The Trump administration has directed American consular officers abroad to deny visas to applicants who are fat or have other common medical conditions, framing them as potential burdens on the American healthcare system.

A new State Department directive, sent to embassies and consulates globally, instructs officers to reject visa applicants if they are deemed likely to require significant medical care at public expense. The policy singles out a wide range of health issues as grounds for potential denial, including obesity.

“You must consider an applicant’s health,” the internal cable says, according to one report. “Certain medical conditions — including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions — can require hundreds of thousands of dollars’ worth of care.”

The guidance specifically mentions obesity as a contributing factor, linking it to conditions like asthma, sleep apnea, and high blood pressure, all of which “can require expensive, long-term care.”

Officials are now instructed to evaluate whether an applicant has the financial means to cover potential medical costs for their entire life without relying on public assistance. “Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan without seeking public cash assistance or long-term institutionalization at government expense?” the directive says.

The move effectively revives the controversial “public charge” rule from the first Trump administration, which aimed to deny green cards to immigrants who might use public benefits. The Biden administration rescinded that rule in 2022.

A Trump spokesman defended the policy. “It’s no secret the Trump administration is putting the interests of the American people first. This includes enforcing policies that ensure our immigration system is not a burden on the American taxpayer,” principal deputy spokesman Tommy Pigott said in a statement, The Hill reported.

While visa applicants already undergo mandatory medical exams for infectious diseases, this new directive gives consular officers — despite their lack of medical training — broad discretion to make judgments about an applicant’s future health risks.

Immigration experts have raised concerns about the policy’s expansive and subjective nature.

“Taking into consideration one’s diabetic history or heart health history — that’s quite expansive,” immigration lawyer Sophia Genovese told KFF Health News. “If this change is going to happen immediately, that’s obviously going to cause a myriad of issues when people are going into their consular interviews.”

The policy’s wide net could impact a significant number of applicants, as many of the listed conditions are prevalent worldwide. According to the World Health Organization, cardiovascular diseases are the leading cause of death globally, and about 10 percent of the world’s population has diabetes.