The dramatic weight loss results produced by GLP-1 medications have generated significant excitement — but not everyone is a good candidate for semaglutide or tirzepatide. A physician evaluation before starting these medications is essential to assess appropriateness, identify contraindications, and establish a safe and effective treatment plan. Here are the eight key questions physicians use to evaluate candidacy for GLP-1 weight loss therapy.
1. Does Your BMI Meet the Clinical Threshold?
FDA-approved indications for Wegovy (semaglutide 2.4 mg) and Zepbound (tirzepatide 15 mg) for weight management include: a BMI of 30 or greater (obesity), OR a BMI of 27 or greater with at least one weight-related comorbidity such as type 2 diabetes, hypertension, high cholesterol, or obstructive sleep apnea. Your physician will calculate your BMI and assess comorbidities to determine whether you meet criteria.
2–8: Medical History Questions That Matter
- Personal or family history of thyroid cancer (specifically medullary thyroid cancer): GLP-1 medications carry a black box warning for a rare association with thyroid C-cell tumors. This is an absolute contraindication.
- History of Multiple Endocrine Neoplasia syndrome (MEN 2): Another contraindication related to the thyroid cancer concern.
- History of pancreatitis: GLP-1 medications may increase pancreatitis risk — active or recent pancreatitis is a contraindication.
- Current medications: Particularly insulin and sulfonylureas, which increase hypoglycemia risk when combined with GLP-1 agents.
- Gastrointestinal conditions: Gastroparesis (delayed stomach emptying) can be worsened by GLP-1 medications that further slow gastric emptying.
- Pregnancy or planned pregnancy: GLP-1 medications should be discontinued at least two months before attempting pregnancy.
- Willingness for ongoing physician follow-up: These medications require dose titration, side effect monitoring, and regular check-ins — not a one-and-done prescription.
Dr. Arpana Pillay at Vish Medical conducts a thorough candidacy evaluation as part of the $99 GLP-1 consultation. Book your consultation to find out whether semaglutide or tirzepatide is right for you.