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A MedPage Today opinion essay by Pakistani American physician Hamayle Saeed describes being screened for diabetes at a BMI of 23 but denied a GLP-1 medication at BMI 26.5 because she did not meet the usual BMI-based eligibility thresholds. The essay argues that diabetes-screening guidance and drug access rules treat BMI differently for Asian patients; the extent to which insurers will change their policies remains unclear.
Pakistani American physician Hamayle Saeed says she was screened for diabetes after her BMI passed 23, a threshold used for Asian Americans, but was denied a GLP-1 medication at a BMI of 26.5 because she did not meet the usual BMI criteria for weight-management treatment. In an October 31 MedPage Today opinion essay, Saeed argues that the difference leaves Asian patients facing earlier risk recognition without matching access to medication.
Saeed writes that the American Diabetes Association (ADA) recommends diabetes screening for Asian Americans at a BMI of 23, reflecting higher risk at lower body weights. She says her clinician followed that approach. But at a BMI of 26.5, she did not qualify under the commonly applied thresholds she describes: a BMI of 30, or 27 with at least one weight-related condition. She says she did not have diabetes, and her request for a GLP-1 receptor agonist was declined.
The essay connects her experience to changes in public coverage. Saeed says Medi-Cal ended coverage for GLP-1s for weight loss in January and MassHealth followed in July. She also cites the ADA’s 2026 guidance on ethnicity-appropriate measures of excess adiposity and a 2025 study of semaglutide in South Korea and Thailand. In that trial, participants had a BMI of at least 25 under local obesity criteria; the essay reports average weight loss of 16% with semaglutide versus 3.1% with placebo.
Saeed further cites a post hoc analysis of 68 participants in the study who began below BMI 30. The 45 people assigned semaglutide lost an average of 17.6% of body weight, compared with 4.4% among 23 assigned placebo. These findings concern a subgroup analysis, not a change to U.S. prescribing or insurance rules. The essay’s central point is that a screening threshold and a medication-coverage threshold serve different purposes but can produce a stark difference in care for the same patient.
How BMI Rules Shape GLP-1 Access
The account highlights how a single measurement can trigger closer diabetes screening without opening the door to medication coverage. For patients, that may mean clinicians recognize elevated risk while insurers continue to apply eligibility criteria based on higher BMI cutoffs or other requirements. Screening eligibility does not automatically establish drug eligibility, and the two policies may be set by different organizations for different reasons.
The issue also reaches beyond one patient’s experience. Saeed cites research suggesting Asian people may have different body composition and diabetes risk at a given BMI than white people. If trials and coverage policies rely on criteria that enroll or qualify fewer Asian patients, evidence and access may not reflect their risk well. But the essay does not establish how many people are denied treatment under these rules, or whether a particular insurer’s decision was unlawful or inconsistent with its policy.
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Why Screening Uses Lower BMI
The essay says the World Health Organization identified lower BMI action points for Asian populations in 2004, including 23 and 27.5. It also cites a study of nearly 1.5 million adults in England that estimated South Asians reached the diabetes risk associated with BMI 30 among white adults at a BMI of 23.9. These findings help explain why some screening guidance uses ethnicity-specific thresholds; they do not by themselves determine U.S. drug coverage.
Saeed argues that GLP-1 trial entry criteria and payer forms have retained familiar BMI numbers even as clinical definitions have evolved. She points to the 2026 ADA Standards of Care, which she says direct clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity, and to U.S. product labels that describe eligible patients as having obesity or overweight with a weight-related condition. Her account says the labels do not state a specific BMI number, while trial criteria and prior authorization forms may still use 30 and 27. Coverage rules can vary by plan, indication, and patient circumstances.
“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 her MedPage Today opinion essay
Coverage Rules Still Vary
The essay describes Saeed’s reported experience and cites studies and policy documents, but it does not identify the insurer or provide the prior authorization decision itself. It is not clear whether the denial was based solely on BMI, which specific plan rules applied, or whether she could have qualified through another indication or a different clinical assessment. Coverage depends on the plan and prescribed use; the account should not be read as showing that every patient below BMI 30 is denied.
It is also unclear whether U.S. insurers will revise their criteria in response to the cited research or ADA guidance. Trial results from South Korea and Thailand, including the smaller post hoc subgroup, do not alone establish how treatment should be covered for all Asian American patients. The essay raises a policy mismatch; it does not report a new federal rule or a change in FDA approval.
Whether Insurers Revise Criteria
The next development to watch is whether health plans update prior authorization forms or coverage policies to reflect the product-label language and ethnicity-specific clinical guidance cited by Saeed. Patients and clinicians will also need to check the criteria for the relevant plan and indication rather than assume that diabetes-screening thresholds determine medication eligibility.
Further evidence may come from larger studies involving Asian populations and from policy decisions by public programs and private insurers. Saeed’s essay does not announce a review, deadline, or planned rule change, so no specific coverage revision has been confirmed.
Key Questions
Why was Saeed screened for diabetes at a BMI of 23?
Saeed says her clinician followed guidance that uses a BMI of 23 for diabetes screening in Asian Americans, reflecting the increased risk that can occur at lower body weights. Screening guidance is distinct from medication coverage criteria.
Why did she say she did not qualify for a GLP-1?
In her account, her BMI was 26.5, below the usual BMI threshold of 30 and below 27 without a weight-related condition. She says she did not have diabetes and was denied the medication. The essay does not identify her insurer or provide the full decision record.
Does this mean all Asian patients are denied GLP-1 treatment below BMI 30?
No. Saeed describes her experience and discusses commonly used thresholds, but eligibility can depend on the specific medication, indication, health conditions, and insurance plan. The essay does not establish a rule applying to every patient or insurer.
Did the cited semaglutide study change U.S. coverage rules?
No change is reported. The study described in the essay tested semaglutide in South Korea and Thailand using local BMI criteria. Its results may inform discussion, but the essay reports no U.S. coverage-policy change resulting from the trial.
Source: medpagetoday.com
