Patricia Hewitt, the Health Secretary, has given her blessing to the policy of denying operations to smokers until they kick the habit.
Endorsing a position adopted by some health trusts, the minister also voiced support for doctors who order patients to lose weight before treatment.
Mrs Hewitt said she backed the increasing number of doctors who make decisions about whether it is appropriate and safe to operate on smokers, or patients who are significantly overweight.
"What I've been seeing. . . is more and more health centres and GP practices focussing on that kind of support," she told The Sunday Times.
"They will say to patients, you shouldn't have this operation until you've lost a bit of weight and stopped smoking."
However, she added that it would be "dreadful" to deny treatment on the basis that patients were to blame for their condition.
Hip and knee replacements are among the operations likely to be denied to those who are overweight, while smokers could miss out on heart bypasses.
The Health Minister's views on the issue, which mirror those of a growing number of medical experts, are based on what she describes as "best practice" – because operations are less likely to be successful when the patient is very fat or a heavy smoker.
However, some doctors have expressed concern that the stance could be used by some NHS trusts as a means of saving money, while others have questioned the criteria that will be used to judge an appropriate weight for surgery.