The people's voice of reason
The people's voice of reason
GLP-1 medications like Ozempic, Wegovy, and Zepbound have quickly become tools for helping people with obesity and diabetes lose weight and lower blood sugar. But emerging research suggests these medicines may also offer healthspan–extending benefits for people without these conditions.
A growing number of clinicians view GLP-1 medications as an essential ingredient in a well-rounded metabolic health optimization program, even for people who don’t meet the current prescribing criteria.
While GLP-1 medications shouldn’t replace exercise, nutrition, sleep, and other healthy lifestyle changes, weight loss medications may enhance weight loss, and in many cases, make lifestyle changes possible, Hone Health reports.
Traditional medicine waits to prescribe GLP-1 medications until a patient’s BMI hits 30 (obesity) or 27 with at least one weight-related health condition, such as high blood pressure or high cholesterol. Clinicians can prescribe GLP-1s off-label for people with BMIs below 27, but insurance rarely picks up the tab.
Unfortunately, BMI—which measures only weight and height—is a poor gauge of body composition and overall health. It’s especially problematic for people between the clinical diagnoses of “overweight” and “obesity.” Here’s why:
Muscle mass and bone density skew BMI
BMI doesn’t reflect the difference between the weight of muscle and fat. Based on BMI alone, some very muscular people would qualify for GLP-1 treatment under current FDA guidelines, even though they don’t need it. A growing number of experts believe patients with BMIs of 25 or 26 who have low muscle mass (“skinny fat”) might benefit metabolically from the medication.
People with BMIs under 30 can be metabolically unhealthy
Where you carry fat on your body—a metric BMI doesn’t measure—can mean the difference between healthy and unhealthy. Visceral fat, found around vital organs like the liver and pancreas, raises inflammation and accelerates biological aging more than subcutaneous fat, which resides just under the skin. People with more visceral fat (“apple shaped”) tend to have higher cholesterol, blood sugar, and blood pressure at a given body weight than those whose fat is more evenly distributed around the body (“hourglass” or “pear-shaped”).
BMI doesn’t reflect patterns
Two people can have the same BMI but drastically different future health risks. Compare two people at the same BMI, one with relatively higher muscle mass than the other. The first person will have an easier time keeping a stable weight, and the second is more likely to consistently gain, inching their way toward diabetes and cardiovascular disease. (Most women tend to gain 1.5 pounds per year and men tend to gain 1–2 pounds per year in midlife.) Current FDA guidelines recommend waiting until this latter person becomes sick or obese (or both) to treat them with a GLP-1 medication. But by stopping and reversing this creeping fat gain, early intervention with a GLP-1 can prevent the resulting cascade of health problems.
Because BMI is such a flawed metric, the Lancet Commission—made up of 58 experts from multiple medical specialties and countries—in 2025 recommended redefining “overweight” as “preclinical obesity”—a nod to the fact that carrying extra weight increases the risk for many chronic diseases.
And earlier this year, the European Association for the Study of Obesity (EASO) released a new obesity definition that includes many people who previously would have been considered overweight.
According to this new framework, people with a BMI of 25 or higher would be classified as having obesity if they also:
Roughly one in five adults previously defined as overweight would be considered obese based on the new EASO definition—and would therefore be eligible for insurance reimbursement for GLP-1 treatment, according to a study published in the Annals of Internal Medicine.
People who are overweight (BMI in the 25 to 30 range) drop less weight on GLP-1s than those with clinical obesity, losing just 5%-10% of their body weight on average versus 15%-20% for the obese cohort.
These smaller losses may not seem as dramatic. However, they make major differences for longevity.
Hundreds of studies have linked small changes in weight to big benefits:
GLP-1s facilitate weight loss by slowing the movement of food through the gastrointestinal tract, increasing fullness, and suppressing appetite. Along the way, they help reduce inflammation and directly support heart, liver, and brain health, lessening the severity of sleep apnea, reducing the risk of heart attacks and premature mortality, easing joint pain, and boosting energy.
Newly emerging indications for GLP-1 medications—including heart disease, metabolic liver disease, peripheral artery disease, Alzheimer’s/dementia risk, and even alcohol and substance use disorders, as highlighted in a 2025 study in JAMA—suggest these drugs may soon play a much broader role in medicine than just treating diabetes or obesity. Taken together, the evidence points to a future where eligibility for GLP-1 treatment could expand significantly as guidelines catch up with the science.
Unfortunately, while growing numbers of clinicians understand the many benefits of GLP-1 medicines for early intervention and metabolic health optimization, not everyone is on board. Many traditional healthcare professionals either refuse to entertain any conversation about prescribing GLP-1 medicines or derisively tell patients they just need to try harder.
But GLP-1s are not a crutch or a form of cheating. It’s the opposite: Most people won’t lose 5% or more of their body weight without medical treatment.
Research shows that only about one in 10 people with a BMI of 25 or higher will lose 5% of their body weight and keep it off with lifestyle changes alone.
For the remaining nine in 10, a GLP-1 prescription can serve as a jumpstart, helping them lose enough weight to make important lifestyle changes possible. Others consider it simply leveling the playing field for individuals who’ve inherited genes associated with obesity.
“Food noise” is a relatively new term used to describe the incessant mental chatter around food that leads to overeating.
GLP-1s help quiet food noise by influencing the release of dopamine in the reward center of the brain. As their food noise ebbs, people say they finally have the cognitive bandwidth to stick to healthier eating—reaching for more veggies, legumes, lean proteins,and fewer sweets and chips.
Losing even a little weight on GLP-1s, often just 10 to 30 pounds, often translates to vast improvements in self-esteem, which fuels healthy habits in a positive feedback loop.
This story was produced by Hone Health and reviewed and distributed by Stacker.
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