GLP-1s for Weight Loss Without Diabetes

FDA thresholds in plain English

Wegovy (semaglutide 2.4 mg): approved for chronic weight management in adults with BMI ≥30, or BMI ≥27 with at least one weight-related comorbidity.

Zepbound (tirzepatide): same BMI thresholds — ≥30 alone or ≥27 with a comorbidity.

Both are also approved in adolescents 12+ with obesity (BMI ≥95th percentile for age and sex).

Comorbidities that count

• Hypertension
• Type 2 diabetes (though you'd typically get Ozempic or Mounjaro instead)
• Dyslipidemia (high cholesterol or triglycerides)
• Obstructive sleep apnea
• Established cardiovascular disease
• Non-alcoholic fatty liver disease (documented)
• Osteoarthritis attributed to weight

Calculating your BMI

BMI = weight (lb) × 703 / height (in)². Practical shortcut: for a 5'6" (66") person, BMI 27 = 167 lb, BMI 30 = 186 lb. For a 5'10" (70") person, BMI 27 = 188 lb, BMI 30 = 209 lb.

BMI is a crude tool. Muscular athletes can have BMI ≥30 without excess fat. Some people at BMI 26 have high visceral fat and would benefit. Telehealth providers work off BMI because insurance and FDA labels use it, but a good clinician will look at your whole picture.

What telehealth providers screen for

• BMI meeting FDA threshold
• No personal or family history of medullary thyroid carcinoma or MEN 2
• No history of pancreatitis (some programs are stricter than others)
• Not pregnant or breastfeeding
• Kidney function within acceptable range
• State residency where the provider is licensed

What you can expect from weight loss

Trial averages for adults with BMI ≥30 (no diabetes):

• Wegovy 2.4 mg: 14.9% at 68 weeks (STEP-1)
• Zepbound 15 mg: 20.9% at 72 weeks (SURMOUNT-1)

Real-world outcomes are lower, mostly because many patients don't titrate to max dose. A realistic band is 10–15% for Wegovy and 15–20% for Zepbound over 12–18 months.

Insurance coverage

Coverage for weight management without diabetes is inconsistent. Roughly 40–50% of commercial plans cover Wegovy or Zepbound in 2026. Medicare covers them only under narrow indications (CV risk for Wegovy, OSA for Zepbound). Medicaid varies by state. See our Wegovy coverage guide for the appeal playbook.

Cash-pay paths

• LillyDirect Zepbound vials: $349–$499/month, the cheapest brand-name path
• NovoCare Wegovy vials: ~$499/month for uncovered commercial patients
• Compounded semaglutide: $150–$400/month, legal only under narrow medical-necessity criteria

Off-label Ozempic and Mounjaro

Historically, clinicians prescribed Ozempic or Mounjaro off-label for weight loss because supply and insurance friction on Wegovy/Zepbound was easier to bypass. In 2025, most commercial payors began denying off-label use for weight loss. Some cash-pay telehealth programs still write for either brand off-label, but the on-label options (Wegovy, Zepbound, or compounded semaglutide) are the mainstream path in 2026.

What to expect from a telehealth intake

1. Fill out a health questionnaire (medical history, meds, height/weight)
2. Video or messaging consult with a licensed clinician in your state
3. Baseline labs (some providers require them, some don't)
4. Prescription sent to their preferred pharmacy (or shipped direct)
5. Monthly check-ins and dose escalation on a 4-week schedule

The whole intake usually takes 2–7 days.

FAQ