0:00:02 > 0:00:05In Britain, we have a serious problem with our weight.
0:00:06 > 0:00:10More of us are getting heavier and suffering from ill health.
0:00:10 > 0:00:12But who's to blame?
0:00:12 > 0:00:18The cost of obesity is now so great, it threatens to bankrupt our NHS.
0:00:18 > 0:00:21But what if I were to tell you there is a treatment
0:00:21 > 0:00:24that could help tackle our obesity crisis?
0:00:24 > 0:00:29I've never, never lost weight like that before.
0:00:29 > 0:00:32One we're not using because of an anti-fat prejudice.
0:00:32 > 0:00:34Why is it any different for fat people?
0:00:34 > 0:00:37Why do they have no responsibility?
0:00:37 > 0:00:40We don't wake up in the morning and think, "Today, I want to be fat."
0:00:40 > 0:00:44A bias that may even extend to our health service.
0:00:44 > 0:00:46I think there is a deep-rooted prejudice
0:00:46 > 0:00:48in some quarters as well.
0:00:48 > 0:00:51Meaning many patients aren't getting the best available care.
0:00:52 > 0:00:55I felt like I was completely dumped by the very people
0:00:55 > 0:00:58that were supposed to offer me all of the help that I needed.
0:00:58 > 0:01:03A prejudice that has made the problem worse for us all.
0:01:03 > 0:01:06I'm ashamed to work in a health care profession
0:01:06 > 0:01:10that actually treats people in such a manner.
0:01:11 > 0:01:13And we shouldn't be doing it.
0:01:21 > 0:01:24I'm Professor Rachel Batterham,
0:01:24 > 0:01:26a doctor and research scientist at UCL,
0:01:26 > 0:01:29looking at differences in genes and body chemistry
0:01:29 > 0:01:33that means some people are more likely to put weight on than others.
0:01:35 > 0:01:38What we're learning in the lab should be shaping the future
0:01:38 > 0:01:40of obesity care in the UK.
0:01:40 > 0:01:43But there's a reluctance to accept what this could mean
0:01:43 > 0:01:45in terms of treatment.
0:01:47 > 0:01:50There's a battle brewing within our NHS about the best way
0:01:50 > 0:01:53to deal with our obesity crisis.
0:01:53 > 0:01:54One, two, three.
0:01:54 > 0:01:58Between those who view obesity as a lifestyle issue
0:01:58 > 0:02:00and those who see it as a disease
0:02:00 > 0:02:04that needs specialist treatment and even weight loss surgery.
0:02:04 > 0:02:06Knife, please.
0:02:06 > 0:02:09I know most people will disagree with this,
0:02:09 > 0:02:13but I'm very much in the camp that see obesity as a disease
0:02:13 > 0:02:15and I've long argued that we need to increase
0:02:15 > 0:02:19the number of weight loss surgeries funded by the NHS.
0:02:19 > 0:02:23So there we can see the new egg-sized stomach.
0:02:31 > 0:02:35Before I start to make my case, let's meet someone who's just had
0:02:35 > 0:02:39weight loss surgery and is about to receive some life-changing news.
0:02:39 > 0:02:42Robert had weight loss surgery yesterday
0:02:42 > 0:02:45and we're running some tests on him.
0:02:45 > 0:02:47It's not to see if he's lost any weight.
0:02:47 > 0:02:49It's too soon for that.
0:02:49 > 0:02:53But it's not too early to see if it's had an impact on his diabetes.
0:02:53 > 0:02:58- Hi. Good afternoon, Robert. How are you feeling?- A lot better.
0:02:58 > 0:03:00Yes, I'm feeling really well.
0:03:00 > 0:03:04I didn't think I'd feel this well, if I'll be honest with you.
0:03:04 > 0:03:08- So you've had the diabetes for eight years, is that right?- Yes.
0:03:08 > 0:03:11And what's it been like? How has it affected you having it?
0:03:11 > 0:03:15When you first find out you have it, it affects you really bad.
0:03:15 > 0:03:18You hear stories about people losing limbs,
0:03:18 > 0:03:24going blind and I've had family pass away with diabetes.
0:03:24 > 0:03:26- Of course.- So it's been very frightening, yes.
0:03:26 > 0:03:29And what's your sugars been like since the operation?
0:03:29 > 0:03:32Since the operation, his blood sugar level has been,
0:03:32 > 0:03:35even when he's been having his soup and teas,
0:03:35 > 0:03:37between five and six, so...
0:03:37 > 0:03:42Your sugar is normal. It's just truly amazing, really.
0:03:42 > 0:03:45Just less than 24 hours after the operation.
0:03:45 > 0:03:48You're not going to need any more tablets when you go home today.
0:03:48 > 0:03:51The diabetes has gone into, I hope, long-term remission.
0:03:51 > 0:03:54This is just so life-changing.
0:03:54 > 0:03:56I'm absolutely overwhelmed.
0:03:58 > 0:04:01Yes. How lucky am I?
0:04:02 > 0:04:06'We've known for over 20 years that weight loss surgery
0:04:06 > 0:04:09'can put type 2 diabetes into remission,
0:04:09 > 0:04:13'even before the patient has lost any weight.
0:04:13 > 0:04:17'I can't understand why we're not doing more of these operations.
0:04:18 > 0:04:21'It can transform someone's life
0:04:21 > 0:04:25'and help cut the mammoth bill of this disease to the NHS.'
0:04:25 > 0:04:30No medication. 18 hours after the operation, off I go.
0:04:32 > 0:04:38Type 2 diabetes costs the NHS nearly £8.8 billion each year.
0:04:39 > 0:04:41In less than 20 years,
0:04:41 > 0:04:45it's estimated it will cost us 15.1 billion.
0:04:47 > 0:04:50That's £280 million each week
0:04:50 > 0:04:54or a staggering 1.7 million every hour.
0:04:56 > 0:04:59Weight loss surgery puts over 60% of patients
0:04:59 > 0:05:02with type 2 diabetes into remission.
0:05:03 > 0:05:07Despite this, Robert could only get his life-changing treatment
0:05:07 > 0:05:09on the NHS by chance.
0:05:09 > 0:05:14Being a taxi driver, I was driving around last September in 2015.
0:05:14 > 0:05:16A gentleman puts his hand up,
0:05:16 > 0:05:22gets in and ends up explaining to me he was a surgeon from UCLH.
0:05:22 > 0:05:25He then says, "Would you be interested in having
0:05:25 > 0:05:27"this surgery done to help you out?"
0:05:27 > 0:05:29And it all started from there.
0:05:29 > 0:05:32So if you'd picked up somebody else, then you wouldn't be sitting here?
0:05:32 > 0:05:34I wouldn't be sitting here now.
0:05:34 > 0:05:36It was the right time, right pace.
0:05:36 > 0:05:40Your whole access to treatment for your diabetes and your weight
0:05:40 > 0:05:42was just complete luck.
0:05:42 > 0:05:43Yes.
0:05:44 > 0:05:46That's really quite shocking.
0:05:46 > 0:05:48Yes.
0:05:49 > 0:05:50Thank you.
0:05:50 > 0:05:56I find it really concerning that this is happening in today's NHS.
0:05:56 > 0:06:00Robert's access to treatment was not based on a medical pathway,
0:06:00 > 0:06:02it was pot luck.
0:06:02 > 0:06:06What's even more worrying is that there's thousands of other people
0:06:06 > 0:06:11just like Robert who don't know that weight loss surgery
0:06:11 > 0:06:13really could change their lives.
0:06:16 > 0:06:21In the UK, severe obesity rates have trebled over the last 30 years
0:06:21 > 0:06:24and type 2 diabetes has seen a similar rise.
0:06:24 > 0:06:28But in the last five years, there's been a 30% fall in the number
0:06:28 > 0:06:31of weight loss surgeries on the NHS,
0:06:31 > 0:06:34with only 6,000 undertaken last year.
0:06:34 > 0:06:38I've come to Chichester to meet Chris Pring,
0:06:38 > 0:06:40a bariatric surgeon at St Richard's Hospital...
0:06:40 > 0:06:43- Good morning, Chris. - Nice to see you.
0:06:43 > 0:06:45'..to see if he knows why there's been a drop in numbers.'
0:06:47 > 0:06:50And how many operations are you doing a year at the moment?
0:06:50 > 0:06:53We're probably doing about maybe 350 cases a year.
0:06:55 > 0:06:59A few years ago, we were probably doing about maybe 600 cases a year.
0:06:59 > 0:07:02So in the last five years, I'd say we've seen
0:07:02 > 0:07:07quite a significant drop in the number of cases that we're doing.
0:07:07 > 0:07:09And why have the numbers gone down?
0:07:09 > 0:07:12It may be there's a bit of prejudice out there.
0:07:12 > 0:07:19It may be that people don't feel this sort of treatment is, erm,
0:07:19 > 0:07:21not only worthwhile, but deserved.
0:07:21 > 0:07:24Do you think there's any prejudice within health care professionals?
0:07:24 > 0:07:27Unfortunately, I have to say yes, I think there is.
0:07:27 > 0:07:31I think there is a deep-rooted prejudice in some quarters as well.
0:07:31 > 0:07:34This is surgery to improve health.
0:07:34 > 0:07:37Diabetes, blood pressure, life expectancy.
0:07:37 > 0:07:39This isn't surgery to lose weight.
0:07:39 > 0:07:43And if we can get that message across,
0:07:43 > 0:07:46then I think we will start to see our numbers increasing again
0:07:46 > 0:07:47and rightly so.
0:07:47 > 0:07:50And we will see, I hope,
0:07:50 > 0:07:53that latent prejudice that I know exists,
0:07:53 > 0:07:56we will see that being eroded.
0:07:57 > 0:07:59It's shocking to think that people
0:07:59 > 0:08:01could be experiencing prejudice within the NHS.
0:08:01 > 0:08:04But it's something I'm hearing more and more.
0:08:04 > 0:08:07Can it be true that people are really discriminated against
0:08:07 > 0:08:08because of their weight?
0:08:08 > 0:08:11- Hi, good morning, Richard. - Hi, Rachel. How are you?
0:08:11 > 0:08:12- Nice to meet you.- Thanks for coming.
0:08:12 > 0:08:15'We sent out a survey to the UK members
0:08:15 > 0:08:16'of Lighterlife slimming group
0:08:16 > 0:08:20'and asked them what they'd experienced as patients
0:08:20 > 0:08:22'when they accessed the NHS for treatment.
0:08:23 > 0:08:25'And Richard now has the results.'
0:08:25 > 0:08:32We had 991 people get back to us and the response we got was staggering.
0:08:32 > 0:08:34The first question that we asked was,
0:08:34 > 0:08:37"Have I ever experienced any negative attitudes
0:08:37 > 0:08:39"from somebody within the NHS because of my weight?"
0:08:39 > 0:08:42The upsetting topline figure
0:08:42 > 0:08:45is that 43% of the responders agreed with this.
0:08:45 > 0:08:49So, almost one in two people with a weight problem
0:08:49 > 0:08:53are experiencing a negative attitude towards them...
0:08:53 > 0:08:56Whilst engaging with the NHS in their area, yes.
0:08:56 > 0:08:59So, over a quarter of the people who responded
0:08:59 > 0:09:02to the overall questionnaire were happy to take the time
0:09:02 > 0:09:04to share quite personal stories
0:09:04 > 0:09:07about the prejudice that they had encountered within the NHS with us.
0:09:07 > 0:09:09Perhaps you'd like to take a look.
0:09:11 > 0:09:15"I was refused a consultation with a view to knee surgery
0:09:15 > 0:09:18"because of my age and my weight.
0:09:18 > 0:09:20"I went privately.
0:09:20 > 0:09:23"Otherwise I would have ended up in a wheelchair
0:09:23 > 0:09:25"for the rest of my life.
0:09:25 > 0:09:27"The operation was a success
0:09:27 > 0:09:30"and I'm now able to walk normally again."
0:09:31 > 0:09:33That's just unbelievable.
0:09:33 > 0:09:36"I was refused a steroid injection in my hip
0:09:36 > 0:09:41"as losing weight would be more beneficial, so I remain in pain."
0:09:42 > 0:09:44"I was told by my GP that my health problems
0:09:44 > 0:09:47"were all connected to my overweight.
0:09:47 > 0:09:49"I did not have the confidence to argue
0:09:49 > 0:09:52"and did not go back for three years.
0:09:52 > 0:09:57"My diagnosis of multiple sclerosis was delayed by over four years.
0:09:57 > 0:09:59"Due to this, I suffered in silence."
0:09:59 > 0:10:01That is just appalling.
0:10:08 > 0:10:14Working mum Gemma is another patient who felt badly let down by the NHS.
0:10:14 > 0:10:18I was referred by the GP to the NHS weight loss service.
0:10:18 > 0:10:23I think it was the most distressing actual weight loss experience
0:10:23 > 0:10:24I've actually had.
0:10:27 > 0:10:30They have the NHS Eatwell plate, which is a guide
0:10:30 > 0:10:32to what you should have with every meal
0:10:32 > 0:10:35and the different food groups within them.
0:10:35 > 0:10:38I know that a lot of trigger in my weight gain are carbohydrates.
0:10:38 > 0:10:40Potatoes, rice, pasta, bread.
0:10:40 > 0:10:44They're all really bad triggers for me gaining weight.
0:10:44 > 0:10:45I tried to explain this,
0:10:45 > 0:10:48but I was told I need to conform to that plate.
0:10:48 > 0:10:51In the time from starting to actually leaving the service,
0:10:51 > 0:10:54I'd gained just over 2st by the end of it.
0:10:54 > 0:10:58It was a horrific experience emotionally, physically
0:10:58 > 0:11:01and has resulted in me being in a worse-off position
0:11:01 > 0:11:04than I was before I joined the service.
0:11:04 > 0:11:08Gemma only found out that she was eligible for weight loss surgery
0:11:08 > 0:11:12on the NHS after seeing her surgeon privately.
0:11:12 > 0:11:17Today's the day I find out if I can go on the surgical list.
0:11:18 > 0:11:22We'll have an idea then of when my surgery will be, if I'm accepted.
0:11:24 > 0:11:25Right, who's next?
0:11:25 > 0:11:29Gemma Graham. 38. BMI of 47.
0:11:29 > 0:11:31She wants a bypass.
0:11:32 > 0:11:36But she'll need careful management.
0:11:38 > 0:11:41Gemma's future is now in the hands of Chris and his team
0:11:41 > 0:11:44of psychologists, dieticians and nurses
0:11:44 > 0:11:47who will decide if she's suitable for surgery.
0:11:48 > 0:11:50I couldn't sleep, couldn't eat.
0:11:51 > 0:11:53My tummy's in knots. It's just...
0:11:55 > 0:11:57It means everything today to me.
0:11:58 > 0:12:01Kind of all my hopes are on a "yes" today.
0:12:04 > 0:12:07- Hello, Gemma.- Hi.- Are you all right? - Yes, good thanks. You?
0:12:07 > 0:12:09Yes. Come in. Chris Pring. Come and have a seat.
0:12:12 > 0:12:14- Have a seat.- Thank you.- Good, good.
0:12:14 > 0:12:20Certainly, today, the team have assessed you for surgery
0:12:20 > 0:12:25and we all agree that surgery's going to give you improved health
0:12:25 > 0:12:29- and a better weight and better outcomes as a result.- Fabulous.
0:12:29 > 0:12:31This is keyhole surgery.
0:12:31 > 0:12:35We staple across the stomach to give you a small stomach pouch.
0:12:35 > 0:12:37We then divide the bowel down here.
0:12:37 > 0:12:40We bring it up to the stomach pouch and we stitch it on.
0:12:40 > 0:12:44So the food goes down the gullet into the stomach pouch.
0:12:44 > 0:12:46It passes down the bowel here.
0:12:46 > 0:12:49Thereby, the food bypasses this part of the stomach and bowel,
0:12:49 > 0:12:52which we join on down here.
0:12:52 > 0:12:54- The end of a long journey.- Yes.
0:12:54 > 0:12:57The end of one journey, the start of a new one. It is, yes.
0:12:57 > 0:13:00We'll organise some dates for you and put you on the list.
0:13:00 > 0:13:02Everyone's happy. You're all sorted now. There we go.
0:13:02 > 0:13:05- Thank you so much for your help. - That's OK.- Thank you.
0:13:05 > 0:13:07- Have a safe trip home. - Thank you.- See you.
0:13:07 > 0:13:12Very relieved. I'm over the moon that I'm going to get the surgery.
0:13:12 > 0:13:15It's a fantastic feeling and it's going to be a new beginning for me.
0:13:17 > 0:13:20I think Gemma had got so frustrated with the system
0:13:20 > 0:13:23because she felt that she wasn't getting anywhere.
0:13:23 > 0:13:26She's here now as an NHS patient
0:13:26 > 0:13:29and she's like a lot of people I see.
0:13:29 > 0:13:33They can find it very difficult to navigate towards a point
0:13:33 > 0:13:36where you will end up having a healthier weight.
0:13:38 > 0:13:42For those lucky enough to get onto the surgical list
0:13:42 > 0:13:46here in Chichester, weight loss surgery is a daunting prospect
0:13:46 > 0:13:50and far from the easy option many people believe it to be.
0:13:50 > 0:13:53What's happening here, the surgeon is actually dissecting
0:13:53 > 0:13:56a little bit of your stomach tissue off to make you a new pouch.
0:13:56 > 0:13:57It's about the size of an egg.
0:13:57 > 0:13:59He cuts the bowel.
0:13:59 > 0:14:02The bit of bowel that's been cut is then re-routed
0:14:02 > 0:14:04and pushed up to the new tummy pouch.
0:14:04 > 0:14:07OK? The rest of this stomach here, it stays there. We don't remove it.
0:14:07 > 0:14:10- It stays there, but does it do nothing?- Does it die?
0:14:10 > 0:14:11No. It's perfectly fine.
0:14:11 > 0:14:14And that's why you can reverse it because your stomach...
0:14:14 > 0:14:16Yes, because everything is still there.
0:14:16 > 0:14:19My first reaction to that is it's quite frightening.
0:14:19 > 0:14:21This does frighten a lot of people.
0:14:21 > 0:14:23With this type of surgery,
0:14:23 > 0:14:27post-surgery and getting back to eating, you are on the equivalent
0:14:27 > 0:14:30of around about two tablespoons of pureed food per meal.
0:14:30 > 0:14:33If you try to eat any highly refined sugared items
0:14:33 > 0:14:37with this type of surgery, you get a syndrome called dumping syndrome.
0:14:37 > 0:14:40The food comes into the pouch, it then hits a part of the bowel
0:14:40 > 0:14:43where it's not used to having large molecules of sugar.
0:14:43 > 0:14:46It throws the body into a bit of a spin so what you then feel
0:14:46 > 0:14:52is faint, sick, sweaty, nauseous, it can give you an upset stomach.
0:14:52 > 0:14:55It's not pleasant and it happens to most people.
0:14:56 > 0:14:58Any operation carries a risk.
0:14:58 > 0:15:01So risks of infection, risk of bleed,
0:15:01 > 0:15:04risks of deep vein thrombosis, risk of chest problems.
0:15:04 > 0:15:07Probably around about one in 100.
0:15:07 > 0:15:11I want to see my child grow up and I don't want to die young.
0:15:11 > 0:15:16My dad died at 42 of pancreatic cancer, which is a lifestyle cancer.
0:15:16 > 0:15:19He was overweight for years.
0:15:19 > 0:15:22He drank, he ate what he wanted.
0:15:22 > 0:15:27But, in the end, he died very young and I'm only two years away
0:15:27 > 0:15:30from that age and it frightens the hell of me.
0:15:30 > 0:15:32Yes, and that's the help we can give you
0:15:32 > 0:15:34is to avoid you being in that position.
0:15:34 > 0:15:39- And it's giving you almost a second chance, isn't it?- Yes.
0:15:39 > 0:15:42In terms of how your GP have helped you,
0:15:42 > 0:15:44have you felt that they've been supportive?
0:15:44 > 0:15:52It took for me to find a very, very lovely sympathetic GP
0:15:52 > 0:15:54who I'd sat down one day with
0:15:54 > 0:15:59and I literally, I did cry, and I said, "This is all facing me.
0:15:59 > 0:16:03"I don't know what to do," and finally got a referral
0:16:03 > 0:16:07because doctor after doctor after doctor just refused to refer me.
0:16:10 > 0:16:13'I think today shows us that it's really hard for people
0:16:13 > 0:16:14'to access surgery,
0:16:14 > 0:16:17'even when they're eligible under current guidelines.'
0:16:17 > 0:16:20You get a bit stiff sitting down, don't you?
0:16:20 > 0:16:24'In England, the National Institute for Health and Care Excellence
0:16:24 > 0:16:27'recommends weight loss surgery for people with severe obesity
0:16:27 > 0:16:29'or with a BMI of 35 or more
0:16:29 > 0:16:33'with a significant disease like type 2 diabetes.'
0:16:33 > 0:16:35Thank you. See you later.
0:16:35 > 0:16:39'Wales and Scotland follow similar criteria, but in Northern Ireland,
0:16:39 > 0:16:43'it's policy to only provide surgery in extreme circumstances.'
0:16:44 > 0:16:47Getting referred for weight loss surgery is hard enough,
0:16:47 > 0:16:50but there's another obstacle.
0:16:52 > 0:16:56'Before anyone can be assessed for weight loss surgery,
0:16:56 > 0:16:59'patients are required to complete a diet and exercise programme
0:16:59 > 0:17:03'known as Tier 3 for up to two years.'
0:17:03 > 0:17:06- Hi, good morning. Great to see you. - Welcome to RIO.
0:17:06 > 0:17:09Let me give you a tour and show you what we do here.
0:17:09 > 0:17:12'I've come to Rotherham to meet Dr Matthew Capehorn,
0:17:12 > 0:17:14'who runs one of these programmes.'
0:17:14 > 0:17:19We've got specialist equipment built for patients with severe obesity
0:17:19 > 0:17:23and we can actually tailor exercises specific to the individual.
0:17:23 > 0:17:27If they've got heart problems, we start off very gently and build up.
0:17:27 > 0:17:30'Not everyone here will want surgery,
0:17:30 > 0:17:33'but for those who have considered it, like Carol,
0:17:33 > 0:17:37'Tier 3 will help determine if it's the best course of treatment.'
0:17:37 > 0:17:42My initial thought was maybe I should try bariatric surgery
0:17:42 > 0:17:45because I had done diets and they had failed.
0:17:45 > 0:17:49- At that point, I weighed 21 and a half stone.- OK.
0:17:49 > 0:17:55And that was quite horrific and my BMI was 49.
0:17:55 > 0:18:02And in the last 18 months, I've gone down to 15st
0:18:02 > 0:18:05and my BMI is now 34.
0:18:05 > 0:18:10- That's brilliant.- So it has been a very radical change.- Absolutely.
0:18:10 > 0:18:13Hopefully, surgery won't be necessary
0:18:13 > 0:18:16because I know what I'm doing now.
0:18:16 > 0:18:18I know what I need to do.
0:18:18 > 0:18:22It is so important to have the right mental attitude
0:18:22 > 0:18:25and to develop that mental attitude
0:18:25 > 0:18:29because, effectively, this is a lifelong change.
0:18:29 > 0:18:34Sometimes it's the ups and downs of that weight loss....
0:18:34 > 0:18:37Diet and exercise is only part of the programme.
0:18:37 > 0:18:40To be effective, patients attend therapy sessions
0:18:40 > 0:18:42and behavioural workshops.
0:18:42 > 0:18:45So what we'll do now is we'll go into one of our group sessions,
0:18:45 > 0:18:47which is a problem-solving session
0:18:47 > 0:18:50for patients that are finding it difficult to lose weight.
0:18:51 > 0:18:54Lots of people out there, including health care professionals,
0:18:54 > 0:18:57who say, "Weight loss is simple,
0:18:57 > 0:19:00"you just need to eat less and exercise more..."
0:19:00 > 0:19:03Yes, but it doesn't work for everybody.
0:19:03 > 0:19:06I think it's quite ignorant for people to think things like that,
0:19:06 > 0:19:09unless you've been in the situation and you're finding yourself
0:19:09 > 0:19:11struggling every single day.
0:19:11 > 0:19:12We don't wake up in the morning
0:19:12 > 0:19:14and think, "Today, I want to be fat."
0:19:14 > 0:19:17You don't. It happens over a period of time
0:19:17 > 0:19:20and usually by the time you've found out, it's too late,
0:19:20 > 0:19:22you're already overweight.
0:19:22 > 0:19:24So all you can do then is try and stop that
0:19:24 > 0:19:27and try and work your way backwards to be healthy.
0:19:27 > 0:19:29People can binge drink, they can take drugs,
0:19:29 > 0:19:33they can smoke and things like that, but if you're overweight
0:19:33 > 0:19:37you must be lazy, you must eat loads and all this.
0:19:37 > 0:19:38I think there's too much prejudice
0:19:38 > 0:19:41involved with people that are overweight.
0:19:41 > 0:19:42I've seen it.
0:19:42 > 0:19:46People will nudge other people. You know, "Have a good look at her."
0:19:46 > 0:19:50It does hurt because you know that you're really trying your best
0:19:50 > 0:19:53and what I've found with coming to RIO is,
0:19:53 > 0:19:56it's helping me realise that these people,
0:19:56 > 0:20:00they are ignorant, I do agree with you,
0:20:00 > 0:20:02for having those opinions
0:20:02 > 0:20:04because, unfortunately, through my upbringing,
0:20:04 > 0:20:08I didn't know this is a good food, this is a bad food.
0:20:08 > 0:20:13So now I'm re-educating myself as to what goes in
0:20:13 > 0:20:18and what these foods will do to help myself lose that weight.
0:20:18 > 0:20:20Thank you so much for being so honest.
0:20:20 > 0:20:23I really appreciate your time and we'll leave you to your session.
0:20:23 > 0:20:25- Thank you. ALL:- Thank you.
0:20:25 > 0:20:27'I'm impressed with what I've seen.
0:20:27 > 0:20:30'This service helps over 1,000 people every year
0:20:30 > 0:20:34'and I think it's the ideal preparation for the small number
0:20:34 > 0:20:36'that then go on to have surgery.'
0:20:36 > 0:20:40So the key thing is, bariatric surgery or weight loss surgery
0:20:40 > 0:20:43is the most cost-effective weight-loss intervention
0:20:43 > 0:20:46for certain people, if it's the right person.
0:20:46 > 0:20:48But who's doing that screening?
0:20:48 > 0:20:52We need Tier 3 centres like this to identify the right person
0:20:52 > 0:20:55and also to treat the patients who, for whatever reason,
0:20:55 > 0:20:58aren't suitable for the weight loss surgery.
0:20:58 > 0:21:01You've got a fantastic service and facilities here.
0:21:01 > 0:21:04Is your funding going forward secure?
0:21:04 > 0:21:08No, it isn't in the slightest and it's very frustrating.
0:21:08 > 0:21:14We only have secure funding until July of 2017 and so we could end up,
0:21:14 > 0:21:17despite all of the great services that you've seen,
0:21:17 > 0:21:20we could lose all of it.
0:21:20 > 0:21:21That's worrying.
0:21:21 > 0:21:25How will our Rotherham patients feel if they lose the one place
0:21:25 > 0:21:29where they know they can come to where they get free NHS advice
0:21:29 > 0:21:33and support to actually help them lose the weight,
0:21:33 > 0:21:36become more healthy and get them that surgery?
0:21:36 > 0:21:38They must feel like second-class citizens.
0:21:40 > 0:21:45With services like this at risk of closure, it's clear to me
0:21:45 > 0:21:48that we're just not taking the obesity crisis seriously.
0:21:51 > 0:21:55If we're not getting it right here in Rotherham, that has one
0:21:55 > 0:22:00of the highest obesity levels anywhere, then what hope do we have?
0:22:01 > 0:22:05Without NHS diet and exercise programmes, people will be left
0:22:05 > 0:22:09with no support to lose weight or a pathway to surgery.
0:22:11 > 0:22:14Surgical intervention is the most effective treatment
0:22:14 > 0:22:17for long-term weight loss and improved health,
0:22:17 > 0:22:22but I'm concerned some patients don't even have access to Tier 3.
0:22:24 > 0:22:27'Last year, Professor John Wass carried out a report
0:22:27 > 0:22:32'on the availability of NHS Tier 3 services across England.'
0:22:32 > 0:22:35- Good trip?- Lovely, yes. I'm sorry about the weather. Terrible.
0:22:37 > 0:22:41John, you carried out this survey looking at Tier 3 provision
0:22:41 > 0:22:43on behalf of the Royal College of Physicians.
0:22:43 > 0:22:46How comprehensive is access to treatment?
0:22:46 > 0:22:49It's far from comprehensive.
0:22:49 > 0:22:52There's only 67% of the country covered now,
0:22:52 > 0:22:55so there's 30% or more not covered
0:22:55 > 0:22:58and that means there's a real postcode lottery.
0:22:58 > 0:23:03There is not adequate provision up and down the country to Tier 3
0:23:03 > 0:23:05and therefore to the surgery
0:23:05 > 0:23:10and I really do worry that the situation is going to get worse.
0:23:11 > 0:23:14'The NHS needs to be doing far more for people
0:23:14 > 0:23:18'struggling with their weight, but not everyone shares my opinion.'
0:23:19 > 0:23:21"I am a fatist.
0:23:21 > 0:23:25"I find obese people unappealing and they are a strain,
0:23:25 > 0:23:29"not only on their clothing, but on NHS resources.
0:23:30 > 0:23:34"The obese should pay for their treatments."
0:23:34 > 0:23:40Amanda Platell is a well-known newspaper columnist.
0:23:40 > 0:23:44Her views are read by millions.
0:23:46 > 0:23:53What this is doing, it's fuelling a public anti-obesity agenda.
0:23:53 > 0:23:58How are we going to even think of obesity as a real health problem
0:23:58 > 0:24:01if we're saying it's totally down to the individual?
0:24:01 > 0:24:04'As a professional who works with obesity every day,
0:24:04 > 0:24:08'I want to understand where Amanda's prejudice comes from.'
0:24:08 > 0:24:10- Nice to meet you. - It's good to meet you.
0:24:10 > 0:24:13Thank you so much for agreeing to chat with me today.
0:24:13 > 0:24:15I did have second thoughts about it because we do have
0:24:15 > 0:24:18quite different views on this whole subject.
0:24:18 > 0:24:22So for a person who is really struggling to lose weight,
0:24:22 > 0:24:25to read something in the newspaper that,
0:24:25 > 0:24:28actually, it's all their fault
0:24:28 > 0:24:31and they should have no support from the NHS,
0:24:31 > 0:24:35I think that's quite a damaging standpoint to take.
0:24:35 > 0:24:38These are self-inflicted conditions.
0:24:38 > 0:24:40People stuff their faces with too much food
0:24:40 > 0:24:42and don't get off the sofa.
0:24:42 > 0:24:44You've spent all this money on wrecking your life
0:24:44 > 0:24:48and wrecking your body and now you expect us to pick up the tab.
0:24:48 > 0:24:51I think that's a very interesting view.
0:24:51 > 0:24:53There are lots of people not getting any treatment,
0:24:53 > 0:24:56there are lots of old people who are not getting meals provided for them
0:24:56 > 0:24:58because so many billions now
0:24:58 > 0:25:00are going into treating people who are fat.
0:25:00 > 0:25:03We know that, actually, weight loss surgery
0:25:03 > 0:25:08reduces the cost of the drugs, reduces the chances of dying by 40%.
0:25:08 > 0:25:10Gastric bands, basically. That's what you're talking about.
0:25:10 > 0:25:12- It's not gastric bands.- OK.
0:25:12 > 0:25:17So it's specifically not gastric bands, it's gastric bypass.
0:25:17 > 0:25:20- OK, so it's much more severe. - It's gastrectomy.
0:25:20 > 0:25:22Well, if they had surgery today,
0:25:22 > 0:25:27they would most likely go home tomorrow off all their treatment.
0:25:27 > 0:25:31And when people come back six months after surgery,
0:25:31 > 0:25:33they've lost my body weight and more.
0:25:33 > 0:25:36And that weight stays off for lifelong.
0:25:36 > 0:25:39It's not that it restricts the ability to eat,
0:25:39 > 0:25:42it changes the way their brain responds to food.
0:25:42 > 0:25:45But surely if someone's faced with something like,
0:25:45 > 0:25:48here's a drug we can give to a young mum with breast cancer
0:25:48 > 0:25:50so she can have five extra years of life,
0:25:50 > 0:25:54compared to someone who comes in really overweight,
0:25:54 > 0:25:57the sympathy is going to be all in the other direction.
0:25:57 > 0:26:00But you've highlighted some of the key problems
0:26:00 > 0:26:02that come with overweight and obesity.
0:26:02 > 0:26:06As you increase your body fat mass, then your chances of dying,
0:26:06 > 0:26:10your chances of diabetes, your chances of cancer really escalate.
0:26:10 > 0:26:12That's the interesting thing you've said.
0:26:12 > 0:26:15If you're fat, you're much more likely
0:26:15 > 0:26:16to get a whole range of cancers.
0:26:16 > 0:26:19But that education isn't out there.
0:26:19 > 0:26:21You know, I can see on a pure calculation,
0:26:21 > 0:26:24if you take someone who is not treated
0:26:24 > 0:26:26and is obese for their entire life,
0:26:26 > 0:26:29they're going to be a huge burden on the NHS and the taxpayer.
0:26:29 > 0:26:34And if you just take the cold hard facts - a really obese person,
0:26:34 > 0:26:38an operation that will be paid for on the NHS
0:26:38 > 0:26:41to treat them within a few years, the outcome of this
0:26:41 > 0:26:44is that they will not go back to being obese again.
0:26:44 > 0:26:46- Yes.- It's kind of a win-win.
0:26:46 > 0:26:48It's incredibly effective.
0:26:48 > 0:26:51But we're not using it in terms of a treatment.
0:26:55 > 0:27:00The right information just isn't out there, but if I can sway Amanda,
0:27:00 > 0:27:03I'm hopeful society's views towards weight loss surgery
0:27:03 > 0:27:05can also be changed.
0:27:07 > 0:27:10Prejudice against weight can leave people like Mark
0:27:10 > 0:27:12feeling unworthy of help.
0:27:13 > 0:27:16'I wish something had worked and I didn't have to have the operation,
0:27:16 > 0:27:19'but I know that it's the only way
0:27:19 > 0:27:21'that I can get out of the hole that I've dug...'
0:27:21 > 0:27:23- Nice to meet you.- You too. - Come down.
0:27:23 > 0:27:26'..many people would say myself and I accept that.'
0:27:28 > 0:27:30- Come and have a seat.- Thank you.
0:27:30 > 0:27:34'At the end of the day, the only person to blame is myself.'
0:27:36 > 0:27:39So, your weight is at the moment 196kg.
0:27:39 > 0:27:43- That presents a significant challenge to your health.- Yes.
0:27:43 > 0:27:46Not only just your sciatica, but your health in general,
0:27:46 > 0:27:49life expectancy, all this sort of thing.
0:27:49 > 0:27:52So there's no doubt that moving for surgery
0:27:52 > 0:27:55to help you reduce your weight and get you to a healthier weight
0:27:55 > 0:27:58is going to be your best option.
0:28:00 > 0:28:03I'm sort of, like, worried a little bit
0:28:03 > 0:28:06because half of me is thinking I really need this surgery,
0:28:06 > 0:28:11- but then the other half is thinking do I deserve the surgery?- OK.
0:28:14 > 0:28:18This is the picture that gives me a little bit of inspiration
0:28:18 > 0:28:22cos I would like to get back to the way I looked then.
0:28:22 > 0:28:24I'm about 29.
0:28:24 > 0:28:27It's not a good sight, is it?
0:28:28 > 0:28:31It's not a good sight at all.
0:28:31 > 0:28:33I'm sorry, I've got to sit down again.
0:28:39 > 0:28:44Mark has sciatica, a trapped nerve, that is restricting his mobility.
0:28:46 > 0:28:50He has to take painkillers at 3:30 every morning
0:28:50 > 0:28:52so that he can work as a driver.
0:28:54 > 0:28:56I got lost in the system
0:28:56 > 0:29:01and I then took matters into my own hands and phoned up.
0:29:01 > 0:29:03They said, "You've been in the system too long,
0:29:03 > 0:29:08"we need to move on now and get you the surgery as quickly as possible."
0:29:08 > 0:29:11Normally, it's about 18 months to go through the programme.
0:29:11 > 0:29:17In my case, it just ended up that it was about four years
0:29:17 > 0:29:21and I know that the only way now is to have that operation
0:29:21 > 0:29:24because I know that it will basically save my life.
0:29:24 > 0:29:27And if I carry on the way that I am
0:29:27 > 0:29:30or if I'm left the way I am, I will die.
0:29:30 > 0:29:34We know that for people in your situation,
0:29:34 > 0:29:38an operation is going to give you the best health outcome,
0:29:38 > 0:29:40not only in the short term, but in the long-term.
0:29:40 > 0:29:44When we look at life expectancy, when we look at the chance
0:29:44 > 0:29:48of you having a lower risk of heart attack, a lower risk of stroke.
0:29:48 > 0:29:50I mean, look, you're young.
0:29:50 > 0:29:52You're only 56 so you've got a lot of time ahead of you,
0:29:52 > 0:29:54so you need to have healthy time of it.
0:29:54 > 0:29:56And I would say to you
0:29:56 > 0:29:59that over the course of the next six to eight months,
0:29:59 > 0:30:02you will probably lose about 1st a month.
0:30:02 > 0:30:05The most important thing is that it's the right thing for you
0:30:05 > 0:30:08and it's the treatment that's going to make you healthy again.
0:30:08 > 0:30:12I'll see you again on the day that you have your operation.
0:30:12 > 0:30:16Smashing, you don't know how much of a weight that is from me.
0:30:16 > 0:30:18- Good on you, Mark.- Thank you very much.- We'll get there.
0:30:18 > 0:30:21- Right, let me show you out. - Thank you.
0:30:21 > 0:30:25I think, if this was another health issue, there'd be more emphasis
0:30:25 > 0:30:28and determination in seeking effective treatments.
0:30:28 > 0:30:31But I think, as a health community,
0:30:31 > 0:30:34we are tending to ignore this as a problem,
0:30:34 > 0:30:38and this isn't difficult on an individual level,
0:30:38 > 0:30:41this is difficult on a global level.
0:30:41 > 0:30:46And we are suffering, in the Western world particularly,
0:30:46 > 0:30:50from the health consequences of weight.
0:30:53 > 0:30:56Let's look at the bigger picture here in Britain.
0:30:56 > 0:30:59How widespread has the obesity crisis become?
0:31:00 > 0:31:03Figures published by The Lancet show
0:31:03 > 0:31:07that there are 14.5 million people with obesity in the UK.
0:31:07 > 0:31:11And it's estimated that, by 2030, this number will rise
0:31:11 > 0:31:15by a further 11 million new cases across Britain.
0:31:15 > 0:31:17And what are the costs?
0:31:17 > 0:31:19Currently, the NHS spends
0:31:19 > 0:31:22£5.1 billion every year on obesity.
0:31:24 > 0:31:28This is expected to rise to £10-12 billion by 2030.
0:31:30 > 0:31:33Despite the rise in obesity,
0:31:33 > 0:31:36the numbers of NHS surgeries are falling.
0:31:36 > 0:31:41The European average is 50,000 operations each year.
0:31:41 > 0:31:45But here in the UK, we only do just over 6,000.
0:31:47 > 0:31:51The only option for some people is to go private.
0:31:51 > 0:31:5452-year-old Karen was so desperate,
0:31:54 > 0:31:58she felt she had no option but to pay for her surgery two years ago.
0:31:58 > 0:32:01That's what I used to look like.
0:32:03 > 0:32:08I was quite ill, I was sort of bloated out with water retention,
0:32:08 > 0:32:12and it was causing all my other organs to fail.
0:32:15 > 0:32:17I was too young to die.
0:32:17 > 0:32:21But it would have been on the cards if it had carried on.
0:32:21 > 0:32:24You never used to like your picture being taken before.
0:32:24 > 0:32:26- Oh, no, I do now.- It was very hard to get a picture of you.
0:32:26 > 0:32:29The surgery actually cost me £11,000.
0:32:29 > 0:32:34I had some inheritance from my mother's estate
0:32:34 > 0:32:39which led to the fact that I could have it done.
0:32:39 > 0:32:42I was 25st there.
0:32:44 > 0:32:47And this is me at 12½ stone.
0:32:48 > 0:32:51It's just such a difference.
0:32:54 > 0:32:56That's my mum.
0:32:58 > 0:33:02She never got to see my transformation.
0:33:02 > 0:33:05- She always wanted you to lose weight.- Yeah.
0:33:05 > 0:33:08It is bittersweet that she never got to see it.
0:33:10 > 0:33:12I'm sorry.
0:33:15 > 0:33:19I don't think I could have taken the risk going on the Tier 3 system
0:33:19 > 0:33:22because I don't think I could have waited that long.
0:33:22 > 0:33:25I don't think I would have lasted.
0:33:28 > 0:33:34In England, there are 209 clinical commissioning groups - CCGs -
0:33:34 > 0:33:38who are given two-thirds of the NHS budget.
0:33:38 > 0:33:42CCGs have the responsibility of how to spend that money,
0:33:42 > 0:33:44and the situation for obese people
0:33:44 > 0:33:48in many parts of England is about to get worse.
0:33:48 > 0:33:51They face being denied access to routine care,
0:33:51 > 0:33:52like hip operations,
0:33:52 > 0:33:55that are readily available to non-obese patients.
0:33:55 > 0:33:57If you're in the Vale of York
0:33:57 > 0:34:00and you have a BMI of over 30, which is obese,
0:34:00 > 0:34:03then you can't have orthopaedic surgery to replace a knee.
0:34:03 > 0:34:07The bottom line is that the money is not there
0:34:07 > 0:34:12And this means that this group of people is actually disenfranchised.
0:34:12 > 0:34:16They're actually illegitimately sort of victimised, if you like.
0:34:16 > 0:34:19There are some people that have been waiting for huge lengths of time.
0:34:19 > 0:34:24So, in certain areas of the country, if you have a BMI over 30,
0:34:24 > 0:34:27then you're discriminated against in that you can't have access
0:34:27 > 0:34:32to surgery that other members of the population can have.
0:34:32 > 0:34:33How can that be fair?
0:34:33 > 0:34:35It's not fair.
0:34:36 > 0:34:38And it's not just the Vale of York CCG
0:34:38 > 0:34:41delaying treatment based on a person's BMI.
0:34:41 > 0:34:44A recent report from the Royal College of Surgeons
0:34:44 > 0:34:49found that about one in three CCGs have a mandatory threshold
0:34:49 > 0:34:53to access surgery based on weight and smoking status.
0:34:54 > 0:34:58We asked the Vale of York CCG for an interview.
0:34:58 > 0:35:00But they declined our offer.
0:35:00 > 0:35:04A number of CCGs with similar criteria also refused
0:35:04 > 0:35:07to explain the rationale behind their policy.
0:35:07 > 0:35:12However, north-east Essex CCG, who have a BMI threshold
0:35:12 > 0:35:16of below 35 for routine surgery, did agree to speak to us.
0:35:17 > 0:35:21This shouldn't really be seen as a cost-cutting exercise
0:35:21 > 0:35:23because what we're hoping for is that
0:35:23 > 0:35:26when we have patients who have a body mass in excess of 35,
0:35:26 > 0:35:29they're able to put into place a change in their lifestyle
0:35:29 > 0:35:32that allows them to bring their body mass index below 35
0:35:32 > 0:35:35and we can still carry on and have that surgical procedure.
0:35:35 > 0:35:38But through the process, they may have gained a health advantage.
0:35:38 > 0:35:42If you start discriminating on who should have treatment
0:35:42 > 0:35:46on the grounds that there are one lot perhaps who are seen
0:35:46 > 0:35:49as secondary citizens because they happen to be overweight
0:35:49 > 0:35:53compared with those that have led a more healthy life,
0:35:53 > 0:35:56I think that's creating a two-tier NHS.
0:35:56 > 0:35:57Now, that's not good.
0:35:57 > 0:36:02That is rationing on grounds that really are not humane.
0:36:03 > 0:36:06Bear in mind, this isn't meant to be a punitive measure,
0:36:06 > 0:36:09it's meant to be around improving better health outcomes
0:36:09 > 0:36:12for our patients, and so that's why we put it in place.
0:36:13 > 0:36:16NHS England issued a statement saying,
0:36:16 > 0:36:20ultimately, these are legally decisions for CCGs,
0:36:20 > 0:36:24but informed by best evidence and national guidance where appropriate.
0:36:24 > 0:36:2869-year-old Helen is waiting for a hip replacement,
0:36:28 > 0:36:31but she's been told to lose 5st
0:36:31 > 0:36:34before she can be referred for surgery.
0:36:34 > 0:36:38I've struggled with weight, really, since a child.
0:36:41 > 0:36:45When I was ten, I had osteomyelitis,
0:36:45 > 0:36:50which caused my ankle to be really misshapen.
0:36:50 > 0:36:52As the years have gone on,
0:36:52 > 0:36:56it's made my knee and my hip start to go.
0:36:57 > 0:36:59It's like the chicken or the egg.
0:36:59 > 0:37:01Which comes first, the losing of weight,
0:37:01 > 0:37:05which isn't going very fast, if at all,
0:37:05 > 0:37:09or having the operation and being able to move around a little?
0:37:09 > 0:37:13Five years ago, we went dancing,
0:37:13 > 0:37:17I went to exercise classes,
0:37:17 > 0:37:21I can't do any of that now because I can't walk fast enough.
0:37:21 > 0:37:26I'll get... Well, if you bring it down for me.
0:37:26 > 0:37:28- OK.- Are you OK?- Yeah.
0:37:29 > 0:37:32I just think, in the future, if I don't have anything done,
0:37:32 > 0:37:34I will end up in a wheelchair.
0:37:36 > 0:37:39But I used to do all this area of gardening.
0:37:40 > 0:37:44- That was her bit. - Yes, that area was my bit.
0:37:44 > 0:37:48And I just can't get down to it. It hurt too much.
0:37:48 > 0:37:51We can't see any way out of it, really, this hip.
0:37:51 > 0:37:52It's going to get worse.
0:37:52 > 0:37:56And they keep on telling her that she's got to lose this weight,
0:37:56 > 0:38:00but it's quite hard to lose weight when you can't exercise.
0:38:00 > 0:38:01Okey doke.
0:38:05 > 0:38:10I am getting worse, and I do feel as though I could be housebound.
0:38:16 > 0:38:17I just...
0:38:17 > 0:38:20Yes, I just find that...
0:38:20 > 0:38:26um...it's something that will probably never happen.
0:38:28 > 0:38:31How hard is it to lose weight when going it alone?
0:38:33 > 0:38:37A recent UK-wide study of patients with simple obesity
0:38:37 > 0:38:41by King's College London showed the annual chance for women
0:38:41 > 0:38:45returning to normal weight was 1 in 124,
0:38:45 > 0:38:47and 1 in 210 for men.
0:38:49 > 0:38:53For those with severe obesity, it was 1 in 677 for women,
0:38:53 > 0:38:57and 1 in 1,290 for men.
0:38:58 > 0:39:02To make matters worse, for the few who did lose weight,
0:39:02 > 0:39:0678% put it back on after five years.
0:39:15 > 0:39:19Mark's road to surgery has taken four years,
0:39:19 > 0:39:22and today he's finally getting his treatment.
0:39:22 > 0:39:25It's like the light is at the end of the tunnel.
0:39:28 > 0:39:32It's a life-changing operation
0:39:32 > 0:39:35and it's going to improve my life no end.
0:39:36 > 0:39:40Many people believe Mark's treatment is too expensive.
0:39:40 > 0:39:41And it's true to say
0:39:41 > 0:39:45the NHS can't afford to operate on everyone who qualifies.
0:39:45 > 0:39:49- Hello there.- Hi.- If you'd like to take your gown off...
0:39:49 > 0:39:53A number of studies state that weight-loss surgery pays for itself
0:39:53 > 0:39:56within two to three years due to savings on drugs.
0:39:58 > 0:40:01A recent more comprehensive study by King's College
0:40:01 > 0:40:04found that despite the cost of weight-loss surgery -
0:40:04 > 0:40:06between £7,000 and £10,000 -
0:40:06 > 0:40:09it's one of the most cost-effective treatments
0:40:09 > 0:40:12of any kind available to the NHS.
0:40:12 > 0:40:14There we go, all done. Thanks, Hazel.
0:40:14 > 0:40:15Cheers, Sharon, Cheers, Rich.
0:40:15 > 0:40:17We can't say it will save money
0:40:17 > 0:40:20because Mark's life expectancy will increase
0:40:20 > 0:40:23and it's impossible to predict what care he might need
0:40:23 > 0:40:25as he becomes older.
0:40:26 > 0:40:28But with existing weight-loss surgery centres,
0:40:28 > 0:40:33we could increase surgery numbers to 25,000 each year
0:40:33 > 0:40:36and help more people live healthier and longer lives.
0:40:38 > 0:40:40Obviously, it's a second chance.
0:40:41 > 0:40:44I just don't want to be like this any more.
0:40:53 > 0:40:57I'm on my way to Harrogate to meet 59-year-old accountant Philippa.
0:40:59 > 0:41:03Like many people in this film, she has multiple health problems
0:41:03 > 0:41:06and has asked for weight-loss surgery,
0:41:06 > 0:41:08but has been refused at every turn.
0:41:09 > 0:41:12However, there's a chance I can help.
0:41:13 > 0:41:14- Hi, Philippa.- Hello. - Lovely to meet you.
0:41:14 > 0:41:17- Thank you so much for letting me come and see you.- Come on in.
0:41:17 > 0:41:21When you went and asked about weight-loss surgery,
0:41:21 > 0:41:23can you remember what your BMI was?
0:41:23 > 0:41:28Um, my BMI has been over 50 for quite a while now.
0:41:28 > 0:41:30Um...
0:41:30 > 0:41:33the overall impression that I was left with
0:41:33 > 0:41:39was that I wasn't worthy of being considered.
0:41:41 > 0:41:44I'm sorry to have to tell you this,
0:41:44 > 0:41:48but you did qualify for weight-loss surgery
0:41:48 > 0:41:51because you had a BMI of over 50.
0:41:53 > 0:41:56- So...- That's even more upsetting...
0:41:57 > 0:41:59..that I was just dismissed.
0:42:02 > 0:42:05So, what's happened since?
0:42:05 > 0:42:08Having had the family here at Christmas...
0:42:09 > 0:42:13..and some of them concerned about my general health...
0:42:14 > 0:42:18..um, I decided to go back to my GP
0:42:18 > 0:42:22and ask again about weight-loss surgery.
0:42:22 > 0:42:26He was saying that because of my heart condition,
0:42:26 > 0:42:30I wouldn't be referred for weight-loss surgery.
0:42:30 > 0:42:34- What heart condition? - I've got atrial fibrillation...
0:42:35 > 0:42:41..which was diagnosed in September '15.
0:42:41 > 0:42:47So you've had an irregular heartbeat for over a year and a half, really?
0:42:47 > 0:42:51But the consultant said that,
0:42:51 > 0:42:54because of my weight,
0:42:54 > 0:42:58they weren't prepared to operate, to do even...
0:42:58 > 0:43:01um...
0:43:01 > 0:43:03to restart my heart.
0:43:03 > 0:43:08So I seem to be in a Catch-22 situation.
0:43:08 > 0:43:11We commonly see people with your heart condition,
0:43:11 > 0:43:14if you can't have the heart condition treated
0:43:14 > 0:43:17because of their weight, who we operate on,
0:43:17 > 0:43:21they lose the weight and then they have the heart condition treated.
0:43:23 > 0:43:28Potentially, if you'd had the surgery five years ago,
0:43:28 > 0:43:31then you wouldn't have developed the heart condition
0:43:31 > 0:43:34because there is a link between the two.
0:43:38 > 0:43:41I'm ashamed to work in a health care profession
0:43:41 > 0:43:44that actually treats people in such a manner.
0:43:45 > 0:43:48- And we shouldn't be doing it.- No.
0:43:51 > 0:43:54I...I actually can't believe
0:43:54 > 0:43:56that, basically, she's been left.
0:43:56 > 0:44:02She has severe obesity, type 2 diabetes, a heart condition,
0:44:02 > 0:44:05and she's stuck.
0:44:07 > 0:44:11I just think that it's terrible that we're leaving people
0:44:11 > 0:44:14in this situation with effectively no way out
0:44:14 > 0:44:17and not supporting them at all.
0:44:19 > 0:44:22Philippa needs surgery for health reasons.
0:44:22 > 0:44:26I'm going to see what I can do to get her the help she needs
0:44:26 > 0:44:28before it's too late.
0:44:30 > 0:44:33I'm really concerned that more people like Philippa
0:44:33 > 0:44:35will be denied access to weight-loss surgery
0:44:35 > 0:44:39because of the recent funding changes for this treatment,
0:44:39 > 0:44:42switching from NHS England to CCGs.
0:44:42 > 0:44:46The way that weight-loss surgery is funded is going to change.
0:44:46 > 0:44:49So it's going to go from being centrally funded
0:44:49 > 0:44:51- to locally commissioned.- Yeah.
0:44:51 > 0:44:53What impact is that likely to have?
0:44:53 > 0:44:56When the money comes down from NHS England,
0:44:56 > 0:44:59I worry that it won't get ring-fenced,
0:44:59 > 0:45:04so it could easily be absorbed in the CCG's general financial pool.
0:45:04 > 0:45:07And we already know that there are huge members of CCGs
0:45:07 > 0:45:11that are in financial difficulties, which is a real worry.
0:45:13 > 0:45:16If Philippa doesn't get the help she needs,
0:45:16 > 0:45:19her health is set to get worse.
0:45:19 > 0:45:22I can't stand by and let that happen.
0:45:22 > 0:45:25Her referral has been a real race against time.
0:45:25 > 0:45:28And if I'd seen her just a few weeks later,
0:45:28 > 0:45:32then she wouldn't have been able to access weight-loss surgery.
0:45:34 > 0:45:39The CCG were arguing that she hadn't been through Tier 3.
0:45:40 > 0:45:43Her CCG doesn't offer Tier 3,
0:45:43 > 0:45:46so, effectively, Philippa is stuck.
0:45:46 > 0:45:48Despite my intervention,
0:45:48 > 0:45:52her CCG are still intent on refusing her treatment.
0:45:52 > 0:45:56And this latest setback was hard for Philippa to take.
0:45:57 > 0:46:03I received a copy of an e-mail to say that there was
0:46:03 > 0:46:07no funding available and that I wasn't eligible.
0:46:08 > 0:46:12I was numbed that evening.
0:46:14 > 0:46:20I probably demolished more food in three hours
0:46:20 > 0:46:24than a normal person would have eaten in one day.
0:46:26 > 0:46:29We can offer her the Tier 3
0:46:29 > 0:46:33and the assessment for weight-loss surgery at the same time.
0:46:33 > 0:46:39So her CCG has finally agreed that Philippa can go forward
0:46:39 > 0:46:41to be assessed for surgery.
0:46:43 > 0:46:45Without my intervention,
0:46:45 > 0:46:50I very much doubt that Philippa would be alive in five years' time.
0:46:51 > 0:46:53I'm just...
0:46:54 > 0:46:57..one of the lucky ones that...
0:47:00 > 0:47:03..I've been given this opportunity.
0:47:05 > 0:47:08If we're serious about tackling obesity,
0:47:08 > 0:47:12we need effective prevention and treatments, including
0:47:12 > 0:47:17investing far more in surgery, as the results speak for themselves.
0:47:18 > 0:47:2226-year-old Michael had weight-loss surgery
0:47:22 > 0:47:24here at UCLH just nine months ago.
0:47:26 > 0:47:28I weighed about 28½ stone
0:47:28 > 0:47:31and this was four or five weeks ago now,
0:47:31 > 0:47:33where I've lost 7st 13lb
0:47:33 > 0:47:37where I'm now 22st,
0:47:37 > 0:47:40which is quite a big difference.
0:47:40 > 0:47:43Michael is now helping us with our research
0:47:43 > 0:47:45to understand the benefits of surgery.
0:47:45 > 0:47:47- How are you doing?- You look fantastic.- Thank you.
0:47:47 > 0:47:50- Since last time I saw you. - I'm feeling very well,
0:47:50 > 0:47:51- thank you, yeah.- Sit down.- Cheers.
0:47:51 > 0:47:54'What makes this treatment successful long-term
0:47:54 > 0:47:57'are the biological changes to the body.'
0:47:57 > 0:48:00So, what taste changes have you noticed?
0:48:01 > 0:48:03Realistically, it just feels like
0:48:03 > 0:48:06everything is being taken up a level in sensitivity.
0:48:06 > 0:48:08Saltier foods, fattier foods,
0:48:08 > 0:48:13you can bear them a lot less than you used to be able to.
0:48:13 > 0:48:16But I think mainly it doesn't amplify the sense of taste
0:48:16 > 0:48:18is what I've noticed,
0:48:18 > 0:48:22which ensures you have a greater balance and variety
0:48:22 > 0:48:25of what you have, rather than having the same things,
0:48:25 > 0:48:27the same textures and same tastes over and over again.
0:48:29 > 0:48:32Our research is helping us to understand why some people
0:48:32 > 0:48:35are more likely to put weight on than others.
0:48:35 > 0:48:39We'll be giving you three samples, and for each one, I'll ask you
0:48:39 > 0:48:42to taste them and tell me which one tastes different to the other two.
0:48:42 > 0:48:43OK.
0:48:44 > 0:48:48What we're seeing is that immediately after surgery,
0:48:48 > 0:48:52the hormones coming from the gut that are present in the blood
0:48:52 > 0:48:56completely change, and we know that these hormones act on the brain
0:48:56 > 0:48:59to control how hungry a person feels.
0:48:59 > 0:49:03We also know that these gut hormones affect taste
0:49:03 > 0:49:06because they bind to the taste buds in the mouth
0:49:06 > 0:49:10and change what sort of food a person will crave for.
0:49:12 > 0:49:15I'd say the first one is definitely different.
0:49:15 > 0:49:17When a person has surgery,
0:49:17 > 0:49:20what our research is really helping us to understand
0:49:20 > 0:49:23is why weight loss with dieting
0:49:23 > 0:49:27is so difficult for the vast majority of people,
0:49:27 > 0:49:31whereas weight loss with surgery and the changes in their hormones
0:49:31 > 0:49:35actually really help them to continue to lose weight,
0:49:35 > 0:49:39but, more importantly, to keep that weight off in the long term.
0:49:40 > 0:49:44We know some people are predisposed to gain weight.
0:49:44 > 0:49:49But the latest research doesn't seem to be widely understood or accepted,
0:49:49 > 0:49:52even amongst health care professionals.
0:49:57 > 0:50:02'If we're going to increase the number of NHS weight-loss surgeries,
0:50:02 > 0:50:05'we need to educate the wider medical profession
0:50:05 > 0:50:07'on how the surgery works.
0:50:07 > 0:50:11'So I've invited a group of GPs and CCG commissioners
0:50:11 > 0:50:13'to share my research with.
0:50:13 > 0:50:17'These are the people I have to convince.'
0:50:17 > 0:50:19Thank you, all of you, for coming today.
0:50:19 > 0:50:25I really need your help to try and understand why GPs and commissioners
0:50:25 > 0:50:30are not really pushing for more access to bariatric surgery.
0:50:30 > 0:50:32So, how is it working?
0:50:32 > 0:50:37It's become recognised that the gut plays a key role
0:50:37 > 0:50:42in regulating how hungry you feel and also your blood glucose.
0:50:42 > 0:50:46Now, there's a gut hormone called peptide YY.
0:50:46 > 0:50:49And when a person eats, the levels in the blood go up
0:50:49 > 0:50:52and they stay elevated for several hours,
0:50:52 > 0:50:53depending on what you've eaten.
0:50:53 > 0:50:58Children and adults with obesity have low levels of this hormone
0:50:58 > 0:51:00that tells your brain if you've eaten.
0:51:00 > 0:51:04So, when they eat, the brain isn't getting the right signal
0:51:04 > 0:51:06to say you've eaten enough food.
0:51:06 > 0:51:09Ghrelin, which has been dubbed the hunger hormone,
0:51:09 > 0:51:14we know that this hormone again acts on your brain to tell you to eat.
0:51:14 > 0:51:19After surgery, PYY, which is a fullness hormone, they go up.
0:51:19 > 0:51:23Ghrelin, which is the hunger hormone, goes really down.
0:51:23 > 0:51:26And why do we get the taste changes?
0:51:26 > 0:51:30Well, in your saliva, you have all these gut hormones
0:51:30 > 0:51:32and your taste buds have got receptors
0:51:32 > 0:51:35where these hormones bind to.
0:51:35 > 0:51:38So, when we change these hormones coming from the gut,
0:51:38 > 0:51:42we change the saliva and we change taste perception
0:51:42 > 0:51:45and how people taste different foods.
0:51:45 > 0:51:48Patients no longer feel hungry.
0:51:48 > 0:51:49And when we image their brain,
0:51:49 > 0:51:52their brain now responds completely differently
0:51:52 > 0:51:54when we show them pictures of food.
0:51:54 > 0:51:57By replumbing the gut, we're changing the nerves,
0:51:57 > 0:51:59we're changing the micro-biome,
0:51:59 > 0:52:02and it's all of these things together
0:52:02 > 0:52:06which lead to the beneficial effects of surgery.
0:52:07 > 0:52:09I'd really like your comments
0:52:09 > 0:52:13as to why you think that weight-loss bariatric surgery
0:52:13 > 0:52:17isn't being more widely commissioned or being made available.
0:52:17 > 0:52:19Well, first of all, I do confess
0:52:19 > 0:52:22that I wasn't aware and perhaps it was more of a misconception
0:52:22 > 0:52:24of the risk, or less risk,
0:52:24 > 0:52:27in terms of the surgical interventions.
0:52:27 > 0:52:31So, what's missing in order to really facilitate
0:52:31 > 0:52:34the right treatment to the right person?
0:52:34 > 0:52:39I guess... I feel that there probably is lack of awareness
0:52:39 > 0:52:44of what is the outcomes that can be achieved
0:52:44 > 0:52:47of bariatric surgery, Tier 4.
0:52:47 > 0:52:50And I wasn't entirely aware of the hormone studies
0:52:50 > 0:52:54that you've quoted as well. It's interesting to see that.
0:52:54 > 0:52:57I don't think there's any question that there is great benefit
0:52:57 > 0:52:59in managing obesity and treating obesity.
0:52:59 > 0:53:02The difficulty is that I think there probably is
0:53:02 > 0:53:04a lack of information out there at primary care level
0:53:04 > 0:53:07in terms of the benefits and balancing the risks.
0:53:07 > 0:53:10And I don't know whether there's a great deal of public sympathy
0:53:10 > 0:53:13out there for obesity. And I think that's a barrier.
0:53:13 > 0:53:19I completely agree that this kind of surgery is extremely effective,
0:53:19 > 0:53:20impressively effective.
0:53:20 > 0:53:26But, for many people, and we are influenced by society at large,
0:53:26 > 0:53:31many people's view is that morbid obesity is a lifestyle choice,
0:53:31 > 0:53:32it's self-inflicted.
0:53:32 > 0:53:35There's a lack of sympathy.
0:53:35 > 0:53:38And that impinges on the decisions that we make sometimes.
0:53:38 > 0:53:40It's a pity, but I think it's the case.
0:53:40 > 0:53:43I think that, as health care professionals,
0:53:43 > 0:53:45we really need to instigate this.
0:53:45 > 0:53:47See, I think, until doctors take it seriously,
0:53:47 > 0:53:50how can we expect patients to?
0:53:51 > 0:53:55We probably have got an unconscious bias over obesity.
0:53:55 > 0:53:57- Thank you so much for your time. - Thank you very much.
0:53:57 > 0:53:59Really appreciate it.
0:53:59 > 0:54:02I think raising that scientific justification
0:54:02 > 0:54:05for bariatric surgery is the biggest take-home message.
0:54:06 > 0:54:08As a commissioning group,
0:54:08 > 0:54:11we would be accountable to our population for our standing.
0:54:11 > 0:54:14So it's just about getting the country better informed,
0:54:14 > 0:54:17as well as clinicians, around the benefits and the merits
0:54:17 > 0:54:18for bariatric surgery.
0:54:19 > 0:54:22I find it quite surprising that there seemed to be
0:54:22 > 0:54:26a lack of understanding of the health benefits
0:54:26 > 0:54:29and also a complete lack of understanding
0:54:29 > 0:54:31of how the surgery works.
0:54:31 > 0:54:33It tells me that we obviously need to do
0:54:33 > 0:54:38a lot more to actually get out to CCGs, to talk to GPs,
0:54:38 > 0:54:42about the health benefits that surgery can bring.
0:54:51 > 0:54:55It's just over three weeks since Mark had his operation.
0:54:57 > 0:55:01So, what I've got here tonight is some potatoes,
0:55:01 > 0:55:06boiled potatoes, fish in a parsley sauce, and that's basically it.
0:55:06 > 0:55:09Tonight's dinner.
0:55:09 > 0:55:13I've actually lost about 1½ stone.
0:55:13 > 0:55:17I've never, never lost weight like that before.
0:55:17 > 0:55:22In all of the diets, all of the plans that I've been on,
0:55:22 > 0:55:26I've never lost anywhere near as much as I have now.
0:55:28 > 0:55:32It's been a life change already, and we're just three weeks in.
0:55:40 > 0:55:43This meal here is going to take me
0:55:43 > 0:55:45at least 20 minutes to eat.
0:55:47 > 0:55:48If not longer.
0:55:49 > 0:55:53Because I try to let everything settle before I take another bite.
0:55:58 > 0:56:01Sometimes you feel it going down
0:56:01 > 0:56:02and, er...
0:56:03 > 0:56:06..it's...there's like a little button,
0:56:06 > 0:56:08it's the best way to explain it,
0:56:08 > 0:56:12that you sort of think, you know, "Is that too much?"
0:56:12 > 0:56:14Or, "Did I chew that right?"
0:56:14 > 0:56:19That's why I tend to try to use just half a teaspoon at a time.
0:56:21 > 0:56:24So I don't put too much in.
0:56:30 > 0:56:33Ever since the op, I've felt a different person, to be honest.
0:56:33 > 0:56:36I'd been out for a meal, not a problem.
0:56:36 > 0:56:39I just order from the kiddies. The kiddies menu.
0:56:41 > 0:56:42So I'm a cheap date.
0:56:49 > 0:56:52This has about done me, to be honest.
0:56:52 > 0:56:56And the other beautiful thing is, since the operation,
0:56:56 > 0:57:01I'm actually off my meds as well, completely.
0:57:02 > 0:57:06My blood pressure has gone back to normal.
0:57:08 > 0:57:10Happy days.
0:57:17 > 0:57:20We all know someone whose life is affected by their weight.
0:57:20 > 0:57:25I began the programme by asking who is to blame
0:57:25 > 0:57:29and why more is not being done to tackle our obesity crisis.
0:57:29 > 0:57:34Commissioning of obesity services to help people manage their weight
0:57:34 > 0:57:35is a postcode lottery.
0:57:37 > 0:57:40Worse still, many of the people that we've met,
0:57:40 > 0:57:42including health care professionals,
0:57:42 > 0:57:47believe that there's a prejudice within the NHS that is preventing
0:57:47 > 0:57:51people struggling with their weight from accessing health care services.
0:57:51 > 0:57:56Weight-loss surgery really can transform a person's life.
0:57:56 > 0:58:02But despite this, I fear that the number of operations undertaken
0:58:02 > 0:58:04is going to fall even further.
0:58:04 > 0:58:08This will effectively condemn thousands of people
0:58:08 > 0:58:10to years of unnecessary ill health.
0:58:12 > 0:58:16Rather than adopting a postcode lottery approach to treatment,
0:58:16 > 0:58:20we need to make sure that people can access specialist obesity services,
0:58:20 > 0:58:23including surgery.
0:58:23 > 0:58:28Both to tackle our obesity crisis, but also to preserve
0:58:28 > 0:58:30the central ideal of our NHS -
0:58:30 > 0:58:34of providing good health care to all.