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A MedPage Today opinion article by physician Hamayle Saeed describes being screened for diabetes at a BMI of 23 under guidance for Asian Americans, while saying she was denied a GLP-1 weight-loss drug at BMI 26.5 because she did not meet the commonly applied 30-or-27 eligibility thresholds. The article points to research and updated clinical guidance, but does not establish that insurers have changed their coverage rules or that all plans apply the same criteria.
South Asian physician Hamayle Saeed says she was screened for diabetes once her body mass index reached 23, but was denied a GLP-1 drug for weight loss at a BMI of 26.5 because she did not meet the eligibility thresholds used in her case. In an October 31 MedPage Today opinion article, Saeed argues that the mismatch exposes a gap between risk guidance for Asian patients and the BMI rules applied by insurers.
Saeed writes that American Diabetes Association guidance prompted her doctor to begin diabetes screening at a BMI of 23, a lower point used for Asian Americans because diabetes can develop at lower body weights. She says that when she asked about a GLP-1 receptor agonist, she was told she did not qualify: her BMI was 26.5, she did not have diabetes, and the eligibility criteria applied to her required a BMI of 30, or 27 with a weight-related condition.
The piece describes this as a conflict between clinical risk assessment and access to treatment. Saeed cites the World Health Organization’s lower action points for Asian populations, BMI 23 and 27.5, and a study of nearly 1.5 million adults in England. In that study, the BMI associated with the diabetes risk seen among white adults at BMI 30 was 23.9 for South Asian adults and 26.9 for Chinese adults, according to Saeed’s account.
She also points to a 2025 semaglutide study, STEP 11, conducted in South Korea and Thailand using a local obesity threshold of BMI 25. Saeed reports that participants taking semaglutide lost 16% of body weight, compared with 3.1% for participants on placebo. A post hoc analysis of 68 participants who began below BMI 30 found weight loss of 17.6% among 45 semaglutide recipients and 4.4% among 23 placebo recipients. These study results do not establish that every patient below BMI 30 should receive a GLP-1 or that an insurer must cover it.
Why BMI Rules Affect Access
The issue matters because screening thresholds and drug-coverage thresholds serve different purposes, yet patients may encounter both as decisions based on the same BMI number. A lower threshold for screening can recognize elevated diabetes risk without changing the separate clinical indications, prescribing decisions, or insurance requirements for a medication. Saeed’s account illustrates how that distinction can leave some Asian patients identified as at risk but unable to obtain coverage under criteria applied to them.
Coverage restrictions also have practical consequences beyond an individual case. Saeed says Medi-Cal ended coverage of GLP-1s for weight loss in January and MassHealth did so in July. Those are claims in her opinion article; it does not provide plan documents or detail exceptions. If public coverage narrows, people who do not meet a plan’s criteria may face out-of-pocket costs or go without treatment, while patients and clinicians may need to appeal or seek clarification about the rules.
The article raises a policy question rather than resolving it: whether obesity definitions and reimbursement criteria should account for differences in risk across populations. The clinical evidence and guidance Saeed cites inform that discussion, but they do not by themselves establish how coverage should be set or prove that a different threshold would be appropriate for every patient.
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How Screening and Labels Differ
Body mass index is calculated from height and weight. Saeed says people of Asian descent may have more visceral fat and less muscle than people of European descent at the same BMI, which can make BMI a less complete indicator of body composition and metabolic risk. She cites 2025 iCARDIO global obesity guidance that places Asian BMI about two to three units below white BMI at comparable body-fat levels. These population-level observations do not determine an individual’s diagnosis.
The article says the ADA’s 2026 Standards of Care call on clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity and specifically identify South Asian patients. It also says that in June the ADA issued Asian-specific waist and BMI thresholds for diagnosing obesity. Separately, Saeed reports that US GLP-1 labels revised in 2026 describe treatment indications using terms such as obesity and overweight with a weight-related condition, while trial descriptions and payer prior-authorization forms may continue to use BMI values of 30 and 27.
Saeed cites a 2026 analysis of 352 GLP-1 trials that found BMI eligibility criteria excluded a larger share of Asian participants than non-Asian participants. For a BMI cutoff of 30, she reports eligibility rates of 13.5% for Asian Americans and 41.5% for non-Asian American adults, with a rate of 7.2% for Koreans. She also compares US payer criteria with guidance from the UK’s National Institute for Health and Care Excellence, which she says lowers its BMI starting point by 2.5 units for several ethnic groups. These figures and policy descriptions are reported in the opinion article and have not been independently verified here.
“The ADA guideline that flags me for annual diabetes screening and the prior authorization form that denies me the drug are describing the same 26.5. Only one of them was written with an Asian body in mind.”
— Hamayle Saeed, MD, in a MedPage Today opinion article
Which Coverage Rules Apply
The opinion article does not identify the health plan or provide the denial letter, so the specific coverage policy behind Saeed’s case is not independently established. Prior-authorization criteria can differ by insurer, plan, drug, indication, and patient history. The article’s description of common 30 and 27 BMI thresholds should not be read as proof that every US plan uses the same rules.
It is also unclear whether the label revisions Saeed describes have led payers to change their forms, whether ethnicity-adjusted criteria are used in particular coverage decisions, or how regulators and insurers would weigh the cited research. A study’s average results do not show that a treatment is suitable for every person below BMI 30. The article does not report a response from an insurer, drug manufacturer, or ADA representative on the specific case or on proposed changes to coverage.
The Next Steps for Coverage
The next practical step for readers facing a similar decision is to check the current prescribing information and their own plan’s written criteria, since coverage requirements can vary. Patients can ask a clinician or insurer whether a denial can be reviewed or appealed and what documentation is required. Saeed’s article does not say whether she appealed her own denial.
For the broader policy issue, attention is likely to turn to whether insurers update prior-authorization forms to reflect current drug labeling and population-specific clinical guidance. The article provides no announced review, deadline, or policy change from a payer. Until plans publish revised criteria or explain how they apply existing ones, the gap Saeed describes remains a reported concern rather than a confirmed nationwide coverage change.
Key Questions
What happened in the report?
Hamayle Saeed wrote that she was screened for diabetes at BMI 23 under guidance for Asian Americans, but says she was denied a GLP-1 weight-loss drug at BMI 26.5 under the criteria applied in her case.
Does a BMI of 23 qualify someone for a GLP-1?
No. The article describes BMI 23 as a threshold for diabetes screening in Asian Americans, not a general eligibility rule for GLP-1 treatment. Screening guidance and medication coverage criteria are separate, and a clinician’s recommendation and an insurer’s rules may also depend on other factors.
Why does Saeed say BMI thresholds can differ for Asian patients?
She cites research and clinical guidance indicating that some Asian populations can face elevated diabetes risk at lower BMI values. These are population-level findings; they do not diagnose an individual or establish a single treatment rule for all people of Asian descent.
Have insurers changed their GLP-1 coverage rules?
The article does not report a nationwide change. Saeed says some plans continue to use BMI values of 30 or 27 in prior-authorization criteria, but requirements vary by plan and the piece does not provide a survey of insurers or confirm what every plan currently requires.
What should a patient do after a denial?
Patients can request the written reason for denial and the plan’s current criteria, then discuss the decision with their clinician. Appeal procedures and coverage rules differ, so the plan’s documents are the relevant source for an individual case.
Source: medpagetoday.com
