Obese people who refuse to exercise could have their benefits cut under controversial plans being considered by a flagship London council.
The report, published for Conservative-led Westminster City Council by think-tank the Local Government Information Unit (LGIU), points out obesity costs the NHS £1.5bn every year and comes ahead of responsibility for public health being transferred to local councils.
'A Dose of Localism: The Role of Council in Public Health' suggests GPs should prescribe exercise as treatment for some conditions - and councils could monitor patients, rewarding those who take activity while restricting payments such as council tax and housing benefit for those who do not.
The report suggests oyster-style smart cards, used to access gyms and leisure facilities, can provide councils with data on whether benefit claimants take exercise - with the council using a 'carrot and stick' approach to penalise those who do not.
Laurie Thraves, policy manager at the LGIU and author of the report, told The Huffington Post UK while it was a "sensitive" issue, they were not trying to stigmatise obese people.
"This isn't really about penalising anyone," he said.
"The real thrust of the report is to provide incentives to people who want to get fitter. There's a lot of evidence to show incentives, not penalties, are the way forward. This is about rewarding people who are making a positive change."
He added: "We don't want to make obesity the be-all and end all [to public health] there's a range of other suggestions there."
Despite assurances, the policy idea has generated controversy, with some Twitter users suggesting politicians should be subject to similar obesity tests.
Liberal Democrat peer Baroness Hussein-Ece said it was a "completely outrageous notion."
Westminster City Council's leader, Cllr Philippa Roe, welcomed the report, saying it contained "exactly the sort of bright, forward-thinking and radical ideas that need to be looked at.
"Local government needs to seriously start considering how it is going to manage public health," she said in a statement.
"The potential improvements to the nation’s health and to the public purse could be significant," she said.
A spokesperson for the council said: "We have the ability to vary benefits depending on behaviour so it is an option."