Dive Brief:
- Cigna did not discriminate against a patient by refusing to cover her weight-loss medications because she did not plausibly allege that her obesity was a disability, the 1st U.S. Circuit Court of Appeals held Thursday (Whittemore v. Cigna Health and Life Insurance Co.).
- Upholding a district court decision, the 1st Circuit determined the plaintiff “merely outline[d] obesity’s potential impact” on individual health when she laid out complications related to the condition, but she “failed to set forth adequate support for her allegations that her obesity substantially limits one or more major life activities.”
- The case, and another like it, showed “a possible reticence of courts to accept the presumptive disability status of individuals diagnosed with obesity,” according to an analysis by Groom Law Group.
Dive Insight:
Whittemore v. Cigna was first filed in a Maine district court in June 2024. The plaintiff was enrolled in a Cigna-administered health plan through her employment with the University of Maine system. She sued under the Affordable Care Act’s Section 1557, which protects individuals with disabilities from discrimination in the design and administration of their health coverage.
As the 1st Circuit noted, Section 1557 borrows from Section 504 of the Rehabilitation Act and the definition of “disability” from the Americans with Disabilities Act — a “physical or mental impairment that substantially limits one or more major life activities.”
While the plaintiff alleged her obesity “substantially limits the major life activities of walking, standing, and sleeping” and that she “is substantially limited when compared to most people in the general population,” the 1st Circuit found that her allegations were “conclusory” and “merely recit[ed] the major life activities under the ADA without providing any factual support” about her specific case.
In addition to courts potentially requiring rigorous arguments to show obesity is a disability, Groom Law Group noted that “even if a court were to find that obese individuals are presumptively disabled, courts may still be skeptical of arguments — as the District of Maine was — that exclusions for weight loss treatment can be considered a proxy for obesity.”
With the use of GLP-1 medications becoming widespread, employers have struggled with whether they should offer medical plans that cover their cost. Soon, however, they may not have a choice, as all insurance companies will likely be covering GLP-1 use for weight loss, according to an insurance professional who responded to a KFF survey in the second half of 2025.
The expense may balance out in the long run, however; a report from Aon released in January found that workers’ sustained GLP-1 use can actually lower employers’ healthcare costs over time.