Once you start talking about “refining” menus and cutting back the amount of food you serve, make sure you are providing the nutrients the body needs. Eliminate junk whenever possible. Serve a meal that is low in fats, sugars, and salt and that, instead, is high in fiber, protein, fruit, and vegetables—not additives or condiments. While many people are advocates of eating something from each of the four food groups, you may end up with too fatty a diet that way and with insufficient fiber. I suggest you think of the balanced meal as composed of three elements: One Fruits & Vegetables selection, plus one Animal Foods & Nuts selection, plus one Pasta & Staples selection equals a very nice meal.

I’ve made my calories go as far as they can by using this method. It is essential that you not buy too many shoes with your calories, or too many little black dresses—the well-rounded diet, like the well-rounded wardrobe, needs a little of everything.

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There are four superstars in the antioxidant nutritional world—three vitamins and a mineral. Individually they are all megastars in their own right. Together, in combination, it’s like the Woodstock of cellular concerts—it’s as if the four Beatles got together in Strawberry Fields in Central Park—can you imagine? Well, that’s what it’s like when vitamin C vitamin E, beta-carotene and calcium get together deep inside your very life programme. It’s a happening!

What do these superstars do? They do lots of good things. They patrol our cells looking for free radicals. And when they find a free radical they give it an electron, making it stable and harmless. Antioxidants can do this because they are specially designed to be able to give away their own electrons without becoming unstable or turning into free radicals themselves.

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The term ‘bariatric surgery’ refers to surgical interventions and techniques that lead directly to weight loss and which are used for the treatment of obesity. The aim is to achieve the loss of around 50% of the excess body weight and to maintain weight loss in the long term.

Bariatric surgery is an extremely successful long-term treatment for obesity. Because the surgical intervention is almost always permanent there is a much lower risk of rebound weight gain. Current procedures can be expected to induce a weight loss of, on average, 50-60% of excess body weight and a decrease in BMI of 10 kg/m2 during the first 12-24 postoperative months.

Mason et al studied 14 000 patients following various bariatric surgical procedures and found that they resulted in a mean loss of 53% of excess weight for vertical-banded gastroplasty and of 72% for gastric bypass.

In the Swedish Obese Subjects (SOS) cohort study, which compared surgery (vertical-banded gastroplasty, gastric banding and gastric bypass) with conventional treatment, patients treated surgically had lost significantly more weight (on average 23%) after 2 years than patients managed conventionally, whose weight remained unchanged. This weight loss was maintained at 8 years and was equivalent to a difference in weight loss of 20.7 kg between those patients treated surgically and those managed conventionally (NICE 2002).

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