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In an October 31, 2026, MedPage Today opinion article, South Asian physician Hamayle Saeed says she was screened for diabetes at BMI 26.5 under lower Asian-specific guidance but did not meet the BMI thresholds used for GLP-1 weight-loss coverage. Her account highlights a gap between ethnicity-adjusted clinical guidance and payer authorization rules; the article does not establish a new policy or a change in eligibility.
South Asian physician Hamayle Saeed says she was screened for diabetes at a body mass index (BMI) of 26.5 but denied a GLP-1 drug for weight management because she did not meet the BMI eligibility thresholds commonly used for coverage. In an October 31 MedPage Today opinion article, she describes a gap between lower Asian-specific diabetes-risk guidance and the higher thresholds used in drug labels and payer authorization forms.
Saeed writes that the American Diabetes Association’s guidance calls for diabetes screening in Asian Americans from a BMI of 23, reflecting evidence that diabetes risk can arise at lower body weights in Asian populations. She says her clinician screened her, but that she did not qualify for a GLP-1 under the thresholds applied to her case: BMI 30, or BMI 27 with a weight-related condition. At BMI 26.5, she says she had no diabetes and did not meet either threshold.
The article argues that the clinical and coverage approaches do not align. Saeed cites a study of nearly 1.5 million adults in England that compared BMI levels associated with the diabetes risk seen among white adults at BMI 30. The reported equivalent was BMI 23.9 for South Asian adults and 26.9 for Chinese adults. These figures concern risk comparisons in that study; they are not, by themselves, U.S. drug-coverage rules.
Saeed also points to a 2025 semaglutide study in South Korea and Thailand that used a local obesity definition of BMI 25 or higher. In a post hoc analysis of 68 participants who started below BMI 30, the 45 participants taking semaglutide lost an average of 17.6% of body weight, compared with 4.4% among 23 placebo recipients. The source says this study informs the debate about treatment at lower BMI levels, but it does not establish that U.S. insurers must cover treatment for people below their criteria.
The Divide Between Risk and Coverage
The issue matters because screening thresholds and treatment access can shape different parts of a patient’s care. If clinicians are prompted to test Asian patients at lower BMI levels while insurers rely on higher BMI cutoffs for weight-loss medications, patients may receive earlier risk assessment without qualifying for a treatment that could be considered in other circumstances. Saeed’s account illustrates that mismatch; it does not show how frequently patients encounter it or represent every insurer’s policy.
The article also connects eligibility rules to who has been included in drug research. Saeed cites a 2026 analysis of 352 GLP-1 trials that found BMI criteria disproportionately limited eligibility for Asian participants. According to the figures in her article, a BMI 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 Korean Americans. Those are trial-eligibility estimates, not measured rates of insurance approval.
For patients and clinicians, the practical distinction is between clinical assessment and reimbursement criteria. A clinician may identify elevated risk using population-specific guidance, while a payer can apply separate requirements for coverage. That difference can affect access, out-of-pocket costs and treatment discussions, but the source does not quantify those effects.
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How BMI Rules Diverge
BMI is a measure based on height and weight, but Saeed notes that it does not directly measure body fat or its distribution. She cites research indicating that people of Asian descent may carry more visceral fat and less muscle at a given 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, according to the article.
The opinion piece says the American Diabetes Association’s 2026 Standards of Care advise clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity and specifically identify South Asian patients. It also describes a June release of Asian-specific waist and BMI thresholds for diagnosing obesity. Meanwhile, Saeed says payer forms continue to use the familiar BMI cutoffs of 30, or 27 with a weight-related condition, even as some U.S. drug labels now describe indications without printing a specific BMI number.
Coverage is also changing by state, according to Saeed: Medi-Cal stopped covering GLP-1s for weight loss in January, and MassHealth followed in July. The article presents those changes as examples of narrowing public coverage. It does not provide a full account of each program’s current exceptions or eligibility rules.
“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 a MedPage Today opinion article
Coverage Rules Still Vary
The source is an opinion article built around Saeed’s personal experience, not a report of a new national rule or a systematic survey of denials. It does not identify her insurer, give the wording of the prior authorization decision, or establish whether an appeal or alternative coverage route was available. It is also unclear how widely the policies she describes apply across U.S. plans.
The article reports that current labels for Wegovy and Zepbound state indications using the terms obesity or overweight with a weight-related condition without specifying a BMI number. It does not reproduce the full prescribing information or explain how each insurer reconciles that wording with its own authorization criteria. The relationship between label language, trial entry criteria and coverage therefore remains a central question.
While the cited studies describe risk and treatment outcomes in particular populations, they do not answer every question about long-term benefits, risks, or cost-effectiveness for people seeking treatment below BMI 30 in the United States. The source also does not establish that lower BMI thresholds should automatically determine an individual’s prescription or coverage.
Policy and Payer Decisions Ahead
The next developments to watch are whether insurers and public programs revise prior authorization forms to reflect current label language and ethnicity-specific clinical guidance. The source reports no announced national change or timetable for such a revision. Patients seeking coverage will still need to check the rules of their specific health plan and discuss their clinical circumstances with a qualified clinician.
Further research and clearer reporting on payer criteria could show how often BMI thresholds lead to denials among Asian patients and whether coverage decisions change as clinical guidance evolves. For now, Saeed’s account raises the issue through an individual case and cited studies; it does not establish a new eligibility standard.
Key Questions
Why was Saeed screened for diabetes at BMI 26.5?
She says the American Diabetes Association’s guidance supports screening Asian Americans from BMI 23 because diabetes risk can occur at lower BMI levels in these populations.
Why did she say she did not qualify for a GLP-1?
According to Saeed, the criteria applied to her required a BMI of 30, or 27 with a weight-related condition. At BMI 26.5, she said she had neither the required BMI nor a qualifying condition.
Does the cited semaglutide study change U.S. insurance rules?
No. The study provides evidence from participants in South Korea and Thailand, including a post hoc analysis of people with BMI below 30. It does not set U.S. coverage requirements or compel insurers to approve treatment.
Are all GLP-1 coverage rules the same?
No. The article describes commonly used BMI criteria and state Medicaid coverage changes, but it does not document every plan’s current policy. Eligibility can depend on the specific insurer, plan and authorization requirements.
Source: medpagetoday.com
