The criteria for Wegovy for weight loss, explained clearly

What the NICE appraisal actually requires, not just the BMI number

NICE published its recommendation for semaglutide (Wegovy) in March 2023 under Technology Appraisal 875. The headline BMI figures get quoted often; the surrounding conditions get quoted less. To qualify under NICE guidance, adults need a BMI of 35 or above (or 30–34.9 where a clinician considers a specialist referral appropriate), plus at least one weight-related comorbidity, and they must be managed within a specialist weight management service that includes multidisciplinary support. Treatment is approved for a maximum of two years, and NICE advises reviewing whether to continue if less than 5% weight loss has been achieved after six months on the maintenance dose.

For South Asian, Chinese, Middle Eastern, Black African or African-Caribbean backgrounds, those thresholds shift down by 2.5 kg/m², reflecting established differences in cardiometabolic risk at lower BMI values. NHS England quotes 32.5 instead of 35, and 27.5–32.4 instead of 30–34.9, for those groups. The NICE TA875 recommendations chapter is the authoritative reference if you want to read the exact wording.

This matters in practice: a significant number of people who could benefit from Wegovy sit below the NICE threshold or outside specialist services, which is why private routes exist and are legal for clinically suitable adults.

The licensed criteria, what makes someone eligible for a private prescription

The licensed criteria are set by the Wegovy SmPC and are broader than the NICE recommendation. A prescriber may issue a private prescription for an adult with a BMI of 30 or above, or 27 or above where at least one weight-related condition is present. Conditions that qualify include type 2 diabetes, high blood pressure, dyslipidaemia (raised cholesterol or triglycerides), obstructive sleep apnoea and osteoarthritis, among others.

A question our prescribers hear most weeks is whether these thresholds are automatic approvals. They are not. The SmPC criteria define who the medicine is licensed for; a prescriber still weighs the full clinical picture (other medicines you take, your medical history, any contraindications) before issuing a prescription. For Wegovy specifically, a history of medullary thyroid carcinoma or MEN2 syndrome rules it out, as do certain other conditions that a clinical assessment will identify.

If you want to understand how BMI interacts with these conditions in more detail, the BMI threshold guide for Wegovy covers the numbers systematically. For a side-by-side look at how semaglutide's eligibility compares across different products and indications, the criteria for semaglutide page is worth reading alongside this one.

NHS access versus private access: a practical comparison

The NHS eligibility bar is set well above the licensed threshold. If you're wondering whether you can get Wegovy for weight loss through the NHS, it is available only through specialist weight management services under TA875, and waiting lists are commonly long. That affects a large number of people who meet the licensed criteria but not the NHS specialist-referral pathway.

Private treatment through a GPhC-registered pharmacy is the legal alternative for people who are clinically suitable but can't access NHS services, or who prefer not to wait. The prescription must still follow a genuine clinical assessment, there is no lawful route to obtain Wegovy without one. If you're weighing up what private treatment actually costs relative to what's included, the Wegovy cost breakdown sets out what legitimate pricing looks like and what headline prices sometimes leave out.

For those in Scotland, Wales or Northern Ireland, commissioning criteria and phased rollouts differ from England; the principles here remain accurate but check local NHS guidance for nation-specific thresholds.

Who cannot use Wegovy, and when to pause treatment

Wegovy is not recommended during pregnancy, breastfeeding or when trying to conceive. It is not licensed for anyone under 18. People with a personal or family history of medullary thyroid carcinoma, or with multiple endocrine neoplasia type 2, should not use it. A history of pancreatitis or severe gastrointestinal disease requires careful prescriber assessment.

Reviewing the full Wegovy criteria is a useful step before a consultation, because NICE guidance also advises that treatment should be reviewed and potentially stopped if weight loss remains below 5% after six months at the maintenance dose. That review is a clinical decision, made with the prescriber. The NHS semaglutide medicines page carries the full list of contraindications and cautions in plain language.

If you're unsure whether your medical history affects eligibility, that uncertainty is exactly what a clinical consultation is for. Our prescribers at nume review every case individually. Check your eligibility by starting a free consultation, a GPhC-registered Independent Prescriber reads your answers the same day.