BMI vs. Body Composition: Do You Qualify for Semaglutide?

I had a patient recently who was "medically obese" according to his BMI, but he looked like a professional athlete. He was all muscle. On the flip side, I see "thin" patients with a massive amount of visceral fat around their organs who are at high risk for heart disease.

The medical world loves the Body Mass Index (BMI), but if you are looking to qualify for medications like Ozempic or Wegovy, you need to understand why that number isn't the whole story.

The Flaw in the Formula

BMI is a simple math equation: weight divided by height squared. It doesn't know the difference between a pound of fat and a pound of muscle. Because muscle is denser than fat, very active people often get "flagged" as overweight when they are perfectly healthy.

However, for insurance companies, BMI is the "gatekeeper." Most require a BMI of 30+ (or 27+ with a condition like high blood pressure) to even consider covering these drugs.

Why Body Composition Matters

What we should be looking at is Body Composition. How much of your weight is "adipose tissue" (fat) versus lean mass? Visceral fat—the kind that wraps around your liver and heart—is what actually drives metabolic disease.

If your BMI is "borderline," but you have high blood sugar or fatty liver, you are a prime candidate for GLP-1 therapy. These drugs help clear that dangerous internal fat in a way that "just dieting" often can't.

Getting the "Yes" You Need

Don't let a single number define your health journey. If you've been denied because your BMI wasn't "high enough," or if you're struggling to pay the $1,300 out-of-pocket price because your insurance is being difficult, we can help.

Our advocates look at your whole picture. We help you qualify for assistance based on your actual medical needs and financial situation, getting your cost down to $40 a month.

Stop fighting the insurance gatekeepers. Get your meds for $40/mo.