Weight-loss drugs: Who thinks GLP-1 medicines should be for whom?
Updated 7 October 2026
National Institute for Health and Care Excellence (NICE) · BMI ≥35 + comorbidity
NICE recommends tirzepatide for weight management when initial BMI is at least 35 kg/m² and at least one weight-related comorbidity is present, with lower thresholds for specified ethnic groups. This is an NHS reimbursement recommendation for tirzepatide, not the full regulatory indication for every GLP-1 medicine.
National Institute for Health and Care Excellence (NICE) · All adults with obesity
NICE's TA1026 access criterion requires BMI at least 35 kg/m² plus a weight-related comorbidity, so BMI 30–34.9 without that threshold does not qualify under this recommendation.
National Institute for Health and Care Excellence (NICE) · BMI 27–29.9 + comorbidity
The NICE recommendation starts at BMI 35 kg/m² plus a comorbidity, subject to specified ethnicity adjustments; it does not adopt the broader regulatory BMI 27–29.9 plus comorbidity threshold for NHS use.
National Institute for Health and Care Excellence (NICE) · Risk-based below BMI 27
TA1026 uses a substantially higher BMI threshold for NHS tirzepatide access and provides no general pathway below BMI 27 based on central adiposity or clinical staging.
World Health Organization (WHO) · BMI ≥35 + comorbidity
WHO conditionally recommends GLP-1 therapies as a long-term treatment option for adults with obesity, which WHO defines as BMI at least 30 kg/m², rather than restricting treatment to BMI at least 35 plus comorbidity.
World Health Organization (WHO) · All adults with obesity
WHO's current recommendation covers adults with obesity at BMI at least 30 kg/m², excluding pregnant women, after clinical assessment and as part of comprehensive care.
American College of Physicians (ACP) · BMI ≥35 + comorbidity
ACP suggests semaglutide or tirzepatide as first-line pharmacologic options for adults with BMI at least 30, and also for BMI 27–30 with specified comorbidities; it therefore does not confine treatment to BMI at least 35 plus comorbidity.
American College of Physicians (ACP) · All adults with obesity
ACP suggests initiating pharmacologic treatment with lifestyle modification for nonpregnant adults with obesity, defined as BMI at least 30 kg/m²; semaglutide and tirzepatide are first-line choices.
American College of Physicians (ACP) · BMI 27–29.9 + comorbidity
ACP suggests pharmacotherapy for adults with BMI 27 to 30 kg/m² and type 2 diabetes, dyslipidemia, hypertension, obstructive sleep apnea or cardiovascular disease; semaglutide and tirzepatide are first-line choices.
American College of Physicians (ACP) · Risk-based below BMI 27
ACP notes clinical considerations around BMI and that evidence below traditional trial thresholds is limited, but its pharmacotherapy recommendations start at BMI 27 with specified comorbidities. That does not establish a general treatment recommendation below BMI 27.
American Diabetes Association Professional Practice Committee for Obesity · BMI ≥35 + comorbidity
The ADA obesity standards discuss obesity medications for adults with obesity and for adults with overweight plus obesity-related disease, so eligibility is broader than BMI at least 35 plus comorbidity.
American Diabetes Association Professional Practice Committee for Obesity · All adults with obesity
The 2026 standards treat pharmacotherapy as part of obesity care and recommend offering it to adults with obesity or high risk of obesity-related disease according to clinical context rather than reserving it for severe obesity.
American Diabetes Association Professional Practice Committee for Obesity · BMI 27–29.9 + comorbidity
The standards describe obesity medications as indicated in adults with overweight or obesity when obesity-related diseases or complications are present, with GLP-1 or dual GIP/GLP-1 agents preferred in relevant conditions such as type 2 diabetes.
European Association for the Study of Obesity (EASO) · BMI ≥35 + comorbidity
EASO's framework recommends obesity medication according to standard indications at BMI at least 30 or BMI at least 27 with complications and additionally proposes clinical consideration at lower BMI when central adiposity and impairment are present.
European Association for the Study of Obesity (EASO) · All adults with obesity
EASO's clinical framework retains obesity pharmacotherapy at BMI at least 30 kg/m² as a standard treatment threshold while moving diagnosis and treatment toward clinical disease burden.
European Association for the Study of Obesity (EASO) · BMI 27–29.9 + comorbidity
EASO retains the conventional BMI at least 27 kg/m² plus obesity-related complications threshold as a standard pharmacotherapy indication.
European Association for the Study of Obesity (EASO) · Risk-based below BMI 27
EASO's 2024 framework says obesity medication should be considered at BMI at least 25 kg/m² when waist-to-height ratio exceeds 0.5 and medical, functional or psychological impairment or complications are present. Its 2025 pharmacotherapy framework simultaneously notes that trial evidence below BMI 27 is entirely lacking, so this is a clinical-framework position rather than a well-tested drug threshold.
Obesity Canada · BMI ≥35 + comorbidity
Obesity Canada's 2025 guideline recommends pharmacotherapy at BMI at least 30, or at BMI at least 27 with adiposity-related complications, and explicitly adds clinical measures beyond BMI.
Obesity Canada · All adults with obesity
The guideline says pharmacotherapy for obesity management should be offered to people with BMI at least 30 kg/m², alongside health-behaviour changes.
Obesity Canada · BMI 27–29.9 + comorbidity
The guideline recommends pharmacotherapy at BMI at least 27 kg/m² when adiposity-related complications are present, including semaglutide and tirzepatide.
Obesity Canada · Risk-based below BMI 27
The guideline recommends central-adiposity measures, ethnicity-specific BMI thresholds and adiposity-related complications to guide initiation and marks its BMI drug thresholds with a cross-reference to that broader assessment. This supports individualized consideration beyond a single BMI cut-off but is not an unqualified recommendation for GLP-1 use at every BMI below 27.
Novo Nordisk · BMI ≥35 + comorbidity
Novo Nordisk states that Wegovy is used for adults with obesity, or adults with overweight who also have weight-related medical problems; it does not limit the indication to severe obesity.
Novo Nordisk · All adults with obesity
Novo Nordisk's 2026 Wegovy information states that the medicine is used for adults with obesity as part of weight management with diet and physical activity.
Novo Nordisk · BMI 27–29.9 + comorbidity
Novo Nordisk states that Wegovy is used for adults with overweight who also have weight-related medical problems, matching the standard label pathway below the obesity threshold.
Eli Lilly and Company · BMI ≥35 + comorbidity
Lilly states that Zepbound is indicated for adults with BMI at least 30, or BMI at least 27 plus a weight-related condition, rather than only severe obesity.
Eli Lilly and Company · All adults with obesity
Lilly states that Zepbound is indicated for adults with obesity at BMI at least 30 kg/m², alongside reduced-calorie diet and increased physical activity.
Eli Lilly and Company · BMI 27–29.9 + comorbidity
Lilly's stated indication includes adults with BMI at least 27 kg/m² who also have at least one weight-related condition.
Eli Lilly and Company · Risk-based below BMI 27
Lilly explicitly says it does not promote or encourage use outside FDA-approved indications and that its tirzepatide medicines should not be used for cosmetic weight loss. Its stated weight-management indication begins at BMI 27 with a weight-related condition.
Obesity Action Coalition (OAC) · BMI ≥35 + comorbidity
OAC says everyone living with obesity deserves access to safe, effective care and calls on insurers and policymakers to remove barriers to GLP-1 treatment; it does not restrict that call to severe obesity.
Obesity Action Coalition (OAC) · All adults with obesity
OAC endorses GLP-1 medicines as part of long-term obesity treatment and calls for comprehensive coverage for people living with obesity.
Sources
- National Institute for Health and Care Excellence (NICE) — Tirzepatide for managing overweight and obesity ·
- World Health Organization — WHO issues global guideline on the use of GLP-1 medicines in treating obesity ·
- World Health Organization — Statement from the Joint Meeting of the Advisory Committee on Safety of Medicinal Products (ACSoMP) and the Global Advisory Committee on Vaccine Safety (GACVS) on the safe and appropriate use of GLP‑1 receptor agonists ·
- American College of Physicians / Annals of Internal Medicine — Pharmacologic Treatments With Lifestyle Modifications in Nonpregnant Adults With Overweight or Obesity in Outpatient Settings: A Living Clinical Guideline From the American College of Physicians (April 2026) ·
- American Diabetes Association — Pharmacologic Treatment of Obesity in Adults: Standards of Care in Overweight and Obesity ·
- European Association for the Study of Obesity / Nature Medicine — A new framework for the diagnosis, staging and management of obesity in adults ·
- European Association for the Study of Obesity / Nature Medicine — Framework for the pharmacological treatment of obesity and its complications from the European Association for the Study of Obesity (EASO) ·
- Obesity Canada — Canadian Adult Obesity Clinical Practice Guideline – Pharmacotherapy in Obesity Management [Updated 2025] ·
- Novo Nordisk — Wegovy® Pill Available Nationwide ·
- Eli Lilly and Company — Open Letter Regarding the Use of Mounjaro® (tirzepatide) and Zepbound® (tirzepatide) ·
- Eli Lilly and Company — Zepbound linked to lower healthcare costs in adults over age 55 with obesity according to a real-world study ·
- Obesity Action Coalition — OAC Statement on GLP-1 Medications as a Long-Term Treatment Strategy for Obesity ·
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