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A MedPage Today opinion article by Pakistani American physician Hamayle Saeed describes a mismatch between lower BMI thresholds used to screen Asian patients for diabetes and the higher thresholds often used for GLP-1 coverage. The article cites clinical guidance and research supporting population-specific risk assessment, but coverage decisions remain shaped by payer forms and eligibility policies. The author’s account is an opinion report, and the source does not establish a nationwide change to insurance rules.
A Pakistani American physician says she was screened for diabetes at a BMI of 23 under guidance recognizing elevated risk among Asian Americans, but was denied a GLP-1 medication at a BMI of 26.5 because she did not meet the thresholds used for treatment eligibility. In an Oct. 31 MedPage Today opinion article, Hamayle Saeed argues that the mismatch can leave Asian patients identified as higher-risk without comparable access to weight-loss treatment.
Saeed writes that her clinician screened her for diabetes in line with the American Diabetes Association’s lower screening threshold for Asian Americans. She says she does not have diabetes and was told she did not qualify for a GLP-1 receptor agonist: the criteria she describes require a BMI of 30, or 27 with a weight-related condition. At 26.5 without diabetes, she fell short of both criteria. Her experience is a personal account, not evidence that every insurer applies the same rule.
The article says the ADA’s 2026 Standards of Care advise clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity, and specifically identify South Asian patients. Saeed also points to the association’s June release of Asian-specific waist and BMI thresholds for diagnosing obesity. She contrasts those clinical approaches with prior-authorization forms that, she says, continue to use BMI thresholds of 30 and 27.
To support the concern, Saeed cites research on differences in diabetes risk and body composition, as well as a 2026 analysis of 352 GLP-1 trials. In that analysis, she reports, a BMI cutoff of 30 would make 13.5% of Asian Americans and 7.2% of Korean Americans eligible, compared with 41.5% of non-Asian American adults. She also cites a 2025 semaglutide study in South Korea and Thailand that used a local obesity threshold of BMI 25 or higher. These findings provide context for her argument, but do not by themselves establish what coverage an individual patient should receive.
The Screening and Coverage Divide
The discrepancy described by Saeed has practical implications: a lower BMI may prompt diabetes screening for an Asian patient while a higher BMI remains the gatekeeper for a medication. That can leave people who are considered at elevated metabolic risk in a different category for treatment and insurance purposes. Screening thresholds and drug coverage criteria serve different roles, but when they rely on different definitions of risk, patients and clinicians may face conflicting signals.
The stakes extend beyond an individual prescription. Saeed says public coverage for weight-loss GLP-1s has narrowed in some places, citing Medi-Cal’s January decision and MassHealth’s July decision to drop coverage. The source does not provide the details or scope of those policy changes, but argues that patients near eligibility cutoffs are particularly exposed when benefits contract. For readers, the issue is whether clinical guidance that recognizes population-specific risk is reflected in insurer policies, not simply whether a drug is available.
Evidence about treatment response and health outcomes can inform that discussion, but it does not settle coverage policy on its own. Payers weigh approved indications, clinical evidence, cost and plan rules. The article calls attention to a potential inconsistency between risk assessment and access, while leaving open how broadly the described experience applies.
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How BMI Thresholds Diverged
BMI is a screening and classification measure based on height and weight; it does not directly measure body fat distribution. Saeed cites World Health Organization action points of BMI 23 and 27.5 for Asian populations, and a study of nearly 1.5 million adults in England that estimated the BMI at which diabetes risk among South Asian adults matched that of white adults at BMI 30 as 23.9. These are population-level findings, not individual diagnoses.
The article says U.S. GLP-1 trial criteria and payer forms have often retained conventional BMI cutoffs, even as some clinical guidance recognizes lower thresholds for Asian patients. Saeed also cites STEP 11, a 2025 study of semaglutide 2.4 mg in South Korea and Thailand. Among 68 participants who began below BMI 30, she reports, the 45 assigned semaglutide lost an average of 17.6% of body weight, compared with 4.4% among 23 assigned placebo. The study and its subgroup analysis add evidence relevant to populations underrepresented in earlier trials, but do not automatically change U.S. labeling or insurance coverage.
Saeed notes that current U.S. labels for Wegovy and Zepbound describe use for adults with obesity, or overweight with a weight-related condition, without stating a numerical BMI cutoff in the indication. She argues that trial descriptions and prior-authorization policies may nevertheless preserve numerical thresholds. The article also compares U.S. practice with guidance from England’s NICE, which it says applies a 2.5-point BMI reduction for several ethnic groups in its tirzepatide guidance.
“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.”
— Hamayle Saeed, MD, in a MedPage Today opinion article
Coverage Rules Still Vary
The article does not identify the insurer or plan involved in Saeed’s reported denial, provide the prior-authorization form, or say whether an appeal was filed. It is therefore unclear how widely the exact BMI criteria she describes are applied, or whether the denial reflected a specific plan rule, a clinical judgment, or another coverage condition.
The source also does not establish that the cited clinical findings require a change to FDA-approved use or payer policy. Study results, including subgroup analyses, do not guarantee the same benefit for every patient. The extent to which the 2026 label wording changes how insurers interpret eligibility is also unclear; Saeed says numerical cutoffs remain in trial descriptions and prior-authorization forms, but does not provide a survey of plans.
Watch for Payer Policy Changes
The next developments to watch are whether insurers revise prior-authorization criteria to reflect ethnicity-specific clinical guidance, and whether professional organizations issue further recommendations on applying BMI and other measures of adiposity. Patients seeking coverage will need to check the rules for their own plan, since a clinical screening threshold does not itself guarantee medication coverage.
More evidence from trials that include Asian populations may inform future treatment and reimbursement decisions. For now, the source describes a gap between risk assessment and access, but does not report a national policy change or a scheduled decision that would resolve it.
Key Questions
What happened in the report?
Physician Hamayle Saeed wrote that she was screened for diabetes at BMI 23 but was denied a GLP-1 at BMI 26.5 because she did not meet the criteria she says applied to her: BMI 30, or BMI 27 with a weight-related condition. Her account appeared in a MedPage Today opinion article published Oct. 31, 2026.
Why can diabetes screening begin at a lower BMI for Asian patients?
The article says clinical guidance recognizes that some Asian populations face diabetes risk at lower BMI levels than white populations. A screening threshold helps identify people for assessment; it is not itself a diagnosis or a guarantee of drug coverage.
Does a BMI of 23 qualify someone for a GLP-1 medication?
Not based on the information in this report. Saeed describes BMI 30, or BMI 27 with a weight-related condition, as the criteria used in her case. Coverage and prescribing rules can differ by medication, indication and insurance plan.
Did the studies cited change U.S. insurance rules?
The article does not report a nationwide insurance policy change. It cites studies and clinical guidance that may inform future decisions, while saying numerical thresholds remain in some prior-authorization processes.
Source: medpagetoday.com
