Secretary of State Marco Rubio has instructed U.S. diplomats to consider obesity alongside various chronic medical conditions as among the reasons to reject foreigners seeking U.S. visas, according to excerpts of a cable viewed by POLITICO.

Rubio’s guidance is a relatively strict interpretation of the federal government’s “public charge” rule. That rule bars prospective immigrants from entering the country if they are deemed likely to later require public assistance, such as Supplemental Security Income and funding from the Temporary Assistance for Needy Families program.

“Self-sufficiency has been a longstanding principle of U.S. immigration policy, and the public charge ground of inadmissibility has been a part of our immigration law for more than 100 years,” the Nov. 6 cable states.

KFF Health News was first to report on the missive.

Adult obesity increases the risk of conditions including high blood pressure, breathing problems, gallstones and gall bladder disease, according to the cable, which cites the Centers for Disease Control and Prevention and states that “all of these can require expensive, long-term care.”

Visa officers are also instructed to screen for and consider cardiovascular diseases, cancers and diabetes, according to the cable.

White House spokesperson Anna Kelly said the guidance is an extension of the administration’s efforts to focus federal spending on U.S. citizens.

“For 100 years, State Department policy has included an authority to deny visa applicants who would pose a financial burden to taxpayers, such as individuals who were seeking publicly-funded health care in the United States and could further drain healthcare resources from American citizens,” she said. “President [Donald] Trump’s Administration is finally fully enforcing this policy, and putting Americans first.”

Trump has sought to substantially cut back legal as well as illegal immigration to the United States since returning to the White House in January. The effort has included stricter interpretation and enforcement of existing immigration laws.

Trump and congressional Republicans are pushing to reach 1 million deportations a year, with billions in funding from his signature One Big Beautiful Bill Act going towards bolstering U.S. Immigration and Customs Enforcement.

“It’s no secret the Trump administration is putting the interests of the American people first,” State Department spokesperson Tommy Pigott said. “This includes enforcing policies that ensure our immigration system is not a burden on the American taxpayer.”