After six years living in New Zealand, Albert Buitenhuis may have to go back to South Africa. The government decided he’s too heavy to stay.

Buitenhuis is now facing deportation after officials denied his request to renew his work visa. He and his wife claim to have had no previous trouble with their annual visa renewals.

New Zealand’s immigration ministry maintains that, at more than 280 pounds, Buitenhuis’s weight puts him at added risk for diabetes, high blood pressure, and heart disease. Despite reports from Buitenhuis’s physician that he’s on track to correct a number of his health problems, the ministry remains concerned that weight-related issues will translate into hefty future costs. New Zealand claims that it is simply exercising its policy to hold immigrants to standards that minimize their burdens on the country’s health services. This year’s assessments included flagging and reviewing every immigrant with a body mass index greater than 35 (medically defined as “severely obese”), meaning Buitenhuis no longer meets those standards.

Though the decision is potentially inflammatory, there is a medical and public health basis for it. Obesity clearly predisposes one to a number of diseases: high blood pressure, diabetes, high cholesterol, heart disease, sleep apnea, arthritis, liver and gallbladder disease, and even some cancers. It can limit the usefulness of diagnostic studies, necessitating special or repeat testing. It can affect therapeutic decisions, including those about drug dosages, anesthetic risk, and indications for additional surgery. When amplified on community and national levels, these issues create costs that can strain health systems. In New Zealand’s case, leaders must find ways to finance the care of obese adults like Buitenhuis, who now comprise approximately 30 percent of the population.

We face similar problems here at home—more than one-third of the U.S. population is obese. The American Medical Association recently voted to officially classify obesity as a disease in order to increase awareness, encourage more aggressive treatment, and broaden insurance coverage for weight loss interventions. Other groups have made similar suggestions, realizing that prevention is much more cost-effective than treating complications after they develop. Waves of new obesity-related research and medications have further highlighted the issue. Medical evidence, public health, and societal stewardship compel us to do everything necessary to stem the tide of obesity. But what are we really doing when we use weight to change someone’s immigration status?

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