Obese and diabetic applicants face possible U.S. visa denials

WASHINGTON--Foreign nationals applying to live in the United States could be refused visas if they have medical conditions such as diabetes or obesity, under a directive issued Thursday by the Trump administration.

A State Department cable, reviewed by KFF Health News and sent to embassies and consulates, tells visa officers to find applicants ineligible for several new reasons, including age and the likelihood of relying on public benefits. The guidance frames these applicants as potential “public charges,” people who could draw on U.S. resources because of their health or age.

Health checks have long been part of the visa process, including screenings for tuberculosis and verification of vaccinations. Experts say the new instructions widen the range of conditions to be weighed and give consular officers more discretion to judge applicants based on health status.

The move comes amid a broader campaign to remove immigrants without authorization and to deter new arrivals, including frequent arrests, limits on refugee admissions, and efforts to cut overall entries.

According to Charles Wheeler, a senior attorney with the Catholic Legal Immigration Network, the cable appears to apply to most visa categories, though it will likely be used primarily in immigrant cases. “You must consider an applicant’s health,” the cable states, listing cardiovascular and respiratory diseases, cancers, diabetes, metabolic and neurological diseases, and mental health conditions. It notes that such conditions can require costly care.

The cable also points to obesity, citing associated risks like asthma, sleep apnea, and hypertension, and urges officers to weigh whether an applicant could become a public charge for that reason.

State Department spokespeople did not immediately comment. Officers are instructed to assess whether applicants can pay for treatment without government help, asking if they possess sufficient resources to cover medical costs over their expected lifetimes without cash assistance or long-term institutionalization at public expense.

Wheeler said parts of the language seem to conflict with the Foreign Affairs Manual, which cautions officers against denials based on hypothetical scenarios. He argued the directive pushes officers to project future medical needs despite lacking medical training.

The cable also asks officers to consider the health of family members, including children and older parents, and whether dependents’ needs could prevent the applicant from maintaining employment.

Immigrant applicants already undergo exams by embassy-approved physicians, disclose histories of substance use and mental health conditions, and must meet vaccine requirements for diseases such as measles, polio, and hepatitis B. The new guidance goes further, placing additional emphasis on chronic illnesses, said Sophia Genovese, an immigration lawyer at Georgetown University. She noted it invites speculation about long-term costs and employability based on medical histories. “Taking into consideration one’s diabetic history or heart health history, that’s quite expansive,” Genovese said. “If this change takes effect immediately, consular interviews could see a host of new complications.”

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