Rates of obesity and related health problems such as type 2 diabetes are skyrocketing in the UK and the US.
On both sides of the Atlantic around three quarters of middle-aged men are overweight or obese.
The impact of this is not only physical health issues – being overweight causes a great deal of stigma in our body beautiful obsessed societies of today.
There has been some movement in terms of acceptance of all shapes and sizes for women, and a general support for women to make healthy changes to diet and lifestyle.
But while exercise and protein-packing is marketed to men, counting calories and dieting is generally seen as a girly domain - even though men are more likely to be obese.
Cutting calories and eating salads has been marketed as a woman's domain
'Weight loss is commonly defined as a feminine concern which some men find difficult to relate or react to,' Rob Hobson, Healthspan head of nutrition, says.
'In some cases, embarking on weight loss can be especially tricky when in the presence of male peers, which can create an environment that puts pressure on men to retain their 'real' male identity.
'Living up to the cultural script of masculinity can impact on weight loss efforts and also influence decisions to seek help and advice, which may have a huge impact on long-term health as symptoms of disease take longer to be diagnosed.'
Stigma and men's dieting
For men, even considering changing what they eat can be a stumbling block.
In Gary Barlow's raw and honest autobiography A Better Me, he illustrates just how hard it can be for men to change their eating patterns. In response to ordering a salad, Gary was jeered 'What? What's wrong with him? Salad? Are you gay?'
This lack of social support is a significant barrier to change.
Countless research studies demonstrate the transformative benefits of encouragement from those around us, and conversely the detrimental effect of being surrounded by people who stigmatize health-promoting behaviors such as healthy eating.
It can be incredibly hard for me to admit that they want to lose weight and are usually only open about their struggles once they've shed the pounds.
This is because being overweight is also stigmatized – leaving men in an impossible catch-22 of wanting to shed pounds but not be perceived as 'dieting'.
This is one reason why men tend to control their weight through exercise rather than diet.
But not being able to talk about their struggles can obviously affect men's mental health. There has been wonderful coverage and discussion of men's mental health in recent years with regards to depression and suicide prevention, but less so on issues of body image and self-esteem.
It's OK to get fit, but not diet
Here is a typical case that I see in my practice:
Middle-aged man, often quite fit, sporty and happy with their body at school and beyond. It's only when the years creep up and life gets a bit more demanding (work plus kids plus friends plus aging parents, etc.) that the pounds insidiously pile on.
This may seem rather cruel – just when life is at its fullest, health niggles start to rear their heads. Usually, this leads to a short-term 'fitness' goal – 10k run, triathlon, amateur boxing match for charity, etc.
These goals are often reached relatively easily. With the training