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A MedPage Today opinion essay by physician Hamayle Saeed describes being screened for diabetes at a BMI of 23 under guidance for Asian Americans, but not qualifying for a GLP-1 weight-loss drug at BMI 26.5 without diabetes or another weight-related condition. The account highlights a gap between ethnicity-specific clinical risk thresholds and common drug coverage rules; the essay does not identify the insurer or establish how often patients face the same denial.
South Asian physician Hamayle Saeed says she was screened for diabetes once her BMI exceeded 23, but at a BMI of 26.5 she was told she did not meet the criteria for a GLP-1 weight-loss medication because she had neither diabetes nor another qualifying condition. In an October 31 MedPage Today opinion essay, she argues that the contrast exposes a gap between lower BMI thresholds used to assess diabetes risk in Asian Americans and the higher thresholds commonly used in drug coverage decisions.
Saeed writes that the American Diabetes Association recommends diabetes screening for Asian Americans at a BMI of 23, reflecting the risk of developing the disease at lower body weights. She says her doctor screened her under that approach. But when she asked about a GLP-1 receptor agonist, she was not eligible under the criteria she describes: a BMI of 30 or higher, or 27 or higher with a weight-related condition. Her essay says she had no diabetes and did not meet either threshold.
The author cites research and guidelines to explain why the mismatch matters. She points to World Health Organization action points of BMI 23 and 27.5 for Asian populations, and to a study of nearly 1.5 million adults in England that estimated South Asians reached the diabetes risk associated with a BMI of 30 among white adults at a BMI of 23.9. These figures concern risk comparisons; they do not establish an individual diagnosis or guarantee drug eligibility.
Saeed also cites a 2026 analysis of 352 GLP-1 trials, which she says found BMI cutoffs disproportionately limited Asian participation. In the analysis, a BMI entry threshold of 30 made 13.5% of Asian American adults and 7.2% of Korean adults eligible, compared with 41.5% of non-Asian American adults. She further discusses the 2025 STEP 11 trial in South Korea and Thailand, where semaglutide was studied using a local obesity threshold of BMI 25. The essay reports average weight loss of 16% with semaglutide and 3.1% with placebo; a smaller post hoc subgroup starting below BMI 30 had results of 17.6% and 4.4%, respectively.
The Divide Between Risk and Coverage
The account illustrates how a single BMI can be interpreted differently across clinical care and insurance administration. A lower screening threshold can prompt earlier testing for diabetes risk, while a payer’s higher BMI cutoff can still block access to a weight-loss medicine for someone who has not developed a qualifying condition. For patients, that distinction may mean monitoring risk without being eligible for a treatment they seek.
The issue also concerns how evidence is built. If trial eligibility rules exclude a smaller share of Asian patients, the resulting evidence base may be less representative of those populations. Saeed argues that the mismatch can persist even as medical guidance becomes more attentive to population-specific risk. The essay is an individual account and an argument about policy; it does not quantify the number of patients affected or show that every insurer applies the same rules.
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How BMI Rules Diverge
Saeed’s essay describes two developments moving in different directions. She says the ADA’s 2026 Standards of Care advise clinicians to confirm excess body fat using cutoffs appropriate to ethnicity and specifically identify South Asian patients. She also says the FDA-approved labels for Wegovy and Zepbound, as revised in 2026, describe eligible patients using terms such as obesity or overweight with a weight-related condition, rather than stating a BMI number in the indication. In practice, she writes, the 30 and 27 thresholds remain in trial descriptions and insurer prior-authorization forms.
Coverage decisions can also change over time. Saeed reports that California’s Medi-Cal program stopped covering GLP-1s for weight loss in January and Massachusetts’ MassHealth followed in July. Her essay does not provide policy documents or specify the precise exceptions and coverage terms for each program. She contrasts U.S. insurer thresholds with Britain’s NICE guidance, which she says lowers BMI thresholds by 2.5 points for several population groups, including South Asian people, when applying its tirzepatide criteria.
“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, physician and MedPage Today opinion contributor
Coverage Rules Still Need Detail
The essay does not name Saeed’s insurer, include a denial letter, or provide the plan’s written criteria, so the specific basis for her reported decision cannot be independently assessed from the account alone. It is also unclear how widely the same criteria are applied across private insurance, employer plans, and public programs, or how many Asian American patients are denied on BMI grounds.
The evidence Saeed cites includes different populations, study designs, and outcomes. Trial weight-loss results and cardiovascular findings do not by themselves establish coverage policy or prove that every person below BMI 30 would benefit from treatment. The source material does not provide the full FDA labeling language or a regulator’s explanation of how the 2026 label revisions should affect insurer rules.
Policy Decisions to Watch
The next practical test is whether insurers and public programs revise prior-authorization forms or coverage policies to reflect population-specific definitions of obesity and risk. Saeed’s essay does not report a pending rule change, insurer response, or scheduled policy decision. Patients and clinicians will need to check the current criteria for each plan rather than assume that label language or screening guidance automatically changes coverage.
Further research and policy review could clarify how lower BMI thresholds should be applied in treatment decisions, and whether trial evidence supports changes for particular groups. Until then, the gap described by Saeed remains a reported example of a broader disagreement over how clinical risk guidance translates into access to medication.
Key Questions
What happened to Hamayle Saeed?
Saeed says she was screened for diabetes at a BMI above 23, but at BMI 26.5 did not qualify for a GLP-1 weight-loss drug under the criteria she describes because she had neither diabetes nor another qualifying weight-related condition.
Why does the essay refer to a BMI of 23?
The essay says diabetes screening guidance uses a lower BMI threshold for Asian Americans because diabetes risk can arise at lower body weights. A screening threshold is not the same as a diagnosis or a medication coverage threshold.
What BMI criteria did Saeed say blocked access?
She describes eligibility criteria of BMI 30 or higher, or BMI 27 or higher with a weight-related condition. Exact coverage rules vary by health plan, and her essay does not identify her insurer.
Does the cited research show GLP-1s work for everyone below BMI 30?
No. Saeed cites a trial in South Korea and Thailand and a post hoc subgroup analysis, but those findings do not establish that every person below BMI 30 should receive treatment. Individual eligibility and coverage depend on clinical circumstances, product labeling, and plan rules.
Have insurers changed their rules?
The essay says numeric thresholds remain in prior-authorization forms despite changes it describes in drug labels and clinical guidance. It does not report a specific insurer announcing revised criteria.
Source: medpagetoday.com
