Doesn't matter. I asked how significantly overweight I had to be to have access and the insurance company told me there's no weight-- it's purely obesity related health condition only. Theoretically also I could be 10 lbs overweight and diabetic and get a fast track to ozempic, lol.

At one point my family medicine guy suggested he could write down something arguable just to get me to a nutritionist (think making me do some wicked pose while measuring my blood pressure and then writing it down as "high blood pressure") and I told him just don't bother. We did however in future meetings ensure I always had something else to talk about besides my weight progress so I'd never get billed again.

They usually consider you for surgery if your bmi is over 40 and you've tried ( and failed) conservative approaches to weightloss.

No, that's not the case for many insurance companies. My insurance company only qualified surgery if you had a qualifying health condition. If you were just obese you didn't qualify.

The most serious health effects tend to come not from absolute weight per se, but from excessive body fat percentage. And particularly from visceral (intra-abdominal) fat, which is far more dangerous than subcutaneous fat in terms of risk for conditions like type-2 diabetes, arteriosclerosis, and COVID-19.

The excess adipose tissue causes subtle, progressive damage which won't necessarily be obvious in the regular preventative screening exams that most younger patients receive. But as some point after age 50 or so the systems decompensate and the patient's overall health deteriorates rapidly.