Welsh Weight Clinic - The Next Generation

Last year, we followed three people battling obesity

at Wales' only weight management clinic.

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

-No.

Are you sure?

Led by Dr Nadim Haboubi, the clinic is now facing

an ever growing challenge,

as worrying numbers of morbidly obese young people

are coming through the doors.

-Easter eggs, is it?

-Yeah.

Who buy them?

Over one in three Welsh youngsters are now officially overweight

or obese, and Wales' weight problem costs £73 million a year.

It's a problem that needs tackling early on.

I don't want to see him upstairs in bed for the rest of his life.

Something will have to give.

So we've been filming with three of the youngest patients,

all with complex reasons for being obese

but with one urgent aim - to lose weight.

They know that's going to be tough.

No, because I'll start crying.

-I can't. I'm sorry.

-Don't worry.

It's hard. It's really, really hard.

Can this next generation in Wales win their fight for life?

It's early morning on the outskirts of Aberdare

and James is indulging in the typical passions of someone in their early 20s.

A fledgling DJ, he's also obsessed with computer games

and fantasy characters.

What catches me the most is if I'm depressed, if I'm stressed,

I go straight for food. Food is my number one comfort.

It's like food's my drug.

You've got people who are alcoholics,

people who are drug abusers.

Me, food is my substance of comfort, then.

See, I can have a bacon sandwich.

Where normal people would have two slices, I'll had five.

Sometimes I fight myself.

I'm always in a constant battle with myself.

Which...

Which is hard.

James' weight problem goes back to the first difficult

years of his life, before he met his new family.

We adopted James when he was three-and-a-half.

We think that this problem he has with food

is connected to that.

Emotionally he is quite fragile

and does depend on food a lot to make him feel better.

James weighs over 34 stone,

his health is at serious risk.

Morbid obesity increases his chances of getting heart disease,

diabetes and other dangerous medical conditions.

But losing weight is a battle that James is not winning

and there are other issues he's having to deal with.

Knowing that I've got Asperger's, which I only got diagnosed last year,

plus like the learning difficulties,

the dyspraxia...

It's like loads of stuff that, really,

are like layered on each other,

which makes everything harder to get through.

So say something, as simple as, routine going off plan,

some people know how to get back on plan.

Someone like me has to stick to a set routine.

If anyone breaks that, I just lose the plot.

Going through school, I got bullied so much.

My parents were so scared of what might happen

because I came so close to thinking, "Why should I bother?"

Why should I bother just living like this getting bullied constantly,

maybe just kill myself, really.

Once you get into that mind status, it's really hard to get out of.

You know, my parents have done a hell of a lot to help me

and, you know, I'm still here.

James lives at home with his parents.

Due to his learning disability, he's visited by support worker,

Nicola, several times a week.

She's trying to make sure he develops the skills to live

independently and is encouraging James to exercise and eat healthily.

James doesn't buy typical junk food, crisps, chocolate, biscuits.

There would be the rare occasion.

But what he does buy, he buys large.

Probably if I wasn't here today, he would have cooked

-the whole joint of it. A lot of it is about portion control.

-Yeah.

Typically it's not what I eat, it's how much I eat.

Like now I'm just peeling potatoes, I'm feeling out of breath,

I'm sweating.

Only I can change myself, but I find it really hard to do that.

I know I can do it, but trying to put it into practice...

It's not so easy.

James is due for a regular appointment at Wales'

only weight management clinic.

Since starting there last September he's lost two stone,

then put it back on again.

Now radical surgery is on the agenda.

Dr Haboubi has given me the option of having a gastric bypass,

which has been playing on my mind a lot

because, you know, it's going to be a massive life-changer, really.

The Clinic at Ebbw Vale has a team to support patients lose weight

slowly and then keep it off.

It's about motivation, praise and getting under people's skin.

But Dr Nadim Haboubi knows that young patients are desperate

when they're referred to see him.

A lot of these patients will give an arm,

would prefer being blind,

than being obese.

James and his family have come to the clinic to discuss

whether he should be put forward for weight loss surgery.

Bad news on the scales, a further half stone weight gain,

puts pressure on them to make a decision.

With James in his early 20s, he could be one of the youngest

people in Wales ever to have the operation.

Just tell how much you've been trying?

And, how hard?

Obviously, not a lot.

I just feel like I've gone downhill.

Completely lost the plot as far as food is concerned.

It's been Easter time.

-Chocolate...

-OK.

-Easter eggs, is it?

-Yeah.

Who buy them?

-I buy them all a small one.

-Why?

Why, why, why?

With James struggling with conventional weight loss programmes,

Dr Haboubi asks for a final answer about putting him

forward for surgery.

Obviously, surgery means risk.

I, personally, think that'll probably have to be taken here.

There are things which are against him, that he's not diabetic

and he's not hypertensive and he hasn't got sleep apnoea

They might say, "Well, he's not ill enough."

-Yet...

-Exactly. Exactly, yet.

I keep on coming up with the same answer, not yet.

Now I have an answer from you,

I think...

-I think it's probably I have to refer you. OK?

-OK.

Even with a referral from Dr Haboubi,

James has to prove he can stick to a diet and lose weight,

so there's no risk of him stretching his stomach after an op.

I don't want to see him upstairs in bed for the rest of his life,

getting bigger. I mean, a district nurse coming back and forth

to look after him. I mean, he's 22 years of age.

That's...

That's not what I want.

Come on, then...

In Blaenafon, Stacey is one of Dr Haboubi's younger patients.

She's been overweight for most of her life

and admits that, as a child, she was spoilt.

I was allowed anything I wanted.

Which sometimes can be a good thing, other times a really bad thing,

as in this case, really.

CHUCKLES

I've always been overweight.

My weight always fluctuates.

Like most teenagers, goes up and down.

In school, I always had the odd person who'd have a go at you

for your weight, calling you fatty and all this lot.

When I was in school, I just didn't care.

Call me whatever you want, it doesn't hurt.

Deep down inside it did, when I left.

Got home from school and I'd sit there and cry.

The only people who know how much I weigh, really,

are the nurses and doctors in the clinic

and my partner because I hate saying how heavy I weigh.

I just tell him how much I lose and leave it at that.

Excess weight has always been an issue for Stacey,

but in recent years she's had to deal with another

debilitating condition.

I've had depression for just over three years now.

My job was as a carer. I was working long hours to start with.

I slowed down and then something just hit me for six.

I've been on the sick now for just under a year.

Stacey's depression isn't unique.

Obesity can often trigger the condition

and many of the clinic's patients are on anti-depressants.

But will it knock Stacey's motivation?

Today's appointment with Dr Haboubi

is to see if she's on the right path.

Can you tell me what changes have you made since we've met?

Erm, eating a bit more healthier.

Drinking less pops and squashes, it's mainly water.

-Less or no?

-Less.

A lot less.

-Do you know the healthiest drink in the world?

-Water.

Do you know which one?

Tap water.

Do you know which tap water?

Welsh water. You are not as depressed as you were before

-when you came last time.

-I know.

Do you know why?

-Because you lost the weight.

-Yeah.

-I'm very proud of you.

-Thank you.

Thank you for coming.

Stacey's lost almost five pounds, and has taken the first steps to

hitting the clinic's target of a 10% loss in body weight over a year.

Gradual weight loss can avoid the danger of yo-yo dieting,

ensuring the patient keeps it off long term.

Her main snack weakness are crisps.

Their availability in every supermarket is a problem.

The clinic's psychotherapist, Janet, wants Stacey to try

and resist the bad snacks at source...

Don't buy them in the first place.

Sometimes when we go round the shop and that,

I'll say, "Oh, no, we don't want crisps, we don't need 'em."

-So you don't go down that aisle.

-We don't go down that aisle.

It's a shame we can't have like a sticker on them, or something,

that says, "Stop, do you really need these?"

Then that's like the red button thing.

-"Do not press a red button," you just want to press it.

-Ah, OK.

So if it was on, "These are bad for you..."

A shame we can't put a picture of Dr Haboubi's face on the crisps.

I know, that would scare anyone! THEY CHUCKLE

Over the next two weeks, Stacey will have to knuckle down

and stick to her lifestyle changes.

But will the clouds of depression

allow her to improve on her early success?

In Cwmbran, another of Dr Haboubi's young patients, Haike,

is fighting morbid obesity.

Her teenage weight gain was made worse by a medical condition.

The weight started when I hit puberty

because I suffered from polycystic ovaries.

Before that I was quite average.

As soon as I hit puberty, the weight started piling on.

Like all the patients at Ebbw Vale, the solution to Haike's problems

is changing her lifestyle, but this isn't the first time

she's tried to get to grips with her weight.

I've been on and off diets since 15/16

and going to Slimming World and Weight Watchers, I've tried them all.

It's nice to finally go to someone who has to the whole team

to try to get to the bottom of why you are like this, really.

Haike's main motivation at the moment is her wedding

in a year's time.

To raise the funds for this, and a new house, she's moved back home

and is holding down two jobs.

But can she find the time to prepare food and take proper exercise?

Yeah, working two jobs is hard because sometimes

I don't finish till 9pm at night.

By the time you get home and you're trying to think of something to eat,

sometimes you just think, "Oh, sod it, I'll have something naughty."

Now I'm living back at home for a bit,

it's going to be easier because Mum can make me something

to get home to.

Dr Haboubi has put Heike on a prescription for tablets

that prevent fat being absorbed from her food.

The results can be dramatic and potentially embarrassing.

On these tablets I can't eat any fat.

Because of the side effects of the tablets

you are scared to eat any fat.

Basically...

If you eat any fat, you're going to pass fat

and it's a bit of short notice to get to the toilet.

So...

Haike's fiance, also started to hit the gym

with her in the past few months.

With his moral support she's been working out three times a week,

a major commitment with such limited time.

Trying to fit it in around two jobs is hard,

but I do have some time off so I just make sure that I go

when I can and just do as much as I can.

I find it really helpful that I've got someone to go with me.

I find that he pushes me more when he's with me. If I go on my own,

it's just a case of, "Oh, that'll do,"

whereas I work as hard as he does.

After a session like that, I feel good. I feel like I've done

what I need to do to lose weight.

But will even three workouts a week and all the changes to her diet

be enough when Haike has her next appointment

with Dr Haboubi's scales?

In Blaenafon, Stacey isn't the only one counting the calories.

Partner Phil has lost more than half his body weight in the past

five years, and it's been a key motivating factor for Stacey.

That's me. I was 33 stone, 4.

I'm now 16 stone, 5.

You can't make someone do it, they've got to want to do it.

It's all well and good going through the motions but unless you want to lose the weight,

you are not going to lose it.

Seeing the scale of her partner's achievement has been

just the inspiration that Stacey needed.

It started off when we were at my parents' house with my old clothes.

I had a pair of 66 inch trousers.

That's a big, old pair of trousers.

Stacey was looking at them and said she wouldn't mind losing a bit of weight.

We discussed if I can do it, Stacey can do it

and I'll offer as much as I can.

But despite this, Stacey's depression still has a major

effect on her ability to lose weight.

She's back for her regular appointment with Dr Haboubi.

Stacey.

And in the two weeks since her last visit, a lot has changed.

You're not going to be my friend. I've put on weight.

-Just tell me first.

-BAD couple of days.

-Tell me more.

No, cos I'll start crying.

You mind if they're filming us while you're like that, or not?

-TEARFUL: No, I can't, I'm sorry.

-Don't worry, don't worry.

At times like these, Dr Haboubi feels there's

an even greater need for support and encouragement.

He wants to make sure that small setbacks

don't stop future weight loss.

The weight is something like just a pound more.

I don't call this a failure at all.

I know you're upset about it, but I'm not.

You came and you cried, and that was it. That's a bonus, that's a plus.

And I'm grateful to you, and I thank you.

'I feel better now we've had a chat and he's not too worried about me'

putting on a pound in a couple of weeks, so...

I feel a bit better about that.

Stacey will be back to see Dr Haboubi in two weeks.

Will she be able to overcome the effects of her depression

and get back on her weight loss path?

James in Aberdare is having a similar battle with depression.

His motivation has taken a nosedive,

and he's struggling to hide his emotions.

I try and make myself look, "Oh, yeah, I'm all happy",

but really, in reality, I'm just... I'm not.

I just sometimes feel really, really bad about why I'm doing what I am.

I'm sorry, but this thing is hard, it's really, really hard.

It's only now I've started to think why it's so hard. Don't know why.

Despite his struggles, James knows he needs to keep trying.

His visits to the gym have become rare, but today,

personal trainer Andrew hopes to lift his mood

as well as burn calories.

Hard as you can, ten punches.

One, two, three, four, five, six, seven, eight, nine, ten.

Go on, then, push me. Go on. Ohhh, come on.

Good, there you are. Well done, good.

I'm just really tired now, feel like I've been punching brick walls.

All that pent-up anger and frustration I had building up,

feels good after doing it.

Next time we should really go, "This...is...Sparta!"

-And just punch into it.

-That's the way. Show them who's boss.

-Not sure about "This is Aberdare" instead!

-Nah, look at it.

James and his parents have hear about a local weight loss coach

who successfully conquered his own teenage obesity problems.

He's even been offered work as a David Beckham lookalike.

But at 14, Merthyr-born Nathan Hewitt

weighed a staggering 23 stone.

One event motivated him to make a change.

I was around 15 years of age

and I couldn't get on a theme park ride at Alton Towers.

When I sat down, the seat clamp would not secure me in fully.

I felt very disgusted with myself, I thought, "How did I allow myself to

"become this person?" I felt very sad in that moment,

but at the same time

it was a moment of clarity where I realised I had to make a change.

It was something I needed to do

so I would never have this situation occur again.

Can Nathan offer help to motivate James to make a similar life change?

One of my expertise is obviously

motivational things. The problem is,

if you don't have a big enough reason to lose weight, you'll

never find anything to motivate you long enough to follow through.

-James, why lose weight?

-To be better, to be more confident.

You want to be able to walk out the door

and feel happy about the person that you are.

Using Nathan as a coach is one of the things that James

is now considering as an alternative to weight loss surgery.

He still isn't 100% sure if he wants to go under the knife,

or even if he'll be accepted for an op.

Back at the clinic, bride-to-be Haike knows what she needs to do.

Lifestyle changes are in place, and she wants to know

if they're working.

Today, there's consultations with the full team -

dietician Sian, psychotherapist Janet and Dr Haboubi.

For Janet, the truth is in the tape measure.

What we got Tina, the nurse, to do was measure you, your waist,

how many inches is it you've lost?

-About 18cm since first starting.

-Wow.

What do you know about you that might sabotage, that might go wrong?

Not seeing the numbers on the scale change!

Especially if you're exercising, they might not

go down quite as quickly, but the inches might be coming off.

I only lost half a pound this week,

-but then I lost six centimetres, so...

-Absolutely.

-That's really good.

You look so different, you look an absolute babe.

HAIKE LAUGHS

Janet's thrilled, and Haike's lost two-and-a-half stone so far,

but what will Dr Haboubi make of her progress?

Wow. This is lovely.

-How did you do it? I'm jealous.

-With a lot of hard work.

-Tell me more.

-Just eating healthy and going to the gym.

It's worked, hasn't it?

You're not hungry, you're losing weight, you're much happier.

-Because you're lighter.

-Mm-hmm.

I'm confident that weight will come down,

but if I want you to increase your focus and your activity.

When you want to lose weight, I think you could afford

being more active, especially with your age now.

-Well done, thank you very much.

-Thank you.

-See you again. Cheers.

'Compared to a year ago, I'm a lot happier.'

I feel like I've got more energy and I'm a lot fitter.

I'm just happy with the fact my body's getting smaller.

Haike's been given the good news that instead of attending the clinic

every two weeks, she doesn't have to come back for a couple of months.

From now on, it's a case of staying on the right path.

In Aberdare, James continues to struggle.

Over the past few months he and his family have been waiting

to hear whether he's been accepted

for a weight loss operation, and they're not sure

that it's the best option.

They've arranged to meet one of Dr Haboubi's former patients

- Mark Weller - who's gone under the knife.

When we filmed with Mark a year ago, he weighed almost 30 stone.

He underwent an operation in the autumn.

Despite some complications, he's eight stone lighter

and counting, and has no regrets about taking such a drastic measure.

If and when you're accepted for the operation.

Once you go through that process, it's like somebody's waved a wand.

It's just amazing.

Are you disciplined in what you eat?

I think what is significant now is the quantities I'm able to eat.

For example, I had the first opportunity to have a bacon sandwich

last week, but I only had one slice of bread with a few

bits and pieces of bacon in it, and I struggled to eat that.

Previously, I'd have had no problem demolishing probably

four slices of bread with at least four, maybe six pieces of bacon.

Now, there is no way on Earth I could eat that,

I just haven't got the capacity to swallow that much food.

Not only am I not able to, I don't want to do it,

cos it makes you feel uncomfortable.

With Mark's words ringing in their ears,

James and the family go to a crunch appointment.

They're meeting top obesity surgeon Jonathan Barry.

With operations rationed in Wales to less than 70 a year,

the barrier for entry is high.

Mr Barry has concerns about James.

Post-op, he'd have to stick to a diet of smaller portions

or he could reverse the op's effects.

Does he have the self-control?

People who can't stick to quite strict diets after surgery

can actually dilate up that stomach.

So really, they can put a significant amount

of weight back on.

We need to be sensible that putting James through

quite a big operation without a great improvement in his weight

post-operatively probably wouldn't be in his best interests.

No, I agree.

-Do you understand what we mean by that, James?

-Yeah.

As James hasn't shown he'll be able to control his diet after an op,

Jonathan Barry doesn't think that surgery is in his best interest.

It stands to reason that you wouldn't put somebody through quite

a major operation in order for them not to achieve a good result.

Surgery is no longer an option,

so James concentrates on getting motivated.

Over the past few weeks, he's been meeting weight loss coach

Nathan Hewitt, who has conquered his own weight problems.

Although James is yet to start on major changes to diet

and exercise, the pair have been working on setting key goals

that will see James through his weight-loss journey.

-So what's the main goal here?

-Number one goal is lose weight.

Yeah, and if you lose weight, these are all the things

you'll get in life, and I can see you've written here,

"I can buy new clothes."

I can buy new clothes, I can feel good,

I can prove to others I can do it.

"I'll be a different person and others will be amazed."

There's no greater feeling than having someone look at you

and go, "My God, James, you look amazing."

-That's a good feeling.

-Oh, that's what I want.

Yeah, it might take you two years to be where you want to be in life,

but you can absolutely achieve all of those in the next year.

Soon James will be going back to Dr Haboubi,

and although it's too early to know if his work with Nathan

will help him lose weight, first signs are promising.

He told me that every time we have a session, he says,

"I feel better about things, I feel excited about the future."

And that's key, because it's important

he believes what's possible.

I think I've made up my own little saying.

Life's a puzzle, it's up to you how you put it together.

It sounded better in my head.

Back in Ebbw Vale, Stacey has her latest appointment.

Her last visit two weeks ago saw her gaining a pound

after suffering from a serious bought of depression.

Will the scales have a happier tale to tell today?

-Yes! Woo-hoo, I've lost weight.

-You have.

Lovely! I'm happy now.

Stacey's lost over three pounds in two weeks.

But following her recent ups and downs,

is it enough to persuade Dr Haboubi she's on the right path?

SING-SONG: I've been good.

SHE LAUGHS

Yeah, you've been very good actually. Hmm.

-So what's the magic?

-Eating brown bread like you told me to.

-Tell me about your activities.

-We'll take the puppy with us

and we'll go for a walk round a lake or the pond.

-You need to think of yourself.

-Yeah.

-You've got to believe in yourself.

"Because I want to be healthy. Because I want to live longer.

"I'll do it. Of course I can do it."

-Yeah.

-Of course, yes.

-Let me see you in two months. But don't let me down.

-Not a problem.

-Thank you for coming.

-Thank you.

Stacey's regular two-weekly visits to the clinic are at an end.

She's proved she's committed to lifestyle change

and won't be back for several months.

If all goes to plan, she'll have lost 10% of her body weight within

a year, like the majority of Dr Haboubi's patients.

Just take your weight card, Stacey.

A victory for Dr Haboubi in the ongoing war,

but as more and more young people struggling with obesity

come to the clinic, the staff have a warning to us all.

The sooner you start treating these patients, the better.

And the less heavy they are, the success is higher as well.

If you catch somebody at an early age then you've set

a new pattern and a much more helpful pattern.

And the more they do it the more that becomes their norm.

This is currently the only NHS weight management clinic

in Wales, and it continues its battle against the odds.

But young people like Stacey - who's keeping up her diet

and exercise changes - Haike - who's on track to fit into

next year's wedding dress - and James - who's been meeting

his weight loss coach regularly -

have to win this war if Wales is to have a lighter and healthier future.