0:00:04 > 0:00:09Obesity is an epidemic happening right here in the UK, right now.
0:00:09 > 0:00:13Honestly, the first thing I'll say is I'm a big girl.
0:00:14 > 0:00:18How my friends would describe me would be large - fat, probably.
0:00:18 > 0:00:21I don't like to use the word fat but, at the end of the day,
0:00:21 > 0:00:26that is what I have inside me - I have a large amount of extra fat.
0:00:26 > 0:00:30We all know what fat looks like on the outside.
0:00:30 > 0:00:33I think of cellulite, rolls...
0:00:34 > 0:00:36..big thighs, big arms.
0:00:36 > 0:00:40If you're Kim Kardashian you can have a really fat arse.
0:00:40 > 0:00:43I... I've got a fat stomach.
0:00:43 > 0:00:45She's got a fat arse.
0:00:45 > 0:00:48But what if we could see what fat looks like from the inside?
0:00:48 > 0:00:53Do we have any idea of the damage obesity is doing under our skin?
0:00:53 > 0:00:57When you say to somebody, "Oh, well, it's affecting your health,
0:00:57 > 0:01:00you know, show me. I can't see inside.
0:01:00 > 0:01:02I can't see what's happening inside me.
0:01:02 > 0:01:05BBC Three has secured the first televised access
0:01:05 > 0:01:07to a full postmortem
0:01:07 > 0:01:10on an obese person whose body was donated to medical science.
0:01:11 > 0:01:16This summer, our pathology team assemble to reveal, from the inside,
0:01:16 > 0:01:19the dangers of us all getting too fat.
0:01:32 > 0:01:34Postmortems are tightly controlled,
0:01:34 > 0:01:37and access to them is strictly limited
0:01:37 > 0:01:41to protect the privacy and dignity of the deceased.
0:01:41 > 0:01:43Filming is not usually allowed.
0:01:43 > 0:01:46But for this postmortem, we have been allowed in,
0:01:46 > 0:01:49to help understand a problem that costs the nation billions
0:01:49 > 0:01:52and ruins so many lives - obesity.
0:01:55 > 0:01:58Carla Valentine and Dr Mike Osborn
0:01:58 > 0:01:59are the specialist team responsible for
0:01:59 > 0:02:01carrying out the postmortem.
0:02:02 > 0:02:05Carla is an anatomical pathology technologist,
0:02:05 > 0:02:08and technical curator of the pathology museum
0:02:08 > 0:02:12at London's Queen Mary University.
0:02:12 > 0:02:15For this postmortem, I'll be carrying out the evisceration,
0:02:15 > 0:02:18which means removing all of the organs.
0:02:18 > 0:02:22Being part of a filmed postmortem is a very unique opportunity.
0:02:22 > 0:02:24Death terrifies some people,
0:02:24 > 0:02:28but what it also does is it eventually gives you
0:02:28 > 0:02:30a real sense of the fragility of life.
0:02:32 > 0:02:34The topic of obesity is a huge problem,
0:02:34 > 0:02:38and it's something that I get to see quite a lot,
0:02:38 > 0:02:41but it's not something that I get to study in depth.
0:02:42 > 0:02:44Mike is a consultant pathologist,
0:02:44 > 0:02:47and fellow of the Royal College of Pathologists.
0:02:47 > 0:02:52He's been working with death and disease for over 20 years.
0:02:52 > 0:02:56Obesity is very much there, it's seen, but I think it's very,
0:02:56 > 0:02:58very poorly understood.
0:02:58 > 0:03:02It seemed that making this film would be a way of exploring that,
0:03:02 > 0:03:05and allowing a broader public to learn about
0:03:05 > 0:03:08the problems that are associated with obesity.
0:03:11 > 0:03:15Carla and Mike have performed thousands of postmortems,
0:03:15 > 0:03:18but always behind closed doors.
0:03:18 > 0:03:23Today, we'll witness what really happens in an autopsy,
0:03:23 > 0:03:26and discover what the body of our donor can tell us about
0:03:26 > 0:03:29the creeping effects of obesity over time.
0:03:44 > 0:03:48We don't know this woman's name, but we do know a few details about her.
0:03:51 > 0:03:52She was in her early '60s...
0:03:54 > 0:03:56..five foot five...
0:03:57 > 0:03:59..almost 17st...
0:04:00 > 0:04:04..and, just like a quarter of people in the UK,
0:04:04 > 0:04:06clinically obese.
0:04:07 > 0:04:11But where did she come from, and how did she end up here,
0:04:11 > 0:04:13on a postmortem table in London?
0:04:20 > 0:04:24Long Beach, on the west coast of the United States.
0:04:24 > 0:04:28Glamorous, sunny, carefree California.
0:04:29 > 0:04:31But, away from the beach,
0:04:31 > 0:04:35on an anonymous industrial estate on the outskirts of the city,
0:04:35 > 0:04:39is where our donor began her journey to the postmortem table.
0:04:44 > 0:04:47This is a place where people who donate their body
0:04:47 > 0:04:50to essential medical science are brought when they die.
0:04:51 > 0:04:53Up to 20 donated bodies -
0:04:53 > 0:04:57or cadavers - a day come through these doors,
0:04:57 > 0:04:59destined for thousands of medical research projects
0:04:59 > 0:05:00all over the world.
0:05:02 > 0:05:06My name is Randall Delgato. I'm 29.
0:05:06 > 0:05:09My main role, now, would be in charge of distribution.
0:05:09 > 0:05:12Some days, you know, we have an order for cadavers
0:05:12 > 0:05:14heading into Lebanon, and so then, you know,
0:05:14 > 0:05:18we have to start checking on them. How are they looking? Are they firm?
0:05:18 > 0:05:20Is there mould growing on them?
0:05:20 > 0:05:24You've got to be a certain breed of person to be able to do this,
0:05:24 > 0:05:26you know? I mean, at first, it was very like, "Oh..."
0:05:26 > 0:05:28But, you know, eventually you get used to it.
0:05:28 > 0:05:32I'm Kelsey, I'm 32, and I live in Costa Mesa, California.
0:05:32 > 0:05:35We perform a procurement on each donor that comes in,
0:05:35 > 0:05:41which entails us dissecting different specimens from each donor.
0:05:41 > 0:05:44We get to dissect the brain, take certain parts of the brain,
0:05:44 > 0:05:47and the internal organs, or taking
0:05:47 > 0:05:51veins and arteries, different parts of the eye.
0:05:51 > 0:05:53The job itself can still be pretty taboo.
0:05:53 > 0:05:57I mean, even when I first came here, I wasn't exactly sure what they did.
0:05:57 > 0:05:59I knew they recovered tissue,
0:05:59 > 0:06:01but I didn't know to, like, the extreme of,
0:06:01 > 0:06:04like, really recovering almost everything.
0:06:07 > 0:06:11Our donor was processed here, in preparation for her final trip.
0:06:12 > 0:06:15Her left arm was removed for cremation,
0:06:15 > 0:06:18and its ashes returned to her family in California.
0:06:19 > 0:06:24The rest of her body was frozen, placed in a body bag, boxed,
0:06:24 > 0:06:27and labelled for transportation to London.
0:06:29 > 0:06:31From here, she made her last car journey
0:06:31 > 0:06:33through the streets of California.
0:06:34 > 0:06:36She was loaded into the hold
0:06:36 > 0:06:39of a plane and carried 5,000 miles from her home.
0:06:43 > 0:06:47And, finally, she arrived in London.
0:06:47 > 0:06:49Her body remained in a cool chamber for ten days,
0:06:49 > 0:06:51to allow it to thaw completely,
0:06:51 > 0:06:54before it was brought to the postmortem table.
0:06:59 > 0:07:02The first stage of every postmortem,
0:07:02 > 0:07:05before any cut is made to the flesh,
0:07:05 > 0:07:07is an external examination of the body.
0:07:11 > 0:07:15The donor's ID number is confirmed against her medical record,
0:07:15 > 0:07:18which details the cause of her death - heart disease -
0:07:18 > 0:07:22and that she'd only had minor surgery and drank minimal alcohol.
0:07:24 > 0:07:28But what will her body go on to reveal about the way that she died?
0:07:29 > 0:07:31This lady died of heart disease,
0:07:31 > 0:07:34which is one of the things that is associated with obesity.
0:07:34 > 0:07:36And, interestingly, already in this lady
0:07:36 > 0:07:39we've got signs of heart failure, because if I press here,
0:07:39 > 0:07:42- particularly, on this side, you can see...- Oh, that's very evident.
0:07:42 > 0:07:45The dimpling, there. And that's because you've got too much fluid,
0:07:45 > 0:07:48and that's the side-effect of heart failure.
0:07:49 > 0:07:52The other obvious external damage to our donor are the blisters
0:07:52 > 0:07:54on her skin.
0:07:54 > 0:07:57They are one of the earliest signs of her body decomposing
0:07:57 > 0:07:58after death,
0:07:58 > 0:08:02and they're particularly noticeable on larger bodies.
0:08:02 > 0:08:04But they're not what Mike and Carla are focusing on.
0:08:06 > 0:08:09The most important thing about this lady is that the obesity that she's
0:08:09 > 0:08:11got is centred on her abdomen.
0:08:11 > 0:08:14So this lady's carrying a lot of weight around her tummy.
0:08:14 > 0:08:17That's associated with more of the complications
0:08:17 > 0:08:20than if somebody weighs the same but they carry their weight
0:08:20 > 0:08:22around the bottom and around the thighs.
0:08:22 > 0:08:25So that's less associated with complications.
0:08:25 > 0:08:29That's more associated with complications.
0:08:29 > 0:08:34So we can see the distribution of the fat from the external exam.
0:08:34 > 0:08:37But once we actually get inside, we'll see more of
0:08:37 > 0:08:40how that's affected the inside of her body and her
0:08:40 > 0:08:42internal organs, as well.
0:08:42 > 0:08:45When we open this lady, there may be other findings
0:08:45 > 0:08:48that are less easy to diagnose before somebody has died,
0:08:48 > 0:08:51that won't have killed her but are examples of problems that can
0:08:51 > 0:08:55get worse and lead to illness and death in other people.
0:08:55 > 0:08:57So we may find some of those, we may not.
0:09:04 > 0:09:07To uncover if there are deadly medical truths
0:09:07 > 0:09:11lying beneath the skin, Carla must first cut open the body.
0:09:13 > 0:09:17The incision is a large and deep single vertical cut,
0:09:17 > 0:09:19beginning at the suprasternal notch
0:09:19 > 0:09:23at the base of the neck, and ending at the top of the pubis.
0:09:23 > 0:09:27It's a skill that requires both great precision and intense
0:09:27 > 0:09:31concentration, especially performed on someone with so much fat.
0:09:53 > 0:09:58So what I can feel at the moment is an awful lot of yellow,
0:09:58 > 0:10:01very sort of greasy, fatty tissue,
0:10:01 > 0:10:06which...is quite a thick layer in a body this size.
0:10:29 > 0:10:32Reflecting the skin, back from the ribcage, here,
0:10:32 > 0:10:36and what that means is I'm just kind of loosening it
0:10:36 > 0:10:37away with the muscle,
0:10:37 > 0:10:40to give me a bit of room to manoeuvre within the body.
0:10:43 > 0:10:45What we seem to have here is a breast implant.
0:10:45 > 0:10:47This is an incidental find.
0:10:47 > 0:10:49Sometimes, when we do postmortems,
0:10:49 > 0:10:52it's not just about what we're expecting to find, it's incidental.
0:10:53 > 0:10:56There is a very large amount of fat here,
0:10:56 > 0:11:00and the reason it makes it so difficult is it actually is greasy -
0:11:00 > 0:11:02it feels very much like butter.
0:11:02 > 0:11:06So what I'm doing here is just trying to make sure that my...
0:11:07 > 0:11:09..knife doesn't slip too much on it.
0:11:09 > 0:11:12Mike, did you want to come and take a look at this?
0:11:12 > 0:11:18OK. So, we can see, immediately, the thickness of fat that is here.
0:11:18 > 0:11:22And even though there is a large amount on the anterior chest wall -
0:11:22 > 0:11:24the front of the chest -
0:11:24 > 0:11:28there's also a very large amount around the abdomen.
0:11:28 > 0:11:31The abdominal fat - that is the most dangerous,
0:11:31 > 0:11:34associated with the problems of obesity.
0:11:34 > 0:11:37There's quite a lot of fat around the organs.
0:11:37 > 0:11:41There's fat in the omentum.
0:11:41 > 0:11:44It would appear that this lady's carrying much of her weight in the
0:11:44 > 0:11:47abdominal fat and possibly around organs, as well.
0:11:47 > 0:11:50So there's lots of changes, which I think we'll get a better view of
0:11:50 > 0:11:52when we've opened the rest of the body.
0:11:54 > 0:11:57Everybody knows what obesity looks like from the outside but,
0:11:57 > 0:11:59unless you do a job like ours,
0:11:59 > 0:12:03most people don't see what obesity looks like inside.
0:12:03 > 0:12:05I've done thousands of postmortems.
0:12:05 > 0:12:07It's always a fascinating procedure.
0:12:07 > 0:12:10Even if it's a case where you've seen lots and lots of
0:12:10 > 0:12:12similar cases in the past,
0:12:12 > 0:12:15that particular case will be individual,
0:12:15 > 0:12:18and you'll certainly learn from that.
0:12:18 > 0:12:22We'll never know exactly why our donor became so overweight.
0:12:22 > 0:12:25The reasons for obesity are multilayered and complicated -
0:12:25 > 0:12:30a mixture of lifestyle and environment, biology and psychology.
0:12:30 > 0:12:34But now that overweight is the new normal weight in the UK,
0:12:34 > 0:12:36there is a whole new young generation
0:12:36 > 0:12:39living with the consequences of obesity.
0:12:39 > 0:12:42Fat! You know? "Oi, fatty", "fat bastard",
0:12:42 > 0:12:45you know, whatever it might be. I mean, I remember walking past
0:12:45 > 0:12:47my local pub once and someone said,
0:12:47 > 0:12:50"Oh, fat bastard, how are you?"
0:12:50 > 0:12:52It doesn't matter how old you are,
0:12:52 > 0:12:54if you're fat, you are marginalised by society.
0:13:00 > 0:13:03There's a lot of medical contributing facts
0:13:03 > 0:13:05to people's weight that a lot of people don't realise,
0:13:05 > 0:13:07and all they see is somebody that's big,
0:13:07 > 0:13:09and they assume that they eat a lot.
0:13:09 > 0:13:11Myself, you know,
0:13:11 > 0:13:15I suffer from polycystic ovaries and also underactive thyroids.
0:13:15 > 0:13:18So, as a child, I was always slim.
0:13:18 > 0:13:22I come from a family that's quite slim, their build is quite slim.
0:13:22 > 0:13:24You know, it was only when I hit puberty that I started
0:13:24 > 0:13:26putting on this weight.
0:13:26 > 0:13:28I was diagnosed with epilepsy,
0:13:28 > 0:13:31and the first medication they put me on,
0:13:31 > 0:13:34I put on a lot of weight quite quickly.
0:13:34 > 0:13:36I lost a lot of self-confidence,
0:13:36 > 0:13:41which I think also led to me putting on more weight.
0:13:47 > 0:13:51The emotions and feelings that I associate with eating
0:13:51 > 0:13:54are quite difficult, because I...
0:13:54 > 0:13:58There's a part of me, because I'm recovered
0:13:58 > 0:14:00from binge-eating disorder,
0:14:00 > 0:14:04there's a part of me that still, if I've had a difficult day,
0:14:04 > 0:14:08wants to go home and eat a lot of things in one go, which,
0:14:08 > 0:14:10you know... I wouldn't enjoy them,
0:14:10 > 0:14:14it would just be because that's what I have done in the past,
0:14:14 > 0:14:17and that just seems to be something that I've picked up as a way
0:14:17 > 0:14:19of coping, which I've now moved away from.
0:14:19 > 0:14:21But that's still something that I'm conscious of,
0:14:21 > 0:14:24and still occasionally want to go and do that.
0:14:24 > 0:14:26Sometimes, you know, I'm not going to lie,
0:14:26 > 0:14:28I do eat some of the wrong foods.
0:14:28 > 0:14:31And, you know, I don't go to the gym as often as I should.
0:14:32 > 0:14:35During my 20s, you know, I did, I partied a bit.
0:14:35 > 0:14:37I was going out with my friends on the weekend.
0:14:37 > 0:14:38You know, binge drinking
0:14:38 > 0:14:41all weekend's not a good, healthy lifestyle but,
0:14:41 > 0:14:42at the time, I didn't care.
0:14:48 > 0:14:52Food is pretty much central to our existence.
0:14:52 > 0:14:55Mum would always complain that we're always thinking about our stomachs.
0:14:55 > 0:15:00I suffer from a sort of severe lack of self-discipline.
0:15:00 > 0:15:01So, when I go to the supermarket,
0:15:01 > 0:15:04I'll generally walk through the door and the first thing I'll see is the
0:15:04 > 0:15:06things on offer - biscuits, two for one.
0:15:06 > 0:15:08And then I'll see the salad.
0:15:11 > 0:15:13And it's salad.
0:15:13 > 0:15:16And you've got carrots and you've got hummus,
0:15:16 > 0:15:20and you've got Maltesers and you've got Twirl and you've got Buttons,
0:15:20 > 0:15:24and Dairy Milk this and Twix that, and it's cheaper and it's on deal -
0:15:24 > 0:15:28why wouldn't I? It spirals, and it gets out of control.
0:15:28 > 0:15:29It's just quite sneaky, really,
0:15:29 > 0:15:32the way that it kind of creeps up on you if you sort of
0:15:32 > 0:15:34take your eye off the ball.
0:15:38 > 0:15:41The next stage of our postmortem is for Carla
0:15:41 > 0:15:42to go deeper into the body -
0:15:42 > 0:15:46beyond the surface fat - to get to the organs.
0:15:46 > 0:15:50What will we discover from them about the damage that fat has done?
0:15:50 > 0:15:52The organs come out in blocks,
0:15:52 > 0:15:55because they all fit together in a certain way.
0:15:55 > 0:15:58So, for example, with the cardio-respiratory block,
0:15:58 > 0:16:00which is the heart and the lungs,
0:16:00 > 0:16:04these are specifically together and above the diaphragm,
0:16:04 > 0:16:07so you have a natural line there that sort of
0:16:07 > 0:16:11makes them into one block or "plug".
0:16:11 > 0:16:15So if I remove those and I give those to the pathologist,
0:16:15 > 0:16:17he can then take a look at those organs
0:16:17 > 0:16:20while I carry on with the next block.
0:16:21 > 0:16:25To get to each block, Carla must first remove the sternum -
0:16:25 > 0:16:28the bony armour that protects the major organs of the body.
0:16:29 > 0:16:31It's not an easy job,
0:16:31 > 0:16:35requiring skill perfected over years and a bit of brute force.
0:16:42 > 0:16:44So I'm going to take my rib shears -
0:16:44 > 0:16:48we use these specifically for this job as they can cut through bone.
0:16:48 > 0:16:52And what I'm going to do is just make some very even cuts,
0:16:52 > 0:16:55right through all of these bones.
0:16:55 > 0:16:58You can hear the bones are snapping.
0:16:58 > 0:16:59This lady isn't exactly young.
0:17:01 > 0:17:04The older people get, the more calcified their bones become,
0:17:04 > 0:17:06so they become very, very crunchy,
0:17:06 > 0:17:11whereas younger people tend to have much more soft bones.
0:17:13 > 0:17:17In order to do this job you have to be strong of stomach, to start with.
0:17:17 > 0:17:21But I think that's just something that you either know or you don't.
0:17:21 > 0:17:24I never would have considered doing this job if I didn't know I had
0:17:24 > 0:17:28a strong stomach. I'm now removing the breastbone,
0:17:28 > 0:17:32or the breast plate, the sternum, with upward strokes.
0:17:32 > 0:17:37And this way, I don't damage any of the pericardium,
0:17:37 > 0:17:40which is the sack that keeps the heart safe.
0:17:42 > 0:17:44The first time I saw somebody doing a postmortem,
0:17:44 > 0:17:48I think I was just absolutely rapt, I was fascinated.
0:17:48 > 0:17:53And it's because the human body is an incredibly complex machine.
0:17:53 > 0:17:58To open a human being, to see all of that absolutely perfect sort of
0:17:58 > 0:18:01jigsaw of organs and perfectly placed,
0:18:01 > 0:18:05it really did make me feel very awed.
0:18:07 > 0:18:09When you do an autopsy on somebody who's very slim,
0:18:09 > 0:18:12the organs are there and they're very evident.
0:18:12 > 0:18:14It's like a game of Operation,
0:18:14 > 0:18:17or like one of those anatomical models that you would use at school.
0:18:17 > 0:18:19In a woman this size,
0:18:19 > 0:18:23a lot of it is really hidden by this extra yellow fat.
0:18:23 > 0:18:27It is making it quite difficult to see the structures -
0:18:27 > 0:18:29much more difficult than it would if she was a thinner person.
0:18:33 > 0:18:35Before Carla removes the heart and lungs,
0:18:35 > 0:18:38Mike wants to take a look at the organs while they're still
0:18:38 > 0:18:40in the body, to see if we'll discover
0:18:40 > 0:18:43any early indications of trauma or damage.
0:18:44 > 0:18:47You can see the heart here.
0:18:47 > 0:18:50There's a large amount of fat around the heart.
0:18:50 > 0:18:54- There's more here than you would see normally.- Definitely. - Quite considerably more.
0:18:54 > 0:18:57Underneath the heart and lungs, in this area, here,
0:18:57 > 0:18:58is what you call the diaphragm -
0:18:58 > 0:19:01that's a big muscle that helps you breathe.
0:19:01 > 0:19:04Even the diaphragm - I was going to ask - seems very fatty to me.
0:19:04 > 0:19:07That's right. Even on the surface,
0:19:07 > 0:19:09where the heart fat and the diaphragm are meeting,
0:19:09 > 0:19:10there's more fat than usual.
0:19:10 > 0:19:16And, actually, the thing you can see most is an extremely enlarged liver.
0:19:16 > 0:19:17This is very, very large,
0:19:17 > 0:19:20and it's got what we call "fatty liver change".
0:19:20 > 0:19:22So this is a fatty liver,
0:19:22 > 0:19:27and fatty liver is very much associated with obesity.
0:19:27 > 0:19:31You can see there's a lot of fat around these organs,
0:19:31 > 0:19:35so what would be between my hands now would be the kidneys.
0:19:35 > 0:19:37Now, the kidneys always have fat around them.
0:19:37 > 0:19:40I think it's important, while we're talking about the fat,
0:19:40 > 0:19:42to realise fat is a normal thing.
0:19:43 > 0:19:44Everybody has fat in.
0:19:44 > 0:19:47However thin you are, there will be some fat, and fat has got very,
0:19:47 > 0:19:52very important roles, and one of those roles is to protect things.
0:19:52 > 0:19:55It's the too much fat that is the problem.
0:19:57 > 0:20:01Fat is made up of cells called adipocytes, which are fat cells.
0:20:01 > 0:20:04And, really, for a long, long time - until very recently -
0:20:04 > 0:20:08people thought that fat was just an inert substance that just sort of
0:20:08 > 0:20:10sat there and didn't really do anything.
0:20:10 > 0:20:13But it's becoming increasingly understood now,
0:20:13 > 0:20:15that fat is actually a very active substance.
0:20:17 > 0:20:21Fat cells work almost like an endocrine organ.
0:20:21 > 0:20:23People will have heard of some endocrine organs -
0:20:23 > 0:20:26things like the thyroid gland is related to how much energy you have,
0:20:26 > 0:20:29how cold you are, so forth.
0:20:29 > 0:20:32The ovaries, the testes - so, obviously,
0:20:32 > 0:20:35these hormones related to the ovary and the testes define whether you're
0:20:35 > 0:20:37going to be a man or you're going to be a woman.
0:20:37 > 0:20:41So those are the sorts of activities hormones have, so they're very, very powerful things.
0:20:41 > 0:20:45And then it's become obvious that the adipocytes, the fat cells,
0:20:45 > 0:20:47do play an endocrine-type role
0:20:47 > 0:20:49and so have some very powerful effects that
0:20:49 > 0:20:51were previously unknown.
0:20:54 > 0:20:57Exactly how fat works and what it does is still far
0:20:57 > 0:21:00from completely understood,
0:21:00 > 0:21:04but the day-to-day reality of obesity can be devastating.
0:21:05 > 0:21:09I wish I hadn't left it so late to try and start losing weight.
0:21:09 > 0:21:11It's not good on your back. It's not good on your knees.
0:21:12 > 0:21:16You know, God knows what it's doing inside.
0:21:16 > 0:21:18I thought, "Right, OK, I'm 30 -
0:21:18 > 0:21:20"let's start thinking about trying to have a baby."
0:21:20 > 0:21:22But with the size that I am,
0:21:22 > 0:21:24you know, you won't even get any help with,
0:21:24 > 0:21:28sort of, IVF and things like that because it's...
0:21:28 > 0:21:30You know, the answer is, "You're too big."
0:21:36 > 0:21:37I've always felt insecure,
0:21:37 > 0:21:41thinking that I would perhaps never ever find love because I'm fat.
0:21:43 > 0:21:48Even if it's practical things such as travelling,
0:21:48 > 0:21:51going to a funfair or going to a theme park
0:21:51 > 0:21:54and knowing I have to sit in a seat that is tiny -
0:21:54 > 0:21:57things like that, and...
0:21:57 > 0:22:00There's so many things. My wedding day - preparing for that,
0:22:00 > 0:22:03preparing my body for that, so how it will look in photos.
0:22:03 > 0:22:05And even social media.
0:22:05 > 0:22:09In fact, my whole life is surrounded by it.
0:22:09 > 0:22:11I've got sleep apnoea because of my weight.
0:22:11 > 0:22:13And what that means is that
0:22:13 > 0:22:17when I lie down to go to sleep at night,
0:22:17 > 0:22:20the extra weight on my neck and on my face
0:22:20 > 0:22:22actually compresses my airways,
0:22:22 > 0:22:26so that it stops me breathing properly and therefore wakes me up.
0:22:26 > 0:22:30It was waking me up about every two minutes throughout the night.
0:22:30 > 0:22:35So I wear a machine, and it's essentially a small air pump.
0:22:35 > 0:22:38It just keeps pressured air going into my airways
0:22:38 > 0:22:41through the night, so I don't wake myself up,
0:22:41 > 0:22:45so that my sleep's a lot better. Very glad to have the machine.
0:22:45 > 0:22:48Would have been much gladder to have not needed it at all.
0:22:59 > 0:23:02When I first properly started thinking of myself
0:23:02 > 0:23:06as overweight was when I started looking at wedding dresses.
0:23:06 > 0:23:09It's meant to be, like, a really, really happy time,
0:23:09 > 0:23:12and I just felt uncomfortable,
0:23:12 > 0:23:16and just ugly and disgusting,
0:23:16 > 0:23:19and I just - I didn't want to be there.
0:23:19 > 0:23:22The woman said that they were going to have to order me a size 20,
0:23:22 > 0:23:25and I thought it was going to be, like, a size 16,
0:23:25 > 0:23:30and I was just, like, absolutely out of my mind.
0:23:30 > 0:23:33I had, like, no idea I'd got that big.
0:23:33 > 0:23:37It was really, really awful. I think I cried most of that night.
0:23:37 > 0:23:41I was angry at myself to have got so big and not have noticed.
0:23:41 > 0:23:43Like, I just felt stupid.
0:23:46 > 0:23:49The next stage of the postmortem is the dissection
0:23:49 > 0:23:53of the heart and lungs. For Mike to be able to do this,
0:23:53 > 0:23:55Carla needs to remove the cardio-respiratory block
0:23:55 > 0:23:56from the body.
0:24:02 > 0:24:05I'm cutting through the diaphragm, here,
0:24:05 > 0:24:07just to make sure that I've freed the lungs completely.
0:24:10 > 0:24:12Free them along the spine here.
0:24:13 > 0:24:16I'm going to do the exact same thing on the other side.
0:24:22 > 0:24:25And then chop across the oesophagus and the trachea here,
0:24:25 > 0:24:27and then all I need to do is, basically,
0:24:27 > 0:24:29pull the organs towards me,
0:24:29 > 0:24:31at the same time as releasing these, sort of,
0:24:31 > 0:24:35white fibrous tissues that are holding the organs to the spine.
0:24:35 > 0:24:37And then we'll get to a point...
0:24:39 > 0:24:41..where this block - the cardio-respiratory block -
0:24:41 > 0:24:43is completely free.
0:24:44 > 0:24:46And then we can take this out as one block.
0:24:48 > 0:24:52And we've got the heart and the lungs and the heart sack -
0:24:52 > 0:24:54the pericardium.
0:24:55 > 0:24:57When you initially carry out a postmortem
0:24:57 > 0:25:01and you hold an organ such as the heart in your hands...
0:25:01 > 0:25:03And the heart is very symbolic...
0:25:04 > 0:25:07..you know? We use it in all sorts of logos.
0:25:07 > 0:25:11It has a sort of power and a sort of agency
0:25:11 > 0:25:13that makes you kind of stop and think.
0:25:13 > 0:25:17Because it looks so mundane, but then you realise that within it
0:25:17 > 0:25:19has the electrical impulses to keep a person alive.
0:25:22 > 0:25:25With the cardio-respiratory block removed from a donor's body,
0:25:25 > 0:25:29Mike can start his dissection of her lungs.
0:25:29 > 0:25:32Will we uncover any evidence of damage linked to her obesity?
0:25:38 > 0:25:42I'm going to detach the lungs from the heart.
0:25:42 > 0:25:45So we'll start off with the right lung.
0:25:46 > 0:25:47So, just cutting through...
0:25:49 > 0:25:50..where the lung is attached.
0:25:51 > 0:25:53And that's the right lung detached.
0:25:53 > 0:25:56This is the left lung I'm detaching.
0:25:58 > 0:25:59There.
0:25:59 > 0:26:02I'm just going to make some cuts across the lung,
0:26:02 > 0:26:05just to see what the surface of the lung looks like.
0:26:05 > 0:26:08These lungs actually look quite healthy.
0:26:08 > 0:26:12There's no tumours or masses or anything like that in these lungs.
0:26:14 > 0:26:16But what there does seem to be,
0:26:16 > 0:26:21and which should be evident now if I pick this lung up and squeeze it...
0:26:22 > 0:26:26..is you can see the fluid dripping out of these lungs.
0:26:26 > 0:26:29And this is what we call pulmonary oedema -
0:26:29 > 0:26:32that's essentially heart failure fluid.
0:26:32 > 0:26:34This fluid is basically water.
0:26:34 > 0:26:37I know it looks red - that's because, obviously,
0:26:37 > 0:26:40it's within the body and it's been mixed with blood.
0:26:40 > 0:26:42This isn't... Blood is much, much thicker than that.
0:26:42 > 0:26:45This is really just a watery fluid.
0:26:45 > 0:26:48And this has collected because this lady's got heart failure.
0:26:49 > 0:26:53This lady died from heart failure, from hypertensive heart disease.
0:26:53 > 0:26:56But this lady is also obese.
0:26:56 > 0:26:58She did not die from the obesity -
0:26:58 > 0:27:02the obesity increased the risk factors,
0:27:02 > 0:27:07and was associated with the problems that led to her death.
0:27:08 > 0:27:11Fluid has built up in this lady's lungs.
0:27:11 > 0:27:13Because her heart isn't working properly,
0:27:13 > 0:27:17she'd have probably been short of breath and possibly had a cough.
0:27:17 > 0:27:22But, also, because the fluid sits in the chest when you lie flat,
0:27:22 > 0:27:26and that would have given her sensation, almost, of drowning.
0:27:27 > 0:27:30When you become a doctor, one of the questions that they teach you
0:27:30 > 0:27:34very early on is how many pillows do you sleep with?
0:27:34 > 0:27:36And that tends not to be because they're asking
0:27:36 > 0:27:38how comfortable you are at night -
0:27:38 > 0:27:41it's because if somebody says, "Oh, I can't sleep in a bed, doctor.
0:27:41 > 0:27:43"I have to sleep in a chair" or,
0:27:43 > 0:27:45"I have to sleep with eight pillows, sitting up",
0:27:45 > 0:27:48that is very indicative of heart failure.
0:27:51 > 0:27:54From the startling discovery Mike has made in our donor's lungs,
0:27:54 > 0:27:58we now know that she would have felt the impact of her obesity
0:27:58 > 0:28:00and heart failure every single day.
0:28:01 > 0:28:05Heart failure is not the same as a heart attack.
0:28:05 > 0:28:09When a heart fails, it doesn't fail immediately
0:28:09 > 0:28:10in this type of circumstance.
0:28:10 > 0:28:14It fails over a long period of time, so the symptoms are gradual.
0:28:14 > 0:28:19So this lady may have been able to walk up ten flights of stairs
0:28:19 > 0:28:22three years ago, then she suddenly found she got very breathless
0:28:22 > 0:28:26after five flights of stairs, then she found that she found it very,
0:28:26 > 0:28:28very difficult to even walk up one flight of stairs,
0:28:28 > 0:28:31or even carry her shopping. It would have been a progressive disease,
0:28:31 > 0:28:34as the heart became worse and worse and worse.
0:28:34 > 0:28:36Now, the final event, obviously,
0:28:36 > 0:28:38when this lady's heart stopped working -
0:28:38 > 0:28:42that would have been an instantaneous event and led to her death.
0:28:42 > 0:28:45Now it's time for Mike to examine, in detail,
0:28:45 > 0:28:48the organ that catastrophically failed in our donor.
0:28:49 > 0:28:53What will we find out about how and why she might have died?
0:28:53 > 0:28:55You can't really see the heart yet,
0:28:55 > 0:28:58because the heart is sitting in a bag.
0:28:58 > 0:29:00This is called the pericardial sac.
0:29:00 > 0:29:01I'm just going to open that.
0:29:04 > 0:29:08And so I can reflect that back and that's the heart there.
0:29:08 > 0:29:11So the heart, now, is in my hand.
0:29:11 > 0:29:15And you can see all the fat I was talking about earlier really isn't
0:29:15 > 0:29:18around the heart, it's really around the pericardium.
0:29:18 > 0:29:21There is a bit of fat around the heart, which is here.
0:29:21 > 0:29:23This is absolutely typical and everybody's heart,
0:29:23 > 0:29:26even a thin person's heart, would have this.
0:29:26 > 0:29:30And I'm going to cut off the pericardial sac.
0:29:32 > 0:29:35This big blood vessel here is the aorta.
0:29:35 > 0:29:38This is the vessel that takes all the blood
0:29:38 > 0:29:40from the heart round the body.
0:29:40 > 0:29:43When I feel this heart, it feels baggy.
0:29:43 > 0:29:46A heart, in someone who is very athletic -
0:29:46 > 0:29:49their heart would be very tight, very firm.
0:29:49 > 0:29:51It would be like, almost, picking up a piece of steak.
0:29:51 > 0:29:53This is more like a bag.
0:29:53 > 0:29:56What I'm going to do now is weigh this heart.
0:29:59 > 0:30:02So this heart is 449g.
0:30:02 > 0:30:06That's a heavy heart. This lady is, despite her weight,
0:30:06 > 0:30:09this lady is actually quite a petite person.
0:30:09 > 0:30:14So you would expect her heart to be perhaps 275g, something like that.
0:30:14 > 0:30:17So this is very much heavier than you would expect.
0:30:17 > 0:30:19And that is the sort of size heart
0:30:19 > 0:30:22you would expect in someone who has got heart failure
0:30:22 > 0:30:24due to high blood pressure,
0:30:24 > 0:30:26which is what this lady suffered from.
0:30:26 > 0:30:29The heart, basically, has to pump to keep up the pressure.
0:30:29 > 0:30:31The heart gets bigger and bigger and bigger.
0:30:31 > 0:30:35But there comes a point where the heart can't get any bigger,
0:30:35 > 0:30:36and it basically exhausts itself.
0:30:39 > 0:30:43Now that he's discovered the shocking state of our donor's heart,
0:30:43 > 0:30:45Mike wants to look at it from the inside.
0:30:45 > 0:30:49He cuts some slices so he can examine the ventricles -
0:30:49 > 0:30:51the walls of the heart that pump the blood.
0:30:52 > 0:30:55If you're a 6'8", All Black second row,
0:30:55 > 0:30:57or you're, you know,
0:30:57 > 0:31:00one of the professional footballers running around the pitch,
0:31:00 > 0:31:01you need a lot of blood.
0:31:01 > 0:31:05So the wall of the left ventricle, in a young, fit person,
0:31:05 > 0:31:09is usually an inch-thick muscle all the way around.
0:31:09 > 0:31:13Now, if you look at this lady, this lady's left ventricle is very,
0:31:13 > 0:31:18very thin. This is eight millimetres, something like that.
0:31:18 > 0:31:22That's because she developed high blood pressure to start off with -
0:31:22 > 0:31:24the heart had to pump harder and harder.
0:31:24 > 0:31:27In the end, what you get to is a state where the muscle can't keep
0:31:27 > 0:31:29the high blood pressure up,
0:31:29 > 0:31:31and it starts to get thinner and thinner and thinner.
0:31:31 > 0:31:34And, basically, you go from a thick, muscular pump,
0:31:34 > 0:31:38through to a paper bag that's not capable of pumping blood adequately
0:31:38 > 0:31:41around the body. And we see a lot of these hearts.
0:31:41 > 0:31:44We see them on a background of hypertension.
0:31:44 > 0:31:46This is a common finding and becoming more common.
0:31:48 > 0:31:50Hypertension is high blood pressure.
0:31:50 > 0:31:53Obesity is well known to be one of the major risk factors
0:31:53 > 0:31:55for high blood pressure.
0:31:55 > 0:31:58So, in this lady, they were not able to control that.
0:31:58 > 0:32:01That led to changes within the heart which meant the heart failed,
0:32:01 > 0:32:05it couldn't work properly. And that's what this lady died from.
0:32:10 > 0:32:13Obesity is a killer - not by itself,
0:32:13 > 0:32:18but in the many ways that it triggers and accelerates disease.
0:32:18 > 0:32:22But so much of the way that we think about fat isn't medical at all -
0:32:22 > 0:32:23it's personal.
0:32:25 > 0:32:28I have been fat all my life.
0:32:28 > 0:32:32And it's never been a positive thing for me.
0:32:32 > 0:32:36I've always associated it with something negative, to be honest.
0:32:36 > 0:32:38I feel like
0:32:38 > 0:32:41fat is a filter through which I'm seen,
0:32:41 > 0:32:45because there are certain stereotypes that go alongside
0:32:45 > 0:32:48being fat, being overweight,
0:32:48 > 0:32:50that maybe people who are overweight
0:32:50 > 0:32:53are lazy or not very clever.
0:32:53 > 0:32:56I don't know why. I don't know where those have come from.
0:32:56 > 0:33:02But I feel like I have to try extra hard to prove those things wrong.
0:33:08 > 0:33:11I don't think I necessarily would associate my fat with, you know,
0:33:11 > 0:33:14being invited to, you know, get-togethers with friends
0:33:14 > 0:33:16or going out. But, you know, if they were going to play a game
0:33:16 > 0:33:18of football or rugby, they might think twice.
0:33:18 > 0:33:21Socially, in terms of relationships, it definitely has.
0:33:21 > 0:33:25I mean, you go into a bar and you look like a GQ cover model,
0:33:25 > 0:33:29versus me, the girl's always going to go for the GQ cover model, sadly.
0:33:29 > 0:33:31Try as I might to be the funny fat guy.
0:33:38 > 0:33:42You try to build this wall, this wall that, you know,
0:33:42 > 0:33:45you just sort of try to ignore it. And from strangers you can,
0:33:45 > 0:33:47because you think, "Well, they don't know me."
0:33:47 > 0:33:50But when somebody who's supposed to love you and somebody who's supposed
0:33:50 > 0:33:53to care for you and somebody who's supposed to accept you
0:33:53 > 0:33:57for who you are, when they call you fat, just to hurt you,
0:33:57 > 0:34:01the feeling is just horrible. It's not a nice feeling at all.
0:34:01 > 0:34:05It makes you feel really low, sad, alone.
0:34:11 > 0:34:13The next block of organs to be removed
0:34:13 > 0:34:16are the organs of the digestive system,
0:34:16 > 0:34:18called the coeliac block.
0:34:22 > 0:34:26What I'm trying to do here is make sure that I've got the stomach
0:34:26 > 0:34:28and the lower bowel and the liver and the spleen
0:34:28 > 0:34:29all together in one block,
0:34:29 > 0:34:32for Mike to take a look at, and not damage the kidneys.
0:34:32 > 0:34:35But, at this point, I don't think I'm going to be able to damage them
0:34:35 > 0:34:37anyway, because they are so surrounded by
0:34:37 > 0:34:39such a large envelope of fat.
0:34:40 > 0:34:42So we've got some faecal matter,
0:34:42 > 0:34:45we've got some bile and then, obviously, a lot of blood.
0:34:45 > 0:34:47The blood's mixed in with the fat, which is yellow,
0:34:47 > 0:34:50so that's giving us some orangey fluids.
0:34:50 > 0:34:52It's a multisensory rainbow at the moment.
0:34:52 > 0:34:55Every single thing that is in each of these blocks
0:34:55 > 0:34:57is incredibly important and, you know,
0:34:57 > 0:35:00does amazing jobs for our body.
0:35:00 > 0:35:03It's just a case of...it's not very pleasant, once they've stopped
0:35:03 > 0:35:07working and they've started to decompose a little bit.
0:35:07 > 0:35:09To completely free the organs, Carla needs to cut through
0:35:09 > 0:35:12the fibrous membrane that holds them to the spine
0:35:12 > 0:35:14at the back of the body.
0:35:14 > 0:35:17So this is a huge coeliac block.
0:35:17 > 0:35:18It is incredibly heavy.
0:35:18 > 0:35:21The liver, as you can see, is taking up most of it.
0:35:21 > 0:35:24You can just see the spleen, there, and also the stomach,
0:35:24 > 0:35:26and a bit of the small bowel is attached, as well.
0:35:28 > 0:35:30When I first encountered a deceased person,
0:35:30 > 0:35:35I think what really struck me was just the stillness and the cold.
0:35:35 > 0:35:38Because, of course, I'd never, at that point,
0:35:38 > 0:35:40felt flesh that was so cold.
0:35:41 > 0:35:44And it gave me a real sensation of kind of
0:35:44 > 0:35:47dipping my toe into very cold water.
0:35:47 > 0:35:52And then, once I'd done it, that feeling had never quite left.
0:35:52 > 0:35:54It was like this other, subterranean world.
0:35:56 > 0:35:58In the next stage of the postmortem,
0:35:58 > 0:36:02will we find any evidence of fat damage in the organs of our donor's
0:36:02 > 0:36:04digestive system?
0:36:09 > 0:36:12This is the organs that include
0:36:12 > 0:36:14the liver,
0:36:14 > 0:36:17the spleen, the stomach and the pancreas.
0:36:17 > 0:36:23Now, this is much heavier than I would expect it to be in a smaller
0:36:23 > 0:36:27individual, largely because the liver is so big.
0:36:27 > 0:36:29First, Mike is going to take a look at the organ that most people
0:36:29 > 0:36:32associate with obesity.
0:36:32 > 0:36:33This is the stomach.
0:36:34 > 0:36:37Basically just like a bag that holds the food,
0:36:37 > 0:36:40before the food goes through into the bowel
0:36:40 > 0:36:42where it's actually digested.
0:36:42 > 0:36:43And there are actually many...
0:36:43 > 0:36:47of the treatments associated with obesity deal with the stomach.
0:36:47 > 0:36:50And what they try to do is reduce the size of the stomach,
0:36:50 > 0:36:54so that people have a feeling of being satisfied from eating
0:36:54 > 0:36:57without eating so much. So there's a whole variety -
0:36:57 > 0:36:59gastric bands fit around the stomach,
0:36:59 > 0:37:02there's various bypass operations and so forth.
0:37:02 > 0:37:05The stomach is very good at dilating.
0:37:05 > 0:37:08So, if this lady had had a very large meal before she died
0:37:08 > 0:37:11and had not had opportunity to digest it,
0:37:11 > 0:37:13the stomach would be much more obvious.
0:37:13 > 0:37:16But this is a fairly typical size stomach.
0:37:19 > 0:37:22Next, Mike will dissect the liver - the organ he discovered showing
0:37:22 > 0:37:26such dramatic change when he saw it in the open body.
0:37:26 > 0:37:30But what will it reveal to us about the consequences of fat
0:37:30 > 0:37:31building up where it shouldn't?
0:37:33 > 0:37:37First thing I saw when we opened the abdomen was the size of this liver
0:37:37 > 0:37:40and the fact that this liver showed marked fatty change.
0:37:40 > 0:37:42I'm going to make some slices through the liver,
0:37:42 > 0:37:46just so I can see what the surface, cut surface of the liver looks like.
0:37:46 > 0:37:48The sponge, so I don't cut myself.
0:37:56 > 0:37:59So I've made some cuts across the liver, there.
0:37:59 > 0:38:01And you can see that the surface of the liver
0:38:01 > 0:38:03is this sort of pinky colour.
0:38:03 > 0:38:06That's very characteristic of fatty liver change.
0:38:06 > 0:38:10It's very soft. It almost feels like pate in consistency.
0:38:10 > 0:38:15Normal liver is quite soft, but not as soft as this.
0:38:15 > 0:38:19And it has a much meatier, much redder, bloody colour - dark red.
0:38:19 > 0:38:23The lightness in this is caused by the fat within the liver,
0:38:23 > 0:38:26and the fat is deposited within the hepatocytes,
0:38:26 > 0:38:28which are the liver cells.
0:38:28 > 0:38:31This fat would obviously be pale in colour,
0:38:31 > 0:38:34and liver cells themselves are dark, so the combination of the two
0:38:34 > 0:38:37gives you this light, sort of, pink colour. That's a much,
0:38:37 > 0:38:40much lighter colour than you'd expect a normal liver to be.
0:38:40 > 0:38:43That is a classic sign of fatty liver disease,
0:38:43 > 0:38:45and it's becoming a major problem,
0:38:45 > 0:38:50and is one of the major reasons for liver transplant in the world.
0:38:50 > 0:38:52The most common cause of fatty liver, at the moment,
0:38:52 > 0:38:55is alcohol-related fatty liver.
0:38:55 > 0:38:59But we know that this lady drank almost nothing,
0:38:59 > 0:39:02so it's very unlikely that this change is due to
0:39:02 > 0:39:04alcohol consumption.
0:39:04 > 0:39:07Almost certainly an obesity-related change.
0:39:08 > 0:39:11Fatty liver causes damage to the liver.
0:39:11 > 0:39:13It can lead on to cirrhosis,
0:39:13 > 0:39:15and it can actually lead on to cancer as well.
0:39:15 > 0:39:19But even if people do not develop cancer or cirrhosis,
0:39:19 > 0:39:20it can lead to liver failure.
0:39:20 > 0:39:22So there's multiple ways that it can actually lead
0:39:22 > 0:39:24to the death of a patient.
0:39:24 > 0:39:26It didn't lead to the death of this lady,
0:39:26 > 0:39:29really because her heart was itself so bad,
0:39:29 > 0:39:32but this is very dramatic change within this liver.
0:39:34 > 0:39:36Before the postmortem,
0:39:36 > 0:39:39we could never have known how dramatically damaged
0:39:39 > 0:39:41our donor's liver would be,
0:39:41 > 0:39:45or that she'd be carrying a second life-threatening disease.
0:39:45 > 0:39:49But excess internal fat doesn't have to be a death sentence.
0:39:49 > 0:39:54The good news is the fight to beat the dangerous invisible fat
0:39:54 > 0:39:55can be won.
0:39:55 > 0:39:58It is a daily struggle, but the prize is big.
0:40:05 > 0:40:08Now I'm trying to lose weight.
0:40:08 > 0:40:11I've actually lost 3.5 stone.
0:40:11 > 0:40:13I'm in a weight management clinic.
0:40:13 > 0:40:15I get support through a dietician.
0:40:15 > 0:40:17I get support through weekly weigh-ins.
0:40:17 > 0:40:19I get support from a counsellor, you know, which is really,
0:40:19 > 0:40:22really handy to help with your mental,
0:40:22 > 0:40:24you know, frame of mind as well.
0:40:24 > 0:40:29So what I've been doing to lose weight is cutting out the chocolate,
0:40:29 > 0:40:32cutting out the biscuits, cutting out the crisps - all that stuff.
0:40:32 > 0:40:35I'm not perfect. I still have the takeaways, you know?
0:40:35 > 0:40:38I still have the cheeky bar of chocolate.
0:40:38 > 0:40:40But, you know, I've also been exercising a lot more,
0:40:40 > 0:40:43and really pushing myself to exercise, you know?
0:40:43 > 0:40:44Pushing myself to get to the gym.
0:40:52 > 0:40:54In terms of activity, I struggle.
0:40:54 > 0:40:57I try and get in an hour of walking a day,
0:40:57 > 0:41:00but I don't always manage it.
0:41:00 > 0:41:02Just walking around the park
0:41:02 > 0:41:05half a dozen times doesn't really do it for me, you know?
0:41:05 > 0:41:08I don't like running - I have a problem with my knees.
0:41:08 > 0:41:11To start jogging around a park is not only just a physically difficult
0:41:11 > 0:41:13thing, but it's an emotionally difficult thing to do -
0:41:13 > 0:41:15to get out there in jogging gear,
0:41:15 > 0:41:18for all the world to see some, you know, parts of your body's jiggling
0:41:18 > 0:41:21that you just don't want them to see, sadly.
0:41:21 > 0:41:23I've had gym memberships up the wazoo.
0:41:23 > 0:41:25I've done detoxes for 22 days,
0:41:25 > 0:41:28just drinking lemon juice, cayenne pepper,
0:41:28 > 0:41:30water and a bit of maple syrup.
0:41:30 > 0:41:32It's disgusting, I can tell you.
0:41:32 > 0:41:35But I have tried a lot, and I will probably end up trying more.
0:41:35 > 0:41:37But I think slowly getting better and making better choices is really
0:41:37 > 0:41:39where it's all about.
0:41:41 > 0:41:45My motivation to now tackle my weight,
0:41:45 > 0:41:48and to try and reach a healthier weight is because
0:41:48 > 0:41:52I have now recovered from my binge eating disorder.
0:41:52 > 0:41:55It's a shame that it had to get this bad for me to, you know,
0:41:55 > 0:41:58to get to this point, but I did need to access that, sort of,
0:41:58 > 0:42:00psychological help first, in my case.
0:42:00 > 0:42:04You know, I've now seen the limits that being overweight has put on
0:42:04 > 0:42:06my life, and I want to reverse those
0:42:06 > 0:42:10and get back out there and just live life to the full.
0:42:20 > 0:42:22I'm quite conscious, these days, of what I eat.
0:42:22 > 0:42:24I do go to the gym.
0:42:24 > 0:42:27I do what I can to lose weight,
0:42:27 > 0:42:32or at least maintain it even if I can't lose it drastically.
0:42:32 > 0:42:33OK.
0:42:33 > 0:42:35Turn a little bit.
0:42:35 > 0:42:40I am a plus size style, beauty and lifestyle blogger.
0:42:40 > 0:42:42People do get inspired by those sort of things,
0:42:42 > 0:42:44so I think it's quite useful for me to, kind of, you know,
0:42:44 > 0:42:48get out there. It's actually helped me boost my confidence.
0:42:48 > 0:42:50Perfect. Yup.
0:42:50 > 0:42:53Exercise is not my best friend.
0:42:53 > 0:42:57It's quite a chore for me, in a sense.
0:42:57 > 0:43:01But I feel that, in life, with a lot of things, you've just got to,
0:43:01 > 0:43:03you know, make the effort to do
0:43:03 > 0:43:07things even that you don't necessarily love.
0:43:07 > 0:43:12In January, I decided to join a running club
0:43:12 > 0:43:15called Too Fat To Run.
0:43:15 > 0:43:18And it was really, really scary at first.
0:43:18 > 0:43:21I went out and I ran for, like, ten minutes,
0:43:21 > 0:43:26which doesn't sound long, but when you haven't run
0:43:26 > 0:43:29and then, suddenly, you can run for ten minutes,
0:43:29 > 0:43:33you're like, "Oh, crap, I can do that. That was kind of cool."
0:43:33 > 0:43:36Then I did my first 5K race.
0:43:36 > 0:43:41Finishing a race feels so much better than, I don't know...
0:43:41 > 0:43:43It sounds really, really cheesy,
0:43:43 > 0:43:47but it feels so much better than finishing a pack of crisps.
0:43:47 > 0:43:51Every race I do, I can't believe that I've finished it.
0:43:56 > 0:44:00Next, Carla will remove the final group of organs,
0:44:00 > 0:44:02but even in the last stages of the postmortem,
0:44:02 > 0:44:04she takes nothing for granted.
0:44:10 > 0:44:13People who donate their bodies to medical science really are giving
0:44:13 > 0:44:17a gift. It is the gift that keeps on giving, actually, because,
0:44:17 > 0:44:19as a patient, I think we all would prefer
0:44:19 > 0:44:23that our doctors and our surgeons have learned
0:44:23 > 0:44:27on something, you know, realistic to their job
0:44:27 > 0:44:30before they're let loose on a human patient.
0:44:30 > 0:44:32You know, you wouldn't really let a mechanic take care of your car
0:44:32 > 0:44:34if he'd never touched an engine,
0:44:34 > 0:44:36and it's very much the same thing with this.
0:44:38 > 0:44:40Real bodies are very unpredictable
0:44:40 > 0:44:42and very chaotic compared to anything,
0:44:42 > 0:44:46you know, fake - anything like a virtual reality or a fake cadaver -
0:44:46 > 0:44:47because if you look here,
0:44:47 > 0:44:50what you should be able to see are the kidneys -
0:44:50 > 0:44:54granted, they always have a tiny capsule of fat around them,
0:44:54 > 0:44:57a bit like a sort of edamame bean, that you can pop out -
0:44:57 > 0:45:00but these fatty capsules are very, very large.
0:45:00 > 0:45:04So all that you can really see at this point is a kind of yellow,
0:45:04 > 0:45:07glistening mess, really.
0:45:07 > 0:45:10So this is, again, indicative of the fact that she has
0:45:10 > 0:45:12an awful lot of extra fat around her organs.
0:45:12 > 0:45:16So I'm just slicing through the fibrous tissues and the bits of
0:45:16 > 0:45:21muscle that are keeping the kidneys attached to the spine.
0:45:21 > 0:45:24And it's really exactly the same thing that I've been doing
0:45:24 > 0:45:25with the rest of the organs,
0:45:25 > 0:45:27and that is releasing them from the spine,
0:45:27 > 0:45:29which is what anchors them in place.
0:45:33 > 0:45:36And then I can just reflect them all the way down and pull them out.
0:45:36 > 0:45:40And this is the genitourinary block.
0:45:53 > 0:45:57And this is at least slightly smaller, slightly easier to manage,
0:45:57 > 0:45:59cos we've only got the kidneys in this.
0:46:06 > 0:46:07So much fat, still.
0:46:11 > 0:46:15Mike needs to dissect the kidneys to find out just how much damage has
0:46:15 > 0:46:17been caused by all that excess fat.
0:46:22 > 0:46:25This is the right kidney. This is the left kidney.
0:46:25 > 0:46:28This, in the middle, is the big blood vessel
0:46:28 > 0:46:30that carries blood all the way down the body.
0:46:30 > 0:46:34And the most important and the first thing I can see is
0:46:34 > 0:46:37there's an unusual amount of fat around these kidneys.
0:46:37 > 0:46:40Now, the kidneys always have fat around them.
0:46:40 > 0:46:42Kidneys are not protected by bone,
0:46:42 > 0:46:45which means that they can be bashed and they can be hit,
0:46:45 > 0:46:47if you walk into something or something hits you,
0:46:47 > 0:46:50so this fat protects them.
0:46:50 > 0:46:53This lady has much, much more fat than I would expect.
0:46:53 > 0:46:58What I'm going to do first is just cut through this fat,
0:46:58 > 0:47:00which is called the perirenal fat.
0:47:03 > 0:47:08And you can see quite clearly how much fat there really is.
0:47:08 > 0:47:10In a thin person,
0:47:10 > 0:47:12this would probably be...
0:47:13 > 0:47:16..half or a third as thick as I can see here.
0:47:16 > 0:47:19This is bad news for this lady.
0:47:19 > 0:47:22It means that she is more likely to have the complications of obesity,
0:47:22 > 0:47:25because of the way she's carrying the fat.
0:47:25 > 0:47:28This pale area here is the kidney.
0:47:28 > 0:47:30I'm just going to cut into the kidney.
0:47:33 > 0:47:36So the kidney's got a thick capsule around it.
0:47:39 > 0:47:42Now there's a small amount of fat in the middle of the kidney.
0:47:42 > 0:47:44That's completely normal.
0:47:44 > 0:47:47That's where... Basically, the kidney is responsible for
0:47:47 > 0:47:50filtering your blood and for making the urine.
0:47:50 > 0:47:53That urine has to go somewhere, so your kidney's got a funnel
0:47:53 > 0:47:57that collects all the urine from all the bits of the kidney,
0:47:57 > 0:48:00takes it down through your ureter into the bladder and then,
0:48:00 > 0:48:02when you want to go to the loo, it goes out.
0:48:02 > 0:48:08So this bit of fat sits around that funnel area, and is quite normal.
0:48:09 > 0:48:13I'm going to take the thick capsule off of the kidney surface,
0:48:13 > 0:48:16to see what the surface of the kidney looks like.
0:48:23 > 0:48:27The surface of the kidney, ideally, should be very, very smooth.
0:48:27 > 0:48:31This kidney has got some scarring on the surface.
0:48:31 > 0:48:34There's areas of indentation and pock marking.
0:48:34 > 0:48:38There is clear damage to this kidney which would be associated with high
0:48:38 > 0:48:42blood pressure, and we know this lady had high blood pressure,
0:48:42 > 0:48:43which is what led to the changes
0:48:43 > 0:48:46within her heart and which led to her death.
0:48:49 > 0:48:52The visible scarring and pock marking we've discovered
0:48:52 > 0:48:56on our donor's kidneys are the last of the revelations she will yield,
0:48:56 > 0:48:58before Carla completes the postmortem
0:48:58 > 0:49:00and closes the body for ever.
0:49:06 > 0:49:08When Mike's finished his examination,
0:49:08 > 0:49:09I then begin the reconstruction.
0:49:09 > 0:49:12And, in a way, that's one of the most important parts
0:49:12 > 0:49:14of the postmortem.
0:49:14 > 0:49:18What I do is, I place all of the organs into a special viscera bag,
0:49:18 > 0:49:21which will contain all of the elements that we've removed
0:49:21 > 0:49:25in the different blocks, and I place that into the body cavity.
0:49:25 > 0:49:32And then I use very heavy postmortem twine to stitch, as neatly as I can,
0:49:32 > 0:49:34right along the incision that I made.
0:49:34 > 0:49:36We describe this as a baseball stitch -
0:49:36 > 0:49:39it does look very much like a zig-zaggy stitch.
0:49:43 > 0:49:47Each postmortem is unique, and everything they reveal valuable.
0:49:48 > 0:49:52This donor's gift was an opportunity for Mike and Carla to unveil the
0:49:52 > 0:49:55shocking truths hidden inside one body,
0:49:55 > 0:49:59irreversibly damaged by too much fat.
0:49:59 > 0:50:02The evisceration occurred,
0:50:02 > 0:50:06and it wasn't as easy to do as it would be with
0:50:06 > 0:50:07a slightly smaller patient.
0:50:07 > 0:50:12It takes a lot more strength to cut through this yellow adipose tissue,
0:50:12 > 0:50:17which kind of blooms out of the abdomen in this, you know,
0:50:17 > 0:50:20practically neon yellow.
0:50:20 > 0:50:25And it looks very much like butter, and it has a greasy feel.
0:50:25 > 0:50:31And it makes you suddenly very aware of the fat in your own body.
0:50:31 > 0:50:34Well, it made me aware of the fat in my own body,
0:50:34 > 0:50:37and the effect that that might have on my organs,
0:50:37 > 0:50:41the strain it might put on my heart, the way it may affect my liver.
0:50:41 > 0:50:44I think that doing a postmortem such as this
0:50:44 > 0:50:46is a really fantastic way for people
0:50:46 > 0:50:50to consider their own health and their own mortality.
0:50:57 > 0:50:59We never really know what we're going to find
0:50:59 > 0:51:01when we examine the patient.
0:51:01 > 0:51:04The first thing I noticed when the body had been opened
0:51:04 > 0:51:07was the markedly fatty liver.
0:51:07 > 0:51:09I know, from the history that was provided,
0:51:09 > 0:51:12that this lady died from heart failure,
0:51:12 > 0:51:15but the findings in her heart are extremely marked
0:51:15 > 0:51:19and the severity of them actually surprises me.
0:51:19 > 0:51:21But before we did the postmortem there was no indication
0:51:21 > 0:51:25that this lady had a fatty liver, and it's a possibility that,
0:51:25 > 0:51:28even if this lady had not developed heart failure,
0:51:28 > 0:51:31she may have gone on to develop liver failure
0:51:31 > 0:51:34due to the fatty change within the liver.
0:51:35 > 0:51:39We already knew a little about the way that this woman lived
0:51:39 > 0:51:41and how she died.
0:51:41 > 0:51:44What we couldn't have known before the postmortem was the extent
0:51:44 > 0:51:49to which obesity would have ravaged her internal organs,
0:51:49 > 0:51:53from the suffocating fluid in her lungs to her scarred kidneys,
0:51:53 > 0:51:56creating a potent mix of life-threatening,
0:51:56 > 0:51:58obesity-related disease.
0:52:00 > 0:52:02I know that, health-wise,
0:52:02 > 0:52:06being obese and being large, it just isn't good.
0:52:06 > 0:52:11So if I can do this documentary to help other people to see what it's
0:52:11 > 0:52:14doing to them, internally, for them to motivate theirself,
0:52:14 > 0:52:17so that they can lose weight so that they, you know,
0:52:17 > 0:52:20maybe they can have a child or maybe they can live a little bit longer,
0:52:20 > 0:52:22a little bit happier.
0:52:22 > 0:52:24That's why I'm doing this - to help people.
0:52:24 > 0:52:25It's fine to have...
0:52:27 > 0:52:30..like, politicians - like the Health Secretary or,
0:52:30 > 0:52:32like, whoever or, like,
0:52:32 > 0:52:37doctors on TV - saying everyone needs to eat less and move more,
0:52:37 > 0:52:38kind of thing,
0:52:38 > 0:52:43but until you can actually relate that to yourself,
0:52:43 > 0:52:45then you can say, "Oh, that's not me.
0:52:45 > 0:52:47"That's not going to happen to me."
0:52:47 > 0:52:50I think a postmortem of someone with obesity
0:52:50 > 0:52:52is going to be quite shocking
0:52:52 > 0:52:56for a lot of people, who maybe think that they can deal with it.
0:52:56 > 0:52:59And I've been there. I have been there as well.
0:52:59 > 0:53:01"Deal with it tomorrow. I'm all right, right now.
0:53:01 > 0:53:04"It's not affecting, you know... I don't need a machine to sleep.
0:53:04 > 0:53:06"I can get around fine, you know?"
0:53:06 > 0:53:11And just putting those choices off until tomorrow.
0:53:11 > 0:53:13Time goes by so quickly, and...
0:53:14 > 0:53:17..it's really important to think about, you know,
0:53:17 > 0:53:21what's going on inside you now and where that might actually end up -
0:53:21 > 0:53:23where you could end up.