To qualify for Wegovy, adults need a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related health condition. In practical terms, a BMI of 27 translates to roughly 180 pounds for someone who is 5’6″, or about 195 pounds at 5’9″. You don’t need to be severely obese to meet the threshold, but you do need to clear one of these two cutoffs.
BMI Thresholds for Adults
The FDA-approved label breaks adult eligibility into two categories. The first is straightforward: if your BMI is 30 or above, you qualify based on weight alone. A BMI of 30 looks like about 186 pounds at 5’4″, 210 pounds at 5’8″, or 225 pounds at 5’11”.
The second category applies if your BMI falls between 27 and 29.9. At that level, you also need at least one weight-related health condition. The clinical trials that led to Wegovy’s approval specifically enrolled people in this BMI range who had conditions like high cholesterol, high blood pressure, or type 2 diabetes. Other qualifying conditions generally include obstructive sleep apnea and heart disease, though the FDA label doesn’t list every possible condition by name. Your doctor makes the call on whether a specific condition counts.
Requirements for Teens
Wegovy is approved for adolescents aged 12 and older, but the eligibility criteria work differently than for adults. Instead of a fixed BMI number, teens need a BMI at or above the 95th percentile for their age and sex. That percentile corresponds to clinical obesity in pediatric medicine. Unlike the adult criteria, there is no lower-BMI-with-comorbidities pathway for adolescents. The FDA based this approval on a 68-week trial of 201 patients aged 12 and up who met the 95th-percentile cutoff.
The Cardiovascular Indication
In 2024, the FDA approved a separate use for Wegovy: reducing the risk of heart attack, stroke, and cardiovascular death in adults who already have established heart disease and are either obese or overweight. For this indication, the BMI floor drops to 27 regardless of other conditions, because the cardiovascular disease itself is the qualifying factor. In the trial supporting this approval, which enrolled over 17,600 participants, major cardiovascular events occurred in 6.5% of those taking Wegovy compared to 8% on placebo.
What Insurance Actually Requires
Meeting the FDA criteria doesn’t guarantee your insurance will cover Wegovy. Most insurers add their own requirements through prior authorization, and these can be more demanding than what the FDA label specifies. A representative example from Maryland’s Medicaid program shows the kind of documentation you might need: BMI measured within the last 90 days (with current height and weight on file), a prescription from or in consultation with a relevant specialist, and confirmation that the prescriber has screened for all contraindications.
Some private insurers go further, requiring documentation that you’ve tried diet and exercise programs or other weight-loss approaches before they’ll approve coverage. The specifics vary widely by plan. If your insurer denies coverage initially, it’s worth asking your doctor’s office to submit an appeal with detailed medical records, since many initial denials get overturned.
Who Cannot Take Wegovy
Even if you meet the BMI requirements, certain medical histories rule out Wegovy entirely. The drug is contraindicated if you have a personal or family history of medullary thyroid cancer or a condition called multiple endocrine neoplasia syndrome type 2. It is also not recommended for people with severe gastroparesis, a condition where the stomach empties abnormally slowly. If you have a history of diabetic retinopathy, your doctor should monitor your eyes closely during treatment, as the condition can worsen.
What to Expect Once You Start
Wegovy is prescribed alongside a reduced-calorie diet and increased physical activity. It’s not a standalone treatment. The medication is a once-weekly injection that follows a gradual dose increase over 16 weeks. You start at the lowest dose for the first four weeks, then step up every four weeks through progressively higher doses. By week 17, you reach the maintenance dose, which is where you stay long-term.
This slow ramp-up exists to minimize side effects, particularly nausea and other digestive issues that are common when starting the drug. In clinical trials, adults on the standard maintenance dose lost an average of about 15.6% of their body weight over 68 weeks. A higher dose currently being studied showed average weight loss of 18.7%. For context, that means someone starting at 250 pounds could expect to lose roughly 39 to 47 pounds over about a year and a half, though individual results vary considerably.
Weight regain after stopping the medication is well documented, so most people who benefit from Wegovy stay on it indefinitely. That makes insurance coverage and out-of-pocket cost an ongoing consideration, not just a one-time hurdle.