If you have tried diet after diet and are now wondering whether a GLP-1 injection is the answer, the honest first question is not how to get one, but whether it is safe and appropriate for you at all. For a meaningful number of people, it is not. GLP-1 medicines such as semaglutide, liraglutide and tirzepatide carry firm contraindications, strict eligibility criteria, and situations where the correct clinical decision is to wait. If you fall into one of the groups below, this is not the route for you, and there is an evidence-based path that is.

• A personal or family history of medullary thyroid carcinoma or MEN2 rules out all three GLP-1 obesity drugs permanently, regardless of BMI.
• Pregnancy and breastfeeding are absolute contraindications for all three agents.
• India's obesity criteria require a BMI above 27, or above 25 with at least one documented comorbidity such as hypertension, type 2 diabetes, or sleep apnoea.
• Several conditions, including severe gastroparesis, active suicidal ideation, and serious gallbladder disease, may prompt a clinician to hold off or choose a different approach.
• If a GLP-1 is not the right tool, that is not the end of the road. Structured lifestyle change and treatment of the underlying condition are evidence-based alternatives.

1. Contraindicated

What it means: A specific medical history makes the drug unsafe for you.
What this means for treatment: The drug is not an option, regardless of your weight.

2. Not eligible

What it means: You do not meet India's obesity criteria for pharmacotherapy.
What this means for treatment: You do not have a contraindication, but the drug is not currently indicated.

3. Defer for now

What it means: You may qualify for treatment, but another issue needs to be addressed first.
What this means for treatment: Stabilise or address the other issue, then reassess with a clinician.

Each is covered below. This page explains who should step back from GLP-1 medication. Voy covers how the drugs work separately in its GLP-1 knowledge hub.

Some medical histories rule out a GLP-1 medication completely. India's 2025 ESI obesity guideline lists contraindications for each drug individually, and the absolute ones are consistent across all three GLP-1-based agents used for weight management.

All three agents, liraglutide 3 mg, semaglutide 2.4 mg, and tirzepatide, share the same absolute contraindications:

• Personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN2)
• Pregnancy or breastfeeding
• Prior serious hypersensitivity reaction to that specific drug

Medullary thyroid carcinoma and MEN2 are the hard line. If you, a parent, a sibling or a child have either, these drugs are excluded whatever your BMI, a restriction carried over from the Saxenda liraglutide label and mirrored for semaglutide and tirzepatide. Pregnancy and breastfeeding are also absolute. WHO's 2025 guideline recommends long-term obesity use in adults while explicitly excluding pregnant women. A prior serious allergic reaction to a given drug rules out that same drug.

Two further situations behave like contraindications even where a label stops short of the word. Type 1 diabetes and diabetic ketoacidosis are "not indicated" for these agents, so using them in place of insulin is unsafe off-label use. A confirmed episode of pancreatitis while on a GLP-1 is treated by South Asian expert consensus as a "stop and do not restart" event, which functions as a bar on future GLP-1 use even though the global labels frame it as a serious warning rather than a formal contraindication.

Beyond the absolute list, several conditions push the risk-benefit balance far enough that a clinician may hold off or choose a different approach. These appear as warnings in the ESI guideline.

• Gallbladder disease: Rapid weight loss raises gallstone risk, and acute gallbladder disease has been observed more often on treatment than on placebo even after accounting for weight lost. Known gallstones or prior biliary problems usually warrant careful evaluation first.
• Renal impairment: Severe vomiting or diarrhoea on these drugs can cause dehydration, and post-marketing reports include acute kidney injury and worsening chronic kidney disease. Moderate-to-severe kidney disease is a high-risk setting.
• Severe gastrointestinal disease: Because these drugs slow gastric emptying, documented gastroparesis, prior bowel obstruction or severe motility disorders are typically grounds for exclusion or deferral.
• Active depression or suicidal ideation: Trials excluded people with active suicidal ideation or prior attempts, and the guidance is to monitor mood and stop if suicidal thoughts emerge. Where this history is present, intensive psychological and lifestyle support is generally favoured first.
• Planned major surgery: International anaesthesia guidance flags delayed gastric emptying and a possible aspiration risk under general anaesthesia. Starting a weekly GLP-1 shortly before major surgery is widely regarded as ill-timed.

None of these is an automatic "never." Each is a reason a registered clinician may decide the medication is the wrong tool, or the wrong tool right now.

Plenty of people who feel stuck at a frustrating weight simply do not qualify, and that is not a contraindication, it is the absence of an indication. As of 2026, the ESI guideline recommends anti-obesity pharmacotherapy only at a BMI above 27, or above 25 when at least one weight-related condition such as hypertension, dyslipidaemia, type 2 diabetes or obstructive sleep apnoea is present. These thresholds are lower than the classic Western "BMI 30 or above" because South Asians carry higher metabolic risk at lower body weight.

An Indian adult with a BMI below 25 and no significant comorbidity, or one in the overweight band of 23 to 24.9 with no documented hypertension, abnormal lipids, prediabetes, fatty liver or sleep apnoea, would usually not meet the criteria for these drugs, however many diets have failed before. If that describes you, a GLP-1 prescription is not the missing piece.

Some people meet the criteria and have no contraindication, yet the right move is to defer. These are common "eligible but not yet" situations.

• Planning a pregnancy: Guidance is to stop semaglutide at least two months before trying to conceive, with contraception continued for up to three months after stopping any anti-obesity drug. For a woman with PCOS and near-term fertility plans, GLP-1 therapy is generally considered premature. Optimising thyroid status, cycle regularity and lifestyle usually comes first.
• Untreated disordered eating: No GLP-1 label names eating disorders as a contraindication, but given how strongly these drugs suppress appetite, most Indian obesity clinicians will delay starting until active bulimia, binge-eating disorder or severe restriction is properly treated. This is clinical convention, not label wording.
• Unstable comorbidities: Markedly off-range thyroid function, uncontrolled diabetes or untreated severe hypertension are usually stabilised first, so that symptoms are not misattributed and monitoring stays clean.

Being ruled out of GLP-1 medication does not mean being out of options. When a GLP-1 is contraindicated, not indicated, or premature, the evidence supports a clear sequence:

1. Identify and treat the underlying condition: PCOS, hypothyroidism, eating disorders and mood conditions each have their own established treatments. Addressing these directly often shifts the metabolic picture significantly before any pharmacotherapy is considered.
2. Start a structured lifestyle programme: In a two-year Indian trial, a family-based lifestyle programme delivered a 2.61 kg greater weight reduction, a 1.06 kg/m² fall in BMI and a 4.17 cm reduction in waist circumference compared with controls, all statistically significant. Those are smaller numbers than a drug trial reports, but they meaningfully lower diabetes and cardiovascular risk, and they come without any of the contraindications above.
3. Reassess with a clinician after stabilising: Many people who defer today will qualify later. A "defer for now" decision is not a permanent exclusion. A registered medical practitioner can work out which conditions are in play and treat them directly, then revisit pharmacotherapy once the picture is stable.

And if a GLP-1 medicine is not right for you, then it is not right for you, and this is the path that is.

Not sure whether a GLP-1 is right for you?

A Voy clinician-led metabolic assessment starts with exactly this question. Before any treatment decision is made, a registered specialist assesses your eligibility, checks for contraindications, and works out whether a GLP-1 is appropriate or whether a different path makes more clinical sense for you.

This article is for general information and education only and is not medical advice, diagnosis, or treatment. GLP-1 and other medications referenced are prescription-only and are appropriate only for certain people under the supervision of a qualified clinician. Do not start, stop, or change any medication based on this article. Please consult a registered medical practitioner about your individual circumstances. Information reflects what was available at the time of review and may change.