First Circuit: Obesity Alone Isn't a Disability Under the ADA's Insurance Rules

On February 23, 2026, the First Circuit Court of Appeals decided Whittemore v. Cigna Health and Life Insurance Co., affirming a district court's dismissal of a proposed class action over a health plan's refusal to cover weight-loss medication. The plaintiff — identified in the case only by her surname, Whittemore — was enrolled in a Cigna-administered health plan through her employment with the University of Maine System. She sued under Section 1557 of the Affordable Care Act, which prohibits disability discrimination in health programs.

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Section 1557 does not define disability on its own; it incorporates the definition used in the Americans with Disabilities Act — an impairment that substantially limits one or more major life activities. Whittemore alleged that her obesity limited her ability to walk, stand, and sleep. The court did not dispute that she had been diagnosed with obesity or prescribed medication for it. What it found lacking was evidence connecting that diagnosis to an actual, specific limitation on her daily functioning, as opposed to a general description of what obesity can do.

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The court went further, rejecting the broader argument that a diagnosis should be enough on its own. According to Thomson Reuters' and HR Dive's accounts of the ruling, the panel rejected the argument that any individual diagnosed with obesity and prescribed medication for it is, by definition, substantially limited in a major life activity — reasoning that general statements about what obesity can do don't establish that every person in that category meets the ADA's definition. That is a pleading-standard ruling, not a categorical one — the court did not hold that obesity can never meet the ADA's disability definition, only that this complaint hadn't alleged the specific facts needed to support it.

The same underlying question — whether obesity alone counts as a disability, or whether a plaintiff must show it stems from an underlying physiological disorder — has already split federal appeals courts in the employment context. In June 2019, in Richardson v. Chicago Transit Authority, the Seventh Circuit held that extreme obesity is not an actionable impairment under the ADA absent an underlying physiological cause, aligning with prior rulings from the Second, Sixth, and Eighth Circuits. The First Circuit's own precedent actually points the other way on that specific question: in Cook v. Rhode Island, Dept. of Mental Health, Retardation and Hospitals (1993), it held that morbid obesity could qualify as an ADA impairment without proof of a separate underlying physiological disorder. Whittemore didn't have to resolve that tension to decide this case — the panel ruled on what the complaint had actually pleaded, not on whether obesity requires a physiological cause to count as an impairment at all — so it would overstate the ruling to describe it as aligning with the Seventh Circuit's stricter approach. The two questions are related but not the same one, and the First Circuit hasn't revisited the older one here.

The ruling adds to two threads this desk keeps returning to: state weight-discrimination bills that keep passing one chamber and stalling in the other, and retailers' own uncertain math on how many GLP-1 users are actually keeping weight off long enough to change what stores stock.