A regional health authority in the UK will refuse to treat overweight people needing hip and knee replacements on the National Health Service.
The rationing of operations in east Suffolk will save £47.9m and has come about because of "pressing financial problems" in the region.
According to Dr Brian Keeble, director of public health for Ipswich primary care trust, they do pretend that the move was not stimulated by the pressing financial problems of the NHS in east Suffolk.
Keeble headed a group that concluded that cost-cutting thresholds should be placed on nine other procedures, including inserting 'grommets' for children with glue ear.
Children who do not display educational or behavioural problems will not be eligible for the operation, which reduces childhood deafness, under the NHS.
Operations will also be restricted on varicose veins, trigger finger and haemorrhoids.
Patients with a body mass index (BMI) of 30 or more, the clinical definition of obese, will not be eligible for the joint replacement operations, even if they are suffering intense pain.
Dr Keeble says the decision is good science as it is known that patients who are overweight and obese do worse after operations, particularly bigger and longer operations.
Keeble believes people need to take much more responsibility for trying to look after their health, in partnership with their doctor.
If a patient starts to develop symptoms, the first thing they need to think about is how to reduce weight rather than waiting until they are immobile.
It may be that their symptoms will diminish and they won't need the operation, which is not without risk.
Earlier this week, a poll suggested that more than a third of people believe people who smoke, drink or are obese should be charged for medical treatment.
Of 2,000 people questioned by private health provider BUPA, eight per cent said these people should be refused treatment altogether.