Self-discipline it is not 16 that the fear of failure was simply not there and so neither was the motivation. What to do? Realizing that I was ultimately motivated by the fear of pain, the solution became obvious – so I took two days off and went to the beach with friends. Problem solved. When I returned to my studies I was well and truly behind, the fear of failure was real, the motivation and‘ self-discipline’ appeared, and I was able to buckle down to my studies. So why doesn’ t the fear of the medical complications of obesity motivate us not to over-eat? After all it is an impressive list: Type 2 Diabetes, high blood pressure, stroke and heart attack, not to mention more mundane problems like arthritis of the knees. Doctors rely on exactly this fear of illness when they advise you not to eat the wrong foods and to exercise more. The problem is‘ immediacy’. For fear to motivate us we need to have a sense that the pain is just around the corner and is obvious – that it is a‘ clear and present danger’. Even having some of these illnesses is not immediately obvious enough for some people. While a heart attack is pretty obvious, Type 2 Diabetes and high blood pressure are not. But when we have not yet developed any illnesses and they are sitting out there sometime in the future as nothing more than a‘ risk’( which we all read as meaning that there is a good chance‘ It won’ t happen to me’), they have absolutely no motivational power. After some years of treating the overweight, it occurred to me that I did not have any patients who had had a stroke or a heart attack. A colleague of mine, an endocrinologist specializing in obesity, confirmed my suspicions – he had none as patients either. Clearly a stroke or a heart attack provides sufficient motivation to lose weight! I often feel that I am in a race with my patients to release their self-motivation before a stroke or heart attack does it for us – providing they survive it! Another pain factor is the fear of embarrassment that we experience at those times when being overweight is brought home to us. It might be a social event and a frock that will have to stay in the wardrobe. It might be a comment by a friend, partner or acquaintance. It might be a result of