2 diabetes3 | Caution Needs eye checkups3 |
| Severe heart failure | Not studied in the most severe stage4 | Not recommended for weight (European label)4 |
| Eating disorder, now or in the past | Strong appetite effects may make disordered eating worse28 | Tell your doctor Not on the labels, but researchers flag it28 |
From the US Wegovy and Zepbound labels and the European Wegovy label. Read the Medication Guide that comes with your medicine before you start.
What about pregnancy, PCOS and the pill?
Don't take a GLP-1 while pregnant. If you could get pregnant, plan birth control with your doctor before you start.
These medicines stay in the body for a while after the last dose. The US Wegovy label says to stop at least 2 months before a planned pregnancy, because semaglutide lasts a long time in the body.3 The Zepbound label says to stop when pregnancy is recognized.6 The European Mounjaro label advises stopping tirzepatide at least 1 month before a planned pregnancy.8
Tirzepatide can make the birth control pill less reliable. It slows the stomach, which can affect how well the pill is absorbed. The effect is largest after the first dose.6
If you take the pill with Zepbound or Mounjaro, the label advises switching to a non-pill method, or adding a barrier method such as a condom, for 4 weeks after starting and for 4 weeks after each dose increase.6 The Foundayo label gives the same advice for 30 days.7 Methods that aren't swallowed, like a hormonal IUD, are not affected.6
Semaglutide is not expected to make the pill less effective, according to its European label.4
Teens, older adults, kidneys, liver, other medicines and surgery
These groups can sometimes use GLP-1 medicines. But each one needs extra checks, and some need a specialist.
Teenagers
In the US, Wegovy injection is approved for weight management from age 12, for teens with obesity, alongside diet and activity.3 Saxenda is approved from 12 for teens with obesity who weigh more than 132 lb (60 kg).13 Gallstones were more common in teens than adults on Wegovy.3 Zepbound and Foundayo are approved for adults only.6,7
Older adults
Older people can lose muscle along with fat, which raises the risk of frailty. Direct evidence in older adults is scarce.29 In the large Wegovy heart trial, people aged 75 and over had more hip and pelvis fractures: 24 in 1,000 on Wegovy, against 6 in 1,000 on a dummy injection.3 Dehydration from vomiting or diarrhea can harm the kidneys, so drinking enough matters.3
Kidney disease
Kidney injury has been reported, mostly in people who got dehydrated from stomach side effects.3 The European label does not recommend Wegovy if kidney function is very low (an eGFR blood-test result below 30).4 But in people with type 2 diabetes and kidney disease, Ozempic is FDA-approved to help protect the kidneys.5 So this is a decision for your kidney or diabetes doctor.
Liver disease
The FDA approved Wegovy in August 2025 for a type of fatty liver disease with scarring (MASH), under accelerated approval.3,19 It is not recommended in severe liver impairment, and needs caution in milder cases.4
If you take insulin or a sulfonylurea
Sulfonylureas are older diabetes pills that make the pancreas release insulin. Taken with a GLP-1, they and insulin raise the risk of low blood sugar (hypoglycemia), including severe lows.3 Your doctor may lower their dose when you start, and should explain the signs of low blood sugar.3
Before surgery or an endoscopy (camera test)
GLP-1 medicines slow your stomach. Rarely, food has stayed in the stomach despite fasting, and been breathed into the lungs under anesthesia.3 Always tell the surgeon and anesthesiologist you take one.3
US guidance from 2024 says most people can keep taking it before planned surgery. Higher-risk people may need a liquid-only diet for 24 hours first. That includes people in the early dose-increase weeks, on higher doses, or with stomach symptoms.25 Follow your own surgical team's advice.
What if I only want to lose a few pounds?
These medicines are not meant for a few pounds before a wedding or a vacation, or for losing fat for bodybuilding. You'd take on the same risks with no proven benefit.
It's not what they are approved for. The weight labels cover obesity, or overweight with a weight-related condition.3,6 The big trials only included people with obesity or overweight with a condition.21,22
The risks don't shrink because your goal is small. Stomach side effects, gallstones and pancreatitis can still happen.3
The weight tends to come back. A year after stopping semaglutide, people had regained about two-thirds of what they'd lost.24 A short course before an event is likely to be undone afterwards.
Some of what you lose is muscle. In studies, muscle made up as much as a quarter of the weight lost.29 That works against a gym goal.
Unapproved products are a real risk in the US. The FDA warns that compounded GLP-1s are not FDA-approved, and has warned about products sold online for "research use only".1 Fake Ozempic pens have been found in the US supply chain, most recently in December 2025.26
What results can I honestly expect?
Most people in trials lost a meaningful amount of weight. But results vary a lot, side effects are common, and the weight returns if you stop.
Before the numbers, how these trials work:
- People are put into groups at random.
- One group gets the medicine. The other gets a dummy injection (a placebo) that looks the same but has no medicine in it.
- Both groups get the same advice on diet and activity.
- The gap between the groups is what the medicine added.
Trials use losing 5% of body weight as a key marker.21,22 For someone who starts at 200 lb (91 kg), that's 10 lb (4.5 kg). Out of every 100 people in each trial, this is how many reached it:
Adults without diabetes, 68 weeks.21
Adults without diabetes, 72 weeks.22
Adults with type 2 diabetes, 68 weeks.23
These are separate trials with different people, so they can't be compared with each other.
Put the other way, about 1 in 7 people on semaglutide and 1 in 11 on tirzepatide lost less than 5%. With type 2 diabetes, it was nearly 1 in 3.21,22,23
Side effects make some people stop. In the semaglutide trial, 4.5 in 100 people quit because of stomach side effects, against 0.8 in 100 on the dummy. This count includes only stomach side effects.21 On tirzepatide 15 mg, 6.2 in 100 stopped because of any side effect, against 2.6 in 100.22 So the two numbers measure different things.
People with diabetes tend to lose less. The average was 9.6% of body weight in the diabetes trial, against 14.9% in people without diabetes.23,21
Expect check-ins. The Saxenda label says to stop if you haven't lost at least 4% after 16 weeks. The Wegovy and Zepbound labels set no fixed cut-off; your prescriber weighs your response and how well you tolerate it.13,3,6
Think of it as long-term. The study on stopping concluded that ongoing treatment seems needed to keep the benefits.24 Guide 9 covers stopping.
Cost adds up if you pay yourself. Guide 6 explains insurance, Medicare and the makers' self-pay prices.
A way to think it through
Use this to sort your thoughts before a doctor visit. It does not give you a yes. Only a doctor who knows your health can.
Questions to ask yourself
There's no score here. These questions help you know what you want, and what you're ready for.
- Why do I want this now? Is it my health, or pressure from others?
- What have I tried before? What worked, even for a while?
- Could I keep taking a medicine for years, not months?
- Does my insurance cover it? If not, could I pay for a year or more?
- How would I cope with nausea or an upset stomach for a few weeks?
- Am I planning a pregnancy in the next year or two?
- Have I ever struggled with an eating disorder, like bingeing or starving myself?
- Who will support me with food changes and activity?
What should I bring to the doctor?
Bring your history, your medicines and any recent test results. Then ask the questions below. You can print this card.
Bring
- Your weight history: highest weight, recent changes, past attempts
- Your waist size, if you've measured it
- Your insurance card, and your plan's drug list (formulary) if you have it
- A list of every medicine and supplement you take, with doses
- Recent test results, if you have them: HbA1c, cholesterol, liver, kidney and thyroid tests
- Family history: thyroid cancer, MEN 2, pancreatitis, diabetes
- Your own history: pancreatitis, gallstones, stomach problems, eating disorders, eye disease
- Pregnancy plans, and the birth control you use
- Any surgery or endoscopy (camera test) you have planned
Ask
- Is a medicine right for me, or should I try something else first?
- Does my plan cover it, and does it need prior authorization?
- Is this medicine FDA-approved for my condition?
- How will we check if it's working, and when?
- What should I do about my other medicines?
- Which side effects mean I should call you, or 911?
- What happens if I stop?
- Who do I contact between visits?
From GLP Guidebook, Guide 4. General information, not medical advice.
Your primary care doctor is usually the first step. See who pays, above. Guide 6 explains insurance, Medicare and prescriptions, and Guide 7 covers telehealth and clinics.
What support comes with it?
That depends on who prescribes it. The medicine is meant to go alongside changes to food and activity, so ask what help comes with it.
Every weight-loss label approves the medicine alongside a reduced-calorie diet and more physical activity.3,6 The USPSTF recommends that doctors offer or refer adults with a BMI of 30 or more to intensive programs that combine diet, activity and behavior support.27 If you have prediabetes, a CDC-recognized lifestyle change program is another option.30
Whatever route you take, it helps if someone at home knows what you're taking, which side effects to expect, and when to get help.
Questions people ask
My BMI is 28. Can I get a GLP-1?
There's no automatic "yes". The FDA label lets a prescriber consider Wegovy or Zepbound from a BMI of 27 if you also have a weight-related condition, like high blood pressure or type 2 diabetes.3,6 Insurance plans and Medicare's temporary program often set a higher bar.10,11 Either way, it's a decision a prescriber makes with you, after weighing the risks.
Does my ethnic background change anything?
Not for the FDA labels, which use the same numbers for everyone.3,6 Some US guidance uses lower numbers for Asian Americans, such as diabetes screening from a BMI of 23.12 Insurance and Medicare rules don't lower the BMI for any group.11
Can I take it if my mother had thyroid problems?
Most thyroid problems, like an underactive thyroid, are not on the "do not take" list. The ban is for a personal or family history of medullary thyroid cancer, or MEN 2.3 Tell your doctor exactly what your relative had.
Is it safe with metformin?
Metformin is not one of the medicines the labels flag for low blood sugar. That warning is about insulin and sulfonylureas.3 Your doctor will still review all your medicines together.
How long would I need to take it?
Often for a long time. In the stopping study, most of the weight came back within a year, and researchers said ongoing treatment seems needed.24 Your prescriber will check whether it's working.
Can I stop before I try for a baby?
Plan it with your doctor. The Wegovy label says to stop at least 2 months before a planned pregnancy.3 For tirzepatide, the European label says at least 1 month.8
I'm having surgery next month. Should I stop?
Don't decide alone. Tell your surgeon, anesthesiologist and the person who prescribed it. Since 2024, US guidance says most people can continue, with extra steps for higher-risk people.25
Before you move on
- A BMI number is where a doctor may start thinking, not a reason to take a medicine.
- Insurance, Medicare and Medicaid set their own rules, often stricter than the label.
- Never take one with a personal or family history of MTC or MEN 2, or in pregnancy.
- On tirzepatide, add a condom to the pill for 4 weeks after starting and 4 weeks after each dose increase.
- They're not for a few pounds, and weight usually returns after stopping.
- You have a checklist to take to your doctor.
Sources
- US Food and Drug Administration. FDA's concerns with unapproved GLP-1 drugs used for weight loss (compounded drugs are not FDA-approved; products labeled "research use only"). Content current as of October 1, 2026. fda.gov
- CDC. Adult BMI categories. Page reviewed March 19, 2024. cdc.gov
- Novo Nordisk. Wegovy (semaglutide) injection and tablets, US prescribing information, revised June 2026: boxed warning, sections 1, 4, 5, 6 (fractures), 8 (pregnancy: stop at least 2 months before; lactation). PDF
- European Medicines Agency. Wegovy summary of product characteristics: sections 4.1, 4.2, 4.4, 4.5, 4.6. PDF
- Novo Nordisk. Ozempic (semaglutide) US prescribing information, revised May 2026: section 1. PDF
- Eli Lilly. Zepbound (tirzepatide) US prescribing information, revised August 2026: sections 1, 4, 7, 8.1, 8.3. uspl.lilly.com
- Eli Lilly. Foundayo (orforglipron) US prescribing information, revised July 2026 (adults; oral contraceptives: 30 days after starting and after each dose increase). uspl.lilly.com
- European Medicines Agency. Mounjaro (tirzepatide) summary of product characteristics, section 4.6 (stop at least 1 month before a planned pregnancy). PDF
- Eli Lilly. Mounjaro (tirzepatide) US prescribing information, revised August 2026: section 1. uspl.lilly.com
- KFF. 2025 Employer Health Benefits Survey (19% of firms with 200 or more workers, and 43% with 5,000 or more, cover GLP-1s primarily for weight loss; coverage typically subject to prior authorization). kff.org
- KFF. Nearly four million Medicare beneficiaries met the eligibility criteria in 2023 for the Medicare GLP-1 Bridge (dates, $50 copay, drugs and BMI criteria; statutory prohibition unchanged; type 2 diabetes, sleep apnea and MASH covered under Part D). June 29, 2026. kff.org
- US Preventive Services Task Force. Prediabetes and type 2 diabetes: screening. August 24, 2021 ("at a lower BMI (≥23) if the patient is Asian American"). uspreventiveservicestaskforce.org
- Novo Nordisk. Saxenda (liraglutide) US prescribing information, revised February 2026 (ages 12 and up weighing more than 60 kg; evaluate at 16 weeks and stop if under 4% lost). PDF
- American Medical Association. How state licensing has evolved to meet telehealth's challenges (the AMA supports "a state-based licensure system in which physicians are licensed in the state where their patients are receiving their care"). October 12, 2023. ama-assn.org
- Drug Enforcement Administration, Diversion Control Division. Controlled substances, alphabetical order (semaglutide, tirzepatide, liraglutide and dulaglutide are not listed). List dated August 27, 2026. deadiversion.usdoj.gov
- Centers for Medicare & Medicaid Services. Medicare GLP-1 Bridge: information for prescribers (covered drugs: Foundayo, Wegovy injection and tablets, Zepbound KwikPen only; clinical criteria; check eligibility at Medicare.gov/glp1bridge or 1-800-MEDICARE). Product No. 12235, June 2026. cms.gov
- KFF. Medicaid coverage of and spending on GLP-1s (13 state programs covered GLP-1s for obesity under fee-for-service as of January 2026; California, New Hampshire, Pennsylvania and South Carolina ended coverage). January 16, 2026. kff.org
- FDA. FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight. March 8, 2024. fda.gov
- FDA. FDA approves first medication for obstructive sleep apnea. December 20, 2024. fda.gov
- American Diabetes Association Professional Practice Committee. 8. Obesity and weight management: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1), recommendation 8.18. PMC12690172
- Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). NEJM, 2021;384:989–1002. DOI
- Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1). NEJM, 2022;387:205–216. DOI
- Davies M et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2). Lancet, 2021;397:971–984. DOI
- Wilding JPH et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab, 2022;24:1553–1564. DOI
- American Society of Anesthesiologists. New multi-society GLP-1 clinical practice guidance released. October 29, 2024. Declared interests: in the guidance paper, 2 of 10 authors declare consulting or speaking fees from Novo Nordisk (paper's own declaration). Link
- FDA. FDA warns consumers not to use counterfeit Ozempic (semaglutide) found in US drug supply chain (warnings of December 2023, April 2025 and December 2025). fda.gov
- US Preventive Services Task Force. Weight loss to prevent obesity-related morbidity and mortality in adults: behavioral interventions (2018, Grade B). uspreventiveservicestaskforce.org
- The dual role of GLP-1 receptor agonists in weight management and eating disorders: potential benefits and risks. J Psychiatr Res, 2026. DOI
- GLP-1 receptor agonist therapy and skeletal muscle: a narrative review with implications for older adults. JAR Life, 2026. DOI
- CDC. About the National Diabetes Prevention Program. May 15, 2024. cdc.gov
Last checked Oct 12, 2026 · Next review due Jan 2027 · Report an error
How this guide was made. Written by the GLP Guidebook team from the sources above: US and European drug labels, FDA, CMS, USPSTF and ADA guidance, KFF research and published trials. It's general information, not medical advice. Talk to a qualified doctor before starting, stopping or changing any medicine. In an emergency, call 911. How we write