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. For adolescents aged 12 and older, the threshold is obesity as defined by age- and sex-specific BMI percentiles. These are the FDA-approved criteria, though your insurance company may layer on additional requirements before covering the prescription.
BMI Thresholds for Adults
There are two paths to eligibility for weight management. The first is straightforward: a BMI of 30 or above, which is the clinical definition of obesity. At that level, no additional diagnoses are required.
The second path covers adults with a BMI between 27 and 29.9, classified as overweight. In this range, you qualify only if you also have at least one weight-related comorbid condition. In clinical trials, the qualifying conditions included treated or untreated high cholesterol and high blood pressure. Other commonly recognized weight-related conditions include type 2 diabetes, obstructive sleep apnea, and joint problems related to excess weight.
For reference, a BMI of 30 works out to roughly 210 pounds at 5’9″ or 180 pounds at 5’5″. You can calculate yours by dividing your weight in pounds by your height in inches squared, then multiplying by 703. Most doctors will calculate it at your appointment.
The Cardiovascular Risk Indication
Wegovy also carries a separate FDA approval for reducing the risk of heart attack, stroke, and cardiovascular death. This indication has its own eligibility criteria: a BMI of 27 or greater, established cardiovascular disease (prior heart attack, prior stroke, or peripheral arterial disease), and age 45 or older. The clinical trial that supported this approval excluded patients with type 1 or type 2 diabetes, though the prescribing indication itself covers adults with established cardiovascular disease and either obesity or overweight.
This matters because some insurance plans will cover Wegovy for cardiovascular risk reduction even if they won’t cover it purely for weight loss. UnitedHealthcare, for example, requires documented evidence of prior heart attack, stroke, or symptomatic peripheral arterial disease, along with a BMI of 27 or above, for approval under this indication.
Requirements for Adolescents
Wegovy is approved for patients aged 12 and older with obesity. For children and teens, BMI works differently than for adults. Instead of fixed cutoffs like 27 or 30, pediatric obesity is determined by BMI percentile, which compares a child’s BMI to other children of the same age and sex. Obesity in this age group is defined as a BMI at or above the 95th percentile. Your child’s pediatrician will plot their BMI on a growth chart to determine whether they meet this threshold.
What Insurance Companies Actually Require
Meeting the FDA criteria doesn’t guarantee coverage. Insurance companies typically add their own layers of requirements through prior authorization, and these vary widely between plans.
A common pattern looks like this: the insurer requires medical records documenting your BMI, proof that you’re following a reduced-calorie diet and exercise plan, and sometimes evidence that you’ve tried other weight loss methods first. Some plans require documentation from a specific type of specialist. Others won’t cover Wegovy for weight management at all, limiting approval to the cardiovascular or liver disease indications.
UnitedHealthcare’s current prior authorization criteria for the cardiovascular indication, for instance, require not just a BMI of 27 or above and documented heart disease, but also that the patient is already taking medications from several drug classes, including a cholesterol-lowering drug, a beta blocker, and blood pressure medication. Reauthorization requires that BMI remains at 27 or above and that you’re still following diet and exercise guidelines.
If your plan denies coverage, it’s worth asking your prescriber’s office to submit an appeal with detailed medical records. The specific documentation your insurer wants can make the difference between approval and denial.
BMI Isn’t the Whole Picture
BMI estimates body fat using only height and weight. It doesn’t distinguish between muscle and fat, and it doesn’t account for where your body stores fat. Someone with a BMI of 26 who carries most of their weight around their midsection may face greater health risks than someone with a BMI of 31 whose weight is more evenly distributed.
Waist circumference adds useful context. Measuring around your waist just above the hipbones, with the tape horizontal and snug but not tight, gives a rough indicator of visceral fat, the type that wraps around internal organs and drives metabolic risk. Health risks increase as waist size increases, regardless of BMI. Your doctor may consider waist circumference alongside your BMI when evaluating whether Wegovy is appropriate, even though the formal prescribing criteria are built entirely around BMI numbers.
What Happens After You Qualify
Wegovy is a once-weekly injection that starts at a low dose and gradually increases over several months. This stepped approach helps your body adjust and reduces the nausea and digestive side effects that are common early on. You’ll work up to the full maintenance dose over about 16 to 20 weeks. The medication is meant to be used alongside dietary changes and physical activity, not as a standalone treatment.
In clinical trials of adults with a BMI of 27 to 30 (with comorbidities) or 30 and above, the treatment period lasted 68 weeks. Weight loss with Wegovy is gradual, and the drug is intended for long-term use. Stopping it typically leads to weight regain, which is why ongoing prescriptions and insurance reauthorization become practical concerns over time.