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In a MedPage Today opinion article, Pakistani American physician Hamayle Saeed describes being screened for diabetes at a BMI of 23 but told she did not meet BMI-based GLP-1 eligibility at 26.5. Her account highlights a mismatch between lower diabetes-risk thresholds used for Asian populations and the criteria commonly retained in insurance authorization forms; individual coverage rules and clinical eligibility vary.
Pakistani American physician Hamayle Saeed says she was screened for diabetes at a BMI of 23 under guidance for Asian Americans, but was denied a GLP-1 weight-loss prescription at a BMI of 26.5 because she did not meet the higher thresholds she says appear in coverage decisions. In an October 31 opinion article for MedPage Today, Saeed argues the contrast exposes a gap between diabetes-risk screening and access to obesity medicines.
Saeed writes that her doctor began screening her for diabetes in keeping with the American Diabetes Association’s lower BMI threshold for Asian Americans. She says she did not have diabetes and was below the BMI cutoffs commonly associated with FDA-approved GLP-1 use for weight management: 30, or 27 with at least one weight-related condition. She reports that the prior authorization process therefore did not make her eligible. Her account describes her own experience; the article does not document the insurer’s identity or provide the authorization decision.
The physician points to differences between screening guidance and coverage criteria. She says the ADA’s 2026 Standards of Care call for clinicians to confirm excess body fat using cutoffs appropriate to ethnicity, while prior authorization forms may continue to rely on BMI figures of 30 and 27. She also reports that the FDA labels for semaglutide (Wegovy) and tirzepatide (Zepbound) were revised in 2026 to describe indications using obesity or overweight with a weight-related condition, without specifying a BMI number. That does not by itself establish what criteria an insurer must use.
Saeed cites research to support the argument that conventional BMI cutoffs can exclude Asian patients at elevated risk. A 2026 analysis of 352 GLP-1 trials, as described in her article, found that a BMI inclusion cutoff of 30 would have made 41.5% of non-Asian American adults eligible, compared with 13.5% of Asian Americans and 7.2% of Koreans. She also cites the 2025 STEP 11 study in South Korea and Thailand, which tested semaglutide among participants with BMI of at least 25. These figures and findings are presented in the opinion article; the underlying studies and their full methods are not reproduced in the supplied material.
BMI Rules Shape Access to GLP-1s
The mismatch Saeed describes matters because screening thresholds can identify risk without automatically changing the criteria used to diagnose obesity, prescribe medication or approve insurance coverage. A patient can be considered at increased risk of diabetes at a lower BMI while still falling short of a payer’s weight-management authorization rule. That difference may leave some people facing disease screening without access to a treatment they seek for weight management.
The issue also affects how evidence and policy interact. If trials recruit fewer Asian participants because their BMI cutoffs exclude them, the resulting evidence base may be less representative of those populations. Saeed argues this can reinforce existing thresholds in prescribing and coverage systems. Her cited STEP 11 results offer evidence from a study using a lower BMI entry point, but they do not establish that every patient below BMI 30 will benefit or qualify for treatment.
Coverage is not determined by one national rule alone. Saeed says Medi-Cal ended coverage of GLP-1 drugs for weight loss in January and MassHealth followed in July. The article does not detail the exact terms, exceptions or current status of those programs’ policies. The reported changes nonetheless illustrate how people near a threshold may be affected when a benefit is restricted.
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Different Thresholds, Different Purposes
BMI is a ratio of weight to height, not a direct measurement of body fat or its distribution. Saeed cites evidence that people of Asian descent, on average, may have more visceral fat and less muscle at the same BMI than people of European descent. The World Health Organization set lower BMI action points for Asian populations in 2004, at 23 and 27.5, and the ADA uses a BMI of 23 to begin diabetes screening for Asian Americans.
Those action points serve a different purpose from a medication label or an insurer’s prior authorization requirement. Saeed says the difference has become more visible as professional guidance has begun to account for ethnicity while payer forms retain familiar BMI cutoffs. She also points to guidance from Britain’s National Institute for Health and Care Excellence, which she says lowers BMI thresholds by 2.5 units for several groups, including South Asian, Chinese and other Asian people. The comparison is her account of the guidance and does not mean that U.S. insurers are bound by it.
In her article, Saeed also notes that race-based adjustments have been challenged in other areas of medicine, including kidney-function calculations. She argues that using ethnicity-specific BMI thresholds should be tied to measured health risk rather than treated as a blanket substitute for individual assessment. The central policy question is how clinicians, regulators and insurers define obesity when risk differs across populations.
“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, writing in MedPage Today
Coverage Rules Still Vary
The supplied material does not identify Saeed’s insurer, provide the prior authorization form, or establish whether her denial was appealed. It is also unclear how widely the BMI thresholds she describes are used across insurers or how individual plans interpret the revised FDA labels. Coverage rules can differ by plan, indication and patient circumstances.
The source is an opinion article, not an independent investigation of payer policies. Its summaries of the cited trials, guidelines and coverage changes should be distinguished from the author’s interpretation of what those developments mean. The material does not include the full studies or policy documents needed to verify every detail independently. Nor does it show how many Asian patients are denied medication specifically because of a BMI cutoff, or what alternative criteria insurers might apply.
Policy and Payer Decisions Ahead
The next steps depend on whether professional guidance, FDA labeling and insurer authorization rules become more closely aligned. The article does not report a pending federal rule, an announced payer policy revision, or a timetable for changes. Insurers may continue to set coverage criteria within their policies, while clinicians assess each patient’s health and treatment options.
For the broader debate, relevant developments will include updates to ADA guidance, publication of further research involving Asian participants, and any changes insurers make to prior authorization forms. Saeed’s account puts those decisions in focus, but it does not resolve whether lower BMI thresholds should determine GLP-1 coverage or what a uniform alternative would look like.
Key Questions
What happened in the report?
In a MedPage Today opinion article, physician Hamayle Saeed said she was screened for diabetes at a BMI of 23 because she is South Asian, but was not eligible for a GLP-1 weight-loss prescription at a BMI of 26.5 under the thresholds she encountered.
Why can diabetes screening start below BMI 30?
The ADA uses a lower BMI threshold to begin diabetes screening for Asian Americans because diabetes risk can occur at lower BMI levels in some Asian populations. Screening guidance is separate from medication approval and insurance coverage rules.
What BMI thresholds does Saeed say commonly affect GLP-1 access?
She cites thresholds of BMI 30, or BMI 27 with at least one weight-related condition, as criteria commonly used for weight-management eligibility or coverage. The applicable requirements can vary by drug, insurer and plan.
Did the FDA labels remove BMI numbers?
Saeed says the 2026 labels for Wegovy and Zepbound describe their weight-management indications without specifying a BMI number. That does not mean insurers have adopted the same approach or that the labels guarantee coverage.
Is the article an independent investigation of insurance denials?
No. It is an opinion article that includes Saeed’s personal account and summaries of research and policy guidance. The supplied material does not identify her insurer or establish how often similar denials occur.
Source: medpagetoday.com
