But let us not get too technical. Suffice it to note that among the Pima Indians of North America and the Nauran islanders in the South Pacific, the prevalence of diabetes rose from virtually zero per cent to over fifty per cent as they adopted a typically "Western" lifestyle; two extreme examples of what is actually happening to the rest of us. The real "epidemic" that is responsible for the rising prevalence of diabetes lies in the growing proportion of people who are overweight and the decreasing level of physical fitness that are the main features of this Western lifestyle.

Just as misleading as the press reports is the labelling process that is involved in the management of diabetes. Quite often, for example, a patient will be found to have sugar in the urine on a routine check up and a glucose tolerance test will be ordered. The results may show a fasting blood glucose that is "within normal limits"; rising, after half an hour, to a point a little above the kidney threshold at which glucose spills into the urine, and remaining "above normal" two hours after the glucose load. And what does all this mean? Sometimes the patient is told that he or she has "a trace of sugar"; or worse: "you are not a diabetic, but you do have impaired glucose tolerance".

Let us ask again: what does all this mean? Why is the blood glucose "above normal" after two hours? What does "tolerance" refer to? What is "normal"? Do the test results mean that the patient has "nothing to worry about"? Do they mean that no further action is required at this time? Do they mean that the patient is not at increased risk of heart disease, stroke or other complications?

The usual outcome speaks for itself. Life goes on as before. The patient continues to check his or her urine from time to time, sometimes finding a little sugar in the urine. Ten or fifteen years later, often in the midst of a medical or emotional crisis, a lot of sugar will appear in the urine or a high blood sugar will be detected, and the doctor will then declare that the patient is a "diabetic".

So what was happening all along? A patient such as this is almost always overweight and sedentary with a high serum cholesterol. Unfortunately for him, the important issue has not been his overall health, but whether or not he has "diabetes". Unless and until his diabetes is an established diagnosis, no "treatment" will be given and nothing will be done. Doctors deal with diabetes, not with "impaired glucose tolerance" or "a trace of sugar". In other words, if you are not demonstrably sick, you are well.

And so it is that most people who are thirty pounds overweight with a cholesterol of 240 and a trace of sugar in their urine would consider themselves to be in "good" health. So too would most people who get breathless after climbing four flights of stairs; who smoke a pack of cigarettes a day, have a waist of forty-two inches and mild swelling of their legs. They say they are in good health because they have no pain; the doctor has not diagnosed any disease, and they are not on any kind of medication. And so they will remain until sickness forces them to respond otherwise.

And so it will. There are a few exceptional people, the most famous being Winston Churchill, who will get away with unhealthy living for a very long time. Most of those people who fit the description above, however, are going to die in their sixties or seventies, or be crippled with angina, a stroke or other disabling conditions. More important, all of them are living far below their potential.

They probably do not know it, and if they do they will often say they do not care. Living as we do in a society that respects people's right to do with themselves what they will, we will go along with this and pay the medical costs that they incur without question. But consider that the last one hundred people who have had by-pass surgery for (largely preventable) coronary heart disease at the Mount Hope hospital have cost us, directly or indirectly, about ten million dollars, and consider that there are easily another five thousand people in this country who need by-pass surgery, and it will be obvious that we cannot continue in this way for much longer. We simply cannot afford it.

What is the alternative? Quite simple, really. People such as those with "impaired glucose tolerance" have to be treated - or rather, have to treat themselves - differently. We have to recognise the risks to health that are inherent in our way of living and work to reduce those risks before they translate into frank disease. We have to shift our focus - and much of our resources - from treatment to prevention, and we have to recognise that the most effective form of prevention is in fact the promotion of higher standards of health. Obesity is not just a few extra pounds of fat; it is unhealthy, and unhealthy people eventually get sick. The connection is straightforward; so too must be the response.