NHS trusts are restricting access to routine surgery, IVF, breast reductions and fat-loss operations based on people's weight and whether they smoke, according to new data.
Figures from 91 primary care trusts (PCTs) in England show some have restrictions in place requiring patients to reach a certain weight before surgery while others say patients must shed pounds before knee and hip operations.
NHS Hertfordshire, which caused controversy last year by banning hip and knee operations for patients with a body mass index (BMI) over 30 and for smokers until they quit, has now extended the policy to all routine surgery.
Its new policy, introduced in January, is to "block any patient with a BMI over 30 or a smoker from being referred for all routine surgery" except in neurology, cardiac and any surgery to do with cancer.
The Peninsula health technology commissioning group, covering Cornwall, Devon, Torbay and Plymouth, is now banning both men and women from undergoing IVF treatment unless they have been non-smokers for at least six months.
Men and women must also have a BMI of between 19 and 29.9 before they will be given certain fertility drugs.
The two PCTS covering County Durham and Darlington will not treat people for varicose veins unless they have a BMI of 30 or under, the figures also show.
Meanwhile, NHS Oxfordshire has brought in new policies with the aim of encouraging people to lose weight and/or give up smoking before they undergo any planned surgery.
Three PCTs in Devon, Plymouth and Torbay brought in restrictions last June relating to BMI and total hip and knee replacement surgery, where previously there were no restrictions.
While those who need immediate surgery will not be stopped, patients with a BMI of 35 or over will be asked to lose weight "to maximise the functional benefit of surgery and reduce the risk of complications".