The Welsh Weight Clinic

In a small hospital in Ebbw Vale,

at the heart of the South Wales valleys,

one man is waging a war.

-I feel like crying. We need to do it, don't we?

-Yes.

And Dr Haboubi is battling against tough odds.

Almost 60% of adults in Wales are overweight or obese.

I want you to make me smile next time I see you.

His methods are direct and challenging.

First time he met me he grabbed hold of my throat and throttled me.

You feel like killing me now, don't you?

Over six months we'll follow Dr Haboubi and the casualties

of the war against obesity, who are desperate to lose some weight.

Lesley is not a big, fat, lazy bastard.

It affects my sex life.

It affects everything.

-Now that's naughty.

-Yeah. I have started.

No, that's naughty.

Like, oh, she must be thick because she's big.

And for doctor and patients it's a matter of life and death.

I have got to matter, otherwise I won't be here.

I'm on your side, sir.

I consider obesity a disease.

Many of my colleagues don't agree with me. They are wrong.

A few miles from the clinic is the home of 43-year-old Les Price,

one of Dr Haboubi's most challenging patients.

Practically immobile following an industrial accident,

his weight problems took a turn for the worse

when his wife was diagnosed with terminal cancer.

On the second anniversary of her death, he now weighs 37 stone.

I'm very morbidly obese.

I've always been big, but I don't want to be this big.

I lost my uncle when I was 17 and he was only 26 stone.

But he died of a massive heart attack

and, you know, I don't want to go the same way.

Obviously, being immobile and still got to eat,

and it's like boredom and everything like that, and depression

and really feeling depressed and low because I couldn't do nothing.

Maybe when you go shopping, buy a bag of this,

then just sit yourself in your bedroom, and watch telly and munch down.

Lots of takeaways because you just couldn't be bothered to cook,

just didn't feel like going in the kitchen to do anything.

You know, for every year I've got older, I've put a stone on.

Weighing 37 stone has caused Les some unforeseen problems.

There was an incident a few years ago,

I went on an aeroplane to Ireland.

Cos I was over 20 stone you needed two seats on the plane.

But at least on the way over they gave me two seats nearly next to one another,

they were in the same row.

When I came back I had two seats,

one in the left of the plane and one on the right of the plane.

It wasn't funny.

Having reached a life threatening size,

Les knows something has to be done.

His April appointment at the clinic starts with a food interrogation from Dr Haboubi.

-Let's go back to Sunday.

-Yeah.

OK, last Sunday. Lunch? What time?

Er, three o'clock, it was a chicken cooked dinner.

-How many chickens?

-Cooked two chickens.

-How many of you?

-Three.

Gravy?

-Yeah, gravy.

-Why?

-Got to have a bit of gravy.

-No, you don't have to.

-Do you know what gravy is made of?

-Yeah.

-What?

-The fat.

-Exactly. Do you need it?

-Not really, no.

-Would you die if you don't have it?

-Er, no.

But you would be much healthier. Did you have the skin?

-A little bit of the skin.

-You shouldn't really.

I know, but as you said it's the best bit.

I know it's tastier but you can't afford it.

-You wonder why you haven't lost weight.

-True.

I want you to make me smile next time I see you.

-How?

-Lose a bit of weight?

Deal? Or no deal?

-Thank you very much, Les.

-Thank you.

Les' target is to lose 5% of his body weight in the next six months.

We'll be following his progress.

As the only NHS funded weight management clinic in Wales,

there's no shortage of patients at Ebbw Vale.

Dr Haboubi, a world authority on treating obesity,

takes referrals from all over the country.

Turn around.

So you're down by five centimetre for the seven months.

Your weight is not showing that because you have muscle,

muscles are heavy. So I'm not pessimistic.

The waiting list for the clinic is over two years

and the risks are all too clear.

Severely obese people are likely to die early,

losing an average ten years off their life

and face a ticking time bomb of conditions

from heart disease, to diabetes and cancer.

You've lost some four kilogram for the last two months,

which is not bad really, not bad.

Dr Haboubi works with a dietician, a psychotherapist

and specialist nurses.

Whatever you're doing, it's fantastic.

And over six months we've been given exclusive access,

following patients and staff as they put theory into practice.

-You've crashed the 20 stone barrier.

-Yes.

-Two stone and two pounds.

-Mm.

-That's the same as 13 sugar bags.

-Well, there you are.

This is no quick fix.

Patients are signed up for a minimum two year programme

to ensure they reduce their weight gradually and maintain the loss.

We go in-depth. This is not eat this and don't eat this.

No, no, it's far, far more complex.

We do a lot of motivational interviewing

and motivational encouragement and so on.

Most of the patients that we see

have tried at least five or six diets in the past.

They've tried slimming groups,

Weight Watchers, Slimming World, cabbage soup diet,

any diet that's in the newspaper, and they almost set them up to fail.

These are desperate subjects, desperate patients.

They have tried everything before

and they come here only as a last resort.

In Monmouth, nurse Rachel James is another of Dr Haboubi's patients,

and is employed as a nurse by the same health authority.

Her work is physically demanding,

and having reached a weight of 28 stone

she's having to take a step back from the wards.

I felt it was more difficult for my colleagues

because I wasn't as quick or, you know,

I couldn't sort of help, physically help.

I mean, they would say, "Oh, no, no", but I felt I was letting them down.

Just reaching across a bed would become difficult

and, I mean, we have to do cardiac resuscitation and things like that.

It's become difficult for me to do that,

so my employers have basically got me doing this, which is less acute.

In work Rachel has had to cope with many upsetting remarks about her weight.

I have had comments from patients.

They do hurt, and you just have to bite your tongue

and take it basically, which, when your self worth isn't good

you just put yourself down and say,

"Well, see, that's why I'm not worth it."

Suffering with depression over a number of years,

Rachel resorted to binge eating for comfort.

-Oh, that's gone up again.

-Has it?

'It started as a comfort thing, as an emotional comfort,

'trying to cheer yourself up, you know, give yourself a treat.'

Then it just escalates from there really.

I'm talking about three or four packets of biscuits,

a litre and a half of pop.

We're not talking small quantities here.

Rachel's emotionally-led eating is seen all too often

by the psychotherapist at the clinic

who regularly has to address the psychological causes of obesity.

It's almost a form of self-harm at times

but rather than comforting themselves

what they're doing is, you know, harming themselves.

Janet has helped me so much with building up my self-confidence,

my self-worth again, that I realise that I am worth it,

and I can do it now.

Rachel is now ready for the next stage in her weight loss plan.

And at one of her regular appointments at the clinic

Dr Haboubi wants to make sure she really changes her relationship with food.

How big is your appetite?

Quite large at times. I do get hungry.

I don't think I drink enough.

I honestly have, honestly, I have patients come here...

..and the only thing that I have done...

..just asked them to drink a lot of water,

and to eat three times a day, not skip a meal.

And I watched their weight.

You would be surprised at how their weight starts to come down,

and nothing else.

Water is important and healthy, that's one.

-Eating regularly is much better.

-And that's with breakfast? About what time?

I'm trying to eat breakfast, that's something that I never did but I do.

-But that's naughty.

-Yeah, I've started.

-No, that's naughty.

-I know.

-You must never, ever skip breakfast.

-Would you advise people to skip breakfast?

-Never.

Never. Do you snack on anything before you go to bed?

That, again, depends on emotional...

-Sweets, chocolate mainly.

-Where are they?

-I'm not buying them like I used to.

-Who's buying them?

Well, my sons.

I think we should arrest your sons.

-Oh, my God.

-Yeah, but they...

-They shouldn't be in the house.

-No. We do address it. He takes them up to his bedroom.

-OK.

Can we make a... Can we sign a contract, you and I, now?

That in the evening, when you want to snack on something,

when you feel low, that you have a pint of skimmed milk,

hot, with sweetener? What's wrong with that?

-Yes, that's fine.

-Can we try that for a month?

-We can.

-Make it six weeks.

-OK.

Rachel's treatment plan is to continue working

on her emotionally-led eating and maintain her gradual weight loss,

losing a pound or two every week, and keeping it off.

The Miskin Manor Hotel, and a special day for a happy couple.

But it's also a chance for wedding DJ Mark Weller from Brecon to take centre stage.

Today he's busy loading the van for his latest gig.

Mark weighs 27 stone and he's really feeling the effects.

Weddings is all about appearance

and although equipment has got physically smaller

it's, unfortunately, just as heavy as it ever was.

Generally, the majority of my clients don't seem to have an issue

with my physical size.

That's not to say that in some environments you might get

rather well-oiled customers who can be a bit rude.

I'm used to that, I can cope with that quite easily.

They seem to forget that name calling is not a good idea

when I've got a microphone.

Can you get up out of your seats and join us? Thank you.

Ladies and gentlemen, we're going to begin the dancing with this song

that means something special to them both.

The one they've chosen, an absolute classic

and it goes like this.

Mark's main reason for trying to get to grips with the issue

has been his young son, Sam.

Having a six-year-old son,

I'm quite concerned about the issues that lie ahead for him.

I'm very conscious of him eating healthy and not following suit.

The other thing that I'm concerned about with Sam,

the fact that children are going to tease him in school

about having a dad who's fat.

I know my son does gets quite upset when people tease him about that.

You ready? Come on then.

Hold on, this seat's not very strong.

I'll have to push, push this.

All right, look where you're going.

Oh, this is hard work.

HE LAUGHS

'You think that you can do things and then you find

'when you go to do them you can't.

'This process for me has really been about the motivation

'to want to do something about it.'

Let me carry it. Oh, that's easier.

Go on then. Don't go too fast now.

After regular attendance at the clinic Mark has lost a stone,

but he wants a more radical approach.

Dr Haboubi has put him forward for a type of bariatric, or weight loss,

surgery that would remove 80% of his stomach,

drastically reducing the food he can eat for the rest of his life.

There's a long waiting list as the Welsh NHS

funds less than 70 operations a year.

Far fewer than in England.

To get an operation Mark has to continue to show his commitment

to losing weight.

-I'm going to upset you, Mark, because you've actually put on.

-Have I?

-Yeah.

How much? Not a great deal I would have thought.

-Four and a quarter it is, all right? So you were 26.3 last time.

-That makes sense.

But obviously you were expecting that, all right.

I haven't taken my belt off and I haven't been to the toilet

-this morning, that has a significant bearing.

-Of course.

If Mark starts to pile on weight he may be refused surgery.

Dr Haboubi wants to make sure an operation isn't seen as a quick fix,

and that lifestyle changes actually happen.

I cannot see any weight loss.

So my fear and worry...

..is that you're only focused on the surgery.

-Yes, you're well qualified for it.

-Yeah.

Yes, you should have it, and yes, you will have it.

But at the same time...

..I'm expecting changes from you as well.

I'm being harsh on you, sir.

Surgery or not, Dr Haboubi wants Mark to replace

some of his furniture with exercise equipment.

If you can get a treadmill.

You have a television at home?

And in that TV room...

..what else? What kinds of furniture are there?

Two settees and that's it.

So how many people can sit down?

Erm...four maybe five.

-How many of you are there at home?

-Three.

Get rid, get rid of one of these, one of the settees

and put a treadmill there.

-I think so, honestly.

-OK.

I'm on your side, sir.

OK?

Morriston in Swansea is the only NHS hospital in Wales that

carries out bariatric operations such as the one Mark's waiting for.

Just 67 procedures are carried out there each year.

Dr Haboubi only puts one in ten of his patients forward for surgery,

and he doesn't see it as a quick fix for the nation's problems.

Surgery is not the answer but at the same time, certainly,

there are a group of patients who would benefit from surgery.

Dr Haboubi's methods may be less invasive

but his frank and direct approach captures his patients' attention.

First time he met me he grabbed hold of my throat and throttled me.

So I fell in love with him day one.

He's very enthusiastic, very caring,

and I think if you wanted someone to fight your corner,

he would fight your corner for you.

He'll have a go at you and tell you you're not helping yourself, you're not doing yourself no favours.

He's very, very passionate about what he does,

but he doesn't mince his words.

He gives it to you bare bones and all.

You've got to love what you're doing

and that's why, where this trust comes from,

these patients have never seen me before.

They come first time, some of them cry.

Some of them, you know, they are just desperate.

They need help. They're desperate.

A month into his new regime of lifestyle change,

Les is realising it's not just about changing eating patterns.

He has to try and get mobile despite his back injury.

He's been referred to an exercise scheme in a local adult learning centre.

But suffering from a flare up of muscle pain,

he's not looking forward to it.

It's just one of those days, I woke up and I'm in agony.

Nothing special turned it.

It's just...just pain.

Is it going to be worth coming to the session if I can't participate

because of the pain?

Is it going to make me worse?

Cos yet, I've still got to get home.

It's like being in a prison cell because I can't do much

and I can't go far.

Whether it's worth it sometimes, to make you feel...

Les has made an important first step as almost a third of people

referred by health professionals don't turn up for the first session.

A lot of people think that they cannot perform exercise.

This is a totally different kind of way of looking at exercise.

This is exercise for life, trying to manage that health condition

through recognised exercises that they can perform.

Nice and steady. Nice movement in the shoulder. Go.

-Another ten.

-What?

-Lovely.

-That's cheating that is.

He says 40 on the board, then tells you ten more.

He pushes the boundaries all the time.

Before the session, I didn't want to be here.

I wished I'd stayed in the house, I thought the pain would kill me.

But I'm glad I came because I feel really good.

It's been about ten minutes and I physically feel invigorated,

knackered, out of breath but great.

It's better than being in the gym on your own.

I'll try and come three days a week. If I can get in here five days a week, I would.

But the proof of the pudding will be in the monthly weigh in.

Les is back at the clinic to see if his lifestyle changes are working.

Hopefully, I've lost a bit of weight.

Some of my clothes are feeling better on me.

Anything above half a stone I'll be really chuffed with.

Anything over two pound would be good.

Les faces his appointment with the scales with a sense of hope and trepidation.

Oh, it's gone up a pound now.

At least you have lost.

-Have I? What have I lost?

-Yeah.

Three pounds.

Oh, well, I did say anything over two, didn't I?

Yeah. No, well done.

Dr Haboubi is pleased to see some loss,

but it's not as much as he was expecting.

Under questioning, it seems Les has given into temptation.

Since the last time I met you I have had two takeaways.

But say takeaways, it was a shop-bought pizza,

as where I used to eat a big one to myself.

-What did you have?

-A shop-bought pizza.

As where I used to have one to myself

now I have half with my partner.

OK.

Yeah, but, for me that's a big deal, going from a big huge...

No, no, no.

I used to have a 16 inch pizza on my own and I'd eat that in one go.

Now, I'm having a 12 inch pizza...

I've actually never seen a 16, let alone...

The one place I used to have them from did a 16 inch pizza.

But I used to eat myself. Now I'm having half of a 12 inch.

-I want you to come back in about four weeks.

-Right.

But I want some more weight loss.

I'll go for it.

From now on, we are not having pizza any more.

Whether it's half of the 12 inches or not,

-we're not going to have pizza any more.

-OK.

-Very high calorie.

-Right.

-OK?

Thanks for coming.

As Dr Haboubi has just said, you know, it's a weight loss,

it's not a put on, it's not as much as we'd hoped

but I just got to work harder, and get more strict.

No more pizza.

If I lose half a stone by the time I come next time, I'll be over the moon.

The grey matter is working a bit better now than it was.

We've got the summer holidays coming up, I want to get my beach body back.

But Les is way off the target, and will have to work far harder

to get to Dr Haboubi's six month goal of a 5% weight loss.

Rachel also has an appointment at the clinic.

Her session is with psychotherapist Janet.

A chance to see if Rachel's lessons in dealing with stressful situations

have worked and stopped her turning to food in a crisis.

Recently Rachel's had a great deal to cope with.

I mean, a lot, a lot has happened.

My eldest son was assaulted last Sunday morning,

so a lot has happened.

I'm laughing, I shouldn't laugh because he's got a head injury.

He's OK, he's got concussion.

It's hard, I could cry now.

Er, but I'm trying not to, I'm trying to be good.

Trying to be.

So the hardest but most loving thing to do is to actually...

-To actually let him get on with it.

-Yes.

-Just support him.

There's good news as Rachel is maintaining her weight loss

despite family stress.

-Look at the weight.

-I know. I've lost some more weight.

-That's brilliant. Yeah.

It's the old coping mechanisms that you've been helping me with.

Right, because I wonder, was there anything from our meeting last time?

I think just talking about it helps, you know,

-just talking and getting some perspective on it.

-Right.

I've been seeing Jan for about 18 months,

going through why I eat, what causes me to eat, basically.

January of 2012 and I was 28 stone three pounds.

And I'm down to 26 stone, 13½.

So that's in, say, 18 months.

So it's coming down slowly.

Although losing her weight gradually,

Rachel is keeping with the clinic's ethos.

The emphasis here is on avoiding the yo-yo cycle of crash diets

and then weight gain.

Over 90% of patients manage to far exceed their six month weight loss target.

You've lost ten kilograms in six months.

-How do you feel about that?

-Very good, yeah.

I'm feeling good, my clothes are feeling looser, you know.

You have actually lost, almost ten stones.

Almost ten stone.

-You are more active?

-Yes, very much more.

-And you're more careful about what you eat?

-Yeah.

This lady here and this man is wonderful, they're marvellous.

The light at the end of the tunnel is definitely there.

Before, there wasn't even a tunnel.

You're an amazing young lady.

You are amazing. Well done.

I was not far off, I think around 19 stone?

And now I'm 17 stone something.

I've lost five stone two pounds in about a year.

I think in the last eight to ten weeks,

probably about a stone and a half.

And I've lost nearly two stone now.

I've lost a stone and a half in three months.

There's a lot more to go. I'm still a chunky monkey.

As spring turns to summer, Mark's chances of getting

a date for an operation seem to be looking up.

He's come to Morriston Hospital to meet consultant Jonathan Barry

to find out more.

We're going to staple along this part of the stomach to reduce,

-to remove about 80% of the stomach. OK?

-Right.

So we're converting the stomach into a tube.

As a consequence of that you will eat less.

Because we remove the upper part of the stomach here

which has a concentration of cells responsible for producing a hormone called ghrelin,

which is the hunger hormone, we find that when we do this operation

the patients don't actually feel the need to eat as much postoperatively.

That's obviously a big positive step.

What we find with many patients is that they will lose

an average of 60% of their excess weight in about two years.

Our results are coming in about 60% after about a year, 15 months.

But as I've said to you before,

it's not about the fact that you're going to lose weight

it's going to be the improvement in your obesity related comorbidities.

-So I need to wait for the date now.

-Wait for the date, that's right.

A successful operation would reduce Mark's chances

of suffering life limiting and life threatening illnesses.

For Jonathan Barry, there's a frustration that the rules

to qualify for an operation are different in Wales to England.

For a population of approximately three million in Wales

we perform 67 operations per year.

If we were to comply with the recommended guidelines

we should be doing in a steady state, 300.

In our first 15 months of operations down here

we were referred in excess of 1,000 patients.

Over 95% of these patients would have had surgery in England.

Mark now only has to complete a series of health checks

and wait patiently for that all important date.

Les has a target of losing 5% of his body weight over six months.

He's trying to become the model patient.

Working out at home as well as in his regular exercise classes.

Things have been looser fitting,

I've had people telling me I look like I've lost weight,

and hopefully now with the exercise, and trying to cut, you know,

keeping the amount of food I'm eating down.

All right, I'll have a little bit of chocolate,

but it's like, instead of having a Kit Kat with four fingers

you'll have a two finger or something like that.

When everyone else is having stuff, I don't always have it, you know.

Hopefully I would have lost a bit.

Les claims his new regime is taking hold

but only the clinic scales will reveal the truth.

I don't normally weigh with my shoes on but I've got new trainers and I can't take them off.

235.6, OK.

The news is not good.

-I've stayed the same.

-It hasn't gone down.

-Oh, well.

-37 stone one.

Gone back up.

Les is one of Dr Haboubi's most challenging patients,

and he's already put him forward for surgery.

With lifestyle changes not bedding in,

Dr Haboubi picks up the phone to try and see if, or when,

Les will get an operation.

Hi, this is Dr Haboubi again.

I'm sorry, I have got another gentleman whom I referred

back on 28th of February.

I have not had a response yet.

I would be grateful if you could ring me as soon as possible.

-You feel like killing me now, don't you?

-No.

-Sure?

-Positive.

You're a positivity.

But Dr Haboubi has to strike a negative note.

Surgery has its risks and Les' weight isn't helping his chances.

Now, the heavier people are,

-the more likely they will get complications from surgery.

-Yeah.

-And I'm talking about not simple complications.

-No, I know.

Serious complications and mortality, which means death.

-They want to make sure that the procedure is safe...

-Yeah.

..before they embark on it.

So, I'm sorry, but I really haven't got an answer from them yet.

It's not your fault.

-It's never my fault.

-Oh, no, no.

So what are you going to do?

-Persevere and keep going.

-Oooh.

'I wish I'd lost weight.

'Obviously I hadn't, but'

it just means that I've got to keep doing the exercises now,

and hopefully change my eating habits again now

and be more strict.

And hopefully next time I come up it'll be weight loss.

It is time to sort of take a look at what I'm doing now

and say, right, it's got to go, and have a real good...

..good go at it.

Les is a very positive man, he's always kind of...

..eager to address his problem.

But his appetite is big, especially for those who are less active, OK?

If you want to have a bar of chocolate, you can have,

you can have half of it.

Why do you have to have the whole lot?

Then you would have to exercise more,

and if you can't exercise, or you don't want to exercise,

or won't have the time to burn what you are consuming,

then you're going to have a problem.

You're going to accumulate that as fat, which is simple thing.

Same thing, whether sugar or fat and so on.

Most patients at the clinic don't want surgery and Rachel James

is losing weight through changing her relationship with food.

She's also getting more active by stepping into the garden.

It's approximately 160 foot by about 50 foot wide.

You have to do at least two or three days work in it,

full day's work in it, physical work as well.

I feel a lot healthier actually.

I feel a lot brighter in myself because, you know,

depression has been a big factor in my weight problem.

So, yeah, it does make me feel a lot better.

My mobility has definitely improved.

Even just walking down the garden, much more confidence.

Because when you get bigger you become quite unstable actually

and you do fall over quite a bit.

Well, I fall over quite a bit, or have done in the past.

I got stuck the other day

because I did something I shouldn't have done.

But we got out of it so that was fine.

Rachel's controlling her comfort eating.

But at the start of the summer, she's called away to deal with

a family illness that will put her to the test.

Les is also faced with a test.

He's trying to stay healthy on holiday.

And he's too big for the caravan bed.

-As you see, my single bed from the house here...

-HE LAUGHS

..because the ones in there wouldn't hold me.

Basically I've spent the holiday out here staying in watching TV.

Yesterday it was raining, so we went down to ASDA, bought a few DVDs.

I would say I've been 70% good.

We've had a barbecue, we had boiled potatoes.

I've had chips three times through ten days.

A couple of biscuits, but not over the top.

We didn't bring that many with us.

Les' parents are also staying in the area,

and soon thoughts turn to the prejudices

that their son has to face.

People get the wrong impression.

They see Leslie, and the first thing they think is, "Fat, lazy bastard."

And he's not. He's worked hard all his life.

It's just that you've had a catalogue of injuries that have built up

and built up until now, he's practically immobile

with his shoulder, his back, his knees.

Leslie is not a big, fat, lazy bastard.

"Oh, you're his father, you will say these things."

But no, I don't want people to judge him on face value.

You know, on just what they see.

What he'll laugh off as a joke with you,

when he's on his own, it hurts.

He tries hard not to let it hurt, but it does.

But it doesn't take much.

Just one person to say the wrong thing, that can,

he'll laugh it off there and then,

but when you get back, it all sits down and takes him over,

and unfortunately, sometimes,

to compensate for that, he will eat for comfort.

One of his problems would be that he would sit in his room

and perhaps eat a bag of sweets

or something that he shouldn't have had, just for comfort, like.

Les's next weigh-in will test the impact of the holiday,

coming a few days after he returns home.

It's September, and Mark finally receives a date for surgery.

He suffers from Type 2 Diabetes caused by his obesity.

It's one reason he's been accepted for surgery.

He's hoping the operation will reverse his diabetes

and put an end to a bathroom full of expensive medicine.

A year's supply of just one of his drugs costs over £1,000 -

the likely savings are clear.

There is no guarantee that the operation is going to address

the diabetes issue that I have,

but in 90% of cases it does.

And I can expect to see immediate results.

We can look forward to seeing this cabinet as good as empty,

and obviously from a cost perspective, then,

I'm not going to be going to the chemist every couple of weeks

to collect large shipping orders on a regular basis.

So that's bound to be a massive saving on the health service,

I would have thought.

As summer turns to autumn, Les is back at the Ebbw Vale clinic.

He's desperately hoping for weight loss,

despite some dietary slip-ups on holiday,

and also some news on his hopes for surgery.

You have lost.

Woo-hoo!

-Yes, you've lost a bit there, according to that, isn't it?

-Yeah.

That's great.

Aye, you're only just over a pound and a half off a stone there.

-Oh, that's all right, then.

-Yeah. Just, well done.

To everyone's surprise,

Les has managed to lose over 12 pounds.

You've, for a change...

HE LAUGHS I don't know what you do,

but you've really done very well.

I mean, you've lost five kilogram in just over five weeks.

And that is what we normally aim for,

losing about in the range of half to one kilogram a week.

The question is, now you've done it,

therefore it means that you can do anything, isn't it?

Although it's good news on the weight loss front,

Les is still keen to get accepted for surgery.

Any news on the..

Yea, we've had a reply to say that,

I mean, you have been declined to have surgery.

That'll make a change(!)

On the criteria that because you just don't have comorbidities,

which I don't agree with that. Which means that you're not...

I'm not ill enough.

Yeah.

There are two problems here. One is that you are very heavy,

and to be honest, your surgery is not going to be easy.

It's going to be difficult.

I think the only way forward, therefore, is just to carry on

what you're doing now,

and I think the fact that you have lost weight...

It is obviously and definitely possible

and feasible to lose more weight.

I'm chuffed and over the moon with what I've done today,

so that's a good...

you know, carry on and get more off.

Happy that Dr Haboubi is happy with my weight loss.

You do want to make him happy, but not only making him happy,

it's going to make me happy,

because it's going to be a weight loss.

Although close to his short term target,

Les has a long road ahead of him.

After a long wait, the morning of Mark's operation has arrived.

And before he's taken into theatre,

he has a few moments to gather his thoughts.

Things look slightly surreal this morning.

Here we are finally, after this long wait, at the day of my op.

I'm obviously anxious about some aspects of it.

There's always a danger with any surgery,

so fingers and toes crossed.

Surgeon Jonathan Barry and his team at Morriston Hospital

are preparing for what is an irreversible operation.

These operations are performed in people, as you see,

who are very, very large.

That itself causes problems at the time of surgery.

It just adds complications to the procedures.

To be able to operate on the stomach,

Mr Barry and his team create a series of portholes

in Mark's abdomen through which they can pass their instruments,

and inflate the stomach cavity

to give themselves more room to manoeuvre.

We're going to attach the gas up now.

We will be insufflating carbon dioxide

into the abdominal cavity to give us a bit of working space.

Soon it's time to dim the lights to get a clearer picture,

and to start getting to grips with the sheet of fat

surrounding the liver, which has to be pushed out of the way.

Not unusual in a gentleman with a body mass index of this,

he's got a lot of inter-abdominal fat.

So this is a nice bit of equipment,

it's called a triangular flex liver retractor.

Also in the surgeons' way is a large sheet of fat

around the stomach, which has to be cut away.

The way this device works, it vibrates at a very high frequency,

so it seals the vessels before dividing them.

With the sheet of fat out of the way,

it's time to cut and staple the stomach.

First firings here at the bottom are a bit tricky,

because we haven't got a lot of space.

You close the jaws, you fire the gun three times

and it fires a line of staples

and the fourth time you squeeze the gun,

a blade comes out and actually cuts the tissue,

so you've got four lines of staples and a cut in between.

Such as that.

Suddenly, the team come up against a problem.

There are known risks and complications

for operations like this.

A plastic tube which is inserted into the stomach

seems to have lost its shape, and is caught by the staple gun.

A few modifications to this operation, guys.

It now depends on the surgeon's skill and experience

to prevent it becoming a serious problem.

So there we are, chaps. A little change to the planned event there.

The operation now back on course, the team have to test for any leaks.

The important thing is that the join

where we join the two edges of the stomach back together,

that it's watertight, that it's got a good blood supply.

We've checked it. There was no leak whatsoever.

I don't anticipate any problems here at the moment.

Needle there for you, Sister.

Can I have some swabs?

Time for the final crucial stage -

the removal of 80% of Mark's stomach.

Nice specimen.

With Mark in the final stages of surgery,

Jonathan Barry reflects on the funding frustrations he faces.

This operation can cost up to £10,000,

but can still save the NHS money in the long run.

These types of operations are cost neutral at two-and-a-half years,

after which time, there is a cost saving to the UK taxpayer.

This is a good operation

that should be carried out in far greater numbers.

Surgery clearly has a role in this type of individual.

It's certainly not a quick fix for morbid obesity at all, surgery.

Surgery is not the answer.

Major surgery, though, has risks.

A few days after his first operation,

Mark had to return to surgery

to repair a small section of his stomach, slowing his recovery.

Nearly a month after the operation, he remains in hospital.

They have been monitoring me to see if the leak is repaired.

I knew before the op that there was a risk

that things don't always go quite to plan.

It hasn't really changed my motivations,

and what I hope to achieve.

It's made me more, even more determined.

I think that anyone that has put themselves

in the position where they're considering bariatric surgery,

they really, really need to do their research

and be absolutely certain that this is what they want.

For me, there was no question.

I was just physically not able to get the exercise I needed

to get my weight down, even if I was eating correctly.

It was a no-brainer for me.

I've got no regrets about it.

There's no question about it not being easy.

It has been very hard, but without a shadow of a doubt,

so far it's been well worth all the pain and anguish, absolutely.

Yeah, I'm really determined.

More determined now than I've ever been.

Oh, I can't get in through the gate.

It's also been a traumatic time for Rachel James.

Her treatment for emotionally triggered binge eating

was put to the ultimate test when she had to nurse her father

through the final weeks of terminal cancer.

It's been very... emotional roller coaster really,

from your dad becoming ill

to suddenly realising that he's not got long to live.

And just being there, really, being with your mum,

who's lost the love of her life.

Sorry. I'm going to start crying about it now.

But...realising that I don't have to punish myself for that was good.

Highly emotional moments like this in her life

would have triggered Rachel's binge eating,

but something seems to have changed.

When my mother phoned up to tell me Dad was ill,

after I put the phone down from her, I went out to the kitchen

and although I'm still cooking food,

I picked up a packet of crisps, and I opened them,

I put a mouthful in and I thought, "Why am I doing that?

"I'm cooking tea. Why am I actually eating these?"

So I actually threw them away.

So it was actually just...

It was like, you know, it was an automatic reaction,

to stuff that emotion down, to push that emotion down,

and I think that's what I've been doing, pushing, you know,

to stop myself feeling, in effect.

It's the therapy that's, that's done it for me, more than anything.

Back at Ebbw Vale, a steady stream of patients

pass through the doors every Thursday morning.

Most come to report successful weight loss to Dr Haboubi.

Honestly? I'm very happy,

and I don't think I take the credit for this.

But he knows that the stream of casualties keeps growing in Wales.

I'm proud of you.

Thank you very much.

-Honestly.

-Thank you.

With a waiting list of 500 patients,

and only enough capacity to see 160 in a year,

some can wait up to three years before their first consultation.

Why do you think you are better?

Because I'm losing weight and getting fitter.

At the moment, it's a very lonely place on the front line

in the war against obesity,

and Dr Haboubi wants more troops to join him.

You've got to ensure that there are the facility,

the services available to manage those who are already obese,

there is nothing, virtually nothing.

Several of these clinics should be available

in every hospital in Wales.

You are a bit crazy, like, but you're crazy in a good way.

-I don't want to stop coming here!

-Lovely to see you, sir.

-No problem, Doctor.

-Thank you very much.

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