From decision to first dose

1. Pick where your care comes from

There are four common routes. Your own primary care clinician already knows your history. An obesity medicine clinic focuses on this treatment. An online service connects you with a clinician by video, phone or a written questionnaire. Some employers and insurers run their own programs.

None is automatically better. The thing that matters is that a licensed clinician reviews your health history before anything is prescribed, and that someone is there to answer questions once you start.

2. Check whether you qualify

In April 2026 the American College of Physicians suggested starting a medicine alongside lifestyle changes for adults with obesity, meaning a body mass index (BMI) of 30 or more. It also suggested it for adults with a BMI from 27 to 30 who have type 2 diabetes, high cholesterol, high blood pressure, obstructive sleep apnea or cardiovascular disease.

The FDA labels for these medicines are worded a little differently. The Wegovy label covers adults with obesity, and adults with overweight who have at least one weight-related condition. Your own insurer may add rules on top, which is why cost and coverage come next.

3. Sort out cost and coverage

Ask your insurer whether the medicine is covered for weight loss, whether it needs prior approval, and what you would pay each month. Online services often quote one price for the visit and a separate price for the medicine, so ask for the total.

The beginner guide covers this in more depth, including programs for Medicare. See chapter 7, on getting care, and chapter 12, on costs, insurance and access, in the beginner guide.

4. Fill in the intake form

Almost every route starts with a form. It collects your height and weight, health history, current medicines, allergies, pregnancy plans and goals. Most of it is safety screening tied to warnings on the label. The next page, the intake form question by question, explains each part and gives you a worksheet to fill in first.

5. Have the visit

The visit may be a video call, a phone call, or a written review by a clinician with a chance to ask questions. The American College of Physicians says clinicians and patients should discuss benefits, harms, costs, access, other health conditions, weight goals, personal values and the label warnings. The visit page turns that list into plain questions.

6. Get the prescription filled

A pharmacy dispenses the medicine. It might be a local pharmacy, a mail-order pharmacy, or a pharmacy connected to the service you use. Ask whether it is the FDA-approved brand-name product or a compounded version made by a specialty pharmacy. The two are not the same thing, and the online service page explains why it matters.

7. Start low and step up

These medicines are started at a low dose that rises in steps. The labels describe the schedules. For the Wegovy injection that is 0.25 mg weekly for weeks 1 to 4, then 0.5 mg, 1 mg and 1.7 mg in four-week steps, with a usual maintenance dose of 2.4 mg from week 17. For Zepbound it is 2.5 mg weekly for 4 weeks, then 5 mg, and further steps of 2.5 mg with at least 4 weeks on each dose, up to a maximum of 15 mg.

These are the schedules the manufacturers describe, not a plan for you. Your prescriber decides your doses and when to move up or hold.

8. Follow up

Plan for check-ins during the first weeks and at each dose change. The beginner guide covers the common side effects in chapter 6, eating in chapter 8, muscle in chapter 9, and stopping or pausing in chapter 10. A registered dietitian can help with food, especially during dose increases.

Questions to ask

• Which clinician will review my history, and are they licensed where I live?
• What is the total monthly cost, including the visit and the medicine?
• Who do I contact if I have side effects, and how fast do they reply?
• When is my first follow-up, and what will it cover?

What is still unknown

• How long each stage takes varies widely by clinic and service.
• Coverage and price rules change often. Check them close to the time you start.