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Is Tirzepatide Right for You? Eligibility Guide

November 28, 2024·6 min read

Tirzepatide is a prescription medication, which means it's not available to everyone. Understanding the eligibility criteria can help you determine whether to discuss this option with your healthcare provider.

FDA-Approved Indications

Tirzepatide is currently approved for two distinct uses, each with its own eligibility criteria:

Weight Management (Zepbound)

Approved for chronic weight management in adults with:

  • BMI of 30 or greater (obesity), or
  • BMI of 27 or greater (overweight) with at least one weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol
Type 2 Diabetes (Mounjaro)

Approved to improve blood sugar control in adults with type 2 diabetes, as an adjunct to diet and exercise. Used when:

  • First-line treatments like metformin are insufficient
  • Additional glycemic control is needed
  • Weight management is a concurrent goal

Understanding BMI Requirements

Body Mass Index (BMI) is a key eligibility factor. While BMI is an imperfect measure of health, it's the standard metric used in clinical guidelines and insurance criteria.

25–29.9

Overweight — may qualify with a weight-related condition (BMI ≥27)

30–39.9

Obesity — generally qualifies for weight management indication

40+

Severe obesity — strong candidate; may have additional treatment options

Your healthcare provider will assess your overall health picture, not just your BMI, when determining if Tirzepatide is appropriate.

Weight-Related Conditions That May Qualify You

If your BMI is between 27 and 30, having one or more of these conditions may make you eligible:

High blood pressure (hypertension)

Type 2 diabetes

High cholesterol (dyslipidemia)

Obstructive sleep apnea

Cardiovascular disease

Non-alcoholic fatty liver disease

Who Should Not Take Tirzepatide

Tirzepatide is not appropriate for everyone. You should not take this medication if you have:

  • Personal or family history of medullary thyroid carcinoma (MTC) — Tirzepatide carries a boxed warning about thyroid C-cell tumors observed in animal studies.
  • Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) — This genetic condition increases the risk of thyroid cancer.
  • Known hypersensitivity — If you've had a serious allergic reaction to Tirzepatide or any of its components.
  • Type 1 diabetes — Tirzepatide is not approved for type 1 diabetes and should not be used as a substitute for insulin in insulin-dependent patients.
  • History of pancreatitis — Use with caution; your provider will weigh the risks and benefits carefully.
  • Pregnancy or planning to become pregnant — Tirzepatide should be discontinued at least 2 months before a planned pregnancy due to its long washout period.

What to Discuss with Your Provider

Your complete medical history

Be thorough about existing conditions, especially thyroid issues, pancreatitis, gallbladder disease, kidney problems, and any history of eating disorders.

Current medications

Tirzepatide can interact with other medications, particularly oral contraceptives (absorption may be reduced) and insulin or sulfonylureas (increased hypoglycemia risk).

Previous weight loss attempts

Many insurance plans require documentation of prior weight management efforts (diet, exercise, other medications) before approving coverage for Tirzepatide.

Realistic expectations

Discuss what results are reasonable for your situation. Clinical trial averages are helpful benchmarks, but individual results vary based on many factors.

Medical disclaimer: This guide is for informational purposes only and does not constitute medical advice. Only a qualified healthcare provider can determine whether Tirzepatide is appropriate for your individual circumstances. Do not start or stop any medication without consulting your provider.

Find Out If You're Eligible

Schedule a consultation with a healthcare provider to discuss your eligibility and treatment options.

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