EN
Home/Start here/Considering it for weight
Reading path6 guides, in order

I'm thinking about a GLP-1 for my weight. Where do I start?

A reading path for anyone weighing up Wegovy, Zepbound or Foundayo, in the order that makes the decision easier.

GLP Guidebook teamUpdated Oct 12, 20265 min read13 sourcesWritten from published sources
The short answer

Start with your health, not the medicine. BMI and waist size describe your risk. Medicines are one option, alongside food, activity and sometimes surgery. Whether insurance or Medicare pays is a separate question with its own rules; many people pay themselves. GLP-1s are usually long-term and have side effects. These six guides walk you through the decision in order.

Read this page first. It covers what the BMI numbers mean for you, who pays, how to make the decision and what to expect if you start. At the end, six guides take you further, in order.
On this page
  1. BMI and waist
  2. Who pays
  3. The decision, step by step
  4. What to expect
  5. The risks, in brief
  6. What to read next
  7. Sources

What do the BMI numbers mean for me?

They measure health risk. They don't decide whether you should take a medicine.

BMI (body mass index) compares your weight with your height. Waist size shows how much fat sits around your belly.

The CDC counts a BMI of 25 to under 30 as overweight and 30 or more as obesity, for all adults.1 Some US guidance uses lower numbers for Asian Americans: for example, diabetes screening from a BMI of 23.2

Waist size. A waist of more than 40 in (102 cm) for men, or more than 35 in (89 cm) for women, raises the risk of heart disease and type 2 diabetes.3

Where medicines come in. Wegovy, Zepbound and Foundayo are FDA-approved for adults with a BMI of 30 or more, or 27 to under 30 with at least one weight-related health problem, such as high blood pressure. The label numbers are the same for every ethnic background.4,5

A number is not a prescription. Being over a threshold means a prescriber may consider a medicine. It doesn't mean you qualify. It's a starting point for a conversation with your doctor.

Who pays?

It depends on your coverage, and the rules are often stricter than the label.

  • Employer or private plan. Coverage for weight loss is optional: 19% of firms with 200 or more workers covered GLP-1s mainly for weight loss in 2025. Plans that do usually require prior authorization.6
  • Medicare. By law it can't cover medicines for weight loss alone. The temporary Medicare GLP-1 Bridge covers Wegovy, the Zepbound KwikPen and Foundayo at $50 a month from July 2026 to December 2027, for people with a BMI of 35 or more, or lower BMIs with certain heart, kidney or blood-sugar conditions.7
  • Medicaid. Each state decides; 13 states covered GLP-1s for obesity in January 2026.8
  • No coverage. The makers sell directly at their own self-pay prices, which run from $149 to $449 a month depending on brand and dose (checked Oct 12, 2026).9

Guide 6 covers insurance, Medicare, Medicaid and paying yourself in detail.

How should I make the decision?

One step at a time, in this order. Each step has a guide.

1Check your numbers and health (Guide 1)
2Compare all your options (Guide 3)
3Ask if a GLP-1 fits you, and when not (Guide 4)
4Weigh the side effects (Guide 5)
5Talk to your doctor; check your coverage (Guide 6)
6Using telehealth or a clinic? Check it first (Guide 7)
7Review how it's going with your prescriber

Medicines don't replace food and activity changes. The WHO says GLP-1 treatment should come with support for healthy eating and physical activity.10

Step 6 matters if you go online. The prescriber must be licensed in your state, and the medicine should be an FDA-approved brand: the FDA has warned dozens of telehealth companies over compounded versions, which are not FDA-approved.11

The review step matters too. The Wegovy and Zepbound labels set no fixed cut-off; your prescriber weighs your response and how well you tolerate it.4,5

What should I expect if I do start?

Expect three things:

  • weight loss that is real, but varies a lot from person to person
  • stomach side effects for many people, especially early on
  • a long-term commitment, because the weight tends to return after stopping

The main semaglutide weight trial, STEP 1, shows what to expect. People were put into two groups at random. One group got the medicine and the other a dummy injection with no medicine in it. Both groups got the same diet and activity advice. So the gap between the two groups is what the medicine added.12

Average share of body weight lost, and what that means for someone who starts at 200 lb (91 kg):

STEP 1Semaglutide 2.4 mg (Wegovy), weekly

1,961 adults with obesity or overweight and no diabetes, 68 weeks.12

Semaglutide14.9%about 30 lb
Dummy injection2.4%about 5 lb

So about 12.5% of body weight, or 25 lb (11 kg) for a 200 lb person, came from the medicine itself.

These are averages, and people varied a lot. On semaglutide, about 86 in 100 lost at least 5% of their body weight, against about 32 in 100 on the dummy injection, and about 1 in 3 lost 20% or more. Put the other way, about 1 in 7 on semaglutide lost less than 5%.12

Most of the weight usually comes back after stopping. A year after stopping, people followed up from STEP 1 had regained about two-thirds of what they lost.13 So plan as if you'll stay on it, and check what your coverage, or your own budget, can sustain. Guide 9 covers stopping.

Just a few pounds?It's for a family memberBMI calculator

What to read next, in order

These six guides go deeper. Each one ends with a link to the next, so you can read them one after another.

  1. 1Weight and health: what BMI and waist numbers meanGuide 1 of 9UnderstandCheck where you stand with BMI and waist-to-height, and what the CDC categories mean.
  2. 2Your options, and where medicines fitGuide 3 of 9DecideSee lifestyle support, other medicines, GLP-1s and surgery side by side before you pick one.
  3. 3Should I consider a GLP-1? And when not toGuide 4 of 9DecideWho prescribers may consider for a GLP-1, and the times it isn't a good idea.
  4. 4Side effects and risksGuide 5 of 9DecideWhat the first weeks feel like, and the rarer risks to know before you start.
  5. 5Getting a prescription in the USGuide 6 of 9Do it safelyInsurance, Medicare, Medicaid or paying yourself; who may prescribe, the brands, compounded versions and fakes.
  6. 6Choosing a clinic, telehealth service or programGuide 7 of 9Do it safelyWhat your doctor, telehealth services, the makers' pharmacies and clinics offer, how they charge and what to check.
Was this page easy to understand?

Sources

  1. CDC. Adult BMI categories. Page reviewed March 19, 2024. cdc.gov
  2. 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
  3. National Heart, Lung, and Blood Institute. Assessing your weight and health risk (waist circumference: women more than 35 inches, men more than 40 inches). nhlbi.nih.gov
  4. Novo Nordisk. Wegovy (semaglutide) US prescribing information, revised June 2026. Sections 1, 2, 4, 5, 8.3. PDF
  5. Eli Lilly. Zepbound (tirzepatide) US prescribing information, revised August 2026, and Foundayo (orforglipron) US prescribing information, revised July 2026: indications and BMI criteria; oral contraceptives. Zepbound · Foundayo
  6. KFF. 2025 Employer Health Benefits Survey (19% of firms with 200 or more workers cover GLP-1s primarily for weight loss; typically with prior authorization). kff.org
  7. Centers for Medicare & Medicaid Services. Medicare GLP-1 Bridge: information for prescribers. Product No. 12235, June 2026. cms.gov
  8. KFF. Medicaid coverage of and spending on GLP-1s (13 states as of January 2026). January 16, 2026. kff.org
  9. Makers' self-pay prices, checked October 12, 2026: Novo Nordisk, NovoCare Wegovy self-pay offer; Eli Lilly, Zepbound and Foundayo coverage and savings pages. NovoCare · Zepbound · Foundayo
  10. World Health Organization. WHO issues global guideline on the use of GLP-1 medicines in treating obesity. December 1, 2025. who.int
  11. FDA. FDA warns 30 telehealth companies against illegal marketing of compounded GLP-1s. March 3, 2026. fda.gov
  12. Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). NEJM, 2021;384:989–1002. 1,961 adults without diabetes, 68 weeks. DOI
  13. Wilding JPH et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes, Obesity and Metabolism, 2022;24(8):1553–1564. 327 people followed for a year after stopping. DOI

Last checked Oct 12, 2026 · Next review due Jan 2027

How this page was made. Written by the GLP Guidebook team from the sources above: FDA labels, published trials, CDC, NIH, USPSTF and WHO guidance, CMS and KFF pages, and the makers' published prices. It's general information, not medical advice. Talk to your doctor or another qualified prescriber before starting, stopping or changing any medicine. In an emergency, call 911. How we write