Adults with a body mass index of 25 to 26.9 do not qualify for GLP-1 weight-loss drugs, but about half of them may carry heart risk similar to people who do, according to research presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Milan.
The analysis, led by Karen Hvid of Copenhagen University Hospital in Herlev, Denmark, followed more than 313,000 adults with overweight or obesity in the UK and Denmark. People in the 25 to 26.9 BMI range who also had high remnant cholesterol, low-grade inflammation, or both had heart disease risk comparable to that of people eligible for semaglutide or tirzepatide.
The finding does not change who can get a prescription today. It does sharpen a question many U.S. patients already face: whether a BMI cutoff is the best way to decide who gets access to drugs that insurers cover selectively and that can be costly out of pocket.
Inside the 313,000-Person Analysis
According to the EASD summary published by News-Medical, the researchers drew on two long-running population studies: the UK Biobank and the Copenhagen General Population Study. Participants had a BMI of 25 or higher, a median age of 58, roughly equal numbers of men and women, and no coronary heart disease or diabetes at the start.
Over follow-up of more than 10 years, 23,134 people developed coronary heart disease, defined as a diagnosis, heart attack, bypass surgery, an artery-opening procedure, or cardiovascular death. About two-thirds of participants, 204,850 people, met current GLP-1 eligibility for weight loss.
More than 90% of those who were not eligible had a BMI of 25 to 26.9. Within that range, 44% of the Danish group and 48% of the UK group had high remnant cholesterol, low-grade inflammation, or both.
Among ineligible participants, those with both markers were 41% (Denmark) and 47% (UK) more likely to develop heart disease than ineligible participants with healthy levels. By comparison, eligible participants had 41% and 35% higher risk, respectively.
"They had a similar risk of coronary heart disease as those who were eligible for GLP1-RAs for weight loss," Hvid said in the EASD summary, adding that under current rules they would not be prescribed the drugs. "Our study makes the case for extending the indication to this group. Clinical trials are now needed."
Current U.S. Rules Draw the Line at BMI 27
In the United States, weight-loss approvals for semaglutide (Wegovy) and tirzepatide (Zepbound) cover adults with a BMI of 30 or higher, or 27 or higher with at least one weight-related condition such as high blood pressure, abnormal cholesterol, or type 2 diabetes. A person with a BMI of 26 does not qualify for that use, whatever their blood work shows.
Similar thresholds shape public coverage. Under the federal Medicare GLP-1 Bridge, which runs from July 1, 2026, through Dec. 31, 2027, eligible Part D enrollees pay $50 a month for certain GLP-1 drugs. Qualification requires a BMI of 35 or higher; a BMI of 30 or higher with heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease stage 3a or higher; or a BMI of 27 or higher with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease.
No pathway covers a BMI below 27. A KFF analysis of the Medicare program also notes that the $50 copay does not count toward the Part D deductible or the $2,100 out-of-pocket cap in 2026, which could matter for lower-income beneficiaries.
Broadening eligibility to a BMI of 25 to 26.9 would raise spending questions for Medicare, Medicaid, and employer plans. The research team did not estimate costs, and no U.S. agency has proposed changing the thresholds based on this work.
For patients, the gap shows up at the pharmacy counter. Someone with a BMI of 26 and poor blood work may carry heart risk similar to a neighbor with a BMI of 28, yet only the neighbor can be prescribed the drug for weight loss and potentially have it covered. Anyone outside the approved use who still wants the medication generally faces full cash prices, and most commercial plans limit coverage to approved uses.
Limits That Keep This From Changing Prescriptions Now
This was an observational analysis presented at a scientific meeting, and a full peer-reviewed paper has not been released. It shows that some ineligible adults share a risk profile with eligible ones. It does not show that GLP-1 drugs would reduce heart disease in that group; only a clinical trial can answer that.
The participants lived in the UK and Denmark, so the findings may not reflect the racial, ethnic, and income diversity of U.S. patients. The EASD summary did not disclose funding sources or author conflicts of interest, which readers should keep in mind until the full paper appears.
Patients with a BMI of 25 to 26.9 Can Still Ask About Heart Risk
For readers just below the eligibility line, the practical step is a fuller heart-risk check, not a GLP-1 prescription. Remnant cholesterol can be estimated from a standard lipid panel, and a clinician can decide whether an inflammation marker such as high-sensitivity CRP is worth testing.
Established options for lowering heart risk, including cholesterol-lowering medication, blood pressure control, quitting smoking, and physical activity, do not depend on BMI. People should not buy GLP-1 drugs from unverified online sellers to get around eligibility rules.
EASD 2026 runs through Oct. 2, and more GLP-1 heart data is expected this week. MedicalDaily will update this report if the findings are published in full.
Key Questions Answered
What did the study find?
About half of adults with a BMI of 25 to 26.9 had high remnant cholesterol, inflammation, or both, and their heart disease risk resembled that of GLP-1-eligible adults.
Does this mean people with a BMI of 25 should take GLP-1 drugs?
No. The study did not test the drugs in this group. The researchers said clinical trials are needed.
Who is eligible for GLP-1 weight-loss drugs now?
In the U.S., adults with a BMI of 30 or higher, or 27 or higher with a weight-related condition.
Does Medicare cover GLP-1 drugs for weight loss?
Eligible Part D enrollees can get certain GLP-1 drugs for $50 a month through the Medicare GLP-1 Bridge, which requires a BMI of at least 27 plus qualifying conditions, or a BMI of 35 or higher.
What is remnant cholesterol?
It is cholesterol carried in particles other than LDL and HDL. It can be estimated from a standard lipid panel.
What can people below the BMI cutoff do?
Ask a clinician for a full heart-risk assessment and discuss proven options such as cholesterol and blood pressure treatment.
Published by Medicaldaily.com
