GLP-1 for Overweight BMI 25: A Case for Trials

GLP-1 for overweight BMI 25 is a question worth studying, not a new rule that makes someone qualify. A September analysis found raised heart risk in many people just below usual weight-treatment thresholds. It did not test whether a GLP-1 medicine helped them.

BMI means body mass index, a measure of weight relative to height. GLP-1 medicines act on a gut-hormone signal involved in appetite and blood sugar. The news asks whether heart risk should matter more when deciding whom to study next.

GLP-1 for overweight BMI 25: what happened

As of October 1, 2026, the day this article was written, an EASD release dated September 27 makes a case for trials in this overlooked group. EASD is the European Association for the Study of Diabetes. Its annual meeting is taking place in Milan.

Dr. Karen Hvid, of Copenhagen University Hospital in Herlev, Denmark, and colleagues analyzed two groups followed over time. These were the Copenhagen General Population Study and UK Biobank. Together, they included 313,145 people with BMI at least 25, initially without diabetes or coronary heart disease, disease affecting the heart's arteries.

Follow-up exceeded ten years, reaching 18 years in Copenhagen and 15 in the UK. Researchers recorded 23,134 coronary heart disease cases.

Among people with BMI 25–26.9, raised cholesterol remnants, inflammation, or both were common: 44% in Copenhagen and 48% in the UK. That's close to half. Their risk was comparable to people meeting the study's weight-treatment eligibility criteria.

The official EASD programme lists this as abstract 704. Hvid's next-step statement matters: “Clinical trials are now needed.” This is evidence about risk, rather than a treatment result for semaglutide.

What those blood markers mean

Remnant cholesterol is cholesterol carried in particles left after the body processes fats in the blood. It is separate from LDL, the cholesterol commonly called “bad,” and HDL, which helps carry cholesterol away.

Low-grade inflammation means a persistent, low-level immune response. Researchers can assess it using hsCRP, a sensitive blood test for C-reactive protein, a marker of inflammation.

These markers give information that a weight-to-height number cannot supply. Two people with the same BMI can have different blood results and different health histories. The conference finding is a reason to examine that difference more closely.

There is earlier evidence behind the idea. Doi and colleagues' 2023 Atherosclerosis study followed 103,221 Danish adults. Half were followed for at least 9.5 years. Higher levels of both markers were associated with higher heart and artery risk than either alone.

That study also observed people rather than assigning a treatment. A marker linked to later illness does not automatically identify which medicine will help, or how much.

Who qualifies for GLP-1 treatment now?

The September presentation does not change a medicine's label. An indication is the specific use listed on that label. A provider considers the intended use, the person's history, and the evidence together.

As of October 1, 2026, the day this article was written, the current Wegovy prescribing information reads “Revised: 6/2026.” Its adult weight-management indication covers obesity, or overweight with at least one weight-related condition. The usual adult weight-treatment thresholds are BMI at least 30, or at least 27 with a related condition, such as high blood pressure. Those numerical thresholds appear in the label's weight-management trial descriptions.

The heart-risk indication needs a separate reading. Section 1 says adults with established cardiovascular disease, meaning existing disease of the heart or blood vessels, and either obesity or overweight. It does not print a BMI ≥27 cutoff there.

SELECT, the trial supporting that use, enrolled people with BMI at least 27 and existing cardiovascular disease. Its enrollment threshold and the indication's wording are different facts. Neither establishes heart protection for the disease-free, BMI 25–26.9 group in the new analysis.

Tirzepatide was also named in the EASD release's discussion of weight-treatment eligibility. Changing medicines does not turn this finding about risk into evidence that a person now qualifies.

What the study cannot mean for treatment

An observational study tracks what happens to people without assigning them a medicine. It can identify associations worth testing. Other differences between the groups may help explain the result, even after researchers account for measured factors.

A randomized trial assigns treatments by chance, making the groups more comparable. SELECT's original paper, published in the New England Journal of Medicine in 2023, used that design. It studied people with existing cardiovascular disease and BMI at least 27, without diabetes. Our SELECT results guide explains its heart outcomes and side effects.

As of October 1, 2026, the day this article was written, a SELECT analysis published September 23 in the European Heart Journal adds useful caution. It examined whether changes in weight, inflammation, and other known risk factors explained the trial's heart result. The authors could not confidently explain the full effect through those changes. This analysis still concerns SELECT's population; it does not extend its findings to people below its entry threshold.

More prescriptions outside usual populations are a different story. The GLP-1 without diabetes or obesity study describes prescribing patterns. Use becoming more common does not establish the balance of benefits and harms.

What this means for a compounded prescription

The new Copenhagen and UK analysis did not test Promise's semaglutide or tirzepatide. It supplies no outcome estimate for either preparation.

Through Promise, semaglutide and tirzepatide are dispensed as compounded medications, which are different from an FDA-approved product: the formulations offered here are not FDA-approved. Compounding means a pharmacy prepares a medicine for a prescription.

As of October 1, 2026, the day this article was written, FDA's compounding explanation states that it does not verify compounded drugs' safety, effectiveness, or quality before marketing. A licensed provider may still prescribe a compounded formulation; that decision is between you and your doctor.

The useful conversation is about the actual health problem, the specific preparation, and what evidence supports that choice. A blood marker can inform that conversation. It cannot replace it.

What to watch next

The important next development would be a trial enrolling this lower-BMI group and measuring actual heart events, alongside harms and treatment stopping. Lower blood markers alone would not answer the whole question.

A fuller study report would also help readers assess how the researchers defined raised markers and accounted for other risk factors. The headline is a reason to investigate, not a personal prediction.

A prescribing conversation still includes current medicines, relevant medical history, and follow-up. Our questions to ask before semaglutide explain that review. At Promise, a licensed U.S. provider reviews every request, and not everyone qualifies. The prescriber sets the actual dose when treatment is appropriate.