The Trump administration has directed visa officers to consider obesity — and other chronic health conditions such as heart disease, cancer and diabetes — as reasons to deny foreigners visas to the United States.

According to The Washington Post, citing the document, the State Department sent the respective instruction to US diplomatic missions worldwide on November 6.

In the guideline signed by Secretary of State Marco Rubio, it is stated that US visa officers are required to take into account the health condition of applicants. Certain medical conditions, including cardiovascular diseases, respiratory diseases, cancer, diabetes, metabolic diseases, neurological diseases, and mental health disorders, may require treatment costing hundreds of thousands of dollars, the instruction says.

It adds that obesity should be considered a negative factor, as it can lead to sleep apnea, hypertension, and clinical depression. In addition to medical criteria, US consular officers are required to take into account the applicant’s age, number of dependents, and any special need or disability.

This document was developed by the State Department’s policy leadership, bypassing the standard approval process involving relevant experts. Immigration attorney Vic Goel from Reston, Virginia, noted that the new rules give US visa officers broad discretion to deny visas based on common medical conditions that previously were not considered absolute grounds for inadmissibility.

White House Deputy Press Secretary Anna Kelly stated that this practice has existed for 100 years and aims to prevent situations in which foreign citizens become a financial burden on American taxpayers. She added that the Trump administration is finally fully implementing this policy, putting the interests of Americans first.