Obese patients will be refused surgery for up to a year as part of efforts to save money, an NHS commissioning group in North Yorkshire has said.
Officials at the Vale of York Clinical Commissioning Group said the decision came at a time when the local system was under "severe pressure".
The move will see a ban on, for example, hip and knee operations.
The Royal College of Surgeons described the restrictions as some of the most severe the modern NHS has ever seen.
'Discriminatory'
The restrictions will apply to patients with a body mass index of 30 or above which indicates obesity, as well as smokers.
If, however, the patient can shed 10% of their weight, they could be referred within the year.
The new rules will only apply to elective surgery for non-life threatening conditions.
Chris Hopson, the head of NHS Providers representing acute care, ambulance and community services, said it was a real worry that there had been a number of decisions like this.
NHS bosses now believed they have reached the point where the health service was simply being asked to deliver too much for the funding that is available, he told BBC Radio 4's Today programme.
He said rather than commissioning groups making "piecemeal decisions", there should be a national debate about the future of our healthcare system.
There were 14.5 million obese people in the UK in 2014, a study showed
Shaw Somers, a bariatric surgeon based in Portsmouth, said it was a fairly logical step to save money, but was short-term and discriminatory.
"Obesity is an illness and for these people, they are not deliberately waking up each morning thinking 'how do I stay fat?' he told the Today programme.
"They are trying to lose weight in the vast majority of cases and to deny them treatment that they need on the basis of their weight, without then offering them effective help to help them lose weight is rather like discriminating [against] a segment of the population on the basis of their colour or religious persuasion."
Body Mass Index
- Body mass index (BMI) is used to calculate whether a person is underweight, a healthy weight, overweight or obese for their height
- It is calculated by dividing someone's weight in kilograms by the square of their height in metres
- Generally the higher your BMI, the greater your risk of a large range of medical problems
- A BMI above 30 is medically classified as obese
The Royal College of Surgeons told the Daily Telegraph that the true scale of financial pressure on NHS trusts was becoming clear.
It said Clinical Commissioning Groups were now introducing draconian commissioning policies, flouting clinical guidance, just to balance the books.
A major study of the global obesity problem by Imperial College scientists found there were 6.8 million obese men in the UK in 2014, and 7.7 million obese women.
A statement from the Vale of York Clinical Commissioning Group said: "The local system is under severe pressure.
"This work will help to ensure that we get the very best value from the NHS and not exceed our resources or risk the ability of the NHS being there when people really need it."
It added that they wanted to support work to help people in the community to stop smoking and where needed, lose weight.
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