People who cannot work because they are obese or have alcohol or drug problems could have their sickness benefits cut if they refuse treatment, the PM says.
David Cameron has launched a review of the current system, which he says fails to encourage people with long-term, treatable issues to get medical help.
Some 100,000 people with such conditions claim Employment and Support Allowance (ESA), the government says.
Labour said the policy would no nothing to help people off benefits.
Campaigners said it was "naive" to think overweight people did not want to change their lives.
There is currently no requirement for people with such health problems to undertake treatment.
'A life of work'Mr Cameron has asked Prof Dame Carol Black, an adviser to the Department of Health, to carry out the review.
Announcing the proposal, he said: "Some [people] have drug or alcohol problems, but refuse treatment.
"In other cases people have problems with their weight that could be addressed - but instead a life on benefits rather than work becomes the choice.
"It is not fair to ask hardworking taxpayers to fund the benefits of people who refuse to accept the support and treatment that could help them get back to a life of work."
Minister for Disabled People Mark Harper said the government wanted to get people to "engage" with available treatments, adding that the right interventions could be "very successful".
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Disabilities Minister Mark Harper said people who were overweight or had alcohol or drug problems needed treatment to get back to work
Dame Carol said she was keen to "overcome the challenges" posed by the current system.
"These people, in addition to their long-term conditions and lifestyle issues, suffer the great disadvantage of not being engaged in the world of work, such an important feature of society."
But Susannah Gilbert, co-founder of online obesity support group Big Matters, said the policy "wouldn't be feasible".
She said: "I think it's naive to think that people don't want to change their life. Many of them have tried every diet under the sun and they still have a weight problem, so to think they don't want to have help isn't true."
Not helpingKate Green MP, Labour's shadow minister for disabled people, said the number of people claiming sickness benefits had risen under the coalition.
"David Cameron's government has stripped back funding for drug support programmes and their Work Programme has helped just 7% of people back to work, so it is clear the Tory plan isn't working," she said.
"Today's announcement does nothing to help people off benefits and into work while the government continues to fail to clamp down on tax avoiders and offshore tax havens."
ESA was introduced in 2008 to replace incapacity benefit and income support, paid because of an illness or disability.
It requires claimants to undertake a work capability assessment to see how much their illness or disability affects their ability to work.
Some 60% of the 2.5 million people claiming ESA have been doing so for more than five years.
Are you claiming sickness benefit? What is your reaction to the review? You can email haveyoursay@bbc.co.uk with your experience.
Please include a telephone number if you are willing to be contacted by a BBC journalist.
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