Smokers and the morbidly obese in Devon will be denied routine surgery unless they quit smoking or lose weight.
Patients with a BMI of 35 or above will have to shed 5% of their weight while smokers will have to quit eight weeks before surgery.
The NHS in Devon has a £14.5m deficit and says the cuts are needed to help it meet waiting list targets.
The measures were announced the same day government announced an extra £2bn of annual NHS funding.
The Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) organises most NHS treatment in the area.
It announced a range of cost-cutting measures on Wednesday including only providing one hearing aid, instead of the normal two, to people with hearing loss.
Shoulder surgery will also be restricted.
What is morbid obesity?
– People with a body mass index (BMI) of 35 or more are considered morbidly obese by medical professionals
– BMI is calculated by dividing weight in kilograms by height in metres, then dividing the answer by height again
– Women of average height, 1.62 metres (5ft 3ins), are considered morbidly obese if they weigh more than 91.5kg (14st 6lb)
– Men of average height, 1.75 metres (5ft 9ins), are considered morbidly obese if they weigh more than 108kg (17st)
In November, the CCG said it would take “urgent and necessary” measures to prioritise major treatment.
That included delaying hip and knee operations for the morbidly obese, but Wednesday’s announcement applies to all routine procedures.
NEW Devon CCG said it would not restrict IVF treatment or caesarean sections carried out on medical grounds.
A statement said all the decisions were “interim commissioning positions” and would require further consultation.
Patients with a date for surgery will not be affected but will be offered weight management or quit smoking support.
Dr Tim Burke, Chair of NEW Devon CCG, said: “All of these temporary measures relate to planned operations and treatments, not those which must be done as an emergency or to save lives.
“We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case.”
NEW Devon CCG said it would announce another round of cost-cutting measures “in due course”.
“We don’t under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them,” said Dr Burke.
“The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that.”
In a statement the Royal College of Surgeons said it was “concerned” by the move and warned the region was merely storing up “greater pressures” for the future.
It said: “The need for an operation should always be judged by a surgeon based on their clinical assessment of the patient and the risks and benefits of the surgery – not determined by arbitrary criteria.
“Losing weight, or giving up smoking is an important consideration for patients undergoing surgery in order to improve their outcomes, but for some patients these steps may not be possible.
“A blanket ban on scheduled operations for those who cannot follow these measures is unacceptable and too rigid a measure for ensuring patients receive the best care possible.”