Darren Smith, whose BMI (35) is greater than his age (33) has come to see me about his health. As he squeezes himself on to the chair next to my desk, he puts his fat elbow out for a blood pressure measurement and asks if he can have a general check-up: he wants a thyroid level test, perhaps a cholesterol test and also he has a mole. He has chronic back pain, is under the physio for knee pain and has long-term depression and anxiety.

Deftly side-stepping these multiple problems, I zone in on his real health issues: “If you are really concerned about your health, the key thing we should talk about is your weight.”

Of course, poor Darren knows his weight is an issue. “Doctor, I have dieted so many times. I hardly ever eat fat. Growing up my mum never let us have butter only margarine. I eat loads of vegetables, almost never meat, only high glycaemic index foods like brown bread and pasta.’ He pauses: ‘I even brought that special spray for oil.”

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