Mounjaro and a BMI of 28: what the licensed criteria actually say

What the licensed criteria say about BMI 27–29.9

The Mounjaro SmPC (the authoritative document that defines how the medicine may be prescribed in the UK) sets the lower BMI boundary at 27 kg/m², with the explicit requirement that a weight-related comorbidity is also present. At BMI 28, you clear that numerical threshold, and our guide on whether you can get Mounjaro with a BMI of 28 walks through exactly what that means in practice. The question a prescriber then asks is whether you have one of the qualifying conditions: type 2 diabetes, hypertension, dyslipidaemia (raised cholesterol or triglycerides), obstructive sleep apnoea, or another condition in which excess weight plays a direct role.

NICE's appraisal of tirzepatide (TA1026, published December 2024) recommends the medicine for NHS use only at BMI ≥35 with a comorbidity, so the NHS route is not open to someone at BMI 28. Private prescribing follows the licensed criteria, which is the broader 27-plus-comorbidity pathway. Those two thresholds are often confused, and it is worth understanding the difference before you decide how to proceed.

There is also a background-specific adjustment. For people of South Asian, Chinese, Middle Eastern, Black African or African-Caribbean heritage, UK guidance recognises that health risk can be higher at lower BMI values, and thresholds are set approximately 2.5 kg/m² lower. In practice, that can bring a qualifying BMI as low as 25 on the private licensed route, which is something we cover in detail for anyone asking about Mounjaro eligibility at a BMI of 25. If this applies to you, a prescriber can factor it in at consultation.

What the trial evidence tells us about people in the BMI 27–30 range

SURMOUNT-1 (the pivotal phase 3 trial published in the New England Journal of Medicine) enrolled 2,539 adults with obesity or overweight and at least one weight-related condition, and reported average body-weight reductions of around 20–21% at the 15 mg dose over 72 weeks. The trial specifically included participants above BMI 27 with comorbidities, not only those with higher BMIs, which is partly why the licence reflects that wider range.

What the data do not tell you is how your body will respond. Average figures come from thousands of participants across a spread of starting weights and conditions. A BMI of 28 with well-managed hypertension is a very different clinical picture from a BMI of 28 with type 2 diabetes and high cholesterol, and if you are closer to the lower end of the eligible range you may also find our page on Mounjaro eligibility at a BMI of 27 useful for comparison. That individual variation is exactly why prescribers assess each case rather than approve anyone who meets a BMI number.

For context on how the criteria shift across the BMI scale, the full Mounjaro BMI eligibility guide covers the thresholds in detail, including the NHS versus private distinction.

How a prescriber reads a BMI of 28 during a consultation

A prescriber reviewing your consultation at BMI 28 is essentially asking three things: is a qualifying condition confirmed or credibly self-reported; is there any clinical reason the medicine should not be used; and does the overall picture support a treatment plan that includes diet changes and increased activity alongside the injection? Understanding how often you can take Mounjaro is part of that broader treatment picture, since the weekly dosing schedule plays a central role in how prescribers plan ongoing care.

The qualifying condition does not need to be severe or newly diagnosed. Controlled hypertension on medication, a cholesterol reading that prompted a GP conversation, or a diagnosis of prediabetes would each be relevant. The prescriber is not looking for a crisis; they are looking for a genuine health indication that weight management would address.

Evidence checks and identity verification are part of the process at nume, sorry, at the nume pharmacy. Photo ID is required, weight is confirmed on a live video call, and where you are transferring from another provider or requesting a dose increase, supporting evidence is reviewed before anything is approved. That rigour protects you, not just the regulator. For a broader look at what treatment involves, the weight-loss treatment overview sets out the full picture.

BMI 28 and the NHS route: why it is effectively closed at this threshold

It is worth being direct about this. The NHS is rolling out Mounjaro in phased cohorts, and even the most inclusive current cohort requires a BMI of 40 or above with multiple comorbidities. Cohort 2, which activated in June 2026, covers BMI 35–39.9 with four or more qualifying conditions. A BMI of 28 sits well outside those bands, regardless of how many conditions are present.

That is not a permanent rule (the phasing is designed to widen over time) but for now, the NHS route is not a realistic option at BMI 28. Private prescribing through a regulated online pharmacy is the practical alternative for people who meet the licensed criteria and want to start without a waiting list.

If you are weighing up the cost side of that decision, the cost context page for Mounjaro in the UK explains what private pricing typically includes and why the cheapest listing is rarely the right metric when a prescription medicine is involved. Our prescribers are available to talk through your specific situation, you can start a free consultation and have your answers reviewed the same day by a real clinician, not automated software.