Most health care providers go over risks and benefits prior to initiating any kind of treatment.

Sure, most do. I'm talking about those that do not.

and are at risk for metabolic diseases and cardiovascular complications

Seems pretty close the intended use in this case? Not sure this would qualify as the off-label use I'm talking about.

Or would you prefer that fat people remain fat until they develop diabetes (and its various associated complications) before I’m even allowed to discuss semaglutide?

When did I say that? I said nothing of the sort. I'm specifically talking about those that aren't even overweight using it, or those without risk factors for diabetes. Because that's happening, and it's happening a lot.

People don’t jump straight to an expensive injectable drug as the first option for weight management.

This is not true for everyone. Many see Ozempic as a "magic bullet" for weight loss when that is not what it is.