It's the law in every court that falls under the 8th circuit since it was appealed and upheld, so: Arkansas, Iowa, Minnesota, Missouri, Nebraska, North and South Dakota. In those states it is binding authority and if a case comes before any of those courts claiming discrimination based on obesity where it would be reasonable to require a medical for safety reasons a fatty is going to lose. Anywhere outside of that region it is merely persuasive authority. So if a fatty brought a suit against an employer in say California that court is not bound to follow the ruling. It can be used by the employer's lawyer to show that other courts have ruled in such and such a way and therefore the California court should follow suit, but they don't have to.