People usually ask this expecting a single number. There is a number, and it is a starting point rather than the answer.
Medically reviewed by Kent Cohen, MD, FACEP — Medical Director, Balanced Bodies: Longevity + Wellness Clinic. Last reviewed October 2026.
The usual starting threshold
Prescribing for weight management generally begins at a BMI of 30 or above, or 27 and above when there is a weight-related condition such as high blood pressure, type 2 diabetes, sleep apnoea or dyslipidaemia.
That framework comes from how these medications were studied and approved. It is a reasonable starting point and it is not where the conversation ends, in either direction.
Why BMI alone is a poor instrument
BMI is height and weight. It knows nothing about what you are made of.
A muscular man can carry a BMI over 30 with low body fat. An older woman can sit at a BMI of 26 having lost considerable muscle, with more visceral fat than the number suggests. Treating both by BMI alone gets both wrong.
This is why we run an InBody body composition scan at the first visit. It separates fat mass from lean mass, which tells us something BMI cannot: what is actually there.
What else we look at
Blood work. Thyroid function, blood sugar and insulin markers, lipids, kidney and liver function. Partly to identify contributing conditions, partly for safety.
Your history. Personal or family history of medullary thyroid carcinoma, or multiple endocrine neoplasia syndrome type 2, rules out GLP-1 therapy. A history of pancreatitis, gallbladder disease, severe gastrointestinal problems or diabetic retinopathy all change the calculation and need discussing.
Medications you take. GLP-1s slow gastric emptying, which can affect the absorption of other medications. Worth a proper review rather than an afterthought.
Pregnancy plans. These medications are not for use during pregnancy, and if you may become pregnant that needs to be part of the conversation before starting.
What you have already tried. Not as a test you have to pass, but because it tells us what has and has not worked for you.
Who we turn down, and why we would rather do it early
Some people are not candidates on clinical grounds — the contraindications above are the clearest cases.
Others are technically eligible but, on the evidence in front of us, unlikely to be well served. Someone whose weight is stable, who is eating adequately, training sensibly and well within a healthy body composition is not usually going to benefit from a GLP-1, and we will say so.
And occasionally the picture suggests something that needs addressing first — a thyroid problem, or an eating pattern where appetite suppression would not be the right intervention. Those conversations happen at the consultation.
The consultation is free precisely so that this can be an honest assessment rather than a sales call. If the answer is no, you have lost twenty minutes.
What happens if you do qualify
Semaglutide is $199 a month and tirzepatide is $249, each including medication, provider visits, lab work and monthly InBody scans. No membership fee and no annual commitment.
We ask patients to come in about monthly so we can repeat the scan — because the thing that decides whether your plan is working is whether what you are losing is fat or muscle, and a home scale cannot tell you that.
Book a free consultation or call (678) 919-4845.
Further reading
NIDDK: Weight Management · FDA: Human Drug Compounding
The semaglutide and tirzepatide we dispense are compounded by licensed 503A pharmacies. Compounded medications are not FDA-approved finished products and are not the brand-name versions. Results vary between patients and no particular outcome is guaranteed. This article is general information, not medical advice.
