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A MedPage Today opinion article by South Asian physician Hamayle Saeed describes being screened for diabetes at a BMI of 23 but being denied a GLP-1 weight-loss drug at BMI 26.5 because she did not meet the cited eligibility thresholds. The account highlights a mismatch between ethnicity-adjusted clinical guidance and trial-based or insurer rules; it does not establish that all patients or plans apply the same criteria.
A South Asian physician says her doctor began diabetes screening at a BMI of 23, but she was denied a GLP-1 weight-loss drug at BMI 26.5 because she did not meet the eligibility thresholds cited in her account. In an October 31 opinion article for MedPage Today, Hamayle Saeed argues that the gap between ethnicity-adjusted diabetes-risk guidance and drug coverage rules can leave Asian patients assessed as high-risk for screening but ineligible for treatment.
Saeed writes that the American Diabetes Association’s guidance calls for diabetes screening in Asian Americans beginning at a BMI of 23. She says her physician followed that recommendation. But she did not have diabetes, and her BMI was below the 30 threshold she describes for obesity treatment, as well as below 27 with a weight-related condition. She says she met neither criterion for the prescription she sought.
The article connects her experience to differing approaches to BMI and risk. Saeed cites research indicating that people of Asian descent can develop type 2 diabetes and cardiovascular disease at lower BMI levels than white people. She also describes a study of nearly 1.5 million adults in England that estimated the BMI at which diabetes risk for South Asian adults matched that of white adults at BMI 30 as 23.9; the corresponding estimate for Chinese adults was 26.9.
Saeed also points to a 2025 study of semaglutide in South Korea and Thailand. The trial used a local obesity definition of BMI 25 or higher. In a post hoc analysis of 68 participants who began below BMI 30, she reports that participants receiving semaglutide lost an average of 17.6% of body weight, compared with 4.4% among those receiving placebo. These results describe that study population; they do not by themselves establish coverage policy or eligibility for every patient.
The Gap Between Risk and Access
The issue affects how patients move from risk assessment to treatment. If screening guidance recognizes elevated diabetes risk at a lower BMI for Asian patients while drug trials or insurers apply higher cutoffs, a patient may be eligible for closer monitoring but not for a medication sought for weight management. Saeed’s account illustrates that tension, though it does not show how frequently such denials occur across health systems.
Coverage restrictions can shape access even when clinical evidence or drug labeling evolves. Saeed says California’s Medi-Cal program stopped covering GLP-1 drugs for weight loss in January and Massachusetts’ MassHealth followed in July. Those policy changes, if applicable to a patient’s plan and indication, can add another barrier beyond BMI. The article does not provide enrollment figures or quantify how many people have lost coverage.
The broader concern is whether evidence and administrative rules adequately reflect differences in risk across populations. Trial participation, regulatory labeling and insurer authorization criteria serve different purposes. When they rely on different definitions, clinicians and patients may face uncertainty over which threshold controls an actual prescription decision.
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How BMI Rules Diverged
Saeed says the World Health Organization set lower BMI action points for Asian populations in 2004, at 23 and 27.5. She also cites 2025 global obesity guidance that places an Asian person’s BMI roughly two to three units below a white person’s at the same body-fat level. BMI is a screening measure, not a direct measurement of body composition, and population-level thresholds do not determine an individual diagnosis on their own.
The article says many pivotal GLP-1 trials used Western BMI definitions and that those criteria carried into trial descriptions and payer forms. It cites a 2026 analysis of 352 trials in which 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 estimates based on the analysis, not counts of people denied treatment.
Saeed reports that the 2026 ADA Standards of Care advise clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity, including for South Asian patients. She also says current U.S. labels for Wegovy and Zepbound describe indications using obesity or overweight with a weight-related condition, while the numeric thresholds remain in trial materials and payer authorization forms. The article argues that this leaves the definition used in coverage decisions unsettled.
“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, writing in MedPage Today
Who Sets the Eligibility Threshold
The account does not identify the insurer or provide the denial notice, so the exact rule applied to Saeed’s request cannot be independently assessed from the article text provided. Eligibility can depend on the drug, the reason for prescribing it, a patient’s health conditions, the plan’s terms and applicable labeling. It is not established here that every U.S. insurer uses the same BMI criteria.
The article also does not establish that ethnicity-adjusted BMI thresholds have been adopted consistently in prescribing or reimbursement decisions. The reported studies offer evidence about risk and treatment outcomes in particular populations, but they do not settle how regulators, clinicians or insurers should translate those findings into individual eligibility rules. The reported coverage changes in California and Massachusetts may also vary by benefit, indication and date.
Coverage Rules Under Scrutiny
The next practical test is whether insurers and public programs revise prior authorization rules to reflect current drug labels, updated clinical guidance and evidence from studies involving Asian participants. Saeed’s article does not announce a pending rule change or give a timeline for one.
For now, patients and prescribers must check the criteria attached to the specific drug and health plan. Clinicians may need to document the patient’s health risks and the basis for a treatment request, but the article does not describe a universal appeal route or guarantee that an exception will be granted. Any policy response will depend on decisions by guideline groups, regulators and payers.
Key Questions
Why did Saeed say she was screened at BMI 23?
She says her doctor followed ADA guidance recommending diabetes screening for Asian Americans beginning at a BMI of 23.
Why was she denied the GLP-1 drug?
In her account, her BMI of 26.5 was below the cited threshold of 30, and she did not have the weight-related condition required for the alternative threshold of 27. The article does not identify her insurer or provide the denial paperwork.
Do all GLP-1 prescriptions require a BMI of 30?
No universal rule is established by this report. Saeed describes thresholds commonly used for weight-loss eligibility, but criteria can differ by drug, indication, health plan and patient circumstances.
What did the South Korea and Thailand study find?
In a post hoc analysis cited by Saeed, 45 participants who began below BMI 30 and received semaglutide lost an average of 17.6% of body weight, compared with 4.4% among 23 participants receiving placebo. The result applies to that study group and is not itself a coverage determination.
Have U.S. insurers changed their BMI criteria?
The article says numeric cutoffs remain in payer authorization forms, but it does not provide a complete survey of insurers or document a new nationwide policy. Patients should check the current requirements for their own plan and prescription.
Source: medpagetoday.com
