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A MedPage Today opinion article by South Asian physician Hamayle Saeed describes being screened for diabetes at a BMI of 23 but denied a GLP-1 weight-loss drug at a BMI of 26.5. The account points to a mismatch between ethnicity-sensitive clinical guidance and the BMI thresholds commonly used in drug trials and insurance authorization; coverage rules and eligibility vary.
South Asian physician Hamayle Saeed says her doctor began diabetes screening at a BMI of 23, but she was denied a GLP-1 weight-loss prescription at a BMI of 26.5 because she did not meet the stated eligibility thresholds. In a MedPage Today opinion article published October 31, 2026, Saeed describes a gap between ethnicity-sensitive diabetes guidance and BMI criteria used in drug access decisions.
Saeed writes that, as a Pakistani American, she was screened under American Diabetes Association guidance that calls for diabetes screening at lower BMI levels for Asian Americans. She says she did not have diabetes and had a BMI of 26.5 when she asked about a GLP-1 receptor agonist. According to her account, she was told she did not qualify: the thresholds applied to her were BMI 30, or BMI 27 with at least one weight-related condition.
The article argues that this leaves a mismatch between screening for risk and access to treatment. Saeed cites research suggesting that diabetes risk can occur at lower BMI among some Asian populations. In a study of nearly 1.5 million adults in England, she reports, 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. These are study findings reported in the opinion article, not individual eligibility determinations.
Saeed also cites a 2025 study of semaglutide 2.4 mg in South Korea and Thailand. Participants entered at BMI 25 or above, reflecting local obesity criteria. The article reports average weight loss of 16% with semaglutide, compared with 3.1% with placebo. A post hoc analysis of 68 participants who began below BMI 30 found 17.6% weight loss among 45 semaglutide recipients and 4.4% among 23 placebo recipients. The subgroup analysis does not by itself establish coverage policy or individual treatment suitability.
Screening Rules and Drug Access
The account highlights how a person may be considered at elevated risk for diabetes at a BMI below the threshold commonly used by insurers to assess weight-loss drug coverage. For readers, the difference can affect whether a clinician recommends screening, whether a prescription is considered, and whether an insurer pays for it. Clinical risk thresholds and coverage criteria serve different purposes, but Saeed argues they can produce conflicting decisions for Asian patients.
That conflict matters as public coverage for weight-loss GLP-1s changes. Saeed says Medi-Cal ended coverage for weight-loss use in January and MassHealth followed in July. The article does not provide a full account of each program’s current exceptions or appeal procedures. It does describe the broader concern: when coverage narrows, people near eligibility boundaries may face greater barriers, even where clinicians see elevated risk.
The piece also raises questions about how evidence from clinical trials informs labels and payer rules. If trial entry criteria use BMI cutoffs that exclude many Asian patients, the resulting evidence base may be less representative of those populations. That concern is distinct from whether a particular patient should receive a drug, which requires an individual clinical assessment.
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How BMI Thresholds Diverged
Saeed’s argument draws on differences in body composition and disease risk. She writes that some people of Asian descent can have more visceral fat and less muscle at the same BMI than people of European descent, and cites 2025 international obesity guidance estimating that an Asian person’s BMI may be two to three units lower than a white person’s at a similar level of body fat. BMI is a screening measure, not a direct measurement of body fat or a complete assessment of health.
The World Health Organization set lower BMI action points of 23 and 27.5 for Asian populations in 2004, according to the article. Saeed also says the ADA’s 2026 Standards of Care advise clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity, including for South Asian patients. These clinical recommendations do not automatically determine insurance coverage.
The article says revised 2026 U.S. labels for Wegovy and Zepbound describe use for adults with obesity, or adults with overweight and a weight-related condition, without stating a numeric BMI in the indication. However, Saeed reports that trial criteria and payer authorization forms still commonly use 30 and 27. The article also cites U.K. guidance that adjusts BMI thresholds downward by 2.5 units for several ethnic groups, including South Asian and other Asian people.
“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 MedPage Today
Coverage Criteria Still Vary
The article is an opinion piece built around Saeed’s personal account and citations to research; it is not a survey of every insurer or a formal review of all coverage policies. It does not identify the insurer involved in her denial, provide the denial letter, or clarify whether she appealed. Her experience should not be read as a universal coverage decision.
It is also not clear from the source whether insurers have changed their authorization rules in response to the cited label revisions or the ADA’s 2026 guidance. The source says numeric BMI thresholds persist in payer forms, but does not name the plans or establish how widespread that practice is. The STEP 11 figures include a post hoc subgroup, and the article does not establish that the results apply equally to all patients below BMI 30.
Finally, lower population-level BMI thresholds can inform screening and clinical assessment, but they do not establish that a specific medicine is appropriate for every person who meets them. Treatment decisions depend on a clinician’s evaluation, the drug’s approved use, risks, and a patient’s circumstances.
Will Payers Revise Their Rules?
The article does not announce a policy change or provide a date for one. The next practical development to watch is whether insurers and public programs revise prior-authorization criteria to reflect updated labeling and ethnicity-specific clinical guidance. Saeed’s account makes payer rules and appeals processes central to the issue, but the source does not report a commitment from any insurer to change them.
Researchers and health authorities may also add evidence on GLP-1 outcomes among Asian patients and on how BMI thresholds relate to health risks across different populations. For now, patients seeking coverage need to check the current rules for their specific plan and discuss screening and treatment options with a qualified clinician. The article leaves unresolved whether policy changes will narrow the gap it describes.
Key Questions
What happened in the report?
South Asian physician Hamayle Saeed wrote that she was screened for diabetes at a BMI of 23 but denied a GLP-1 weight-loss drug at a BMI of 26.5 because she did not meet the thresholds applied to her. Her article appeared in MedPage Today on October 31, 2026.
Why are lower BMI thresholds used for diabetes screening among Asian Americans?
The article says diabetes risk can occur at lower BMI levels among some Asian populations. It cites ADA guidance and research on differences in body composition and diabetes risk. Screening guidance does not automatically set medication coverage eligibility.
Does a BMI below 30 automatically rule out GLP-1 treatment?
No single answer applies to every drug, patient, or insurance plan. Saeed says the criteria applied in her case were BMI 30, or BMI 27 with a weight-related condition. Readers should check the current drug labeling and their plan’s requirements with a qualified clinician or insurer.
What did the STEP 11 study find?
As reported in the article, the 2025 study in South Korea and Thailand found average weight loss of 16% with semaglutide 2.4 mg and 3.1% with placebo. A post hoc analysis of 68 participants who began below BMI 30 reported different results between the semaglutide and placebo groups. These study findings do not decide an individual’s treatment or coverage.
Have insurers changed their BMI requirements?
The source says numeric thresholds remain in payer prior-authorization forms, despite changes to some drug labels. It does not identify all insurers or establish how widespread any policy change has been, so coverage must be checked plan by plan.
Source: medpagetoday.com
