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A MedPage Today opinion article by physician Hamayle Saeed describes being screened for diabetes under an Asian-specific BMI threshold but denied GLP-1 treatment because she did not meet common U.S. BMI eligibility criteria. The report argues that screening guidance and insurance rules use conflicting definitions, while the precise coverage rules and any policy changes remain unsettled.
Physician Hamayle Saeed says her doctor began screening her for diabetes at a body mass index (BMI) of 23, in line with guidance for Asian Americans, but she was denied a GLP-1 medication for weight loss at a BMI of 26.5 because she did not meet the eligibility thresholds used by her insurer. In an October 31 MedPage Today opinion article, Saeed argues that lower BMI thresholds used to identify diabetes risk in Asian patients have not been reflected consistently in drug coverage rules.
Saeed, who identifies herself as a South Asian physician, says she has no diabetes and was told she did not qualify for an FDA-approved GLP-1 under the criteria applied to her. The article describes the usual U.S. thresholds as a BMI of 30, or 27 with at least one weight-related condition. Saeed says her BMI of 26.5 met neither threshold. The account is her personal experience; the article does not identify her insurer or provide the denial paperwork.
The article says the American Diabetes Association uses BMI 23 as a diabetes-screening point for Asian Americans because diabetes can develop at lower body weights in these populations. Saeed’s central argument is that the same BMI can trigger additional screening while still falling short of payer criteria for weight-loss medication. She also cites the ADA’s 2026 standards, which she says direct clinicians to confirm excess body fat using thresholds appropriate to ethnicity.
Saeed points to changes in coverage and clinical research. She says Medi-Cal stopped covering GLP-1s for weight loss in January and MassHealth followed in July; the article does not give the year for those changes. She also cites the 2025 STEP 11 semaglutide trial in South Korea and Thailand, which enrolled participants using a local obesity definition of BMI 25 or higher. In a post hoc group of 68 participants with baseline BMI below 30, the article reports average weight loss of 17.6% among 45 semaglutide recipients and 4.4% among 23 placebo recipients.
How BMI Rules Shape Drug Access
The gap described by Saeed matters because screening thresholds and treatment coverage rules serve different purposes, yet patients may encounter both as judgments about the same measure. Lower screening thresholds can prompt earlier testing; they do not automatically change a drug’s regulatory indication, clinical eligibility or insurance coverage. For people whose health risks may emerge at lower BMI, that distinction can mean a diagnosis is considered before a payer’s weight-based criteria are met.
The article also raises an access question for clinicians and insurers: whether BMI alone adequately reflects risk across populations with different body composition. Saeed cites research suggesting that Asian adults may carry more visceral fat at a lower BMI, and trial data suggesting standard BMI entry criteria can exclude a larger share of Asian participants. These findings inform the debate, but they do not establish that every patient below BMI 30 should receive a GLP-1. Treatment decisions and coverage also depend on individual health, approved indications, evidence, and payer rules.
Coverage reductions add another pressure. If insurers narrow benefits, patients who fall near the edge of eligibility may lose access first. The article’s examples from California’s Medi-Cal and Massachusetts’ MassHealth illustrate that concern, although it does not provide enrollment figures, the full policy language, or data on how many patients were affected.
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Screening Guidance and Coverage Criteria
The article distinguishes diabetes screening from obesity diagnosis and medication coverage. It says the World Health Organization set lower action points for Asian populations in 2004, including BMI 23 and 27.5, and cites a study of nearly 1.5 million adults in England. In that study, the BMI associated with the diabetes risk of white adults at BMI 30 was 23.9 for South Asian adults and 26.9 for Chinese adults. These are population-level findings, not individual diagnoses.
Saeed says pivotal GLP-1 trials and subsequent payer forms often relied on BMI criteria of 30 or 27 with a related condition. She cites a 2026 analysis of 352 trials that found BMI cutoffs excluded a larger proportion of Asian American and Korean adults than non-Asian American adults. She also notes that U.S. product labels for Wegovy and Zepbound, as described in her article, state indications in terms of obesity or overweight with a weight-related condition without specifying a numeric BMI in the indication itself. Labels, trial criteria and insurer authorization policies are not interchangeable, and the article does not review individual plans’ current 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. Only one of them was written with an Asian body in mind.”
— Hamayle Saeed, MD, in her MedPage Today opinion article
What Coverage Rules Still Leave Open
The article does not name Saeed’s insurer, state whether she appealed, or show the specific prior authorization form behind her account. It also does not establish that every U.S. plan applies the same BMI 30 or BMI 27 criteria, or explain how plans interpret current product labels. The stated Medi-Cal and MassHealth coverage changes are not accompanied by policy documents or details about exceptions.
The STEP 11 subgroup figures are described as a post hoc analysis of 68 participants; the article does not supply enough detail to determine how broadly those results apply to patients outside the trial. It also remains unclear whether regulators, insurers or professional groups will revise numeric eligibility rules in response to the research and guidance Saeed cites. No policy change is announced in the source material.
Policy Reviews and Patient Appeals
The source does not identify a scheduled decision or upcoming policy announcement. The next developments to watch are whether insurers revise prior authorization criteria, whether professional guidance clarifies how ethnicity-appropriate BMI thresholds should inform treatment decisions, and whether additional trial evidence addresses patients who fall below conventional BMI cutoffs. Patients facing a denial would need to check their plan’s current criteria and appeal process; the article does not describe a specific appeal outcome for Saeed.
Key Questions
Why was Saeed screened for diabetes at BMI 23?
Saeed says her doctor followed Asian-specific diabetes-screening guidance. Her article explains that diabetes can occur at lower BMI levels among Asian populations, so screening may begin below thresholds commonly used for other purposes.
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 at least one weight-related condition. She says her BMI was 26.5 and she did not have diabetes. Her account does not identify the insurer or establish the rules used by all plans.
Does a lower screening BMI automatically qualify someone for medication?
No. Screening guidance is not the same as a drug indication or insurance coverage rule. Eligibility can depend on the medication’s approved use, a person’s health circumstances and the specific payer’s criteria.
What evidence does the article cite about lower BMI thresholds?
Saeed cites a 2025 STEP 11 study in South Korea and Thailand, including a post hoc analysis of participants with BMI below 30. She reports greater average weight loss in the semaglutide group than the placebo group, but the subgroup included 68 participants and does not by itself settle coverage policy.
Source: medpagetoday.com
