Once-Weekly Semaglutide for Adults with Overweight or Obesity: Who It's For

You've looked up your BMI and you're not sure which side of the line you fall on

Lots of people arrive at this question after a quick search or a conversation with a friend who's already on treatment. The licensed eligibility for Wegovy is written around two scenarios. In the first, a BMI of 30 or above is enough on its own — no additional conditions required. In the second, a BMI between 27 and 29.9 qualifies provided at least one weight-related condition is also present. That list of conditions includes type 2 diabetes, prediabetes, high blood pressure, dyslipidaemia (raised cholesterol or triglycerides), obstructive sleep apnoea and cardiovascular disease, among others. Osteoarthritis and polycystic ovary syndrome are also commonly considered.

It's worth knowing that BMI alone doesn't tell the whole story. A BMI of 31 doesn't automatically mean treatment is right for you, the prescriber weighs up your full medical history, any medicines you're already taking, and conditions where semaglutide isn't appropriate. That clinical conversation is the thing that can't be skipped. You can check your own figure with the NHS BMI calculator as a starting point.

The ethnic-background adjustment is worth flagging clearly: UK guidance recognises that health risks associated with excess weight appear at lower BMI values in some populations. For adults from South Asian, Chinese, Middle Eastern, Black African or African-Caribbean backgrounds, the thresholds are reduced by 2.5 kg/m² throughout. So a BMI of 27.5, for example, may fall within the qualifying range where it would not for others. The BMI thresholds for semaglutide are explained in more detail if you want to read further on this.

Your doctor mentioned NICE criteria, that's a different question from the licence

There's a distinction that trips people up. The product licence (the SmPC) sets the minimum criteria Eli Lilly (sorry, Novo Nordisk) defined for Wegovy. NICE guidance, published as TA875 in March 2023, sets the conditions under which the NHS will fund treatment. Those two things are not the same, and for most people currently seeking treatment privately, it's the licence that governs eligibility, not TA875.

That said, understanding the NICE criteria is useful context. NICE recommends semaglutide for NHS use only within a specialist weight management service, for a maximum of two years, and currently for adults with a BMI of 35 or above alongside at least one weight-related comorbidity. NHS waiting lists for specialist services are long in many areas, which is one reason many adults explore private routes. As NICE's appraisal of semaglutide (TA875) makes clear, the NHS pathway is specific about service setting, it's not simply a matter of meeting a BMI threshold.

Private prescribing through a regulated pharmacy works differently. There's no referral required, no waiting list, and the prescriber applies the licensed criteria rather than the NICE commissioning ones. For adults who don't meet the NHS cohort thresholds or who prefer not to wait, that's often the more accessible route. If you're weighing up cost alongside eligibility, the weight-loss treatment overview covers the options available.

Why 'overweight' and 'obesity' are defined differently in this context than you might expect

Clinical weight categories (overweight being a BMI of 25 to 29.9, obesity starting at 30) are population-level tools, not personal verdicts. They carry real limitations, particularly for people with high muscle mass or certain body compositions. But in the context of semaglutide eligibility, they're the agreed framework that the licence and prescribing guidance both use. Knowing that framework helps you read trial data and prescribing criteria with clearer eyes.

The STEP 1 trial, published in the New England Journal of Medicine, enrolled adults with a BMI of 30 or above, or 27 or above with a weight-related condition, which maps directly onto the licence. Average weight reduction at 68 weeks on 2.4mg semaglutide was around 15%. That figure came from a specific trial population under specific conditions; outcomes vary between individuals, and a prescriber will never promise a particular result.

One practical detail worth knowing: Wegovy's dosing starts at 0.25mg weekly and is increased gradually, typically over several months, up to the 2.4mg maintenance dose, and more recently a 7.2mg dose option has received MHRA approval. That titration process exists to help your body adjust, and the pace is set by your prescriber based on how you're tolerating each level. People sometimes assume the first pen is the treatment dose; it's really an adjustment phase. If you're wondering how overweight you need to be for Wegovy, that page sets out the thresholds clearly and is a good place to start building your understanding, and our guide to how overweight you need to be to use Wegovy goes into further detail on how those criteria apply in practice.

What happens at the consultation, and what the prescriber is actually checking

If you're considering starting treatment through a private pharmacy, knowing what the consultation involves tends to reduce a lot of the anxiety around it. At nume, every consultation is reviewed personally by a GPhC-registered Independent Prescriber, a real clinician reads your answers, not a piece of software. That review covers your BMI, your medical history, any weight-related conditions you have, medicines you're already taking, and whether there are any reasons semaglutide wouldn't be safe for you.

Certain conditions mean semaglutide isn't suitable, including a personal or family history of medullary thyroid carcinoma or MEN2, a history of pancreatitis, or current pregnancy or breastfeeding. It isn't licensed for under-18s. Your prescriber will ask about these specifically, and you'll have the opportunity to raise anything you're unsure about. Aftercare continues after your first pen arrives: our clinical team is available seven days a week, and questions can always reach us via the contact page.

If you're uncertain whether your BMI and health history meet the criteria, the simplest next step is the free consultation itself, the prescriber will give you a clear answer. Those who are only slightly overweight and considering Wegovy may find it particularly useful to read about how eligibility works at the lower end of the BMI range before booking. Orders placed before 12pm on weekdays, once approved, are dispatched the same day by DPD and arrive the next working day in plain packaging. You can learn more about our clinical team at our prescriber profile page. When you're ready, start your free consultation and a prescriber will review your details the same day, including a clear answer on how overweight you have to be for Wegovy based on your individual circumstances.