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A MedPage Today opinion essay by South Asian physician Hamayle Saeed describes a mismatch: diabetes screening for Asian Americans may begin at a BMI of 23, while U.S. coverage rules commonly use BMI 30, or 27 with a weight-related condition, for GLP-1 weight-loss drugs. The essay cites research and guidelines supporting lower BMI thresholds for some Asian populations, but it does not establish that all insurers apply the same criteria or that the described denial is universal.
South Asian physician Hamayle Saeed says she was screened for diabetes at a BMI of 23 but denied a GLP-1 drug for weight management at a BMI of 26.5, because she did not meet the commonly used U.S. eligibility thresholds of 30, or 27 with a weight-related condition. In an October 31 MedPage Today opinion essay, Saeed argues that the difference exposes a mismatch between how diabetes risk is assessed for Asian Americans and how access to weight-loss medication is often determined.
Saeed writes that her doctor began diabetes screening in line with American Diabetes Association guidance for Asian Americans, for whom screening can start at a lower BMI than for the general population. She says she did not have diabetes and had a BMI of 26.5, leaving her below the drug-eligibility criteria used in the prior authorization process she encountered. Her account describes her own experience; it does not show that every insurer uses identical rules or that every GLP-1 prescription is subject to the same coverage decision.
The essay distinguishes regulatory labeling from payer practice. Saeed says the 2026 U.S. labels for Wegovy and Zepbound describe use for adults with obesity, or adults with overweight and a weight-related condition, without specifying a BMI number in the indication. But she says trial entry criteria and insurance prior authorization forms continue to rely on BMI cutoffs of 30 or 27 with a related condition. The exact criteria can vary by plan, indication and product.
As evidence of the disparity, Saeed cites a study of nearly 1.5 million adults in England that estimated South Asian adults reached the diabetes risk associated with a BMI of 30 in white adults at a BMI of 23.9; the corresponding estimate for Chinese adults was 26.9. She also cites a 2026 analysis of 352 GLP-1 trials, reporting that a BMI cutoff of 30 would make 41.5% of non-Asian U.S. adults eligible, compared with 13.5% of Asian Americans and 7.2% of Korean Americans. These are figures reported in the essay, and the underlying studies’ methods and populations matter to how they should be interpreted.
The Gap Between Risk and Coverage
The issue affects whether patients considered at elevated metabolic risk can obtain a treatment before reaching BMI thresholds used in insurance paperwork. Screening eligibility is not the same as drug eligibility: a lower BMI threshold can prompt testing without changing the rules governing medication coverage. That distinction may be especially consequential for Asian patients, whose health risks may not be reflected by the same BMI cutoffs used for other populations.
Saeed also describes a setting in which access may be tightening. She writes that Medi-Cal ended coverage for GLP-1s for weight loss in January and MassHealth followed in July. The essay argues that when coverage contracts, people near eligibility boundaries may be affected first. The policy implications depend on each program’s rules, the drug’s indication and whether a patient has another qualifying condition.
The research cited in the essay suggests that trial and reimbursement thresholds may not fit all populations equally. But those findings do not, by themselves, establish what coverage policy should be for an individual patient. Decisions involve evidence about benefit and risk, regulatory indications, clinical judgment and payer rules, not BMI alone.
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How BMI Thresholds Diverge
BMI is a measure based on height and weight, not a direct measure of body fat distribution. Saeed cites international guidance and research indicating that, on average, people of Asian descent can have more visceral fat and less muscle at a given BMI than people of European descent. The World Health Organization established lower action points for Asian populations in 2004, including BMI levels of 23 and 27.5. These are population-level reference points, not an individual diagnosis.
The essay says the ADA’s 2026 Standards of Care advise clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity and specifically reference South Asian patients. It also cites a 2025 STEP 11 study in South Korea and Thailand that enrolled people using a local obesity definition of BMI 25 or higher. In a post hoc analysis of 68 participants who began below BMI 30, the essay reports weight loss of 17.6% among 45 semaglutide recipients and 4.4% among 23 placebo recipients. A subgroup analysis does not settle whether U.S. insurers should adopt a different cutoff.
Saeed says the current U.S. coverage gap persists even as some clinical definitions have become more population-specific. She contrasts U.S. payer forms with guidance from Britain’s NICE, which she says applies a 2.5-point BMI adjustment for several ethnic groups when setting thresholds for tirzepatide. That comparison concerns different health systems and policies; it does not mean their eligibility rules are directly interchangeable.
“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 a MedPage Today opinion essay
Coverage Rules Still Vary
The essay does not identify the insurer or provide the prior authorization decision, so the precise basis for Saeed’s denial cannot be independently assessed from the material supplied. It is also unclear how broadly plans have revised their forms after the label language changes Saeed describes. Coverage depends on the plan, product, indication and medical history, and rules may differ across public programs and private insurers.
The cited studies report group-level risks and treatment outcomes, but do not answer every question about long-term benefit, safety, cost-effectiveness or appropriate eligibility thresholds for Asian American patients in the United States. The essay’s source material also ends during its discussion of race-adjusted medicine, so it does not provide the author’s complete final argument. No national policy change is reported.
Whether Payers Revise Their Forms
The immediate issue is whether insurers and public programs will align prior authorization criteria with current product labels and clinical guidance on ethnicity-specific assessment. The essay does not announce a scheduled policy review, regulatory action or payer decision. Patients and clinicians will need to check the criteria for the specific plan and intended use rather than assume one BMI threshold applies everywhere.
Further evidence and policy decisions would be needed to determine whether lower BMI cutoffs should change coverage. For now, the reported development is a physician’s account and argument, supported by studies and guidelines she cites—not a confirmed nationwide change in GLP-1 eligibility.
Key Questions
Why could diabetes screening begin at BMI 23 while GLP-1 coverage requires BMI 30?
Screening guidance and drug coverage rules serve different purposes. The essay says Asian Americans may be screened for diabetes at a lower BMI because risk can arise at lower weights, while coverage forms commonly use BMI 30, or 27 with a weight-related condition. Individual plan rules may differ.
Does a BMI of 23 automatically qualify an Asian American patient for a GLP-1?
No. The reported lower BMI threshold concerns diabetes screening or assessment of obesity-related risk; it does not automatically establish eligibility for a prescription or insurance coverage. A clinician and the relevant payer determine eligibility under the applicable rules and medical circumstances.
Did the FDA set a BMI 30 rule for every GLP-1 prescription?
The essay says current Wegovy and Zepbound labels describe indications without a BMI number, while trial criteria and prior authorization forms may continue to use thresholds of 30 or 27 with a related condition. Coverage rules vary, and the material does not establish a single rule for every GLP-1 product or use.
What evidence does the essay cite about Asian patients?
Saeed cites a large English study estimating that South Asian adults reached the diabetes risk associated with BMI 30 in white adults at BMI 23.9, as well as trial and treatment analyses. These findings concern the populations and methods studied and do not, on their own, determine an individual patient’s treatment or coverage.
Source: medpagetoday.com
