The gap between Britain's self-image and its actual shape in the mirror widened this week, with a report by the British Heart Foundation which put the country third from bottom in the European league of deaths by heart disease.
We are not the sveltest nation, we know, but in those rare moments of nutritional doubt, one glance through the lens of national stereotype - at Germans scoffing fatty sausage and Italians bolting pasta - reassures us enough to retire to the sofa and order a takeaway. But one day, the statistics imply, this moment of self-satisfaction will be spoiled by some shooting pains in the chest and fish-out-of-water breathing.
Look in the mirror again, says Neil Poulter, professor of preventive cardiovascular medicine at Imperial College, London, and this is what you should see: "We've got high levels of smoking; we've got a high fat intake, cholesterol levels are up and we're overweight. We've got high blood pressure, and we have too much salt in our diet. And we don't exercise. More than 30% of the population do nothing whatsoever, apart from breathing. And it's getting worse."
Yet when he appeared on a radio show to discuss the report yesterday morning, the first thing the presenter said was: "Come on, it's the Italians who eat all these creamy and fatty foods, not us." "I said absolutely not," says Poulter. "It is extraordinary that this notion persists. The British breakfast has killed more people than the British army."
Figures released by the British Heart Foundation put the death rate by coronary heart disease in this country at more than double that of France. In the UK, an average of 188 out of 100,000 people between the ages of 35-74 die each year from heart disease. In France, that figure is 57 (which puts it at the head of the league), in Italy, 96, making it joint fourth with Luxembourg.
The reasons are a combination of economic factors and national truculence. Last April, a report entitled Looking to the Future was published, identifying the discrepancy in the amount of heart disease suffered by low and high-income brackets. In the 70s, those on low incomes were 25% more likely to die from heart disease than those on high. In 1999, that figure was more than 30%.
"I'm worried about people thinking we are a healthy-eating nation," says Professor Klim McPherson, who contributed to the study. "It has been apparent for quite a long time that we're high up in the coronary heart disease stakes - even in comparison with America and Australia." The study highlighted not only the relationship between diet and health, but between health and habit.
"The problem is that in some European countries you just eat a more healthy diet because it's how you are brought up: to eat more fruit and vegetables and to drink wine, which is of course very good for your coronary arteries. Your attitude is dominated by where you're born and brought up and what is made available to you."
This question of attitude might be linked to the vague British resentment of interference from the busy-body state and a suspicion of scientists who appear to change their minds every other week. "In the past, we've had some adverse influences from people saying cholesterol didn't matter," says Poulter, "and there have been arguments about the harmfulness of salt in this country, when everyone else in the world acknowledges that there's too much salt and it's not necessary. We've always been very conservative about accepting research."
"There is such a plethora of contradictory medical warnings, that people don't know what is worthwhile and what is cranky," says Dr Peter Marsh, social psychologist and director of the science and research unit in Oxford. But Dr Elizabeth Dowler, of Warwick University's department of social policy and social work, is doubtful that unhealthy eating has much to do with the public's distrust of nutritionists: "There is a strong view that the trouble with nutritionists is they are always changing their minds, and I don't think it is particularly true. There are a lot of popular myths around, but experts have always advocated a balanced diet, and recommended eating fruit and vegetables."
If there is stubbornness over the dinner table, she says, it is more likely to be a generational thing. "Everyone has an Uncle Arthur who smoked like a chimney and lived to be 86," says Dowler. "There's no doubt that this is quite a dominant idea. The kinds of messages that were inculcated in people before the second world war are things that have governed food choice among older people. This always plays an important point in the story."
"My father used to say, I've eaten butter all my life and I'm not going to stop now," says Poulter. "It was all rather Thatcherite." Even accounting for the rash of detoxification diets that were used to advertise a certain lifestyle in the 90s, the consensus still tends to be that watching what you eat is fussy and boring. "It is part peer pressure, part tradition and part habit."
In these circumstances, it is easy to fall back on the familiar cycle of bad eating followed by a prim week off chocolate and a binge at the weekend. "We have an ambivalent relationship to what we eat," says Marsh. "On the one hand, we're rather neurotic, and, on the other, we have some bad consumption habits. The Italians have a much healthier attitude towards eating: they enjoy it and have less of a sense of guilt."
Guilt doesn't cause heart disease, but Marsh strongly believes that the attitude one has towards eating creates a climate in which the likelihood of falling ill can be tipped either way. That attitude is not always determined by choice. "For a lot of people, the health of their children and to a lesser extent themselves, is a source of constant anxiety," says Dowler. "But it is a question of what they can afford to put on the table."
