NICE Wegovy criteria: what the guidelines actually say about who qualifies

You've looked up your BMI and it clears the threshold — here is what comes next

A lot of people arrive at this question having done the same mental arithmetic: BMI over 35, tick. Overweight for years, tick. Tried other approaches, tick. The assumption, and it is a reasonable one to make, is that clearing those numbers means Wegovy is available to you on the NHS. The reality is more layered than that.

NICE's appraisal of semaglutide for weight management, published as Technology Appraisal TA875, recommends Wegovy for adults with a BMI of 35 or above who also have at least one weight-related condition — things like type 2 diabetes, high blood pressure, high cholesterol or obstructive sleep apnoea. For adults with a BMI between 30 and 34.9, the recommendation applies where specialist-referral criteria are already met. These BMI thresholds drop by 2.5 kg/m² for people of South Asian, Chinese, Middle Eastern, Black African or African-Caribbean heritage.

Meeting those numbers, though, is only the entry point. TA875 is explicit that Wegovy should be used for a maximum of two years and only within a specialist weight management service. That means a multidisciplinary team (dietitian, behavioural support, medical oversight) not a single clinic appointment. NHS England's guidance on weight management injections confirms that wraparound lifestyle and dietary support is built into the pathway, not optional alongside it.

So the gap between qualifying on paper and receiving treatment on the NHS can be significant. Waiting lists for specialist weight management services are long in many areas, and capacity varies considerably by region. That practical reality is why many people who meet the NICE criteria turn to a regulated private pharmacy rather than wait.

The five-percent rule and what happens if treatment stops working

There is a built-in review point embedded in the NICE criteria that catches many people by surprise. If, after six months on the maintenance dose of Wegovy (2.4mg weekly, or 7.2mg where the higher-dose pen has been prescribed), a patient has lost less than five percent of their starting body weight, the guidance says that continuing treatment should be reconsidered. This is not a punishment clause, it reflects the clinical rationale that the medicine's risks and costs are only justified when it is demonstrably working for that individual.

In practice this means the prescribing team reviews progress at six months rather than simply renewing the prescription. For people on the NHS pathway this review happens within the specialist service. For those going privately through a service like a regulated online pharmacy, the same clinical logic applies, a prescriber should be assessing response before authorising continuation, and at nume every repeat order is individually reviewed rather than auto-renewed.

The two-year maximum is the other limit worth understanding clearly. TA875 does not recommend Wegovy for indefinite use on the NHS. At the two-year point, the treatment episode ends under the NHS pathway. What happens to weight after that is a genuine clinical question, and one being actively researched, the appraisal itself acknowledges that weight regain after stopping is a known risk. Anyone approaching the two-year point should be discussing what comes next with their clinical team well in advance.

Private treatment and the NICE criteria: what changes and what does not

Private prescribing operates under the licensed indication from the medicines regulator (the MHRA) rather than under NICE's commissioning recommendation. That distinction matters. NICE guidance tells the NHS when to fund a medicine; the SmPC tells any prescriber what the medicine is licensed for. The licensed criteria for Wegovy are adults with a BMI of 30 or above, or 27 or above with a weight-related condition, prescribed alongside a reduced-calorie diet and increased physical activity.

So when someone accesses Wegovy privately through a GPhC-registered pharmacy, the prescriber assesses eligibility against the licensed criteria rather than the NICE TA875 thresholds. The two-year NHS maximum does not automatically apply in private practice. The five-percent review principle, however, reflects good clinical practice regardless of setting, a responsible prescriber applies it because it is the right thing to do, not because a commissioning document requires it.

If you are exploring whether you meet the eligibility criteria for Wegovy privately, the starting point is a clinical consultation. At nume, that consultation is reviewed the same day by a GPhC-registered Independent Prescriber. For those curious about what private Wegovy treatment costs and what is included, the treatment page sets that out transparently. One thing worth knowing upfront: the prescription, consultation and next-working-day delivery are all included in one price, with no auto-renewal and no subscription.

When NICE criteria overlap with the NHS rollout for tirzepatide

A common source of confusion right now is that there are two different GLP-1 weight-loss medicines on the NHS radar, with different NICE appraisals and different rollout timelines. Wegovy (semaglutide) operates under TA875 and the specialist-service route described above, and you can find a detailed breakdown of the Wegovy criteria on our dedicated page if you want to work through the specifics before speaking to a prescriber. Tirzepatide (Mounjaro) has its own appraisal, TA1026, with a phased NHS rollout starting at BMI 40-plus with multiple comorbidities. The two appraisals have meaningfully different criteria, different service requirements and different timelines.

If you are trying to work out which medicine or which pathway applies to your situation, that is exactly the kind of question worth putting to a prescriber rather than answering from a webpage. The clinical picture (your BMI, your health history, any medicines you already take) shapes both what is appropriate and what is available. For a fuller explanation of how each condition and BMI band is assessed, our page on the criteria for Wegovy for weight loss walks through the detail in plain language. You can also read more about the clinical criteria for semaglutide or explore how Wegovy works before deciding whether a consultation makes sense for you. Our clinical team page at Mostafa Damghani gives you a sense of who reviews your case.

Start your free consultation whenever you are ready. There is no commitment in asking the question.