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A MedPage Today opinion article by Pakistani American physician Hamayle Saeed describes being screened for diabetes at a BMI of 23 but denied GLP-1 treatment at a BMI of 26.5, without diabetes. The account highlights a policy mismatch: screening guidance recognizes diabetes risk at lower BMIs for Asian Americans, while coverage criteria often retain thresholds of 30, or 27 with a weight-related condition. Individual coverage decisions and the broader implications of newer drug labels remain unclear.
Pakistani American physician Hamayle Saeed says she was screened for diabetes under a lower BMI threshold used for Asian Americans but denied a GLP-1 medication because she did not meet the BMI criteria used by her insurer. In an October 31 MedPage Today opinion article, Saeed describes having a BMI of 26.5 without diabetes, below the commonly applied coverage thresholds of 30, or 27 with a weight-related condition.
Saeed writes that her clinician began diabetes screening at a BMI of 23, consistent with guidance recognizing that Asian Americans can develop diabetes at lower body weights. But when she asked about a GLP-1 receptor agonist, she says she was told no: she had neither diabetes nor a BMI high enough to meet the criteria used for coverage. The account is a physician’s personal experience; the article does not identify her insurer or provide its written decision.
The report says weight-management drug coverage has also contracted in some public programs. It states that Medi-Cal ended coverage for GLP-1s for weight loss in January and MassHealth followed in July. The piece does not specify the year for those dates in the supplied text. Saeed argues that patients near eligibility cutoffs are most exposed when coverage is reduced.
The article also describes a changing clinical and regulatory picture. It says the American Diabetes Association’s 2026 Standards of Care advise clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity, while updated U.S. drug labels refer to adults with obesity, or overweight plus a weight-related condition, without stating a BMI number in the indication. Nevertheless, Saeed says 30 and 27 remain common in trial criteria and payer authorization forms.
Screening Rules and Drug Access
The difference matters because screening for risk and qualifying for treatment are separate decisions. A lower BMI threshold can prompt earlier diabetes testing for Asian patients, but it does not automatically change a drug’s approved use, a health plan’s coverage rules or a clinician’s prescribing decision. Saeed’s account illustrates how those policies may leave some patients recognized as being at risk while still outside the criteria used to pay for treatment.
The report cites evidence that BMI may not reflect body fat and metabolic risk equally across populations. It says a 2025 international guideline placed Asian BMI values about two to three units below white BMI values at comparable body-fat levels. That framing supports the case for examining eligibility criteria, but it does not establish that every person below a conventional BMI cutoff should receive a GLP-1 drug. Treatment decisions still depend on individual health, approved indications and coverage terms.
For readers, the practical issue is that a guideline or a drug label may not match the rules applied by a particular insurer. The article describes a policy gap; it does not establish that all Asian patients are denied access or that every plan uses identical criteria.
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Evidence Behind Lower BMI Cutoffs
The article traces Asian-specific BMI action points to the World Health Organization, which in 2004 set lower points of 23 and 27.5 for Asian populations. It also cites a study of nearly 1.5 million adults in England that compared diabetes risk across ethnic groups. In that study, South Asian adults reached the diabetes risk observed among white adults at a BMI of 30 when their BMI was 23.9; the corresponding figure for Chinese adults was 26.9. These are findings from the cited study, not universal diagnostic thresholds for every patient.
Saeed says pivotal obesity-drug trials largely used Western BMI definitions, and that the criteria then carried over into access rules. A 2026 analysis of 352 GLP-1 trials, as summarized in the opinion piece, found that a BMI cutoff of 30 made 41.5% of non-Asian American adults eligible by that criterion, compared with 13.5% of Asian Americans and 7.2% of Korean Americans. The article says other trial requirements, including blood sugar, kidney and liver measures, admitted more than 93% of each group.
It also cites the 2025 STEP 11 study in South Korea and Thailand, which tested semaglutide 2.4 milligrams using a local obesity definition of BMI 25 or higher. Participants lost 16% of body weight, compared with 3.1% for placebo. A post hoc analysis of 68 participants who began below BMI 30 found average weight loss of 17.6% among 45 semaglutide recipients and 4.4% among 23 placebo recipients. Those results describe a study group and do not, by themselves, set U.S. coverage policy.
“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 author
Coverage Rules Still Vary
The article does not name Saeed’s insurer, include the denial letter or clarify whether the decision was based on a specific plan policy, a prior authorization form or another requirement. It therefore cannot establish how widespread the particular experience is. The supplied source also ends partway through a discussion of ethnicity-adjusted BMI, so its full argument on that issue is unavailable.
It is also unclear whether U.S. insurers will revise their criteria in response to updated drug labels, the ADA guidance or trial findings. A label that does not state a numerical BMI in its indication does not necessarily mean that every patient below 30 qualifies for coverage. Plans may maintain separate criteria, and eligibility can depend on an individual’s diagnosis and circumstances. The article does not provide plan-by-plan data or a timeline for policy changes.
Whether Payers Revise Eligibility
The next development to watch is whether insurers and public programs change their prior authorization rules to match current drug-label language or take account of ethnicity-specific risk guidance. Patients and clinicians will need to consult the applicable plan documents, because the opinion piece does not report a scheduled policy review or an announced nationwide change. Further studies and clearer reporting on how coverage criteria affect different populations could help show the scale of the gap Saeed describes.
For now, the article documents one physician’s experience and presents research and guideline claims in support of a broader policy argument. It does not show that GLP-1 eligibility has changed, or that a particular BMI threshold has been adopted across U.S. insurers.
Key Questions
What happened to Hamayle Saeed?
Saeed says she was screened for diabetes at a BMI of 26.5 under an approach that uses a lower screening threshold for Asian Americans, but was denied a GLP-1 medication because she did not meet the BMI criteria applied to coverage and did not have diabetes. Her account appeared in a MedPage Today opinion article published October 31, 2026.
Why does the article mention a BMI of 23?
The article says diabetes screening guidance recognizes elevated risk among Asian Americans at lower BMI values and describes 23 as a screening point. A screening threshold is not the same as a drug-coverage threshold or an individual diagnosis.
What BMI criteria are commonly used for GLP-1 coverage?
Saeed says the criteria applied in her case were a BMI of 30, or 27 with at least one weight-related condition. The article reports that these numbers remain common in prior authorization materials, but coverage rules vary by plan and the source does not provide a national survey.
Do updated drug labels mean people below BMI 30 qualify?
Not necessarily. The article says the labels for semaglutide and tirzepatide describe indications without a numerical BMI in the indication, but insurers may use separate coverage rules. The source does not establish that label wording alone changes plan eligibility.
What remains unknown about the reported denial?
The article does not identify Saeed’s insurer or include the written denial, so the precise policy applied in her case cannot be independently assessed from the supplied report. It also does not say whether insurers will change their criteria or how many patients are affected.
Source: medpagetoday.com
