I am a 46-​year old man. After turn­ing 40 I put on 2^st around my stom­ach. For six months now, I have been to my local gym five times a week, burn­ing about 1,000 cal­or­ies each time. But my weight has not changed and I still have ugly flab around my stom­ach. I am becom­ing very dis­il­lu­sioned. Any sug­ges­tions?

The more research we do on weight loss, diet and exer­cise, the more com­plic­ated the pic­ture looks. There are no guar­an­tees that you will lose your paunch, even if you do everything right.

At its simplest, to lose weight you must cre­ate a daily dif­fer­ence of 500 to 1,000 cal­or­ies between what you eat and what you expend in energy. But exactly how your body responds to this cal­orie defi­cit depends on many inter­act­ing vari­ables, includ­ing gender, age, phys­ical fit­ness, body type, meta­bolic make up and so on.

Here are some evidence-​based sug­ges­tions which may help you lose the weight. But even if they don’t, I would urge you not to give up on your exer­cise. Men who put on fat around their mid­riffs are at increased risk of heart dis­ease. Even if the paunch seems immov­able, the exer­cise helps to shift some of the internal fat dis­tri­bu­tion away from the main danger sites, and improves your blood-​fat com­pos­i­tion, so it is still hav­ing an import­ant health bene­fit.

• Change your exer­cise routine. Ensure you are doing a strength train­ing workout three times a week, not just a car­di­ovas­cu­lar régime, as this is the best way to boost your meta­bolic rate. Find new car­di­ovas­cu­lar chal­lenges – our bod­ies rap­idly adapt and if we keep on doing the same routine they simply adjust to that as the norm. Try the row­ing machine. Swap one or two gym ses­sions for a 30 to 45 minute out­door run, and/​or swim­ming ses­sions, both of which are highly cal­orie intens­ive. Aim for longer times and avoid extremely high-​intensity work, as the energy usage is less help­ful for weight loss. Always build up your times gradu­ally, to avoid injury.
• Exercise alone is not enough. You’ll need to cut your over­all food intake and prob­ably change the nutri­tional bal­ance. Concentrate on redu­cing fats, espe­cially if you are a meat-​eater, and select one daily (or fre­quent) high-​calorie item to cut alto­gether (sweet snack, beer, ice-​cream, pizza, cheese etc). Above all, do not allow your food intake to creep up and can­cel out the extra exer­cise.
• Keep act­ive through­out the day – don’t fool your­self into assum­ing the gym visit is enough. Walk, climb stairs, have sex, carry loads and keep mov­ing!