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In a MedPage Today opinion article, Pakistani American physician Hamayle Saeed describes being screened for diabetes at a BMI of 23 and asking about a GLP-1 receptor agonist when her BMI was 26.5. She says the answer was no because she did not meet the stated FDA-approved threshold for someone at that BMI without diabetes. Her account highlights a mismatch between ethnicity-adjusted clinical guidance and BMI criteria she says appear on payer authorization forms.
Pakistani American physician Hamayle Saeed says her doctor began diabetes screening after she said her BMI had passed 23, a threshold recognizing diabetes risk among Asian Americans at lower weights. At a BMI of 26.5, she says she asked about a GLP-1 receptor agonist and was told no because she did not meet the stated FDA-approved threshold for someone at that BMI without diabetes. In an October 31 MedPage Today opinion article, Saeed argues that the gap leaves some Asian patients flagged for earlier screening but outside criteria she says insurers use to cover weight-loss medication.
Saeed writes that her doctor began diabetes screening after she said her BMI had passed 23, a threshold used to identify higher diabetes risk among Asian Americans. She says she did not have diabetes and had a BMI of 26.5. She describes the stated FDA-approved eligibility criteria she encountered as a BMI of 30, or 27 with a weight-related condition. Her account is a first-person report.
The article says the American Diabetes Association’s 2026 Standards of Care tell clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity and specifically name South Asian patients. Saeed contrasts that approach with prior authorization criteria that, she writes, continue to use familiar BMI thresholds. She also says FDA-approved product labeling for semaglutide (Wegovy) and tirzepatide (Zepbound) was revised in 2026 to describe eligibility in terms of obesity or overweight with a weight-related condition, without stating a numerical BMI in the indication. That does not, by itself, establish that insurers have changed their coverage rules.
Saeed cites STEP 11, published in 2025, which tested semaglutide 2.4 mg in South Korea and Thailand. In a post hoc analysis of 68 participants who began below BMI 30, the 45 participants given semaglutide lost an average of 17.6% of body weight, compared with 4.4% among 23 given placebo. The results are from a particular trial and subgroup analysis; they do not show that every patient below BMI 30 should receive the drug or that insurers must cover it.
Coverage Rules Lag Risk Guidance
The issue Saeed raises is a mismatch between how clinicians assess risk and how coverage is authorized. She argues that if a patient’s ethnicity-adjusted BMI prompts earlier screening but a payer applies a higher treatment cutoff, the patient may be identified as at elevated risk without qualifying for a medication that could be considered as part of care. The article presents this as a policy and access concern, not as evidence that a specific insurer violated a rule.
Saeed also discusses coverage for weight-loss GLP-1s in public programs. According to her article, Medi-Cal dropped coverage in January and MassHealth followed in July. She writes that when a benefit contracts, patients whose eligibility was marginal lose access first.
For readers, Saeed’s account illustrates that screening thresholds and medication eligibility criteria can differ. She describes being screened at a lower BMI and then being told she did not meet the stated threshold when she asked about a GLP-1 receptor agonist.
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How BMI Criteria Diverged
Saeed’s argument draws on evidence that BMI does not capture body composition equally across populations. She cites research and guidance indicating that people of Asian descent, on average, may carry more visceral fat and less muscle at a given BMI than people of European descent. The World Health Organization set lower action points for Asian populations—BMI 23 and 27.5—in 2004, according to the article.
The article also cites a study of nearly 1.5 million adults in England that compared the BMI at which different ethnic groups reached the diabetes risk associated with a BMI of 30 in white adults. It reports estimates of 23.9 for South Asian adults and 26.9 for Chinese adults.
Saeed argues that clinical-trial enrollment and the resulting eligibility conventions helped preserve higher thresholds. She cites a 2026 analysis of 352 GLP-1 trials in which BMI cutoffs were the criterion most likely to exclude Asian participants: a BMI 30 cutoff made 13.5% of Asian Americans and 7.2% of Koreans eligible, compared with 41.5% of non-Asian Americans. The article also points to the UK’s NICE guidance, which lowers certain BMI thresholds by 2.5 units for several ethnic groups.
“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 article
What the Account Leaves Unspecified
Saeed describes a prior authorization form that, she says, denied her the drug. The article does not provide further details about the criteria applied in her case.
Saeed says the 2026 label revisions describe eligibility without numerical BMI thresholds, while numerical thresholds persist in payer authorization forms. The article also cites clinical findings, including STEP 11 subgroup results, in discussing questions about reimbursement criteria.
Policy Changes Remain Unconfirmed
The immediate next step for patients facing a denial is to check the exact plan criteria and discuss the decision with their clinician; coverage may depend on the diagnosis, the plan, and the documentation requested. Saeed’s article does not announce a formal appeal, regulatory action, or a change by a named insurer.
At the policy level, the unresolved question is whether U.S. payers will revise prior authorization rules to reflect ethnicity-adjusted clinical guidance and evidence from trials that enrolled patients at lower BMI thresholds. The article identifies no deadline or announced review. Until a payer or regulator publishes a change, the coverage rules patients face remain plan-specific and may not match the screening thresholds described in clinical guidance.
Key Questions
What happened in the report?
Hamayle Saeed wrote that her doctor began diabetes screening after she said her BMI had passed 23. At a BMI of 26.5, she says she asked about a GLP-1 receptor agonist and was told no because she did not meet the stated FDA-approved threshold for someone at that BMI without diabetes. Her account appeared in a MedPage Today opinion article published October 31, 2026.
Does a diabetes screening BMI of 23 qualify someone for a GLP-1?
No. A screening threshold is used to identify people who may need testing; it does not automatically establish eligibility for medication or insurance coverage. The criteria depend on the drug, clinical circumstances, and the patient’s coverage plan.
What BMI thresholds does the article describe for U.S. coverage?
Saeed describes the stated eligibility thresholds she encountered as a BMI of 30, or 27 with at least one weight-related condition. These are not necessarily the rules of every plan, and the article does not provide the policy for her specific insurer.
Did the revised drug labels require insurers to cover GLP-1s at lower BMIs?
The article says revised labels describe the indicated groups without specifying a numerical BMI in the indication. It does not report that the revisions required insurers to change prior authorization criteria. Labeling and coverage decisions are separate.
What remains unknown about the reported denial?
The article describes a prior authorization form that Saeed says denied her the drug, but provides no further details about the criteria applied in her case. It also discusses numerical thresholds that persist in payer authorization forms after the 2026 label revisions.
Source: medpagetoday.com
