US tightens visa screening, flags diabetes and obesity as risk factors

On 7 November 2025, the U.S. Department of State circulated a cable to embassies and consular posts worldwide, signalling a significant shift in the medical screening criteria for immigrant visa applicants.

According to KKF Health News, the guidance directs visa officers to evaluate whether applicants have chronic medical conditions—such as diabetes, metabolic disease, obesity, cardiovascular or respiratory illnesses—and whether such conditions may risk becoming a “public charge”.

Under the new directive, applicants may be declared ineligible if the consular officer determines that their health status, or that of their dependents, may impose long-term costs on U.S. public benefits or health systems. The cable states: “You must consider an applicant’s health… Certain medical conditions … can require hundreds of thousands of dollars’ worth of care.”

What’s new vs. previous practice

Previously, US immigration medical screening focused largely on communicable diseases of public health significance (such as active tuberculosis), admissibility based on vaccinations, and “harmful behaviour” linked to physical or mental conditions.

The updated guidance broadens the scope to include chronic, non-communicable conditions—diabetes, obesity, metabolic disease, neurological or cardiovascular illness—which historically were not automatically grounds for inadmissibility.

Who is affected and how

The policy appears to apply primarily to applicants for immigrant visas or adjustment of status—those seeking permanent U.S. residence. The guidance states consular officers should assess not only the applicant’s health but also that of dependents: “Do any of the dependents have disabilities, chronic medical conditions, or other special needs and require care such that the applicant cannot maintain employment?”

According to immigration-law analysts, non-immigrant visa applicants (such as short-term visitors or students) may be less impacted, although the guidance does not explicitly exclude them.

Stated rationale

The Department of State frames the change as consistent with existing law: the “public charge” ground of inadmissibility, which allows refusal of admission if the applicant is likely to become primarily dependent on U.S. public benefits. Under the new directive, chronic health conditions may be weighed more heavily in determining such reliance.

A cited example from the cable: visa officers should ask whether an applicant has “adequate financial resources to cover the costs of such care over his entire expected lifespan without seeking public cash assistance or long-term institutionalisation at government expense.”

Reactions and concerns

Immigration attorneys and advocates have voiced serious concerns. They argue consular officers are being asked to make speculative judgements on future medical costs—even though they are not medical professionals.

One attorney warned, “That’s troubling because they’re not medically trained, they have no experience in this area, and they shouldn’t be making projections based on their own personal knowledge or bias.”

Critics also say the guidance may conflict with the Department’s own Foreign Affairs Manual, which advises against rejecting applicants based solely on hypothetical future medical costs.

There are concerns that the policy may disproportionately affect older applicants, those from countries with higher prevalence of chronic disease, and families with dependents who have special medical needs. Experts warn of possible discrimination or a chilling effect on migration.

Legal and procedural implications

According to the advisory issued by immigration-law firm Fragomen, this shift does not appear to be a formal amendment of law or regulation but rather a change in internal guidance.

That raises questions about transparency and appealability. Applicants may face denials based on discretionary health assessments without clearly defined criteria. The existing medical grounds of inadmissibility (as codified in law) still centre on communicable disease, vaccination compliance, and mental/physical disorders with harmful behaviour—not chronic illnesses per se.

International implications

For many countries—especially those with high rates of diabetes or obesity—this guidance may affect visa-seeking populations. One analysis notes that the policy could impact applicants from India and other nations where diabetes prevalence is high, particularly those applying for long-term residency in the U.S.

What applicants should know

• Applicants for immigrant visas should disclose chronic health conditions and be prepared to demonstrate financial capacity to cover long-term care without reliance on U.S. public benefits.

• Family members’ health conditions may also be considered in the evaluation.

• As this is a guidance change—not yet clearly codified in regulation—the process may involve nuances and discretionary judgments. Legal advice is advisable.

• The policy may not yet clearly apply to non-immigrant visa categories, but ambiguity remains.