I ask a young 200-kilo patient what he snacks on. “Nothing,” he says. I look him in the eye. Nothing? He nods. I ask him about his chronic skin infections, his diabetes. He tears up: “I eat hot chips and fried dim sims and drink three bottles of Coke every afternoon. The truth is I’m addicted to eating. I’m addicted.” He punches his thigh.

Addicted. The word is useless in my clinic, a mere barrier to any hope of self-determined change. My patient is not addicted; he’s a very lonely, unemployed young man who has gradually become socially isolated to the extent that the only thing available to him for comfort and entertainment is food. He has no friends, no money to buy other consumables, little education, no partner, no job. Some days he doesn’t leave his bed. The choice for him is to eat this food or experience no pleasure. The surgeon and I discuss his situation, concerned that he may overeat after the band has been fitted. We tell him that surgery may not be appropriate for him, given his situation. The patient is perturbed. “Well, what are you going to do for me if you won’t do the operation? Don’t you have some kind of ethical responsibility to help me lose weight?”

Ostensibly cheap food heavily taxes both the individual and the community in terms of disease and redirected health resources. If longevity and the avoidance of disease remain among humanity’s aims, we should try to prevent ourselves from getting very fat. Forget obesity as a disease; it’s a ruse. For whatever reason, the majority of the population can no longer say I have had enough. For whatever reason, the majority of human beings respond to advertisements inviting them to enter a pleasure state by eating a day’s worth of calories in one sitting, again and again. In the face of this, we are stuffed. We could say, “You are free agents, totally free, so pay for your own consequences.” We could make people pay at the point of choice, via a food tax, or we could limit choice. The other option, always unspoken, is: let us have our cake. Let’s just eat and eat, get fatter and fatter, and work out how best to live with it. This is where we are heading now: fatness, outside of morality, as an accepted consequence of the world as we have made it.

We can decide as a country, as a world, that we are going to consume what we have until we’re done, eating as much as we wish and treating all the concomitant diseases by diverting substantial amounts of government revenue into medicine and pharmaceuticals. If we do choose this path – and we are most of the way there already – we must be honest about what we are choosing to do: to spend our country’s money on the consequences of indiscriminate consumption.