It was as I bent over

Newcastle, United Kingdom

It was as I bent over I knew it would happen. And then it did. A ripping, tearing sound, followed by an immediate blast of fresh air to sensitive parts as my trousers ripped from very front to very back. Oh no, why me? I had travelled to the north of England, Newcastle, to help the locals with an operation and was changing out of my theatre blues into a jacket and tie, ready for my journey home. It was a day trip and I had not a stitch of spare clothing with me. I cannot even spell the expletives I uttered at the time.

For the next 20 minutes I tried to work out how to return to London by train without showing my privacy to the world. Walking with my legs crossed was good for three steps at most. One hand fore and one hand aft were simply insufficient to cover the gaping hole. Ah! How about the briefcase? But no, it just about covered the rear but there was still the front. There was only one solution – travel to the capital in my theatre blues and ignore the inquiring looks from fellow passengers.

So I did. Surprisingly, I did not attract the attention I thought. Perhaps that is London, where folk walk the streets dressed in all manner of items, indeed sometimes they are not dressed at all. So a surgeon travelling on a Virgin train dressed and ready to operate - why raise an eyebrow at all?

The lesson from this exercise was not that theatre blues make reasonable travel wear - they do - but that I needed to lose weight. I guess I am a typical male as when I look in a mirror I see muscle, such is the male body image, whereas if I was female all I would see is fat. Actually I should have been ashamed as if there is one thing all surgeons wish to avoid it is operating on an overweight patient. So often that means trouble. Harder access, harder surgery, longer incisions, longer healing, more complications and the likelihood that whatever operation you do, one day it will need to be redone. The only exception is the bariatric surgeon who, by definition, spends his life operating on folk with body mass indices somewhere above the clouds.

Spending so much time overseas has allowed me to see an impressive variety of body types. No greater contrast is there than to board an aircraft in Ethiopia, where only 3% of the population is obese, and disembark in Dubai where that figure rockets to an astonishing 35%. Mind you the dish-dash and the burka are excellent ways of disguising body shape, although they cannot hide how much you eat. Fat people do seem to eat a lot, don’t they? There are some seriously worrying confessions out there where some admit to eating a week’s worth of food in a night. Mind you, the obesity record is held by the tiny Micronesian land of Palau, where a frightening 47% of the population is obese. The population? 18000 souls at most on a land mass of no more than 465 square kilometres spread across 250 islands. Now there’s a thought. Might there be a business opportunity opening a burger bar in Palau?

To make folk happier about being chubby, there is a scientifically recognised difference between being overweight and being obese. Obese means fat. It is all to do with the body mass index, or BMI. Anything under 25 and you are fine, over 30 and you are obese. And between the two? You are overweight but you are definitely, definitely not fat. Hang on to that fact next time you look in the mirror. I do all the time.

Naturally it makes sense to get the blubber off if you can. I realise I make a living from individuals who are falling apart. Obesity is a brilliant way of hastening Nature’s otherwise unavoidable processes and of keeping us medics employed. Heart disease, cancer, diabetes, stroke, gallstones, gout and, in my world, arthritis. Certainly for arthritis, if you put on weight then you can increase the chances of a rotten knee at least five-fold. Even being 10 pounds overweight can increase the force through your knee by as much as 60 pounds with every single step, thanks to the way the mechanical forces are distributed. Imagine being a knee with that lot going on higher up. Not a happy experience. Obesity continues to kill more people worldwide than starvation.

When it comes to eating I am as guilty as the next man and go through phases of making a real pig of myself, regretting it, and then starving myself like an anorectic for the next few months. I hop on and off scales, distrust what I read, and always take the lower measurement as gospel. If the readout declares something unfavourable, the scales are to blame, not me. And I still do not comprehend why everything that tastes good seems to be bad for me and that to live to become a hundred I have to give up anything that makes me want to live that long.

But for the surgeon, the most telling location is always the changing room. That place where you have to choose what size of theatre blue to don. The problem with my international practice is that sizes vary between countries. In UK I wear a simple XL. My conscience can just about cope. In Dubai? Oh dear, an XL is far too small. I can barely get the thing over my head. Even the XXL is something of a struggle. A Dubai XXL makes a UK XS look massive. Or perhaps, just perhaps I am putting on weight once again and simply refuse to admit it.

So where were those scales? You know the ones. The beige-coloured Italian platform that sits in the corner of the bathroom and always reads a few pounds light. That is my favourite, always will be, and I’ll be sure to buy a larger pair of trousers so the crotch cannot split.