0:00:02 > 0:00:04In a small hospital in Ebbw Vale,
0:00:04 > 0:00:06at the heart of the South Wales valleys,
0:00:06 > 0:00:08one man is waging a war.
0:00:08 > 0:00:10- I feel like crying. We need to do it, don't we?- Yes.
0:00:10 > 0:00:13And Dr Haboubi is battling against tough odds.
0:00:13 > 0:00:17Almost 60% of adults in Wales are overweight or obese.
0:00:17 > 0:00:20I want you to make me smile next time I see you.
0:00:20 > 0:00:23His methods are direct and challenging.
0:00:23 > 0:00:26First time he met me he grabbed hold of my throat and throttled me.
0:00:26 > 0:00:28You feel like killing me now, don't you?
0:00:28 > 0:00:31Over six months we'll follow Dr Haboubi and the casualties
0:00:31 > 0:00:36of the war against obesity, who are desperate to lose some weight.
0:00:36 > 0:00:39Lesley is not a big, fat, lazy bastard.
0:00:40 > 0:00:42It affects my sex life.
0:00:42 > 0:00:43It affects everything.
0:00:43 > 0:00:46- Now that's naughty. - Yeah. I have started.
0:00:46 > 0:00:48No, that's naughty.
0:00:48 > 0:00:50Like, oh, she must be thick because she's big.
0:00:50 > 0:00:54And for doctor and patients it's a matter of life and death.
0:00:54 > 0:00:56I have got to matter, otherwise I won't be here.
0:00:56 > 0:00:58I'm on your side, sir.
0:00:58 > 0:01:02I consider obesity a disease.
0:01:02 > 0:01:05Many of my colleagues don't agree with me. They are wrong.
0:01:13 > 0:01:17A few miles from the clinic is the home of 43-year-old Les Price,
0:01:17 > 0:01:20one of Dr Haboubi's most challenging patients.
0:01:20 > 0:01:23Practically immobile following an industrial accident,
0:01:23 > 0:01:26his weight problems took a turn for the worse
0:01:26 > 0:01:29when his wife was diagnosed with terminal cancer.
0:01:29 > 0:01:34On the second anniversary of her death, he now weighs 37 stone.
0:01:34 > 0:01:36I'm very morbidly obese.
0:01:36 > 0:01:39I've always been big, but I don't want to be this big.
0:01:39 > 0:01:44I lost my uncle when I was 17 and he was only 26 stone.
0:01:44 > 0:01:46But he died of a massive heart attack
0:01:46 > 0:01:49and, you know, I don't want to go the same way.
0:01:49 > 0:01:51Obviously, being immobile and still got to eat,
0:01:51 > 0:01:55and it's like boredom and everything like that, and depression
0:01:55 > 0:02:01and really feeling depressed and low because I couldn't do nothing.
0:02:01 > 0:02:05Maybe when you go shopping, buy a bag of this,
0:02:05 > 0:02:09then just sit yourself in your bedroom, and watch telly and munch down.
0:02:09 > 0:02:14Lots of takeaways because you just couldn't be bothered to cook,
0:02:14 > 0:02:18just didn't feel like going in the kitchen to do anything.
0:02:18 > 0:02:21You know, for every year I've got older, I've put a stone on.
0:02:25 > 0:02:29Weighing 37 stone has caused Les some unforeseen problems.
0:02:30 > 0:02:33There was an incident a few years ago,
0:02:33 > 0:02:36I went on an aeroplane to Ireland.
0:02:36 > 0:02:40Cos I was over 20 stone you needed two seats on the plane.
0:02:40 > 0:02:45But at least on the way over they gave me two seats nearly next to one another,
0:02:45 > 0:02:47they were in the same row.
0:02:47 > 0:02:49When I came back I had two seats,
0:02:49 > 0:02:52one in the left of the plane and one on the right of the plane.
0:02:52 > 0:02:53It wasn't funny.
0:02:56 > 0:02:58Having reached a life threatening size,
0:02:58 > 0:03:01Les knows something has to be done.
0:03:01 > 0:03:05His April appointment at the clinic starts with a food interrogation from Dr Haboubi.
0:03:05 > 0:03:08- Let's go back to Sunday.- Yeah.
0:03:08 > 0:03:10OK, last Sunday. Lunch? What time?
0:03:10 > 0:03:13Er, three o'clock, it was a chicken cooked dinner.
0:03:13 > 0:03:16- How many chickens? - Cooked two chickens.
0:03:16 > 0:03:17- How many of you?- Three.
0:03:17 > 0:03:18Gravy?
0:03:20 > 0:03:21- Yeah, gravy.- Why?
0:03:22 > 0:03:25- Got to have a bit of gravy. - No, you don't have to.
0:03:26 > 0:03:30- Do you know what gravy is made of? - Yeah.- What?- The fat.
0:03:30 > 0:03:33- Exactly. Do you need it? - Not really, no.
0:03:33 > 0:03:35- Would you die if you don't have it? - Er, no.
0:03:35 > 0:03:39But you would be much healthier. Did you have the skin?
0:03:39 > 0:03:42- A little bit of the skin. - You shouldn't really.
0:03:42 > 0:03:45I know, but as you said it's the best bit.
0:03:45 > 0:03:47I know it's tastier but you can't afford it.
0:03:47 > 0:03:51- You wonder why you haven't lost weight.- True.
0:03:51 > 0:03:54I want you to make me smile next time I see you.
0:03:54 > 0:03:57- How? - Lose a bit of weight?
0:03:57 > 0:03:59Deal? Or no deal?
0:03:59 > 0:04:01- Thank you very much, Les.- Thank you.
0:04:01 > 0:04:07Les' target is to lose 5% of his body weight in the next six months.
0:04:07 > 0:04:09We'll be following his progress.
0:04:12 > 0:04:16As the only NHS funded weight management clinic in Wales,
0:04:16 > 0:04:19there's no shortage of patients at Ebbw Vale.
0:04:19 > 0:04:23Dr Haboubi, a world authority on treating obesity,
0:04:23 > 0:04:26takes referrals from all over the country.
0:04:26 > 0:04:27Turn around.
0:04:28 > 0:04:32So you're down by five centimetre for the seven months.
0:04:32 > 0:04:36Your weight is not showing that because you have muscle,
0:04:36 > 0:04:39muscles are heavy. So I'm not pessimistic.
0:04:39 > 0:04:42The waiting list for the clinic is over two years
0:04:42 > 0:04:44and the risks are all too clear.
0:04:44 > 0:04:47Severely obese people are likely to die early,
0:04:47 > 0:04:50losing an average ten years off their life
0:04:50 > 0:04:52and face a ticking time bomb of conditions
0:04:52 > 0:04:54from heart disease, to diabetes and cancer.
0:04:54 > 0:04:59You've lost some four kilogram for the last two months,
0:04:59 > 0:05:02which is not bad really, not bad.
0:05:02 > 0:05:05Dr Haboubi works with a dietician, a psychotherapist
0:05:05 > 0:05:07and specialist nurses.
0:05:07 > 0:05:09Whatever you're doing, it's fantastic.
0:05:09 > 0:05:12And over six months we've been given exclusive access,
0:05:12 > 0:05:17following patients and staff as they put theory into practice.
0:05:17 > 0:05:19- You've crashed the 20 stone barrier. - Yes.
0:05:19 > 0:05:21- Two stone and two pounds.- Mm.
0:05:21 > 0:05:24- That's the same as 13 sugar bags. - Well, there you are.
0:05:24 > 0:05:26This is no quick fix.
0:05:26 > 0:05:30Patients are signed up for a minimum two year programme
0:05:30 > 0:05:34to ensure they reduce their weight gradually and maintain the loss.
0:05:34 > 0:05:38We go in-depth. This is not eat this and don't eat this.
0:05:38 > 0:05:40No, no, it's far, far more complex.
0:05:40 > 0:05:42We do a lot of motivational interviewing
0:05:42 > 0:05:45and motivational encouragement and so on.
0:05:45 > 0:05:47Most of the patients that we see
0:05:47 > 0:05:51have tried at least five or six diets in the past.
0:05:51 > 0:05:53They've tried slimming groups,
0:05:53 > 0:05:58Weight Watchers, Slimming World, cabbage soup diet,
0:05:58 > 0:06:04any diet that's in the newspaper, and they almost set them up to fail.
0:06:04 > 0:06:07These are desperate subjects, desperate patients.
0:06:07 > 0:06:10They have tried everything before
0:06:10 > 0:06:12and they come here only as a last resort.
0:06:19 > 0:06:23In Monmouth, nurse Rachel James is another of Dr Haboubi's patients,
0:06:23 > 0:06:27and is employed as a nurse by the same health authority.
0:06:27 > 0:06:29Her work is physically demanding,
0:06:29 > 0:06:32and having reached a weight of 28 stone
0:06:32 > 0:06:35she's having to take a step back from the wards.
0:06:36 > 0:06:39I felt it was more difficult for my colleagues
0:06:39 > 0:06:41because I wasn't as quick or, you know,
0:06:41 > 0:06:44I couldn't sort of help, physically help.
0:06:44 > 0:06:49I mean, they would say, "Oh, no, no", but I felt I was letting them down.
0:06:49 > 0:06:53Just reaching across a bed would become difficult
0:06:53 > 0:06:56and, I mean, we have to do cardiac resuscitation and things like that.
0:06:56 > 0:06:59It's become difficult for me to do that,
0:06:59 > 0:07:04so my employers have basically got me doing this, which is less acute.
0:07:05 > 0:07:10In work Rachel has had to cope with many upsetting remarks about her weight.
0:07:10 > 0:07:13I have had comments from patients.
0:07:13 > 0:07:18They do hurt, and you just have to bite your tongue
0:07:18 > 0:07:22and take it basically, which, when your self worth isn't good
0:07:22 > 0:07:24you just put yourself down and say,
0:07:24 > 0:07:27"Well, see, that's why I'm not worth it."
0:07:27 > 0:07:30Suffering with depression over a number of years,
0:07:30 > 0:07:32Rachel resorted to binge eating for comfort.
0:07:34 > 0:07:36- Oh, that's gone up again.- Has it?
0:07:36 > 0:07:39'It started as a comfort thing, as an emotional comfort,
0:07:39 > 0:07:42'trying to cheer yourself up, you know, give yourself a treat.'
0:07:42 > 0:07:45Then it just escalates from there really.
0:07:45 > 0:07:48I'm talking about three or four packets of biscuits,
0:07:48 > 0:07:49a litre and a half of pop.
0:07:49 > 0:07:52We're not talking small quantities here.
0:07:52 > 0:07:56Rachel's emotionally-led eating is seen all too often
0:07:56 > 0:07:58by the psychotherapist at the clinic
0:07:58 > 0:08:02who regularly has to address the psychological causes of obesity.
0:08:02 > 0:08:05It's almost a form of self-harm at times
0:08:05 > 0:08:07but rather than comforting themselves
0:08:07 > 0:08:11what they're doing is, you know, harming themselves.
0:08:11 > 0:08:14Janet has helped me so much with building up my self-confidence,
0:08:14 > 0:08:18my self-worth again, that I realise that I am worth it,
0:08:18 > 0:08:19and I can do it now.
0:08:24 > 0:08:28Rachel is now ready for the next stage in her weight loss plan.
0:08:28 > 0:08:30And at one of her regular appointments at the clinic
0:08:30 > 0:08:34Dr Haboubi wants to make sure she really changes her relationship with food.
0:08:36 > 0:08:38How big is your appetite?
0:08:38 > 0:08:40Quite large at times. I do get hungry.
0:08:40 > 0:08:43I don't think I drink enough.
0:08:43 > 0:08:47I honestly have, honestly, I have patients come here...
0:08:48 > 0:08:50..and the only thing that I have done...
0:08:52 > 0:08:55..just asked them to drink a lot of water,
0:08:55 > 0:08:57and to eat three times a day, not skip a meal.
0:08:57 > 0:09:01And I watched their weight.
0:09:01 > 0:09:04You would be surprised at how their weight starts to come down,
0:09:04 > 0:09:06and nothing else.
0:09:06 > 0:09:11Water is important and healthy, that's one.
0:09:11 > 0:09:15- Eating regularly is much better. - And that's with breakfast? About what time?
0:09:15 > 0:09:18I'm trying to eat breakfast, that's something that I never did but I do.
0:09:18 > 0:09:20- But that's naughty. - Yeah, I've started.
0:09:20 > 0:09:23- No, that's naughty.- I know. - You must never, ever skip breakfast.
0:09:23 > 0:09:26- Would you advise people to skip breakfast?- Never.
0:09:26 > 0:09:30Never. Do you snack on anything before you go to bed?
0:09:30 > 0:09:33That, again, depends on emotional...
0:09:33 > 0:09:36- Sweets, chocolate mainly. - Where are they?
0:09:36 > 0:09:40- I'm not buying them like I used to. - Who's buying them?
0:09:40 > 0:09:41Well, my sons.
0:09:43 > 0:09:45I think we should arrest your sons.
0:09:47 > 0:09:50- Oh, my God.- Yeah, but they... - They shouldn't be in the house.
0:09:50 > 0:09:54- No. We do address it. He takes them up to his bedroom.- OK.
0:09:54 > 0:09:58Can we make a... Can we sign a contract, you and I, now?
0:09:58 > 0:10:02That in the evening, when you want to snack on something,
0:10:02 > 0:10:06when you feel low, that you have a pint of skimmed milk,
0:10:06 > 0:10:10hot, with sweetener? What's wrong with that?
0:10:10 > 0:10:13- Yes, that's fine. - Can we try that for a month?- We can.
0:10:14 > 0:10:16- Make it six weeks.- OK.
0:10:19 > 0:10:21Rachel's treatment plan is to continue working
0:10:21 > 0:10:26on her emotionally-led eating and maintain her gradual weight loss,
0:10:26 > 0:10:29losing a pound or two every week, and keeping it off.
0:10:33 > 0:10:37The Miskin Manor Hotel, and a special day for a happy couple.
0:10:38 > 0:10:43But it's also a chance for wedding DJ Mark Weller from Brecon to take centre stage.
0:10:44 > 0:10:47Today he's busy loading the van for his latest gig.
0:10:47 > 0:10:51Mark weighs 27 stone and he's really feeling the effects.
0:10:51 > 0:10:54Weddings is all about appearance
0:10:54 > 0:10:57and although equipment has got physically smaller
0:10:57 > 0:11:00it's, unfortunately, just as heavy as it ever was.
0:11:08 > 0:11:12Generally, the majority of my clients don't seem to have an issue
0:11:12 > 0:11:13with my physical size.
0:11:13 > 0:11:16That's not to say that in some environments you might get
0:11:16 > 0:11:19rather well-oiled customers who can be a bit rude.
0:11:19 > 0:11:22I'm used to that, I can cope with that quite easily.
0:11:22 > 0:11:25They seem to forget that name calling is not a good idea
0:11:25 > 0:11:27when I've got a microphone.
0:11:27 > 0:11:31Can you get up out of your seats and join us? Thank you.
0:11:31 > 0:11:34Ladies and gentlemen, we're going to begin the dancing with this song
0:11:34 > 0:11:36that means something special to them both.
0:11:36 > 0:11:38The one they've chosen, an absolute classic
0:11:38 > 0:11:39and it goes like this.
0:11:43 > 0:11:47Mark's main reason for trying to get to grips with the issue
0:11:47 > 0:11:49has been his young son, Sam.
0:11:50 > 0:11:53Having a six-year-old son,
0:11:53 > 0:11:56I'm quite concerned about the issues that lie ahead for him.
0:11:56 > 0:12:00I'm very conscious of him eating healthy and not following suit.
0:12:00 > 0:12:04The other thing that I'm concerned about with Sam,
0:12:04 > 0:12:06the fact that children are going to tease him in school
0:12:06 > 0:12:09about having a dad who's fat.
0:12:09 > 0:12:13I know my son does gets quite upset when people tease him about that.
0:12:13 > 0:12:16You ready? Come on then.
0:12:16 > 0:12:19Hold on, this seat's not very strong.
0:12:19 > 0:12:20I'll have to push, push this.
0:12:22 > 0:12:24All right, look where you're going.
0:12:24 > 0:12:26Oh, this is hard work.
0:12:26 > 0:12:29HE LAUGHS
0:12:29 > 0:12:32'You think that you can do things and then you find
0:12:32 > 0:12:34'when you go to do them you can't.
0:12:34 > 0:12:38'This process for me has really been about the motivation
0:12:38 > 0:12:41'to want to do something about it.'
0:12:41 > 0:12:44Let me carry it. Oh, that's easier.
0:12:44 > 0:12:46Go on then. Don't go too fast now.
0:12:49 > 0:12:53After regular attendance at the clinic Mark has lost a stone,
0:12:53 > 0:12:55but he wants a more radical approach.
0:12:55 > 0:12:59Dr Haboubi has put him forward for a type of bariatric, or weight loss,
0:12:59 > 0:13:03surgery that would remove 80% of his stomach,
0:13:03 > 0:13:06drastically reducing the food he can eat for the rest of his life.
0:13:08 > 0:13:10There's a long waiting list as the Welsh NHS
0:13:10 > 0:13:13funds less than 70 operations a year.
0:13:13 > 0:13:15Far fewer than in England.
0:13:15 > 0:13:18To get an operation Mark has to continue to show his commitment
0:13:18 > 0:13:19to losing weight.
0:13:20 > 0:13:24- I'm going to upset you, Mark, because you've actually put on.- Have I?- Yeah.
0:13:24 > 0:13:27How much? Not a great deal I would have thought.
0:13:27 > 0:13:31- Four and a quarter it is, all right? So you were 26.3 last time. - That makes sense.
0:13:31 > 0:13:33But obviously you were expecting that, all right.
0:13:33 > 0:13:36I haven't taken my belt off and I haven't been to the toilet
0:13:36 > 0:13:39- this morning, that has a significant bearing.- Of course.
0:13:41 > 0:13:45If Mark starts to pile on weight he may be refused surgery.
0:13:45 > 0:13:49Dr Haboubi wants to make sure an operation isn't seen as a quick fix,
0:13:49 > 0:13:52and that lifestyle changes actually happen.
0:13:53 > 0:13:57I cannot see any weight loss.
0:13:57 > 0:14:01So my fear and worry...
0:14:03 > 0:14:07..is that you're only focused on the surgery.
0:14:07 > 0:14:10- Yes, you're well qualified for it. - Yeah.
0:14:11 > 0:14:14Yes, you should have it, and yes, you will have it.
0:14:15 > 0:14:17But at the same time...
0:14:18 > 0:14:21..I'm expecting changes from you as well.
0:14:21 > 0:14:23I'm being harsh on you, sir.
0:14:23 > 0:14:26Surgery or not, Dr Haboubi wants Mark to replace
0:14:26 > 0:14:29some of his furniture with exercise equipment.
0:14:29 > 0:14:31If you can get a treadmill.
0:14:31 > 0:14:33You have a television at home?
0:14:35 > 0:14:36And in that TV room...
0:14:38 > 0:14:41..what else? What kinds of furniture are there?
0:14:41 > 0:14:44Two settees and that's it.
0:14:44 > 0:14:47So how many people can sit down?
0:14:47 > 0:14:49Erm...four maybe five.
0:14:49 > 0:14:52- How many of you are there at home? - Three.
0:14:53 > 0:14:56Get rid, get rid of one of these, one of the settees
0:14:56 > 0:14:58and put a treadmill there.
0:14:58 > 0:15:00- I think so, honestly.- OK.
0:15:00 > 0:15:01I'm on your side, sir.
0:15:02 > 0:15:03OK?
0:15:05 > 0:15:09Morriston in Swansea is the only NHS hospital in Wales that
0:15:09 > 0:15:13carries out bariatric operations such as the one Mark's waiting for.
0:15:13 > 0:15:17Just 67 procedures are carried out there each year.
0:15:17 > 0:15:22Dr Haboubi only puts one in ten of his patients forward for surgery,
0:15:22 > 0:15:26and he doesn't see it as a quick fix for the nation's problems.
0:15:26 > 0:15:30Surgery is not the answer but at the same time, certainly,
0:15:30 > 0:15:34there are a group of patients who would benefit from surgery.
0:15:34 > 0:15:38Dr Haboubi's methods may be less invasive
0:15:38 > 0:15:42but his frank and direct approach captures his patients' attention.
0:15:42 > 0:15:47First time he met me he grabbed hold of my throat and throttled me.
0:15:47 > 0:15:49So I fell in love with him day one.
0:15:49 > 0:15:52He's very enthusiastic, very caring,
0:15:52 > 0:15:55and I think if you wanted someone to fight your corner,
0:15:55 > 0:15:57he would fight your corner for you.
0:15:57 > 0:16:02He'll have a go at you and tell you you're not helping yourself, you're not doing yourself no favours.
0:16:02 > 0:16:05He's very, very passionate about what he does,
0:16:05 > 0:16:07but he doesn't mince his words.
0:16:07 > 0:16:10He gives it to you bare bones and all.
0:16:10 > 0:16:12You've got to love what you're doing
0:16:12 > 0:16:14and that's why, where this trust comes from,
0:16:14 > 0:16:16these patients have never seen me before.
0:16:16 > 0:16:19They come first time, some of them cry.
0:16:19 > 0:16:22Some of them, you know, they are just desperate.
0:16:22 > 0:16:25They need help. They're desperate.
0:16:31 > 0:16:35A month into his new regime of lifestyle change,
0:16:35 > 0:16:39Les is realising it's not just about changing eating patterns.
0:16:39 > 0:16:42He has to try and get mobile despite his back injury.
0:16:42 > 0:16:46He's been referred to an exercise scheme in a local adult learning centre.
0:16:46 > 0:16:49But suffering from a flare up of muscle pain,
0:16:49 > 0:16:51he's not looking forward to it.
0:16:51 > 0:16:54It's just one of those days, I woke up and I'm in agony.
0:16:54 > 0:16:56Nothing special turned it.
0:16:56 > 0:16:59It's just...just pain.
0:16:59 > 0:17:02Is it going to be worth coming to the session if I can't participate
0:17:02 > 0:17:04because of the pain?
0:17:04 > 0:17:06Is it going to make me worse?
0:17:07 > 0:17:09Cos yet, I've still got to get home.
0:17:09 > 0:17:12It's like being in a prison cell because I can't do much
0:17:12 > 0:17:14and I can't go far.
0:17:15 > 0:17:17Whether it's worth it sometimes, to make you feel...
0:17:20 > 0:17:24Les has made an important first step as almost a third of people
0:17:24 > 0:17:28referred by health professionals don't turn up for the first session.
0:17:28 > 0:17:31A lot of people think that they cannot perform exercise.
0:17:31 > 0:17:34This is a totally different kind of way of looking at exercise.
0:17:34 > 0:17:37This is exercise for life, trying to manage that health condition
0:17:37 > 0:17:41through recognised exercises that they can perform.
0:17:43 > 0:17:46Nice and steady. Nice movement in the shoulder. Go.
0:17:54 > 0:17:56- Another ten.- What?
0:18:00 > 0:18:02- Lovely.- That's cheating that is.
0:18:02 > 0:18:05He says 40 on the board, then tells you ten more.
0:18:05 > 0:18:07He pushes the boundaries all the time.
0:18:07 > 0:18:09Before the session, I didn't want to be here.
0:18:09 > 0:18:12I wished I'd stayed in the house, I thought the pain would kill me.
0:18:12 > 0:18:15But I'm glad I came because I feel really good.
0:18:15 > 0:18:20It's been about ten minutes and I physically feel invigorated,
0:18:20 > 0:18:23knackered, out of breath but great.
0:18:23 > 0:18:25It's better than being in the gym on your own.
0:18:25 > 0:18:30I'll try and come three days a week. If I can get in here five days a week, I would.
0:18:30 > 0:18:33But the proof of the pudding will be in the monthly weigh in.
0:18:34 > 0:18:38Les is back at the clinic to see if his lifestyle changes are working.
0:18:38 > 0:18:40Hopefully, I've lost a bit of weight.
0:18:40 > 0:18:43Some of my clothes are feeling better on me.
0:18:43 > 0:18:46Anything above half a stone I'll be really chuffed with.
0:18:46 > 0:18:48Anything over two pound would be good.
0:18:51 > 0:18:57Les faces his appointment with the scales with a sense of hope and trepidation.
0:18:57 > 0:18:59Oh, it's gone up a pound now.
0:18:59 > 0:19:01At least you have lost.
0:19:01 > 0:19:03- Have I? What have I lost?- Yeah.
0:19:03 > 0:19:05Three pounds.
0:19:05 > 0:19:07Oh, well, I did say anything over two, didn't I?
0:19:07 > 0:19:09Yeah. No, well done.
0:19:09 > 0:19:12Dr Haboubi is pleased to see some loss,
0:19:12 > 0:19:15but it's not as much as he was expecting.
0:19:15 > 0:19:19Under questioning, it seems Les has given into temptation.
0:19:19 > 0:19:22Since the last time I met you I have had two takeaways.
0:19:22 > 0:19:25But say takeaways, it was a shop-bought pizza,
0:19:25 > 0:19:27as where I used to eat a big one to myself.
0:19:27 > 0:19:29- What did you have? - A shop-bought pizza.
0:19:29 > 0:19:32As where I used to have one to myself
0:19:32 > 0:19:33now I have half with my partner.
0:19:35 > 0:19:36OK.
0:19:36 > 0:19:40Yeah, but, for me that's a big deal, going from a big huge...
0:19:40 > 0:19:41No, no, no.
0:19:41 > 0:19:46I used to have a 16 inch pizza on my own and I'd eat that in one go.
0:19:46 > 0:19:48Now, I'm having a 12 inch pizza...
0:19:48 > 0:19:51I've actually never seen a 16, let alone...
0:19:51 > 0:19:54The one place I used to have them from did a 16 inch pizza.
0:19:54 > 0:19:57But I used to eat myself. Now I'm having half of a 12 inch.
0:19:57 > 0:20:01- I want you to come back in about four weeks.- Right.
0:20:01 > 0:20:03But I want some more weight loss.
0:20:03 > 0:20:05I'll go for it.
0:20:05 > 0:20:09From now on, we are not having pizza any more.
0:20:10 > 0:20:13Whether it's half of the 12 inches or not,
0:20:13 > 0:20:15- we're not going to have pizza any more.- OK.
0:20:15 > 0:20:17- Very high calorie.- Right.- OK?
0:20:19 > 0:20:20Thanks for coming.
0:20:20 > 0:20:23As Dr Haboubi has just said, you know, it's a weight loss,
0:20:23 > 0:20:26it's not a put on, it's not as much as we'd hoped
0:20:26 > 0:20:30but I just got to work harder, and get more strict.
0:20:30 > 0:20:32No more pizza.
0:20:32 > 0:20:36If I lose half a stone by the time I come next time, I'll be over the moon.
0:20:36 > 0:20:39The grey matter is working a bit better now than it was.
0:20:39 > 0:20:43We've got the summer holidays coming up, I want to get my beach body back.
0:20:43 > 0:20:47But Les is way off the target, and will have to work far harder
0:20:47 > 0:20:50to get to Dr Haboubi's six month goal of a 5% weight loss.
0:20:52 > 0:20:55Rachel also has an appointment at the clinic.
0:20:55 > 0:20:58Her session is with psychotherapist Janet.
0:20:58 > 0:21:01A chance to see if Rachel's lessons in dealing with stressful situations
0:21:01 > 0:21:05have worked and stopped her turning to food in a crisis.
0:21:05 > 0:21:08Recently Rachel's had a great deal to cope with.
0:21:08 > 0:21:11I mean, a lot, a lot has happened.
0:21:11 > 0:21:16My eldest son was assaulted last Sunday morning,
0:21:16 > 0:21:18so a lot has happened.
0:21:18 > 0:21:21I'm laughing, I shouldn't laugh because he's got a head injury.
0:21:21 > 0:21:23He's OK, he's got concussion.
0:21:23 > 0:21:26It's hard, I could cry now.
0:21:26 > 0:21:30Er, but I'm trying not to, I'm trying to be good.
0:21:31 > 0:21:33Trying to be.
0:21:33 > 0:21:36So the hardest but most loving thing to do is to actually...
0:21:36 > 0:21:39- To actually let him get on with it. - Yes.- Just support him.
0:21:39 > 0:21:42There's good news as Rachel is maintaining her weight loss
0:21:42 > 0:21:44despite family stress.
0:21:44 > 0:21:48- Look at the weight.- I know. I've lost some more weight. - That's brilliant. Yeah.
0:21:48 > 0:21:52It's the old coping mechanisms that you've been helping me with.
0:21:52 > 0:21:56Right, because I wonder, was there anything from our meeting last time?
0:21:56 > 0:21:58I think just talking about it helps, you know,
0:21:58 > 0:22:01- just talking and getting some perspective on it.- Right.
0:22:01 > 0:22:04I've been seeing Jan for about 18 months,
0:22:04 > 0:22:09going through why I eat, what causes me to eat, basically.
0:22:09 > 0:22:13January of 2012 and I was 28 stone three pounds.
0:22:13 > 0:22:17And I'm down to 26 stone, 13½.
0:22:17 > 0:22:20So that's in, say, 18 months.
0:22:20 > 0:22:22So it's coming down slowly.
0:22:24 > 0:22:26Although losing her weight gradually,
0:22:26 > 0:22:29Rachel is keeping with the clinic's ethos.
0:22:30 > 0:22:34The emphasis here is on avoiding the yo-yo cycle of crash diets
0:22:34 > 0:22:35and then weight gain.
0:22:35 > 0:22:40Over 90% of patients manage to far exceed their six month weight loss target.
0:22:42 > 0:22:44You've lost ten kilograms in six months.
0:22:44 > 0:22:46- How do you feel about that? - Very good, yeah.
0:22:46 > 0:22:49I'm feeling good, my clothes are feeling looser, you know.
0:22:49 > 0:22:53You have actually lost, almost ten stones.
0:22:53 > 0:22:55Almost ten stone.
0:22:55 > 0:22:57- You are more active? - Yes, very much more.
0:22:57 > 0:23:00- And you're more careful about what you eat?- Yeah.
0:23:00 > 0:23:03This lady here and this man is wonderful, they're marvellous.
0:23:03 > 0:23:06The light at the end of the tunnel is definitely there.
0:23:06 > 0:23:08Before, there wasn't even a tunnel.
0:23:08 > 0:23:10You're an amazing young lady.
0:23:10 > 0:23:12You are amazing. Well done.
0:23:12 > 0:23:16I was not far off, I think around 19 stone?
0:23:16 > 0:23:19And now I'm 17 stone something.
0:23:19 > 0:23:22I've lost five stone two pounds in about a year.
0:23:22 > 0:23:25I think in the last eight to ten weeks,
0:23:25 > 0:23:27probably about a stone and a half.
0:23:27 > 0:23:29And I've lost nearly two stone now.
0:23:29 > 0:23:32I've lost a stone and a half in three months.
0:23:32 > 0:23:35There's a lot more to go. I'm still a chunky monkey.
0:23:39 > 0:23:43As spring turns to summer, Mark's chances of getting
0:23:43 > 0:23:45a date for an operation seem to be looking up.
0:23:45 > 0:23:49He's come to Morriston Hospital to meet consultant Jonathan Barry
0:23:49 > 0:23:50to find out more.
0:23:50 > 0:23:55We're going to staple along this part of the stomach to reduce,
0:23:55 > 0:23:58- to remove about 80% of the stomach. OK?- Right.
0:23:58 > 0:24:01So we're converting the stomach into a tube.
0:24:01 > 0:24:03As a consequence of that you will eat less.
0:24:03 > 0:24:06Because we remove the upper part of the stomach here
0:24:06 > 0:24:11which has a concentration of cells responsible for producing a hormone called ghrelin,
0:24:11 > 0:24:14which is the hunger hormone, we find that when we do this operation
0:24:14 > 0:24:18the patients don't actually feel the need to eat as much postoperatively.
0:24:18 > 0:24:20That's obviously a big positive step.
0:24:20 > 0:24:23What we find with many patients is that they will lose
0:24:23 > 0:24:27an average of 60% of their excess weight in about two years.
0:24:27 > 0:24:31Our results are coming in about 60% after about a year, 15 months.
0:24:31 > 0:24:33But as I've said to you before,
0:24:33 > 0:24:36it's not about the fact that you're going to lose weight
0:24:36 > 0:24:39it's going to be the improvement in your obesity related comorbidities.
0:24:39 > 0:24:42- So I need to wait for the date now. - Wait for the date, that's right.
0:24:44 > 0:24:47A successful operation would reduce Mark's chances
0:24:47 > 0:24:50of suffering life limiting and life threatening illnesses.
0:24:50 > 0:24:53For Jonathan Barry, there's a frustration that the rules
0:24:53 > 0:24:57to qualify for an operation are different in Wales to England.
0:24:57 > 0:25:00For a population of approximately three million in Wales
0:25:00 > 0:25:04we perform 67 operations per year.
0:25:04 > 0:25:09If we were to comply with the recommended guidelines
0:25:09 > 0:25:12we should be doing in a steady state, 300.
0:25:13 > 0:25:16In our first 15 months of operations down here
0:25:16 > 0:25:19we were referred in excess of 1,000 patients.
0:25:19 > 0:25:23Over 95% of these patients would have had surgery in England.
0:25:26 > 0:25:29Mark now only has to complete a series of health checks
0:25:29 > 0:25:33and wait patiently for that all important date.
0:25:39 > 0:25:44Les has a target of losing 5% of his body weight over six months.
0:25:44 > 0:25:47He's trying to become the model patient.
0:25:48 > 0:25:51Working out at home as well as in his regular exercise classes.
0:25:53 > 0:25:55Things have been looser fitting,
0:25:55 > 0:25:58I've had people telling me I look like I've lost weight,
0:25:58 > 0:26:03and hopefully now with the exercise, and trying to cut, you know,
0:26:03 > 0:26:06keeping the amount of food I'm eating down.
0:26:06 > 0:26:08All right, I'll have a little bit of chocolate,
0:26:08 > 0:26:11but it's like, instead of having a Kit Kat with four fingers
0:26:11 > 0:26:14you'll have a two finger or something like that.
0:26:14 > 0:26:17When everyone else is having stuff, I don't always have it, you know.
0:26:17 > 0:26:19Hopefully I would have lost a bit.
0:26:19 > 0:26:22Les claims his new regime is taking hold
0:26:22 > 0:26:25but only the clinic scales will reveal the truth.
0:26:25 > 0:26:29I don't normally weigh with my shoes on but I've got new trainers and I can't take them off.
0:26:29 > 0:26:31235.6, OK.
0:26:31 > 0:26:33The news is not good.
0:26:33 > 0:26:36- I've stayed the same. - It hasn't gone down.
0:26:36 > 0:26:38- Oh, well.- 37 stone one.
0:26:40 > 0:26:42Gone back up.
0:26:42 > 0:26:45Les is one of Dr Haboubi's most challenging patients,
0:26:45 > 0:26:48and he's already put him forward for surgery.
0:26:48 > 0:26:50With lifestyle changes not bedding in,
0:26:50 > 0:26:54Dr Haboubi picks up the phone to try and see if, or when,
0:26:54 > 0:26:56Les will get an operation.
0:26:56 > 0:26:58Hi, this is Dr Haboubi again.
0:26:58 > 0:27:02I'm sorry, I have got another gentleman whom I referred
0:27:02 > 0:27:05back on 28th of February.
0:27:05 > 0:27:07I have not had a response yet.
0:27:07 > 0:27:10I would be grateful if you could ring me as soon as possible.
0:27:10 > 0:27:13- You feel like killing me now, don't you?- No.
0:27:13 > 0:27:15- Sure?- Positive.
0:27:15 > 0:27:17You're a positivity.
0:27:17 > 0:27:20But Dr Haboubi has to strike a negative note.
0:27:20 > 0:27:24Surgery has its risks and Les' weight isn't helping his chances.
0:27:24 > 0:27:27Now, the heavier people are,
0:27:27 > 0:27:31- the more likely they will get complications from surgery.- Yeah.
0:27:31 > 0:27:36- And I'm talking about not simple complications.- No, I know.
0:27:36 > 0:27:39Serious complications and mortality, which means death.
0:27:41 > 0:27:44- They want to make sure that the procedure is safe...- Yeah.
0:27:44 > 0:27:46..before they embark on it.
0:27:46 > 0:27:51So, I'm sorry, but I really haven't got an answer from them yet.
0:27:51 > 0:27:52It's not your fault.
0:27:54 > 0:27:56- It's never my fault.- Oh, no, no.
0:27:58 > 0:28:01So what are you going to do?
0:28:02 > 0:28:05- Persevere and keep going.- Oooh.
0:28:05 > 0:28:06'I wish I'd lost weight.
0:28:06 > 0:28:08'Obviously I hadn't, but'
0:28:08 > 0:28:11it just means that I've got to keep doing the exercises now,
0:28:11 > 0:28:14and hopefully change my eating habits again now
0:28:14 > 0:28:16and be more strict.
0:28:16 > 0:28:20And hopefully next time I come up it'll be weight loss.
0:28:20 > 0:28:23It is time to sort of take a look at what I'm doing now
0:28:23 > 0:28:27and say, right, it's got to go, and have a real good...
0:28:28 > 0:28:30..good go at it.
0:28:30 > 0:28:33Les is a very positive man, he's always kind of...
0:28:36 > 0:28:38..eager to address his problem.
0:28:38 > 0:28:43But his appetite is big, especially for those who are less active, OK?
0:28:43 > 0:28:46If you want to have a bar of chocolate, you can have,
0:28:46 > 0:28:48you can have half of it.
0:28:48 > 0:28:50Why do you have to have the whole lot?
0:28:50 > 0:28:52Then you would have to exercise more,
0:28:52 > 0:28:55and if you can't exercise, or you don't want to exercise,
0:28:55 > 0:28:58or won't have the time to burn what you are consuming,
0:28:58 > 0:29:00then you're going to have a problem.
0:29:00 > 0:29:02You're going to accumulate that as fat, which is simple thing.
0:29:02 > 0:29:05Same thing, whether sugar or fat and so on.
0:29:06 > 0:29:11Most patients at the clinic don't want surgery and Rachel James
0:29:11 > 0:29:14is losing weight through changing her relationship with food.
0:29:14 > 0:29:18She's also getting more active by stepping into the garden.
0:29:19 > 0:29:24It's approximately 160 foot by about 50 foot wide.
0:29:25 > 0:29:28You have to do at least two or three days work in it,
0:29:28 > 0:29:31full day's work in it, physical work as well.
0:29:31 > 0:29:34I feel a lot healthier actually.
0:29:34 > 0:29:39I feel a lot brighter in myself because, you know,
0:29:39 > 0:29:42depression has been a big factor in my weight problem.
0:29:44 > 0:29:47So, yeah, it does make me feel a lot better.
0:29:47 > 0:29:49My mobility has definitely improved.
0:29:49 > 0:29:53Even just walking down the garden, much more confidence.
0:29:53 > 0:29:56Because when you get bigger you become quite unstable actually
0:29:56 > 0:29:59and you do fall over quite a bit.
0:29:59 > 0:30:02Well, I fall over quite a bit, or have done in the past.
0:30:02 > 0:30:04I got stuck the other day
0:30:04 > 0:30:06because I did something I shouldn't have done.
0:30:06 > 0:30:10But we got out of it so that was fine.
0:30:13 > 0:30:16Rachel's controlling her comfort eating.
0:30:16 > 0:30:20But at the start of the summer, she's called away to deal with
0:30:20 > 0:30:23a family illness that will put her to the test.
0:30:28 > 0:30:31Les is also faced with a test.
0:30:31 > 0:30:33He's trying to stay healthy on holiday.
0:30:33 > 0:30:36And he's too big for the caravan bed.
0:30:36 > 0:30:40- As you see, my single bed from the house here... - HE LAUGHS
0:30:40 > 0:30:42..because the ones in there wouldn't hold me.
0:30:42 > 0:30:46Basically I've spent the holiday out here staying in watching TV.
0:30:46 > 0:30:52Yesterday it was raining, so we went down to ASDA, bought a few DVDs.
0:30:52 > 0:30:56I would say I've been 70% good.
0:30:56 > 0:30:59We've had a barbecue, we had boiled potatoes.
0:30:59 > 0:31:03I've had chips three times through ten days.
0:31:03 > 0:31:06A couple of biscuits, but not over the top.
0:31:06 > 0:31:08We didn't bring that many with us.
0:31:09 > 0:31:12Les' parents are also staying in the area,
0:31:12 > 0:31:14and soon thoughts turn to the prejudices
0:31:14 > 0:31:17that their son has to face.
0:31:17 > 0:31:19People get the wrong impression.
0:31:19 > 0:31:23They see Leslie, and the first thing they think is, "Fat, lazy bastard."
0:31:24 > 0:31:28And he's not. He's worked hard all his life.
0:31:28 > 0:31:32It's just that you've had a catalogue of injuries that have built up
0:31:32 > 0:31:36and built up until now, he's practically immobile
0:31:36 > 0:31:38with his shoulder, his back, his knees.
0:31:38 > 0:31:41Leslie is not a big, fat, lazy bastard.
0:31:41 > 0:31:44"Oh, you're his father, you will say these things."
0:31:44 > 0:31:49But no, I don't want people to judge him on face value.
0:31:49 > 0:31:50You know, on just what they see.
0:31:50 > 0:31:55What he'll laugh off as a joke with you,
0:31:55 > 0:31:59when he's on his own, it hurts.
0:31:59 > 0:32:01He tries hard not to let it hurt, but it does.
0:32:05 > 0:32:07But it doesn't take much.
0:32:07 > 0:32:10Just one person to say the wrong thing, that can,
0:32:10 > 0:32:13he'll laugh it off there and then,
0:32:13 > 0:32:18but when you get back, it all sits down and takes him over,
0:32:18 > 0:32:22and unfortunately, sometimes,
0:32:22 > 0:32:28to compensate for that, he will eat for comfort.
0:32:28 > 0:32:31One of his problems would be that he would sit in his room
0:32:31 > 0:32:32and perhaps eat a bag of sweets
0:32:32 > 0:32:36or something that he shouldn't have had, just for comfort, like.
0:32:39 > 0:32:43Les's next weigh-in will test the impact of the holiday,
0:32:43 > 0:32:46coming a few days after he returns home.
0:32:50 > 0:32:54It's September, and Mark finally receives a date for surgery.
0:32:54 > 0:32:59He suffers from Type 2 Diabetes caused by his obesity.
0:32:59 > 0:33:02It's one reason he's been accepted for surgery.
0:33:02 > 0:33:05He's hoping the operation will reverse his diabetes
0:33:05 > 0:33:09and put an end to a bathroom full of expensive medicine.
0:33:09 > 0:33:13A year's supply of just one of his drugs costs over £1,000 -
0:33:13 > 0:33:15the likely savings are clear.
0:33:15 > 0:33:20There is no guarantee that the operation is going to address
0:33:20 > 0:33:22the diabetes issue that I have,
0:33:22 > 0:33:25but in 90% of cases it does.
0:33:25 > 0:33:28And I can expect to see immediate results.
0:33:28 > 0:33:33We can look forward to seeing this cabinet as good as empty,
0:33:33 > 0:33:36and obviously from a cost perspective, then,
0:33:36 > 0:33:39I'm not going to be going to the chemist every couple of weeks
0:33:39 > 0:33:43to collect large shipping orders on a regular basis.
0:33:43 > 0:33:46So that's bound to be a massive saving on the health service,
0:33:46 > 0:33:47I would have thought.
0:33:50 > 0:33:54As summer turns to autumn, Les is back at the Ebbw Vale clinic.
0:33:54 > 0:33:56He's desperately hoping for weight loss,
0:33:56 > 0:33:59despite some dietary slip-ups on holiday,
0:33:59 > 0:34:02and also some news on his hopes for surgery.
0:34:03 > 0:34:04You have lost.
0:34:04 > 0:34:06Woo-hoo!
0:34:06 > 0:34:09- Yes, you've lost a bit there, according to that, isn't it?- Yeah.
0:34:09 > 0:34:10That's great.
0:34:10 > 0:34:14Aye, you're only just over a pound and a half off a stone there.
0:34:14 > 0:34:18- Oh, that's all right, then. - Yeah. Just, well done.
0:34:18 > 0:34:20To everyone's surprise,
0:34:20 > 0:34:24Les has managed to lose over 12 pounds.
0:34:24 > 0:34:27You've, for a change...
0:34:27 > 0:34:30HE LAUGHS I don't know what you do,
0:34:30 > 0:34:32but you've really done very well.
0:34:32 > 0:34:39I mean, you've lost five kilogram in just over five weeks.
0:34:39 > 0:34:44And that is what we normally aim for,
0:34:44 > 0:34:48losing about in the range of half to one kilogram a week.
0:34:50 > 0:34:53The question is, now you've done it,
0:34:53 > 0:34:56therefore it means that you can do anything, isn't it?
0:34:56 > 0:34:59Although it's good news on the weight loss front,
0:34:59 > 0:35:03Les is still keen to get accepted for surgery.
0:35:03 > 0:35:04Any news on the..
0:35:04 > 0:35:09Yea, we've had a reply to say that,
0:35:09 > 0:35:12I mean, you have been declined to have surgery.
0:35:12 > 0:35:13That'll make a change(!)
0:35:15 > 0:35:18On the criteria that because you just don't have comorbidities,
0:35:18 > 0:35:21which I don't agree with that. Which means that you're not...
0:35:21 > 0:35:22I'm not ill enough.
0:35:24 > 0:35:25Yeah.
0:35:31 > 0:35:35There are two problems here. One is that you are very heavy,
0:35:35 > 0:35:39and to be honest, your surgery is not going to be easy.
0:35:39 > 0:35:42It's going to be difficult.
0:35:42 > 0:35:45I think the only way forward, therefore, is just to carry on
0:35:45 > 0:35:46what you're doing now,
0:35:46 > 0:35:49and I think the fact that you have lost weight...
0:35:49 > 0:35:52It is obviously and definitely possible
0:35:52 > 0:35:54and feasible to lose more weight.
0:35:54 > 0:35:58I'm chuffed and over the moon with what I've done today,
0:35:58 > 0:36:00so that's a good...
0:36:01 > 0:36:03you know, carry on and get more off.
0:36:03 > 0:36:06Happy that Dr Haboubi is happy with my weight loss.
0:36:06 > 0:36:08You do want to make him happy, but not only making him happy,
0:36:08 > 0:36:10it's going to make me happy,
0:36:10 > 0:36:12because it's going to be a weight loss.
0:36:12 > 0:36:16Although close to his short term target,
0:36:16 > 0:36:18Les has a long road ahead of him.
0:36:22 > 0:36:27After a long wait, the morning of Mark's operation has arrived.
0:36:27 > 0:36:29And before he's taken into theatre,
0:36:29 > 0:36:32he has a few moments to gather his thoughts.
0:36:32 > 0:36:35Things look slightly surreal this morning.
0:36:35 > 0:36:40Here we are finally, after this long wait, at the day of my op.
0:36:40 > 0:36:44I'm obviously anxious about some aspects of it.
0:36:44 > 0:36:47There's always a danger with any surgery,
0:36:47 > 0:36:50so fingers and toes crossed.
0:36:50 > 0:36:53Surgeon Jonathan Barry and his team at Morriston Hospital
0:36:53 > 0:36:57are preparing for what is an irreversible operation.
0:36:57 > 0:37:00These operations are performed in people, as you see,
0:37:00 > 0:37:01who are very, very large.
0:37:01 > 0:37:04That itself causes problems at the time of surgery.
0:37:04 > 0:37:09It just adds complications to the procedures.
0:37:10 > 0:37:12To be able to operate on the stomach,
0:37:12 > 0:37:15Mr Barry and his team create a series of portholes
0:37:15 > 0:37:18in Mark's abdomen through which they can pass their instruments,
0:37:18 > 0:37:20and inflate the stomach cavity
0:37:20 > 0:37:23to give themselves more room to manoeuvre.
0:37:23 > 0:37:25We're going to attach the gas up now.
0:37:25 > 0:37:27We will be insufflating carbon dioxide
0:37:27 > 0:37:30into the abdominal cavity to give us a bit of working space.
0:37:30 > 0:37:33Soon it's time to dim the lights to get a clearer picture,
0:37:33 > 0:37:36and to start getting to grips with the sheet of fat
0:37:36 > 0:37:40surrounding the liver, which has to be pushed out of the way.
0:37:40 > 0:37:43Not unusual in a gentleman with a body mass index of this,
0:37:43 > 0:37:46he's got a lot of inter-abdominal fat.
0:37:46 > 0:37:48So this is a nice bit of equipment,
0:37:48 > 0:37:50it's called a triangular flex liver retractor.
0:37:50 > 0:37:53Also in the surgeons' way is a large sheet of fat
0:37:53 > 0:37:56around the stomach, which has to be cut away.
0:37:56 > 0:38:00The way this device works, it vibrates at a very high frequency,
0:38:00 > 0:38:04so it seals the vessels before dividing them.
0:38:04 > 0:38:07With the sheet of fat out of the way,
0:38:07 > 0:38:10it's time to cut and staple the stomach.
0:38:10 > 0:38:12First firings here at the bottom are a bit tricky,
0:38:12 > 0:38:14because we haven't got a lot of space.
0:38:14 > 0:38:17You close the jaws, you fire the gun three times
0:38:17 > 0:38:19and it fires a line of staples
0:38:19 > 0:38:22and the fourth time you squeeze the gun,
0:38:22 > 0:38:24a blade comes out and actually cuts the tissue,
0:38:24 > 0:38:28so you've got four lines of staples and a cut in between.
0:38:31 > 0:38:33Such as that.
0:38:33 > 0:38:35Suddenly, the team come up against a problem.
0:38:37 > 0:38:40There are known risks and complications
0:38:40 > 0:38:42for operations like this.
0:38:42 > 0:38:44A plastic tube which is inserted into the stomach
0:38:44 > 0:38:50seems to have lost its shape, and is caught by the staple gun.
0:38:50 > 0:38:52A few modifications to this operation, guys.
0:38:55 > 0:38:59It now depends on the surgeon's skill and experience
0:38:59 > 0:39:01to prevent it becoming a serious problem.
0:39:03 > 0:39:07So there we are, chaps. A little change to the planned event there.
0:39:07 > 0:39:13The operation now back on course, the team have to test for any leaks.
0:39:13 > 0:39:15The important thing is that the join
0:39:15 > 0:39:18where we join the two edges of the stomach back together,
0:39:18 > 0:39:21that it's watertight, that it's got a good blood supply.
0:39:21 > 0:39:23We've checked it. There was no leak whatsoever.
0:39:23 > 0:39:26I don't anticipate any problems here at the moment.
0:39:27 > 0:39:29Needle there for you, Sister.
0:39:29 > 0:39:31Can I have some swabs?
0:39:34 > 0:39:37Time for the final crucial stage -
0:39:37 > 0:39:41the removal of 80% of Mark's stomach.
0:39:42 > 0:39:43Nice specimen.
0:39:43 > 0:39:46With Mark in the final stages of surgery,
0:39:46 > 0:39:50Jonathan Barry reflects on the funding frustrations he faces.
0:39:50 > 0:39:53This operation can cost up to £10,000,
0:39:53 > 0:39:56but can still save the NHS money in the long run.
0:39:56 > 0:40:00These types of operations are cost neutral at two-and-a-half years,
0:40:00 > 0:40:05after which time, there is a cost saving to the UK taxpayer.
0:40:05 > 0:40:07This is a good operation
0:40:07 > 0:40:10that should be carried out in far greater numbers.
0:40:10 > 0:40:12Surgery clearly has a role in this type of individual.
0:40:12 > 0:40:15It's certainly not a quick fix for morbid obesity at all, surgery.
0:40:15 > 0:40:17Surgery is not the answer.
0:40:19 > 0:40:22Major surgery, though, has risks.
0:40:22 > 0:40:24A few days after his first operation,
0:40:24 > 0:40:26Mark had to return to surgery
0:40:26 > 0:40:30to repair a small section of his stomach, slowing his recovery.
0:40:30 > 0:40:34Nearly a month after the operation, he remains in hospital.
0:40:35 > 0:40:40They have been monitoring me to see if the leak is repaired.
0:40:40 > 0:40:43I knew before the op that there was a risk
0:40:43 > 0:40:46that things don't always go quite to plan.
0:40:46 > 0:40:49It hasn't really changed my motivations,
0:40:49 > 0:40:51and what I hope to achieve.
0:40:51 > 0:40:53It's made me more, even more determined.
0:40:53 > 0:40:56I think that anyone that has put themselves
0:40:56 > 0:40:59in the position where they're considering bariatric surgery,
0:40:59 > 0:41:01they really, really need to do their research
0:41:01 > 0:41:04and be absolutely certain that this is what they want.
0:41:06 > 0:41:08For me, there was no question.
0:41:08 > 0:41:11I was just physically not able to get the exercise I needed
0:41:11 > 0:41:16to get my weight down, even if I was eating correctly.
0:41:16 > 0:41:18It was a no-brainer for me.
0:41:18 > 0:41:20I've got no regrets about it.
0:41:20 > 0:41:23There's no question about it not being easy.
0:41:23 > 0:41:27It has been very hard, but without a shadow of a doubt,
0:41:27 > 0:41:33so far it's been well worth all the pain and anguish, absolutely.
0:41:33 > 0:41:35Yeah, I'm really determined.
0:41:35 > 0:41:37More determined now than I've ever been.
0:41:39 > 0:41:41Oh, I can't get in through the gate.
0:41:42 > 0:41:45It's also been a traumatic time for Rachel James.
0:41:45 > 0:41:48Her treatment for emotionally triggered binge eating
0:41:48 > 0:41:52was put to the ultimate test when she had to nurse her father
0:41:52 > 0:41:55through the final weeks of terminal cancer.
0:41:55 > 0:41:58It's been very... emotional roller coaster really,
0:41:58 > 0:42:00from your dad becoming ill
0:42:00 > 0:42:04to suddenly realising that he's not got long to live.
0:42:04 > 0:42:08And just being there, really, being with your mum,
0:42:08 > 0:42:10who's lost the love of her life.
0:42:14 > 0:42:18Sorry. I'm going to start crying about it now.
0:42:18 > 0:42:24But...realising that I don't have to punish myself for that was good.
0:42:28 > 0:42:31Highly emotional moments like this in her life
0:42:31 > 0:42:33would have triggered Rachel's binge eating,
0:42:33 > 0:42:37but something seems to have changed.
0:42:37 > 0:42:39When my mother phoned up to tell me Dad was ill,
0:42:39 > 0:42:43after I put the phone down from her, I went out to the kitchen
0:42:43 > 0:42:45and although I'm still cooking food,
0:42:45 > 0:42:49I picked up a packet of crisps, and I opened them,
0:42:49 > 0:42:53I put a mouthful in and I thought, "Why am I doing that?
0:42:53 > 0:42:56"I'm cooking tea. Why am I actually eating these?"
0:42:56 > 0:42:58So I actually threw them away.
0:42:58 > 0:43:00So it was actually just...
0:43:00 > 0:43:04It was like, you know, it was an automatic reaction,
0:43:04 > 0:43:07to stuff that emotion down, to push that emotion down,
0:43:07 > 0:43:10and I think that's what I've been doing, pushing, you know,
0:43:10 > 0:43:14to stop myself feeling, in effect.
0:43:14 > 0:43:19It's the therapy that's, that's done it for me, more than anything.
0:43:23 > 0:43:27Back at Ebbw Vale, a steady stream of patients
0:43:27 > 0:43:29pass through the doors every Thursday morning.
0:43:29 > 0:43:32Most come to report successful weight loss to Dr Haboubi.
0:43:34 > 0:43:36Honestly? I'm very happy,
0:43:36 > 0:43:39and I don't think I take the credit for this.
0:43:39 > 0:43:44But he knows that the stream of casualties keeps growing in Wales.
0:43:44 > 0:43:46I'm proud of you.
0:43:46 > 0:43:47Thank you very much.
0:43:47 > 0:43:49- Honestly.- Thank you.
0:43:49 > 0:43:51With a waiting list of 500 patients,
0:43:51 > 0:43:54and only enough capacity to see 160 in a year,
0:43:54 > 0:43:58some can wait up to three years before their first consultation.
0:43:58 > 0:44:00Why do you think you are better?
0:44:00 > 0:44:02Because I'm losing weight and getting fitter.
0:44:02 > 0:44:06At the moment, it's a very lonely place on the front line
0:44:06 > 0:44:08in the war against obesity,
0:44:08 > 0:44:11and Dr Haboubi wants more troops to join him.
0:44:11 > 0:44:14You've got to ensure that there are the facility,
0:44:14 > 0:44:18the services available to manage those who are already obese,
0:44:18 > 0:44:21there is nothing, virtually nothing.
0:44:21 > 0:44:24Several of these clinics should be available
0:44:24 > 0:44:26in every hospital in Wales.
0:44:26 > 0:44:28You are a bit crazy, like, but you're crazy in a good way.
0:44:28 > 0:44:31- I don't want to stop coming here! - Lovely to see you, sir.
0:44:31 > 0:44:33- No problem, Doctor. - Thank you very much.
0:44:42 > 0:44:45Subtitles by Red Bee Media Ltd