Horizon on fat: a mechanism is not a cause

Last night, BBC2’s Horizon programme discussed “new” discoveries about what lies behind the “obesity epidemic” that’s assailing us. It was a fascinating programme, and did indeed reveal some very interesting things: but fascinating as it was, it was also deeply misleading.

It was presented by a surgeon who began, so the programme told us, with the belief that obesity was a consequence of people eating too much, and exercising too little. People who exhibited such behaviour did so because they were too weak-willed to do any better. Ergo, what was required was some stern talking, possibly the compulsory viewing of “Supersize vs Super-skinny” (well, had it not been on a rival channel), and for those whose wills were not thus strengthened, the reluctant intervention of an already over-stretched NHS to deal with their inevitable type 2 diabetes, and perhaps an opportunity to recoup some of the money by selling voyeuristic clips of yet another stomach by-pass operation in action. The latter probably wouldn’t be very effective, as the market for gruesome shots of implements that “cut and staple simultaneously” would seem already to be saturated. Every time yet another programme turns the spotlight on our modern gross fatness, and what we might do about it, it seems it is de rigueur to include surgeons at this most unattractive pastime.

But the surgeon starring in yesterday’s programme was obliged to confess to an unsavoury attempt to “take the moral high ground” with her simplistic view that perhaps obese people might have some slight degree of responsibility for their predicament. Because she was wrong. It was all down to genetics. Fat people have a “hunger hormone” that is frankly too lazy to make them feel really hungry when its owner is really hungry, and instead merely makes the hapless person feel a bit peckish all the time. On the other hand, obese people have a “fullness hormone” that never gets its act together at all, and never informs the brain that enough is enough. Later in the programme it was revealed just how the brain was responding to all this hormonal misinformation: thin people’s brains were hardly exercised at all by pictures of cream doughnuts, whilst fat people’s brains produced a veritable frenzy of irresistible urges that their rubbish fullness hormone utterly failed to control.

So obese people are between a rock and a hard place. It is truly wrong to hold them responsible. On the one hand their hormonal chemistry is all up the creek, and on the other their brains conspire against their every attempt at self control. The answer? Well, it seemed to be either hormonal pills, or else an odd side effect from the ubiquitous stomach by-pass surgery referred to earlier, which seemed to have the unlikely additional benefit of re-educating the brain.

It was easy to be carried away with the programme’s scientifically certified approach. Except for one rather glaringly obvious point that was never mentioned at all. The human brain has been as it is for a rather long time. The body’s hormonal chemistry has been as it is for millennia. And yet the obesity crisis that we are constantly being told about has only really taken off in the last, say, 50 years. It’s only reached the consciousness of TV producers in the last 20. Thus I can with absolute confidence say that the cause of this crisis is not to be found in endocrinology or in brain functionality, neither of which has suddenly changed in the last half century. A cause and its effects cannot possibly be separated by such an extravagant slice of time. To believe this proposition is to believe that fundamental aspects of our biology, that never bothered our species before, have suddenly begun to do so. Obviously not.

What the Horizon programme so carefully and thoroughly revealed was not a cause, but a mechanism. The cause is much more obvious, and simpler. It is that our Western diet has changed over the last 50 years in very deleterious, but very profitable, ways. At the same time, our level of physical activity has dropped precipitately. What we can learn from yesterday’s revelations is that this sorry state of affairs does not affect us all equally. Some of us are better equipped than others to resist the doleful consequences of rubbish food and physical slothfulness. True also is the programme’s point that resistance is easier for some of us than others.

What would a rational response be? Surely it would be to attack the causes, rather than to fiddle about with the mechanisms, a fiddling about that is bound to bring other unforeseen consequences in its wake. Why don’t we do this? For two very different, but actually strangely connected reasons. We don’t attack the food culture that is causing our fat malaise because too many people make too much money from its continuance. And we prefer drug or surgical interventions in mechanisms to attacking causes because drugs and scientific medicine are also major money-spinners. Not only that, scientists are as seduced by their flashy toys as any adolescent is by his or her iPad, or Android device, or X-Box console. How much more fun to play with an MRI scanner, or wield a tool that simultaneously cuts and staples, than to wonder about the dominance of hawkers of confectionery or fast food? I can still remember my excitement when I first got to use an electron microscope.

Yes, we should be careful to remember that obese people are indeed people about whom we should care, and not fools that we should castigate. But we should also be very wary of those who would locate every problem in genetics or chemistry, and who seek to minimise human volition or responsibility.

A fat lot of use

It seems the government’s strategic approach to reducing obesity can be contained in two words; Eat less. Whilst it one sense it’s fantastic to have a government strategy that’s so concise, and which avoids so assiduously all the usual flatulent prose of the average government pronouncement, in every other sense this is hopeless. It’s tantamount to addressing the problem of having a leaking roof in the town hall by telling the staff to bring umbrellas. “Take personal responsibility for keeping dry! Stop blaming us for the problem, and do something positive. Take control. Stop expecting nanny to look after you!”

However admirable it might be to encourage a sense of personal empowerment by locating the solution at an individual level, the fact remains that such an approach is notable more for its convenient letting the food industry off the hook than it is for its having the remotest chance of success. The root of the distortion of our diet is both simple and well known: it is the hugely greater density of calories that our food now contains than it has traditionally done, combining in a devastating synergy with our equally dramatic reduction in physical activity. Eat less is not in fact the right answer at all. The right answer is to eat differently, and to exercise more – either by doing something special labelled “exercise”, or better, by simply having a more active way of life, eschewing lifts, half-mile car journeys, and no longer preferring a remote control to getting up from the sofa.

And here’s the rub. One half of the obesity crisis is calorie dense food. Calorie dense food is food that contains high levels of fat and sugar. Fat and sugar have been commoditised by the food industry, and are now sourced from wherever is cheapest on the day. So what was already cheap is getting relatively cheaper all the time. If you want to maximise your profits, you do not need to consult a rocket scientist to know that the way to do so is to create foods with the cheapest ingredients, but which can nevertheless be sold as expensive, highly “value-added” products. Expensive, that is, in relation to the cost of their ingredients. In absolute terms, many of these products are very cheap indeed.

Inevitably, these cheap foods are overwhelmingly purchased by poorer citizens. I suspect we have two quite distinct kinds of obesity in our society. Fat rich people who do simply eat too much, but are frequently eating too much good food. And fat poor people who may not be eating too much at all, but are eating the wrong things, namely the sugar and fat-stuffed products of a food industry fixated on profit, and not remotely concerned with health or nutrition.

The answer to this, however, is not a “fat tax”. Taxing healthy items such as butter or olive oil is counter-productive. As I’ve argued elsewhere, the reductive thinking of “nutritionism” that attempts to substitute chemistry for a healthy food culture, and which demonises things such as butter, is much more part of the problem than it is the solution. The problem is the industrialisation of food processing. Processed food contains hundreds, thousands indeed, of ingredients that are nothing to do with food, and nothing to do with nutrition. Not in any one product, of course, although ingredients lists can easily run into the tens. These ingredients are the things that are needed to keep together the Frankenstein structures of what now passes for food, and to impart to them such things as “mouth-feel” and taste substitutes to make up for the fact that otherwise they’d taste of nothing but anonymous, generic, fat and modified starches. Emulsifiers, texturisers, nutrients to replace those lost by processing, things to stop the added water from dripping out, and all the other paraphernalia of a chemical industry that makes food-like stuff for us to eat, and which is resolutely based on fat, sugar and standardised starch fragments.

If the government really does want to produce an obesity strategy that can both be summed up in a pithy few words, and which might even work, it would be this: Eat food, and get off your arse. But it wouldn’t stop merely in addressing what individuals should undoubtedly do if they want to avoid obesity for themselves. It would also address the food industry with the startling message that to be properly called a food industry, you really do need to produce food. Not a chemically stabilised and flavoured food substitute. The quickest and simplest way of doing that would be to outlaw any food product that contained more than two or three items which were not themselves foods. Foods, in case you’d forgotten, are things that grow in the ground, or come from the bodies of animals.

It won’t happen though. Because this government (and just about every other government since the war-time coalition) is not at all interested in health. But it is interested in the profits to be made from the adulteration and distortion of our diet, and of our food culture, such that remains of it.

Food, inflation, health and the poor

As post titles go, I suppose this piece’s moniker is nothing if not broad and inclusive. It represents the bringing together of a number of my passionate concerns in one glorious concatenation, but before I go further I need to provide something in the way of a disclaimer.

One of the least attractive examples of rank hypocrisy and deliberate misdirection is that hoary old bollocks so beloved of our right-wing press, the (usually) Tory matron who declares that they have lived on £2.50 a week for a month, and that therefore no-one in this country is so poor that they can’t eat both healthily and deliciously, so please could they, and their supporters in evil outfits such as the Child Poverty Action Group, shut-up and stop whinging. The Daily Fail article that follows Lady Living-Bracingly-In-The-Countryside’s heroic experiment in poverty research reports lovingly that her Ladyship has gleefully made stews out of old toe-nail clippings, fricasséed freely available larger spiders, supplemented all this with a bewildering variety of root vegetables, and flavoured it with the juices from her Beeton-style everlasting stock-pot which has preserved her family’s left overs for several generations. Later in the article one casually discovers that it just so happened that Farmer Giles from the estate did in fact lob over a couple of haunches of venison, and his Lordship did allow her Ladyship to wash all this bracing fare down with a choice claret from Château Lafite-Rothschild, and a rather promising white Burgundy that by chance were gracing the cellars at the time. I realise that I might be accused of doing something similar in what follows, minus the classic vintages just mentioned, obviously. I can only hope not.

We heard today that the inflation experienced by the poorest people is greater than that experienced by the richest. This is for the simple reason that inflation in food and fuel is much greater than inflation generally, and even more because the costs experienced by richer people are often represented in large part by mortgage payments on property, and the current minuscule interest rate is in fact making those payments lower than ever before. So feeding ourselves is getting more expensive, but feeding ourselves is also a much greater proportion of poorer people’s expenditure than it is of richer people’s. It’s true as well that feeding ourselves is increasingly becoming not a means of nutrition, but a means of self-abuse. Channel 4’s modern day freak-show, Embarrassing Fat Bodies, illustrated this again last night in its trade-mark gory and repulsive detail. Much of this “eating as self-harm” has its roots in the kind of food people eat, and it’s equally generally true that the diets of poorer people are worse in this respect than those of richer people. One of the commonest explanations of this relationship is that bad food is also cheap food. Poor people cannot afford to eat well or healthily.

That is simply not true. It is true that that in any given category of food, cheaper versions are generally less healthy than more expensive ones. But the extrapolation from the undeniable truth that, for example, expensive sausages with higher proportions of good meat are healthier than cheap versions stuffed with starch and fats procured from commodity markets and made just about palatable with flavourings, texturisers, and colourings, to the overall conclusion that therefore only the rich can eat well is entirely false. Another common fallacy is that the middle-class obsession with organic food is merely an indulgence that the poor cannot afford.

I am not impoverished. And that is why I fear that sharing my own experience about mitigating food inflation might be dismissed in the same terms as my own dismissal of Lady Living-Bracingly-In-The-Countryside. Undeterred, I’m sharing it anyway.

Recently I’ve started taking an organic vegetable box each week from Abel and Cole (and I must immediately add that other providers of poncy delights are also available.) This costs me the princely sum of £11.50p, and is also delivered to the door releasing me from part of my otherwise steadily increasing fuel bill. Along with the box, I generally buy a little meat, some fish, and things like breakfast cereal and milk. I’ve never spent more than £35, including Abel and Cole’s massive delivery charge of £0.99p (eat your heart out Ocado with your charges of anything up to £8.) I also buy pulses and other bits and pieces from supermarkets to create my lunches each day. Perhaps on average I spend an additional £3 a week in this way, producing delights such as today’s red kidney beans, walnut pieces, and apple salad bound together with olive oil and flavoured with home-made garam masala. I eat meat or fish about 4 or 5 days out of the week’s 7, on one of which it will probably be a tin of sardines. If I spend £40 on food in a week I’d be surprised. Before starting to organise myself in this way, I probably spent not far short of £80-£100 every week. I accept that this approach takes some discipline, but that is mostly to do with eating whatever the box contains, and refusing to throw anything away. But be clear, there is nothing hair-shirted about this. I eat better now, and enjoy it more. I do it because it makes me happier, not because I hope it will make me more virtuous.

Ironically, that point about eating whatever the box contains is actually the key to all this. We live in a time when choice is supposed to be king. The new proposals on the NHS may have moderated the foolish pursuit of competition, but they still wax eloquent about the centrality of choice. One of the wonders of modern western capitalism is indeed the supermarket with its bewildering array of choice when it comes to food. This choice is not a liberation, nor a nutritional bonus; it’s exactly the opposite. But it’s also largely an illusion. Of all that vast array of choice, most of it is made of the same 4 or 5 things. Wheat, soya, sugar, corn and a medley of deconstructed and reconstituted plant and seed oils. And even though the resulting confections are not actually all that cheap, the raw materials certainly are and they contribute a tiny minority of the final price.

I hope I haven’t come across as suggesting that poor people’s poor diets are poor people’s own fault. There’s a lot more to it than that. But it is true, I believe passionately, that poor people do not need to be locked into bad food and poor nutrition. There is a choice, but it’s unlikely to be found in Tesco or Sainsburys. And part of that choice, strangely enough, is giving up choice.

This is what I am: Week 2 food diary

So here’s week 2 – from Wednesday 13th April to Tuesday 19th April inclusive:

• 4 Weetabix
• 2,000ml whole milk
• 20g granulated sugar
• 300g cooked chickpeas
• 60g pine-nuts
• 105ml olive oil
• 980g potato
• 4 bananas
• 4 apples
• Half can tuna in water
• 90g Parmesan cheese
• 220g spinach
• 240g home-made cake
• 100ml fruit smoothie
• 210g bran flakes
• 60g fried fish
• 340g chicken
• 90g chorizo
• 2 rounds assorted sandwiches*
• Spinach ricotta parcel*
• 600ml orange juice
• 700ml white wine
• 200ml champagne
• Portion prawn and coconut Thai curry and rice*
• 60g porridge oats
• 30ml golden syrup
• Portion pasta with vegetables*
• Small slice garlic bread*
• Portion fruit trifle*
• 50g tortilla chips
• 2 tins sild in oil (drained)
• 450g purple sprouting broccoli
• 105g (uncooked weight) brown rice
• Corned beef and rice*
• 200ml red wine
• Fried plantain
• 4 shredded wheat
• 1 small pork pie
• 50g grapes
• 100g Yorkshire pudding
• 100g ginger yoghurt
• 2 Ryvita crispbread
• 7g butter
• 75g vegetable crisps
• 165g natural yoghurt
• 300g (cooked weight) pinto beans

Items with asterisks were stuff I ate away from home, and I’ve given my best guess as to their calorific value in the total below. If you’re wondering what happened to my meat-free Lent, er, well, um… My excuses are a) we Anglicans don’t count Sundays as part of Lent and b) I was in other people’s houses several times last week, and didn’t want to be rude. Or something like that.

It all tots up to a total number of calories spookily identical to last week’s tally: 16,400 (about 2,350 a day). Alcohol consumption was slightly up at 16 units (of which about 12 were consumed on one day, so I’m officially a binge drinker!)

My blood pressure (taken in the morning before exercise) was 100/74, and resting heart rate was 56 beats/min. I weighed 69.3Kg.

I know you’ll all be disappointed, but the food diary is taking a couple of weeks off as I’m going to France on Thursday. France and food diaries do not mix, and I’ve no intention of sitting morosely in some Michelin-starred food temple, jotting down chef’s ingredients, and being scowled at by my wife.

For those who perhaps can’t imagine why on earth I’d be doing this, the nearest you’ll get to an answer is here.

This is what I am: Week 1 food diary

Drum roll… So this is what I ate from Wednesday 6th April to Tuesday 12th April inclusive:

• 6 Weetabix
• 310g bran flakes
• 2,385ml whole milk
• 44g granulated sugar
• 680g cooked chickpeas
• 95g pine-nuts
• 210ml olive oil
• 40g lettuce
• 400g natural yoghurt
• 580g potato
• 1 baked sea-bass
• 2 roasted peppers
• 4 Ryvita crispbread
• 65g butter
• 7 bananas
• 5 deep-fried squid rings
• 100g braised mushrooms
• 2 tuna-filled pastries
• 50ml dry sherry
• 115g (uncooked weight) Puy lentils
• 115g (uncooked weight) spaghetti
• 225g onion
• 300ml fruit smoothie
• 350ml red wine
• 2 apples
• 50g Parmesan cheese
• 60g porridge oats
• 30ml golden syrup
• 2 pints beer
• 180g (uncooked weight) wholewheat pasta
• 1 tin sardines
• 85g (uncooked weight) pudding rice
• 4 cloves garlic
• Portion fish pie
• 60g peas
• 100g carrots
• 100g swede
• Portion apple crumble with single cream
• 200g salmon
• 150g spinach
• 105g (uncooked weight) brown rice
• Half can tuna in water
• 3 Matzos crackers
• 125g home-made cake

Estimated total calories consumed = 16,400 (about 2,350 a day). Total alcohol consumption about 10 units.

My blood pressure (taken in the morning before exercise) was 110/80, and resting heart rate was 51 beats/min. I weighed 69.5Kg.

This week’s food contains no meat as I’ve given it up for Lent! Next Wednesday evening I’ll be publishing another week’s food. I’ll bet you can’t wait…

If you are what you eat, then I’m this…

A lot of people are entirely allergic to any television programme that might be described as “reality TV”. Whilst that is often not a bad rule of thumb, I don’t personally agree with such a sweeping generalisation. One such programme that I find by turns fascinating, morbidly voyeuristic, enlightening and irritating is Channel 4’s “Super-size versus Super-skinny”. For the reality TV allergic amongst you this programme brings together two members of the public that have opposing eating disorders. One is “super-sized”, rolling in folds of fat and eating gargantuan quantities of all the wrong foods. The other is “super-skinny”, addicted to punishing exercise, and lives on a couple of haricot beans and a gallon of sugar-free coke a day with resulting skeletal frame and multiple nutritional deficiencies. Under the watchful supervision of a handsome and perfectly proportioned doctor these two unfortunates are then invited to eat each other’s diets for several weeks. The grossly fat one stares disconsolately at a breakfast of water and single digestive biscuit, whilst the minuscule one tries with greater or lesser gusto to force down a grease-laden repast of 10 eggs, several beefburgers, and a couple of bags of crisps, whilst casting a doleful eye on the mid-morning snack of bacon sandwiches that they will shortly also have to consume.

It is nothing if not shock therapy. As in all the best of the reality genre, there is a liberal oiling of cod-psychology to keep everything slipping along nicely, and if you’re lucky you might get a couple of scenes of bitter recrimination in which the thin one fails to consume all the goodies on offer and is chided by the fat one, who claims that the thin one is not keeping to the bargain. In return, the thin one demands to know how they are expected to consume half their own body weight at every sitting. Interspersed between the sequences of ill-matched meals and psychological warfare are the voyeur shots of anatomically incomprehensible folds of blubber in the one case, and a pitifully protruding skeleton in the other.

One of the programme’s fixtures is a scene in which each participant’s weekly food and drink intake is gathered together in one modest, and one spectacularly vast, pile. The contestants (for that is what they really are) are then obliged to stare in horror and amazement at what they are doing to themselves. The doctor intones in a sympathetic but authoritative voice-over all the evils of obesity, the diabetes, the heart disease, the worn-out joints: and the equal and opposite evils of vitamin and mineral deficiency, of potential heart failure, or of acid reflux that will bedevil the anorexic.

But it’s those piles of weekly food that tend to catch my eye. We don’t normally see our week’s food paraded in front of us. And it’s made me wonder what my pile might look like. I’ve absorbed at some level or another over the years all the healthy eating messages with which we are bombarded at every waking moment, but I’ve never really considered what I actually eat en masse. I have no idea how close or far I am from that magical 5 daily portions of fruits and vegetables; from that average man’s 2,500 calories a day; from the proper quantity of saturated and unsaturated fatty acids.

So I’ve decided to find out. I’m keeping a food diary, but I’m not making any attempt to change or modify my diet. I’m simply noting down as accurately as I can everything I eat or drink (other than water). For meals that I prepare for myself (the vast majority) I’m trying to capture quantities and calorific values, but when I eat outside of my home, then I’m using my best guess as to both ingredients and quantities. I started doing this last Wednesday, so later today I’ll be reporting on the week from then (6th April) to yesterday (12th April). I’m not doing it meal by meal, but instead creating my own virtual weekly pile à la Super-size vs Super-skinny. I’ll keep it up as long as I can, or at least until boredom overtakes me. I recognise that no 2 weeks are identical, and that in order to get a reasonable grasp of what I am if I eat this, I need to average it over several weeks. If I really get into the swing of it, and find I’m able to do it over a longer time frame, well I can always sell the results to some researcher into British eating habits.

Food’s not everything, since there’s expenditure as well as income in the food accounts. I work in an office, and am as perfect a sedentary worker as you could wish to meet. Most days I do little walking, although I do always walk up the stairs to my 6th floor office and eschew the lift. However, to set against this, I am rigorously disciplined in taking exercise every day on my cross-trainer. I have programmed it so that I do the equivalent work of 400 calories every weekday morning (before breakfast if you’re interested) and this equates to between 35 and 45 minutes exercise depending on the heart-rate I’m exercising at. The longer times are when I’m working at 122 beats per minute (about 75% aerobic capacity at my age) whilst the shorter times are when I’m working at 146 beats per minute (about 90% aerobic capacity). In addition therefore to the food and calorie data I’ll be reporting, I’ll also include blood pressure, resting heart-rate, and body weight.

So look out for my first set of results later!! And if you’re a doctor or nutritionist, please feel free to analyse my life-style and tell me if it’s still worth me worrying about my pension!

Transmuting fat into thin air: the alchemical delusion of our age

One of the less appealing attributes of modernity is our tendency to look with disdain on our forebears because they didn’t have the scientific world-view that we sophisticates now enjoy. Alchemy, and the doomed search for a method of turning base metals to gold, is frequently trotted out as a pretext for just such condescending self-congratulation. Not enough merely to note that we have found out some things that our predecessors had not: our sense of superiority also requires that we rubbish their pathetic credulity, their seeming willingness to believe any old tripe. Surely the search for the philosopher’s stone was self-evidently fatuous, and yet enormous amounts of money and energy were expended in its fruitless pursuit.

Well, actually, our ancestors had one very big excuse that we do not – they actually were ignorant of the mechanics of chemical transformation. But for our equivalent of alchemy – the equally fruitless search for some magical way of stopping ourselves from getting grossly fat, and of doing something about it when we have already become so – we have no such excuse. There is nothing whatsoever that we do not already know, that we have not already known for well over half a century, about how and why we are getting fatter and fatter, nor about what we need to do to stop continuing down the obesegenic road, nor indeed about what we need to do if we’re already too fat and want to get thinner. Nothing. Oh, to be sure we don’t know all the ins and outs of the duck’s arse that is the exact relationship between our personal genetic make-up and how easily we put on weight, or with how much difficulty we might then shed it. There is always more to know. But apart from the minuscule number of people who have a genuine pathology of weight-gain, we have no need of further knowledge. For all the rest of us we know what to do, and what to stop doing. Doubtless if we all used that knowledge, there would still be some fatter, and some thinner, people. The human species is rich in genetic variation, and our energy metabolism is a part of it. But that is not a “public health disaster”. If I, as a middle-aged man of average height, weigh 75 kilos I’ll be pissed off with an equivalent comrade who behaves exactly as I do but who weighs a more ripped 68 kilos, but then I’m also pissed off that I’ve never resembled Robert Redford in the facial beauty department. Actually, by living a reasonably disciplined life, I no longer weigh 75 kilos, and I endeavour with good success to keep as close to 70 kilos as I can. But if I were less vain, then 75 kilos is unlikely to have me high on anyone’s obesity-related health scare index.

And yet, as the New year comes around once more, we are bombarded again with the alchemy of weight loss. Join this support group. Eat this wonder food. Follow this vacuous celebrity’s DVD. Buy this processed meal substitute. Pop this “natural” pill derived from the roots of an unheard-of miracle plant from the pitiful remnant of some tropical rainforest. As in every New Year preceding this, thousands of men and women – mostly women – will part with their hard-earned cash, lining the pockets of the alchemists de nos jours. None of them will succeed, any more than past believers in hocus-pocus succeeded in turning lead into gold.

But we do know what to do. We all know that we eat too much of the wrong crap, and we sit around the place doing bugger all. We use lifts we don’t need. We have remote controls to spare us the ordeal of getting off the sofa to change the channels of our flat-screen TVs as they peddle more weight-loss alchemy. I can guarantee, absolutely guarantee, that if you do the following things, you will never get obese. Unless you really do have a pathological condition, or are disabled in some significant way that prevents you from undertaking any form of aerobic exercise, then follow this advice. It will work. You can pay me if you like, since you may feel that nothing’s for nothing, but you don’t need to. I am not an alchemist.

• Buy an exercise machine, such as a cross-trainer or treadmill.
• If it doesn’t have a heart-rate monitor, buy one that uses a chest strap rather than relying on finger pulse measurement.
• Put the machine in your bedroom.
• As soon as you get up, before breakfast, get on that machine and use it to raise your heart-rate to 75% of your aerobic capacity (for most middle-aged people about 130bpm).
• Keep going, without stopping, for 30 to 40 minutes.
• Don’t go on a diet, but never (well, hardly ever) buy anything that is a cake, a biscuit, a confectionery item, a ready meal, a pie, or suchlike.
• In Michael Pollan’s pithy phrase, “eat food, not too much, mostly plants”.

I know this will work, because we all know what to do. Mostly we don’t want to admit it. Mostly we want to hide from it. Mostly we want a philosopher’s stone that will shield us from doing what we know we need to do. There is no such thing. Get over it. And whilst, like me, you may have watched “Britain’s fattest man” on Channel 4 last night, you will also know that Paul Mason has no physiological problem. He is mentally ill. His tragic case has nothing to teach you.