GLP-1 medications are prescription drugs with a boxed warning, real contraindications and a clear set of criteria for who should be taking them. Online providers vary from rigorous to careless in how they apply those criteria. Knowing them yourself is the best protection you have.
The standard criteria
Across the FDA labels for Wegovy, Zepbound and Foundayo, and across almost every credible provider, the same two-part threshold applies for chronic weight management in adults:
- •BMI of 30 or higher (obesity), with no additional condition required; or
- •BMI of 27 or higher (overweight) plus at least one weight-related condition - commonly high blood pressure, type 2 diabetes, high cholesterol or dyslipidaemia, obstructive sleep apnea, or cardiovascular disease
The medications are approved as an adjunct to a reduced-calorie diet and increased physical activity, not as a replacement for them. That phrasing appears in every label and is not decorative: the trial results were produced by people taking the drug alongside a lifestyle programme.
BMI is a screening tool, not a verdict
Who should not take these medications
These are the absolute contraindications in the labels. They are not negotiable and no legitimate provider will work around them:
- •Personal or family history of medullary thyroid carcinoma (MTC). GLP-1 receptor agonists carry a boxed warning for thyroid C-cell tumours.
- •Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
- •A previous serious hypersensitivity reaction to the medication or any of its ingredients.
- •Pregnancy. These medications are not for use in pregnancy, and prescribers will normally ask you to stop well before trying to conceive.
Reasons for caution rather than exclusion
- •A history of pancreatitis - the labels carry a pancreatitis warning
- •Gallbladder disease - rapid weight loss increases gallstone risk
- •Severe gastrointestinal disease or gastroparesis - these drugs slow gastric emptying by design
- •Diabetic retinopathy - rapid improvement in blood sugar has been associated with temporary worsening
- •Type 1 diabetes - these are not a substitute for insulin
- •Insulin or sulfonylurea use - the combination raises hypoglycaemia risk and doses usually need adjusting
- •A history of eating disorders - appetite suppression interacts badly with restriction
- •Under 18 - approvals and evidence differ by product and age group
What online providers actually check
This is where the market separates. Across the providers we have reviewed, the assessment ranges from a genuine clinical encounter to a checkout button.
| Approach | What it looks like | What to make of it |
|---|---|---|
| Live consultation | A scheduled video or phone visit with a named clinician, 15 minutes or more | The most rigorous. Your history gets discussed rather than parsed |
| Asynchronous intake plus review | You complete a questionnaire; a licensed provider reviews it, often within hours | The industry norm. Adequate when the questionnaire is thorough and the provider genuinely declines people |
| Checkout with consent | You buy the product and a physician may contact you if something looks wrong | The weakest. The default is approval and the burden of catching a problem falls on a review that may never happen |
A useful signal: does the provider say out loud that it will decline people? The better sites state plainly that treatment is not guaranteed and explain what happens to your money if a clinician says no. Sites that never contemplate refusal are describing a sales funnel, not a clinical service.
Labs and bloodwork
There is no universal requirement, and practice varies widely. Some providers order labs as part of the evaluation and review them with you. Some order them only if your history warrants it. Many never mention labs at all - which is legal, and also a meaningful difference in the standard of care you are buying.
Baseline bloodwork is generally sensible: kidney function, liver function, HbA1c and a lipid panel give a prescriber something to monitor against. If you have diabetes, kidney disease or a history of pancreatitis, it is not optional in any meaningful clinical sense.
If you do not qualify
A clinician declining to prescribe is doing their job. The productive next step is asking why. If your BMI is below the threshold, a conversation about what you are actually trying to change is more useful than a different website. If a contraindication is the issue, there may be non-GLP-1 options - naltrexone-bupropion, metformin in some contexts, or a structured programme with dietitian support.
What is not a good next step is finding a provider with looser standards. The criteria exist because these drugs carry a boxed warning.