Can I use GLP-1 medications if my BMI is under 27?

GLP-1 medications for weight loss are not FDA-approved for BMI under 27, but some providers prescribe off-label for specific situations. Potential candidates include: BMI 25-27 with metabolic syndrome or prediabetes, normal BMI with type 2 diabetes (approved indication), normal BMI with lipodystrophy or other metabolic disorders, and patients with history of obesity who've lost weight but want maintenance support. Insurance rarely covers off-label use, requiring cash payment ($800-1,600/month). The risk-benefit ratio changes at lower BMIs - side effects may outweigh benefits for normal-weight individuals. Discuss with an obesity medicine specialist if you believe you have legitimate medical need below standard BMI thresholds. Documented medical necessity letters may help with insurance appeals.