Eligibility for semaglutide: who qualifies and what the criteria actually mean

Does your BMI put you in the licensed range?

The starting point for semaglutide eligibility is BMI. The Wegovy licence covers adults with a BMI of 30 or above (the clinical threshold for obesity) and adults with a BMI between 27 and 29.9 who have at least one weight-related condition. Qualifying conditions include type 2 diabetes, prediabetes, raised blood pressure, dyslipidaemia (high cholesterol or triglycerides) and obstructive sleep apnoea, among others.

BMI thresholds are not fixed uniformly across all backgrounds. For people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean heritage, NICE guidance recognises lower intervention thresholds, typically 2.5 kg/m² below the standard figures. The BMI criteria for semaglutide are worth reviewing in detail if you sit near the borderline, because the context around your number matters as much as the number itself. The NHS BMI calculator is a useful first check.

A BMI that clears the threshold is a necessary condition, not a sufficient one. Prescribers look at the whole picture, and a BMI of, say, 31 alongside well-controlled health conditions is a different clinical conversation from the same BMI alongside several comorbidities.

Do any health conditions affect your suitability?

Some medical histories raise the complexity of using semaglutide. A personal or family history of medullary thyroid carcinoma, or a condition called multiple endocrine neoplasia syndrome type 2 (MEN2), is a contraindication, meaning the medicine is not suitable. Active or recent pancreatitis also requires careful prescriber review, as does a history of severe gastrointestinal disease.

Certain concurrent medicines need flagging too. If you take levothyroxine or other medicines that require precise absorption timing, your prescriber will factor that in. Insulin and other diabetes medicines need particular attention because combining them with semaglutide can affect blood glucose management.

None of this is a reason to self-screen out before a consultation. The assessment exists precisely to work through these details. What it does mean is that the clinical review is substantive, and that is a feature of a safe process, not a barrier to it.

NHS route versus private prescription: different criteria apply

Semaglutide eligibility looks different depending on whether you are pursuing an NHS or private route, and that distinction catches many people off guard. NICE's appraisal of semaglutide (TA875) recommends it on the NHS only within specialist weight management services, for a maximum of two years, and with stricter BMI and comorbidity thresholds than the licence alone. Waiting lists for those services can be long in most areas.

Private prescribing follows the SmPC (the medicine's licensed summary of product characteristics), which sets the broader BMI criteria described above. A regulated online pharmacy providing a private prescription still requires a full clinical assessment, the difference is speed of access, not lower clinical standards. For a transparent view of what private treatment involves financially, the Wegovy cost page sets out what a complete package typically includes.

If you want to understand the NHS phasing in more detail, the Wegovy eligibility guide covers both routes side by side.

Exclusions that apply regardless of BMI

Several situations sit outside the licensed use of semaglutide entirely. Pregnancy, breastfeeding, and actively trying to conceive are all situations in which semaglutide is not recommended, washout guidance before conception applies, and a prescriber will advise on timing. The medicine is not licensed for under-18s.

Age, on the upper end, is not itself a disqualifier; the clinical picture at any age is what counts. Kidney and liver function may be relevant for some patients at assessment, particularly at higher doses. If treatment does start, NICE guidance notes that continuing beyond six months at the highest tolerated dose is reviewed if less than 5% body weight has been lost, a built-in clinical checkpoint rather than a fixed commitment.

The Wegovy treatment overview covers how semaglutide works and what the weekly injection schedule involves, which is useful context before a consultation. Our clinical team reviews every consultation personally, if you have a specific medical question ahead of starting, the assessment is the right place to raise it. Ready to find out where you stand? You can review the full Wegovy eligibility criteria before booking, or check your eligibility with a free consultation today.