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A MedPage Today opinion article by physician Hamayle Saeed describes a mismatch between diabetes screening guidance for Asian Americans and BMI thresholds commonly used for GLP-1 access. The article says screening may begin at BMI 23 for Asian Americans, while coverage criteria often require BMI 30, or 27 with a weight-related condition; how widely payer policies apply and whether they will change remains unclear.
A South Asian physician says she was screened for diabetes under guidance that uses a BMI of 23 for Asian Americans, but could not obtain a GLP-1 medication for weight management at a BMI of 26.5 because she had no diabetes and did not meet the eligibility criteria she encountered. In an October 31 MedPage Today opinion article, Hamayle Saeed argues that this gap leaves Asian patients facing lower thresholds for screening than for treatment access.
Saeed writes that the American Diabetes Association’s screening approach recognizes that Asian Americans can develop diabetes at lower body weights and supports screening at a BMI of 23. She says she was screened accordingly. But when she sought a GLP-1 receptor agonist, she was told she did not qualify: the criteria she describes require a BMI of 30, or 27 with at least one weight-related condition. Saeed says her BMI was 26.5 and she did not have diabetes.
The article reports that the gap is reinforced by insurance prior authorization forms, which may continue to use the higher BMI figures. Saeed also says Medi-Cal stopped covering GLP-1 drugs for weight loss in January and MassHealth followed in July. The account does not provide plan documents or details establishing how those coverage changes apply to every member or medication.
Saeed points to evidence that BMI may not capture differences in body composition and diabetes risk across populations. She cites an analysis of nearly 1.5 million adults in England that estimated the BMI at which South Asian adults reached the diabetes risk associated with a BMI of 30 among white adults was 23.9; for Chinese adults, it was 26.9. Those are findings from the cited study, not individual diagnoses or universal treatment rules.
Screening Rules Outpace Drug Access
The issue described by Saeed is a difference between risk recognition and treatment eligibility. A lower screening threshold can prompt earlier testing, but it does not automatically change a drug’s regulatory indication, a clinician’s prescribing decision, or an insurer’s coverage rules. Patients may therefore be flagged for closer diabetes monitoring while still falling short of the BMI criteria used to approve weight-management medication.
That difference matters to patients and clinicians because coverage decisions affect access, even when a prescriber considers treatment appropriate. Saeed argues that Asian patients may be disproportionately affected when policies rely on BMI cutoffs developed from trials that included relatively few Asian participants. Whether individual insurers will revise their rules, and what evidence they would require, is not established in the article.
The account also reflects a wider policy question: how to account for population-level differences in risk without treating ethnicity as a substitute for assessing an individual’s health. BMI is one screening and eligibility measure; it does not by itself establish a diagnosis or determine whether a specific medication is suitable.
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Evidence Behind Lower Asian BMI Cutoffs
The article says the World Health Organization set lower BMI action points for Asian populations in 2004, including 23 and 27.5. Saeed cites the 2025 iCARDIO global obesity guidelines, which estimate that Asian people may have a BMI roughly two to three units lower than white people at a similar level of body fat. She also refers to the ADA’s 2026 Standards of Care, which advise clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity and specifically name South Asian patients.
For GLP-1 evidence, Saeed cites the 2025 STEP 11 study in South Korea and Thailand, which enrolled participants using a local obesity definition of BMI 25 or higher. The article reports average weight loss of 16% with semaglutide versus 3.1% with placebo. In a post hoc group of 68 participants who began below BMI 30, it reports weight loss of 17.6% among 45 participants taking semaglutide and 4.4% among 23 taking placebo. The figures describe that study and subgroup; they do not establish coverage eligibility in the United States.
Saeed says current U.S. labels for Wegovy and Zepbound describe eligible patients using terms such as obesity or overweight with a weight-related condition, while trial criteria and insurer forms may still feature numerical thresholds. The article also cites UK guidance that lowers BMI thresholds by 2.5 units for several ethnic groups when setting access criteria for tirzepatide. These examples point to differing approaches, not a single shared policy.
“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 MedPage Today
Coverage Rules Still Vary
The source is an opinion article and personal account, not a survey of insurer decisions or a formal policy announcement. It does not identify the insurer or prior authorization form involved in Saeed’s experience, specify the exact product she sought, or show whether her request was reconsidered. The BMI criteria she describes should not be assumed to apply identically to all plans or patients.
It is also unclear whether the cited study results will lead to changes in U.S. prescribing labels, clinical guidance, or payer rules. The article describes label wording and screening recommendations but does not document a new federal coverage policy. Study results in particular populations do not, on their own, answer questions about long-term outcomes, individual suitability, or insurance reimbursement.
Whether Payers Revise Their Criteria
The next developments to watch are changes, if any, to insurer prior authorization criteria and whether professional guidance clarifies how ethnicity-adjusted BMI thresholds should inform medication access. The article does not announce a scheduled decision or a specific policy review. Patients seeking treatment will still need to check the rules of their own health plan and discuss screening and treatment options with a qualified clinician.
Key Questions
What happened in the report?
Physician Hamayle Saeed wrote that she was screened for diabetes under guidance that uses a BMI of 23 for Asian Americans, but could not access a GLP-1 medication under criteria she encountered because her BMI was 26.5 and she had no diabetes.
Does a BMI of 23 qualify someone for a GLP-1?
Not by itself, based on the criteria described in the article. The BMI 23 figure is a diabetes screening threshold cited for Asian Americans, while the article says the eligibility criteria she faced were 30, or 27 with a weight-related condition. A person’s coverage depends on the specific medication, plan, and clinical circumstances.
Why does the article focus on Asian Americans?
Saeed cites guidance and research indicating that some Asian populations may face elevated diabetes risk at lower BMI values. She argues that screening recommendations have incorporated this risk more readily than drug access criteria have.
Do the cited study results change U.S. insurance coverage?
The article does not report a coverage change prompted by the studies. Its cited STEP 11 results provide evidence from a specific trial, but they do not automatically alter U.S. labels or payer rules.
Source: medpagetoday.com
