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A MedPage Today opinion article by physician Hamayle Saeed describes being screened for diabetes at a BMI of 23 but told she did not meet BMI-based criteria for a GLP-1 weight-loss drug at 26.5. The account highlights a gap between Asian-specific clinical risk thresholds and the BMI cutoffs still used in many coverage forms; the article does not establish how every insurer or patient is affected.
South Asian physician Hamayle Saeed says she was screened for diabetes at a body mass index (BMI) of 23, in line with American Diabetes Association guidance for Asian Americans, but was told she did not qualify for a GLP-1 weight-loss drug at a BMI of 26.5. In an October 31 MedPage Today opinion article, Saeed uses her experience to describe a gap between clinical recognition of health risks at lower BMI and the thresholds appearing on drug coverage forms.
Saeed writes that she does not have diabetes and, at a BMI of 26.5, falls below the commonly cited U.S. weight-management eligibility thresholds of 30, or 27 with at least one weight-related condition. She says the screening recommendation and the prior authorization decision were based on the same BMI measurement but applied different standards. Her account is a personal report, not a survey of insurer decisions or a determination of her individual coverage rights.
The article says the World Health Organization identified lower BMI action points for Asian populations in 2004, at 23 and 27.5. It also cites research involving nearly 1.5 million adults in England, which estimated that South Asian adults reached the diabetes risk observed among white adults at BMI 30 at a BMI of 23.9; the corresponding estimate for Chinese adults was 26.9. These findings concern population-level risk and do not establish an individual diagnosis.
Saeed also describes evidence on clinical trials and treatment. She cites a 2026 analysis of 352 GLP-1 trials that found BMI criteria excluded a larger share of Asian than non-Asian American adults from eligibility. She points to the 2025 STEP 11 study in South Korea and Thailand, where semaglutide was tested using a local obesity threshold of BMI 25. The article reports weight loss of 16% among participants receiving the drug versus 3.1% with placebo; a post hoc subgroup below BMI 30 had reported losses of 17.6% and 4.4%, respectively. Those trial results do not, by themselves, establish U.S. insurance coverage or eligibility.
Why Coverage Cutoffs Matter
The mismatch Saeed describes may affect whether patients can obtain treatment before reaching BMI thresholds developed around other populations. For clinicians, it presents a practical tension: risk screening can start at a lower BMI for Asian patients while treatment authorization forms may still rely on higher figures. That can leave a patient flagged for closer diabetes monitoring without meeting a payer’s weight-loss drug criteria.
The consequences extend beyond one prescription. Saeed says California’s Medi-Cal program ended coverage for GLP-1 drugs for weight loss in January and MassHealth followed in July. The article does not detail the scope, exceptions, or current status of those policies, but its account raises the question of how coverage restrictions interact with population-specific risk. Whether lower BMI cutoffs should change medication coverage is a policy question, not something established by the studies cited alone.
For readers, the distinction is between screening, diagnosis, drug labeling and insurance payment. Different rules can apply to each. A lower screening threshold does not automatically mean a patient has diabetes, qualifies for a prescription, or is entitled to coverage.
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How Risk and Eligibility Diverged
BMI is a calculation based on height and weight; it does not directly measure body fat or its distribution. Saeed cites evidence that, on average, people of Asian descent may carry more visceral fat and less muscle at a given BMI than people of European descent. The article says the 2025 iCARDIO global obesity guidelines estimated Asian BMI values could be two to three units lower than white BMI values at comparable body-fat levels. These are group-level observations, not a substitute for evaluating an individual.
The article contrasts those clinical considerations with the history of drug thresholds. It says pivotal trials used Western obesity definitions and that eligibility language and payer forms retained BMI cutoffs of 30, or 27 with a weight-related condition. Saeed also reports that updated U.S. labels for Wegovy and Zepbound describe adults with obesity, or overweight with a weight-related condition, without stating a numeric BMI in the indication. The article says prior authorization forms may nonetheless continue to use the numeric thresholds.
Guidance is not uniform internationally. Saeed writes that the UK’s National Institute for Health and Care Excellence uses a BMI threshold of 35 with a comorbidity for tirzepatide and advises lowering the threshold by 2.5 units for several ethnic groups, including South Asian and Chinese patients. That comparison does not mean UK and U.S. prescribing or payment systems are otherwise equivalent.
“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, physician and MedPage Today opinion writer
What the Account Does Not Establish
The source is an opinion article based partly on Saeed’s personal experience. It does not identify the insurer or authorization policy involved in her case, provide the form’s wording, or show whether an appeal was made. It also does not establish how common such denials are among Asian patients or whether all U.S. insurers apply the same criteria.
The article argues that updated labels and clinical guidance have not been reflected in payer forms, but it does not provide a systematic review of current policies. The relationship between a clinical definition of obesity and an insurer’s coverage requirements can vary by plan. The cited trial subgroup below BMI 30 was a post hoc analysis, so its findings should not be treated as a separate definitive trial of coverage eligibility. The article’s supplied text also ends during a discussion of race-based medicine, leaving its final argument incomplete.
Questions for Insurers and Clinicians
The article does not announce a new coverage rule, policy decision, or formal response from the ADA, FDA, or insurers. The next practical development would be whether health plans revise prior authorization criteria to reflect updated drug labels and ethnicity-specific clinical guidance, and whether they explain how those criteria apply to individual patients.
Further evidence could include public insurer policies, appeals data, and clinical research enrolling more Asian participants. For people facing a coverage decision, eligibility depends on the drug, medical circumstances, plan rules and applicable prescribing guidance; a clinician or insurer can clarify the requirements for a specific case.
Key Questions
What happened in Hamayle Saeed’s account?
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 drug at BMI 26.5 because she did not meet the BMI-based criteria she describes. The article does not name the insurer or document an appeal.
Why does the article compare BMI 23 with BMI 30?
The comparison illustrates different uses of BMI. Saeed says the ADA recommends diabetes screening for Asian Americans starting at a lower BMI, while commonly cited U.S. weight-loss drug eligibility criteria use BMI 30, or 27 with a weight-related condition. Screening thresholds do not automatically determine drug coverage.
Does a BMI below 30 mean an Asian patient cannot receive a GLP-1?
Not in every case. The article describes commonly used BMI criteria, but eligibility and payment can depend on the specific medication, a patient’s medical circumstances and the health plan’s rules. It does not review every insurer’s policy.
What did the STEP 11 study find?
As reported in Saeed’s article, the 2025 study in South Korea and Thailand found average weight loss of 16% with semaglutide versus 3.1% with placebo. A post hoc group that began below BMI 30 had reported losses of 17.6% and 4.4%, respectively. Those results do not set U.S. coverage rules.
Has the article confirmed that insurers will change their criteria?
No. It raises concerns about a possible mismatch between updated clinical guidance, drug labels and prior authorization forms, but reports no announced insurer policy change or government decision.
Source: medpagetoday.com
