VentralinkYou may qualify if you have a BMI of 30 or higher, or a BMI of 27+ with a weight-related health condition like diabetes, high blood pressure, or sleep apnea.
Cost is a real barrier — list prices run $1,000-1,800/month, but self-pay programs ($299-499/month), insurance coverage, and savings cards can significantly reduce costs.
These are long-term medications — stopping often leads to weight regain. Be prepared for an ongoing commitment, not a short-term fix.
Alternatives exist — older medications like Qsymia and Contrave cost less and are easier to get, though they typically produce less weight loss.
Your doctor is your partner — bring specific questions about your health history, insurance coverage, and what to expect.
You've made it through the whole series. You understand how GLP-1 medications work, you've seen the trial data, and you know what side effects to expect. Now comes the real question: is this the right choice for you?
There's no one-size-fits-all answer. What works beautifully for one person might not be the right fit for another — because of medical history, insurance, cost, personal preferences, or simply where you are in your health journey. This article will help you think through the decision systematically.
Who Are These Medications Designed For?
The FDA has established specific criteria for who can be prescribed GLP-1 medications for weight loss. These aren't arbitrary rules — they're based on the populations studied in clinical trials and where the benefits clearly outweigh the risks.
You May Qualify If:
- •BMI of 30 or higher (the clinical threshold for obesity), OR
- •BMI of 27 or higher with at least one weight-related health condition, such as:
- • Type 2 diabetes or prediabetes
- • High blood pressure
- • High cholesterol
- • Obstructive sleep apnea
- • Heart disease
- • Fatty liver disease (NAFLD/NASH)
To put this in perspective: a BMI of 30 for someone who is 5'6" means weighing about 186 pounds. For someone 5'10", it's about 209 pounds. A BMI of 27 at these heights would be around 167 and 188 pounds, respectively. (Not sure where you fall? The CDC's BMI Calculator can help.)
But BMI isn't the whole story. Your doctor will also consider your overall health status, medical history, previous weight loss attempts, and what medications you're currently taking.
Questions to Ask Yourself
Before your doctor's appointment, it's worth doing some honest self-reflection. These medications work best when you're ready to commit to the process.
🤔 Personal Readiness Check
- → Have I genuinely tried diet and exercise changes and found them insufficient on their own?
- → Am I prepared to take a weekly injection for the foreseeable future — potentially years?
- → Can I handle potential side effects like nausea, especially in the first few weeks?
- → Am I willing to make dietary changes alongside the medication (eating less, focusing on adequate protein intake (1.2–1.6 g/kg/day is recommended to preserve muscle)?
- → Do I understand that stopping the medication often means regaining weight?
- → Is my weight affecting my health, mobility, or quality of life in ways I want to change?
If you answered "yes" to most of these, you're likely a good candidate from a readiness standpoint. If several gave you pause, it might be worth exploring other options first — or having an honest conversation with your doctor about your concerns.
Preparing for Your Appointment
Your doctor will want to understand your full picture to help determine if a GLP-1 medication is right for you. Coming prepared can make the conversation more productive:
📋 What to Bring or Be Ready to Discuss
- → Your weight history and what approaches you've tried before (diets, programs, other medications)
- → Your current medications and any relevant health conditions
- → Your insurance card — many offices can check coverage in real-time
- → Your goals and any concerns you have about starting medication
This is a two-way conversation. Your doctor can explain which medication might work best for your situation, what to expect, and how they'll support you through the process. Don't hesitate to ask about anything that's on your mind — whether it's about side effects, cost, or how long you'd need to stay on the medication.
The Cost Reality
Let's be direct: cost is a major barrier for many people. The list prices for these medications are high, and insurance coverage is inconsistent. But the landscape has improved significantly, and there are more options than there were even a year ago.
| Scenario | Typical Monthly Cost |
|---|---|
| List price (no insurance, no discounts) | $1,000 – $1,800 |
| Insurance with savings card (if covered) | $25 – $200 |
| Manufacturer self-pay programs LillyDirect for Zepbound, NovoCare for Wegovy | $299 – $499 |
| Medicare (limited coverage) May cover for heart disease or sleep apnea, not weight loss alone | Varies by plan |
| Medicaid (varies by state) Only 13 states cover GLP-1s for obesity as of late 2024 | Varies by state |
Tips for Navigating Cost
1. Check your insurance first. Call the pharmacy benefits number on your card. Ask specifically: "Is Wegovy (or Zepbound) covered for weight management? What's my copay? Is prior authorization required?"
2. Ask about manufacturer programs. Both Eli Lilly (Zepbound) and Novo Nordisk (Wegovy) have reduced their self-pay prices significantly. If you can't get insurance coverage, these programs can cut costs by 60-70% compared to list price.
3. Consider the indication. Insurance may cover Wegovy for heart disease risk reduction (if you have cardiovascular disease) or Zepbound for sleep apnea (if you have that diagnosis) more readily than for "weight loss" alone.
4. Appeal denials. More than 65% of insurance appeals succeed with proper documentation. Your doctor can help with a letter of medical necessity.
⚠️ A Word on Compounding Pharmacies
During drug shortages, compounded versions of semaglutide and tirzepatide were permitted. As of early 2025, the FDA has tightened regulations on compounded versions since the shortages have resolved. If you're currently using a compounded version, talk to your doctor about transitioning to FDA-approved options.
What to Expect If You Start
Setting realistic expectations is crucial for success. Here's a general timeline based on what most patients experience:
wks
Adjustment Phase
Starting dose (2.5 mg). Mild side effects common — nausea, decreased appetite. Modest weight loss (2-5 lbs), much of it water weight. Focus on tolerating the medication.
mos
Dose Escalation
Gradual dose increases every 4 weeks. Side effects often improve. Appetite suppression becomes more noticeable. Expect 5-10% body weight loss. Many people report feeling "in control" of eating for the first time.
mos
Maintenance Dose
Reaching your target dose. Significant weight loss becomes visible — 10-15% of body weight for most people. Health markers often improve: blood pressure, blood sugar, cholesterol.
mos
Maximum Benefit
Peak weight loss typically achieved (15-20%+). Weight may plateau, which is normal. Focus shifts to maintenance. Lifestyle habits become more important than ever.
mos
Long-Term Management
Ongoing medication to maintain weight loss. Continued monitoring by your doctor. Possible dose adjustments based on your response and goals.
Remember: these are averages. Some people lose weight faster, others slower. Plateaus are normal and don't mean the medication has stopped working.
When These Medications Might NOT Be Right
GLP-1 medications aren't for everyone. Here are situations where a different approach might be better:
🚫 Medical Contraindications
Do not use GLP-1 medications if you have: personal or family history of medullary thyroid carcinoma (MTC), Multiple Endocrine Neoplasia syndrome type 2 (MEN2), history of severe pancreatitis, or are pregnant or planning to become pregnant.
⚠️ Situations to Discuss Carefully with Your Doctor
- • History of eating disorders — these medications affect appetite and eating patterns in ways that could be triggering
- • Gastroparesis or severe GI conditions — GLP-1s slow stomach emptying further
- • Gallbladder problems — rapid weight loss increases gallstone risk
- • Kidney disease — dose adjustments may be needed
- • Retinopathy (in diabetes) — rapid blood sugar changes can worsen eye problems temporarily
Practical Reasons to Consider Alternatives
Even without medical contraindications, GLP-1s might not be the best choice if:
You can't afford them. If the monthly cost would cause significant financial stress, older medications or intensive lifestyle programs might be more sustainable.
You're not ready for long-term medication. If you're looking for a short-term boost to lose weight for an event, these aren't designed for that. Weight typically returns when you stop.
You haven't yet tried structured lifestyle changes. For some people, a comprehensive program with nutrition counseling, exercise guidance, and behavioral support can be remarkably effective — without medication.
You strongly dislike injections. While oral semaglutide (Rybelsus) exists for diabetes, the weight-loss formulations are primarily injectables. Some people simply cannot tolerate giving themselves shots.
Alternatives to Consider
GLP-1 medications aren't the only option. Here's how other approaches compare:
Intensive Lifestyle Program
Structured diet + exercise + behavioral coaching. Lower cost, no side effects, but requires significant time and effort. Works best with ongoing support.
Qsymia (phentermine/topiramate)
Daily pill. More affordable (~$200/month). Not for those with heart conditions or glaucoma. Can cause dry mouth, tingling, mood changes.
Contrave (naltrexone/bupropion)
Daily pill. Good option if you also have depression. Not for those with seizure history or taking opioids. May cause nausea, constipation, headache.
Bariatric Surgery
Most effective for severe obesity (BMI 40+). Permanent anatomical change. Requires careful evaluation and lifelong follow-up. Covered by many insurance plans.
Note that weight loss percentages are averages from clinical studies. Individual results vary significantly based on adherence, starting weight, and other factors.
A Framework for Deciding
Pulling this all together, here's a practical decision framework:
Consider a GLP-1 medication if:
You meet the BMI criteria (≥30, or ≥27 with a weight-related condition)
You've tried diet and exercise and found them insufficient alone
You have no medical contraindications
You can access the medication at a sustainable cost
You're committed to long-term use and lifestyle changes
You have a doctor willing to partner with you on ongoing management
If most of these boxes check out, GLP-1 medications could be a powerful tool in your health journey. If several don't apply, one of the alternatives might be a better starting point — or you might need to address barriers (like cost or finding the right doctor) before moving forward.
Final Thoughts
We've covered a lot of ground in this series — from the biology of obesity and the limits of willpower, through the landmark trials that changed what's possible, to the practical realities of side effects and costs.
Here's what I want you to take away:
These medications are genuinely transformative for many people. The evidence is clear: 15-20% weight loss is achievable, along with meaningful reductions in heart disease, diabetes risk, and other conditions. For people who've struggled for years, this can be life-changing.
But they're not magic. They require commitment — to taking the medication consistently, to adapting your eating habits, to working with your healthcare team over the long term. They work with your efforts, not instead of them.
The decision is personal. What's right for your neighbor or your cousin or someone on social media might not be right for you. Take the time to understand your options, have honest conversations with your doctor, and make the choice that fits your life.
Thank You for Reading
This completes our six-part series on obesity and GLP-1 medications. Our goal was to give you the knowledge to make informed decisions about your health — with your doctor, based on evidence, in a way that works for your life.
Whatever you decide, we're rooting for you.
Understanding Obesity & GLP-1 Medications
- ✓ The Epidemic: How Obesity Became a Crisis
- ✓ Lifestyle Interventions: What Actually Works
- ✓ GLP-1 Medications: How They Work
- ✓ The Evidence: What the Trials Show
- ✓ Side Effects: Separating Fact from Fear
- Is This Right for You? A Decision Guide ← You are here