Guide
Who Qualifies For A GLP-1?
The criteria used for approved weight-management prescribing, the conditions that rule you out completely, and why a platform willing to approve absolutely anybody should worry you rather than reassure you.
The Standard Thresholds
These are the criteria used for the FDA-approved weight-management products, and the benchmark responsible telehealth platforms apply.
BMI 30+
Obesity. Generally sufficient on its own for weight-management prescribing.
BMI 27+
Overweight, plus at least one weight-related condition — type 2 diabetes, high blood pressure, high cholesterol, obstructive sleep apnoea or cardiovascular disease.
BMI is a crude instrument and everyone involved in obesity medicine knows it. It does not distinguish muscle from fat, and it performs differently across ethnic groups — lower thresholds are often applied for people of South Asian, Chinese and some other ancestries, where metabolic risk rises at a lower BMI. A good clinician treats it as a starting point for a conversation about your actual metabolic health, not as the whole assessment.
Absolute Contraindications
If any of these apply, you should not take a GLP-1 receptor agonist. Disclose them at intake — a platform that prescribes anyway has told you something important.
Medullary thyroid carcinoma, personally or in your family
GLP-1 receptor agonists carry a boxed warning about thyroid C-cell tumours, based on rodent studies. Whether that translates to humans is not known, but a personal or family history of medullary thyroid carcinoma is an absolute contraindication.
Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
The same boxed warning applies. This is not a risk to weigh up — it is a reason not to take the medication.
Pregnancy, trying to conceive, or breastfeeding
These medications should not be used in pregnancy. They also reduce the effectiveness of oral contraceptives in some cases through delayed gastric emptying, which is a genuinely common reason people become pregnant unexpectedly while taking them.
A previous serious allergic reaction to the medication
Prior hypersensitivity to semaglutide, tirzepatide or any component of the formulation rules out re-exposure.
Needs A Real Conversation
Not automatic disqualifiers, but each is a reason for a clinician to think rather than tick.
History of pancreatitis
Pancreatitis is a recognised risk with this drug class. A prior episode does not automatically rule you out, but it needs an explicit conversation with a clinician who knows your history, not a checkbox.
Gallbladder disease
Rapid weight loss of any kind raises gallstone risk, and GLP-1s are associated with gallbladder events. Worth flagging at intake.
Diabetic retinopathy
Rapid improvement in blood glucose can transiently worsen retinopathy. If you have it, this needs ophthalmology input before starting.
Severe gastrointestinal disease or gastroparesis
These medications slow gastric emptying by design. If your stomach already empties slowly, that is a problem rather than a mechanism.
Kidney impairment
Dehydration from vomiting or diarrhoea can precipitate acute kidney injury, and existing impairment raises the stakes considerably.
Eating disorders, current or past
An appetite-suppressing medication in the context of a restrictive eating disorder can be actively harmful. This deserves specialist input, not a telehealth questionnaire.
A Platform That Approves Everyone
It is worth saying plainly, because the incentives in this industry point the other way: a telehealth service that declines to prescribe for people who do not meet clinical criteria is doing its job. One that approves essentially anyone who pays is not being convenient — it is skipping the part you are paying for.
When we reviewed Brightmeds we rated it above several cheaper rivals largely because it applies a real BMI threshold and turns people away. That is the behaviour to look for. Equally, be wary of the mirror image: a "money-back guarantee" that only pays out if a clinician declines you protects the company's conversion funnel, not your outcome.
If you do not meet the criteria, that is not a problem to shop around until someone solves. Older FDA-approved medications, structured programmes and, for some people, bariatric referral are all real options that a good clinician will raise.
This page describes general prescribing criteria and is not an assessment of you. Eligibility is a decision for a licensed clinician with your full history in front of them. If you are weighing providers, our rankings note which ones apply genuine clinical gates, and our side-effect guide covers what to expect if you do start.
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Medical Disclaimer: This page is for informational purposes only and does not constitute medical advice. Always consult a licensed healthcare provider before starting or changing any treatment. Compounded medications are not FDA-approved, are not evaluated by the FDA for safety, effectiveness or quality, and are not equivalent to the branded drug beyond sharing an active ingredient. GLP-1 medications commonly cause nausea, vomiting, diarrhoea and constipation, and carry risks including pancreatitis, gallbladder disease and kidney injury; they are contraindicated in people with a personal or family history of medullary thyroid carcinoma or MEN 2, and should not be used in pregnancy, when trying to conceive, or while breastfeeding. Prescribing is subject to clinician approval and is never guaranteed. Individual results vary and no outcome is promised.