Episode 3 Doctor in the House

What would a doctor discover if they lived with you...

-Hello, Doctor. How are you?

-Hi.

..24 hours a day?

How much would you be willing to reveal?

-Do you think you may be addicted?

-No.

Would they be shocked by what they find?

That's frankly pretty dangerous.

That looks horrible.

Like most busy NHS GPs,

Rangan Chatterjee only gets about ten minutes with each patient.

-TELEPHONE RINGS

-Excuse me one second. Hello.

Now he's taking on the biggest challenge of his career.

I believe that 99% of the patient's health outcome

is what happens in that time outside the surgery room.

He's about to live alongside individual families

who struggle with their health.

-Who needs help with what?

-Me lower back.

I feel out of control of my own body.

I'm worried about cancer.

For the first time, he'll gain insight

into every aspect of his patients' lives.

This is a unique opportunity.

I think I will be able to learn so much.

Do they cook fresh food?

-Is this how you eat every day?

-Pretty much, yeah.

-Is it a noisy street?

-TRAFFIC RUMBLES

Are there stressful relationships?

All these things have a huge and significant role

in determining their health.

Go!

He'll detect undiagnosed diseases...

I think you've already got it.

..he'll deliver some home truths...

-Do you get how serious this is?

-He doesn't.

-Yeah.

I honestly want to help you.

..and discover ways we could all live longer, healthier lives.

Boom!

I think it really has the potential to change the way

we all look at health in this country.

It's imperative that we do something about it

not tomorrow, but now.

Castlefields, a small town near Shrewsbury in Shropshire,

is home to the D'Arcy family.

Come on, stinky girl.

Living in the house are Dotti and Russ,

who is stepdad to her kids, Brandon and Denny.

You're a good girl, aren't you? Yes, good girl.

A bit of naan bread and some sauce. It ain't no normal dog.

Both parents work long shifts.

Dotti sells refreshments on trains

whilst Russ takes 999 calls for the fire service.

The kids combine college with part-time jobs.

Can go two, three days without really seeing her and the kids.

-I think that's why we get on so well.

-Yeah.

It's sort of a marriage saver, some would say.

Over the last few years, the whole family's health has been in decline,

especially the parents.

-DENNY:

-I do get worried about Mum

because the amount of weight she's put on in ten years,

I just think about ten years' time...

..and it's not going to be good.

I want us all to be healthier.

There's always something in the news

about becoming diabetic, heart problems.

You know, I don't want to die of a heart attack at 40.

I want to grow old.

GP Dr Rangan Chatterjee is taking a break

from his NHS practice in Oldham.

The D'Arcys have invited him into their home

to try and turn their health around for good.

What's exciting is the opportunity to learn things

that they may not tell you in your practice.

I'm nervous about what I'm going to find.

You know, how bad are things?

-I

-feel really nervous.

-Why?

I feel like I'm going for a job interview or something.

The doctor is going to investigate

every aspect of the D'Arcys family life.

-Hi.

-Hi, how you doing? I'm Dr Chatterjee.

-How are you? You all right? Come on in.

-Yeah, good, thank you.

-Hello.

-Hi. Hello. Nice to meet you.

-You're very tall.

-I am indeed.

-THEY LAUGH

-I'm Dotti.

-What's your name, sorry?

-Dotti.

-Dotti.

-Hi, Dotti. I'm Dr Chatterjee. Nice to meet you.

-Nice to meet you.

So, what is it you require my help for?

-Well, where do we begin?

-THEY LAUGH

Since I've put all this weight on, it's, oh, it's uncomfortable.

You know, especially to go walking, I'm like...

Russ would rather not go with me, cos I'm like,

"Oh, my back hurts, my legs hurt, my ankles hurt,"

and I'm always moaning.

What sorts of things have you tried before?

The usual sort of milkshake diets, Slimming World, Weightwatchers.

Has something in particular happened that's been the catalyst for this?

Has there been an incident or anything like that?

No, just being miserable all the time, really.

-Miserable? So, is your mood...

-Well, yeah, but...

-Are your moods up and down?

-Yeah. We don't know what to do.

Just cos someone's got a weight problem,

there could be, you know, five, ten different reasons...

-Yeah.

-..erm, why that's causing weight.

-So, weight management. Anything else?

-Er...

-BRANDON:

-Smoking.

-Erm, smoking?

-No.

-Yeah.

-There's nothing. No. We're not going down that road, no.

He smokes and he doesn't want to give up,

-but we all want him to.

-OK.

One thing at a time.

Yeah, I think there's, you know,

I think there's a lot of merit behind that -

as he says, one thing at a time.

But I think what I'd like to do next is...

-actually have a look in the kitchen. Is that OK?

-Yeah.

To tackle the family's weight problem,

Rangan's first step is to examine what they eat.

It's quite empty, isn't it?

-Some orange juice here.

-Yeah.

Fizzy drinks, mayonnaise, roast chicken, bacon.

So...

You don't mind, do you?

-I'm going through your cupboards.

-No, it's fine.

-Today is about me taking in information...

-Yeah.

-..so I'm going to just try and absorb as much as I can.

-OK.

And do you have a lot of cereal in the family?

I'm more of a Shreddies, Weetabix kind of girl.

-Are you?

-Yeah.

-I tend to miss breakfast, to be honest.

-Do you? OK.

Not a huge amount of food here.

-OK. Well, great. Thank you for that.

-That's OK.

Wish I could do this with every patient, actually.

With the fridge and kitchen cupboards only half full,

the doctor wants to know what the D'Arcys actually eat

most of the time.

So, this is a typical run for you guys?

-Yeah.

-Yeah.

-Yeah.

Russ is taking him out to pick up dinner.

You're not actually going to eat this, are you?

Phew! It's a good point.

You're not going to be doing it to yourself, are you?

Don't let us break you.

Have a cheeseburger, fatty!

Let the inner fatty out.

-Let that inner fatty out!

-RUSS LAUGHS

-I'll hold that for you.

-Cheers, mate.

In the UK, we love fast food.

It's how most families spend over a third of their food budget.

Tonight, the four members of the D'Arcy family are tucking into...

four chicken meals, seven burgers,

five large chips and four large sugary drinks.

So, you've got a good routine going on there.

DOTTI LAUGHS

Is it your job always to dish out?

Not always, no.

Is this how you eat everyday?

These are all your set places? You always...?

-Pretty much, yeah.

-Yeah?

-Mm-hm.

Dot, looking at you from here,

to me, it looks quite an uncomfortable position to be...

-No.

-No?

-No.

-Well, I'm just thinking in terms of...your digestion.

-Twisted?

-Yeah.

-Absolutely, yeah.

-In terms of...how your body's going to...

I often think that, but it's just what I'm used to.

It's very useful for me to see, actually.

Do you ever get anything, like heartburn or...?

-Yeah.

-Do you?

-I do.

So, how often do you actually have takeaways or fast food?

It could be five nights a week, easy.

Sometimes I have it about twice a day,

maybe even three times a day.

cos I come home, come home at 12 having one as well.

Right. OK, so that's, and you, that will fill you up?

Well, yeah, and no.

Yeah, sometimes, sometimes.

It's interesting that, isn't it? Because it's a lot of food...

..and you're saying it may not fill you up.

Erm...

I think anyone that eats fast, burger fast food

-knows that after ten minutes you're hungry anyway.

-Yeah.

-I look forward to it...

-Yeah?

..and I have it and I enjoy it, but after, I feel guilty.

It's so fascinating to hear that.

You know, that you're having it, you don't feel good...

yet you keep doing it.

Yeah.

You better get some sleep.

You're going to need it.

"Become a doctor," they said.

-"Live the highlife," they said.

-DOTTI AND RUSS LAUGH

To give him complete insight into the household routine,

24 hours a day...

That's where I'm sleeping.

..Rangan is staying the night.

Right. Thank you, cheers.

I was lying in bed last night.

I was thinking, "I can't believe what I've just seen."

The quantity of how much they were eating was quite overwhelming,

but what really surprised me is how routine that whole episode was.

I've got to help them break that cycle.

Having got a sense of the family's food problems,

Rangan is figuring out how to approach Russ about smoking.

Having a 20-a-day habit could be putting him

at risk of a host of life-shortening diseases,

from cancer to heart disease.

-You carry on.

-Get some sunbathing in.

-Yeah.

I've noticed how you don't like talking about your smoking too much.

No, they just go on about it all the time...

You can talk about it, though.

It doesn't mean you have to do anything about it.

-Just have a chat about it.

-I don't want to chat about it.

Is that because you don't like them telling you all the time

or is it because you don't think it's a problem?

It's... Obviously I know smoking's not healthy,

but I think there's bigger problems first to deal with.

Do you think by actually focusing on it so much

it potentially forces you the other way?

"No. I don't think it's a problem. I'm going to keep going with it.

"In fact, I'm going to smoke more now cos you just told me not to."

Yeah, sometimes. Yeah, it does have that...

When people are constantly going on at you about stuff you do.

It's like if they say, "Don't push the button,"

the first thing you do is push the button.

-You're very defensive about...

-I am very defensive.

I don't say things like, "Oh, you stink,"

or "Can you shut the door if you're having a fag," or...

"Oh, you stink." You know, we only say things like, "Oh, you stink!"

Yeah, but what I mean is, I don't constantly lecture you...

-Yeah, you do.

-No, I don't.

-Quite a lot, Dot.

-No, I don't.

-Yeah, you do, you do.

How is your qualification in marriage counselling?

-Yeah.

-RUSS LAUGHS

Having witnessed the D'Arcy's unhealthy habits,

Rangan wants to see how their lifestyle has affected their bodies.

He's running some basic medical tests with Dotti and Russ.

First up, blood samples to be sent away for analysis.

Are you feeling all right?

Yeah, needles don't bother me at all.

'I want to get a baseline idea of all of their health markers,

'checking for full blood count, kidneys, the liver,

'cholesterol, insulin...'

Just pop this tourniquet on.

'..but specifically the blood sugar.'

Next, Rangan wants to perform physical examinations.

Steady on.

-He hasn't even bought me a drink.

-THEY LAUGH

As the family share similar eating habits,

he's taking everybody's measurements.

So, that's 49 inches there, OK?

A larger waist can indicate dangerous levels of fat

sitting around the internal organs...

35.

..and an increased risk of diabetes, heart attacks and strokes.

That's 53 and a half.

Next, the doctor wants everyone's weight.

At 19st 10lb,

Dotti's almost double the ideal weight for her height of 5'2.

Can you step on?

As well as weight,

these special scales send tiny electrical impulses through the body

to estimate how much fat you're carrying.

OK. So, your fat percentage, according to this, is 41.1%.

The desirable range is 8% to 20%, basically.

The scales also produce a value known as metabolic age.

Using the measurements it's taken,

the machine predicts the age of the patient.

It's telling me that your age, or your metabolic age, is 47,

and you're actually 32.

But that does explain a lot in regards to the way we feel.

You know, a 32-year-old shouldn't necessarily feel

as tired as a 47-year-old.

-That's what you've done to me.

-SHE LAUGHS

-What's your age?

-17.

-17.

Your metabolic age, it's 33.

So it's significantly higher than what we would hope for with you.

So I hope this acts as a...

By you saying, "Look, something's got to change."

-You all right?

-You OK?

It is shocking.

Budge up.

Everything on here is changeable.

I mean, how do you feel?

Guilty.

You know, this is partly our fault.

We're where we are because of us,

but these are sort of where they are because of us.

Sure.

Hey, we're here to understand this is serious.

It's not just a bit about "I'm a little bit overweight."

I mean, you know, these guys are at risk of early death.

Weight is a serious issue in the UK.

These days, one-in-four people are officially classed as obese.

Rangan has arranged for the family to have 3D scans made of their bodies.

These will act as a starting point for any physical changes

that happen over the next few weeks.

A few days later, the results of the blood tests have been sent through.

Having found nothing alarming in Russ' report,

the doctor wants to chat to Dotti about something he's found in hers.

OK. So...

..there's quite a few bloods I did. There was a couple of tests

-that have really actually concerned me quite a lot.

-OK.

Your fasting blood sugar was 7.1.

-The other one is what we call your HbA1c.

-Yeah.

That is basically a marker of your blood sugar

for the past three months.

42 and under is normal.

You were 56. That is way too high.

Those two together,

it makes me suspicious that you may already have type II diabetes.

Oh, God.

That's shocking.

-I can't say 100% that you do have it.

-Yeah.

I would need to do a second test to confirm that

which I'd like to do, if you don't mind, in the next few days.

-But I think you've already got it.

-OK.

-SHE CRIES

-Oh...

-You OK, Dot?

-Not really.

I'll do everything I can to try and help you.

Type II diabetes is a condition

that causes dangerously high levels of blood sugar.

A hormone called insulin usually keeps these blood sugars low

but excess fat can disrupt this process.

What's the matter?

Looks like I'm a diabetic.

Aw...

Feeling constantly thirsty and tired can be signs of the disease,

but in the UK, hundreds of thousands of people live with the condition

without even knowing they have it - just like Dotti.

It's quite upsetting, you know, on a personal level,

to give someone information

that clearly they find deeply distressing and upsetting.

Yeah, it's challenging, but it needs to be said.

I'm here as a doctor.

I'm here to help these guys.

Before Rangan can help Dotti,

he needs to confirm her diagnosis.

He's taking her for another blood test

at the Royal Shrewsbury Hospital.

-Sorry, yeah, on you go.

-Cheers.

In recent years, hospitals like this have had to cope with

a huge rise in the number of cases of type II diabetes.

-That's the last of the blood tests now.

-Fabulous.

Diabetes, as a whole,

now accounts for 10% of the entire NHS budget.

The blood tests that we did this morning

have confirmed that you do have type II diabetes.

As horrible as it is...

it's put it into another gear.

You know, it's sort of changed the boundaries, hasn't it?

-Yeah.

-Yeah.

The blood sugar in people who've got type II diabetes

is chronically elevated.

That sugar goes round your body

-and gets deposited in different places...

-OK.

..and that's what causes many of the complications.

You know, it can get deposited in your eye and cause blindness.

It gets deposited in your kidneys and can cause kidney failure

-and then people need to go on dialysis.

-Yeah.

It can cause damage to your vessels in your heart,

causing heart attacks, strokes, you know,

-and the list goes on, really.

-Yeah.

Where do we go from here?

Will I have to be medicated or is this diet or...?

Yes, there are medications. OK?

But I don't want to start you on any medication at the moment.

Type II diabetes is caused by lifestyle choices.

-Yes.

-OK?

-Yeah.

But the good thing about that is that it's lifestyle choices

-that can actually turn that prognosis around...

-OK.

..and, over the next few weeks, I want to help you do that.

If he can change the way the family eat,

there's a chance he could help Dotti reverse the effects of diabetes

and help them all lose weight.

The first phase of his plan

is to eliminate all fast food from their diet.

It's processed, highly processed food

that is, in many ways,

designed to make you want to eat more and more and more.

That's why, not you guys, not only you guys,

but people all round the country are struggling,

because the food environment out there is semi-impossible.

So we've got to control the environment in your house

first and foremost, and that'll mean we really need to prepare,

and that means you need to go to the shops

and we need to clear out that kitchen.

-We don't really have much in this cupboard...

-Wow! Where to start.

I mean, there's so many things I think needs to come out.

Rangan is removing anything with added sugar

and all highly processed foods.

A good rule is if it's got more than five ingredients, don't eat it.

-That tends to be one of my rules.

-Sort of a basic rule, yeah.

What looks potentially, "Aw, there's a little bit of chilli and garlic."

-Sugar, second ingredient.

-Right.

-What do you think that's doing to your sugar level?

-Yeah.

-Are you enjoying it or are you feeling...?

-I am.

-Are you getting stressed out a bit?

-No, not at all.

And there's something else that Rangan wants the family to eliminate,

especially given Dotti's diabetes.

I'm going to have to be quite extreme with you guys.

Refined carbohydrate, and really most carbohydrates,

I would like you to try and eliminate completely

for the next few weeks.

-OK.

-OK?

So, what am I talking about?

-Potatoes.

-No potatoes, pasta, bread...

-Rice.

-..bread and bread...

-..rice.

-RUSS LAUGHS

Two pieces of wholemeal bread spike your blood sugar

more than a Snickers bar.

Whoa! Now that's shocking.

Cut down on the foods, ideally eliminate the foods

that raise your blood sugar and raise your insulin.

This, even the healthier form of it, is doing the same thing.

-So it's got to go.

-OK.

The D'Arcys will replace the foods they normally eat

with whole, fresh ingredients.

Good quality meat, good quality fish,

nuts, seeds, fruit, vegetables, OK?

When you stick to these for a few weeks,

just watch what happens.

I wanted to ask you, cos I actually really love fish,

are these good, you know, is this a good fish or...?

You know, cos obviously it's in a can...

Compared to what you're currently having,

eating these is going to be absolutely fantastic for you.

And it's not just what they eat that Rangan wants to address.

What I need to do is change your whole relationship with food.

Yeah, I need to change WHAT you eat,

but I also need to change HOW you eat and WHERE you eat.

Eating on the sofa...

..lends itself to mindless eating,

it lends itself to eating more than you would normally eat.

As a kind of rule, for at least four weeks,

I'd like you to eat at the dinner table.

To support his plan, Rangan is giving the family some food supplements

and leaving behind a couple of recipe books.

"Roasted red pepper sauce."

-Now, you'd like that kind of stuff.

-Yeah.

I think what the diagnosis of type II diabetes has done,

not only for Dot, but the whole family,

has give them a wake-up call.

If that is used as a motivating factor for everyone to change,

then maybe they'll look back on this in a few years' time and go,

"Hey, that was the best thing that ever happened."

Now, I would've thought pork was bad.

But for the problems that you guys have got,

it's not a bad thing for you, OK?

With so much food ruled out,

Russ and Dotti need to restock their kitchen.

-Let's try these, eh?

-Yeah.

Extra large...

To control every ingredient of every meal,

they'll have to cook all their food from scratch.

Are you getting any veg?

For the D'Arcys, buying fresh ingredients is an unusual experience.

Feel a bit lost. Yeah.

-Can I just have some turkey, please?

-Yeah, yeah.

As well as high blood sugar,

Dotti's tests revealed she was low on some key vitamins

found in fresh produce.

I'm making a grilled chicken salad.

-Do you know what you're doing?

-Yeah.

Around one-in-three people in the UK

don't eat the recommended five portions of fruit and veg a day.

With the diet established,

Rangan wants to know more about the family's everyday life.

He's visiting Russ at work.

-How you doing? Good to see you.

-All right. How are you?

-Good. Busy.

He works in the control room at the local fire station,

answering emergency calls and despatching fire crews.

He works two day and two night shifts a week.

How long is your shift normally?

Ten hours on a day, 14 hours on a night.

And so, when you're on shift,

-are you basically sat down here...

-Yeah, this is it.

-..the entire time?

-Yeah.

A recent study found that

just under a third of adults in the UK are inactive.

Things weren't always this way for Russ.

He used to fight fires as part of the Emergency Response Team.

I was an officer in charge, so I used to go out in the fire engine

with up to eight other firefighters with me

that I'd be responsible for.

Russ gave up being a firefighter two years ago

when he failed the mandatory fitness test.

Yeah, it's pretty heavy, isn't it?

-Wow, that's some change, isn't it, to being behind a desk...

-Yeah.

-..to lugging these around?

-Yeah, definitely.

You must have been significantly fitter before

-than you are now.

-Massively. Yeah, massively.

-Probably getting worse and worse.

-Probably, yeah.

-I'm certainly not doing anything to help it...

-No.

-..let's put it that way.

-Sure.

-We're recruiting next year.

-Yeah.

So that's an appealing option, I guess?

Oh, that's a massive incentive as to why I want to get fit

and, you know, get in shape and sort myself out.

It is hard to imagine two years ago Russ was, he was active,

because the Russ who I've met doesn't appear to be that person.

I think he knows he's in a rut,

and I think just having me there in his life highlights it even more.

Before he can help Russ improve his fitness,

Rangan needs to know how bad things are.

I thought it would be a good idea

-to get a baseline level of your fitness.

-Yeah.

-Bleep test.

-Yeah.

-You know about it?

-Yeah.

-You like it?

-No. Hate it.

-You hate it?

-Yeah.

-Why?

-I don't like running.

-You don't like running?

No, I don't enjoy running.

-Let's do it, see where we're at.

-Yeah.

-How about that?

-OK.

-Right, let's get started.

-Don't you laugh.

I will not laugh.

Bleep!

-Russ has to run 20 metres...

-Bleep!

..back and forth between the cones before the next bleep.

Bleep!

As the test moves up a level, time between bleeps shortens...

Speed up, I think, Russ.

Bleep!

..meaning Russ has to run faster.

-Bleep!

-There are 18 levels in total.

The minimum requirement for a member of the fire service...

-Bleep!

-..is level eight.

Bleep!

-Bleep!

-Level four - that'll do.

-Yeah, stage four. Oh, well done.

-RUSS BREATHES HEAVILY

-Cheers.

-Well done for trying. I know you don't like it but...

-Hate it.

-Yeah.

Yeah, have a rest and then, yeah.

-Are you annoyed that we put you through that?

-Yeah, absolutely.

-Are you?

-I know that you wanted, like, a base measurement,

but there's lot of other things.

Sure.

It's, you know, it's really not meant to make you feel bad, it's...

-No, I know, I know.

-It's because if, if I've got an objective measure...

-Oh, yeah. No, no.

-..and if we try something...

..then we can both see, actually, is it working?

-Just want to know where we're at...

-Yeah, yeah.

-..and hopefully,

we could re-measure and see where you've got to.

It's just disappointing, isn't it?

You know, to see how far you've let yourself go.

-When you actually start to measure stuff...

-Yeah.

..you know, what you used to do to what you can do here.

If you were to think about raising your level of fitness,

do you have any idea how you would do that at the moment?

I don't know, really, to be honest.

I'm sort of at a bit of a loose end with it all.

-Are you?

-Yeah.

I felt slightly uncomfortable because I'm trying to help him,

I'm not doing it to humiliate him

or to show him how bad his fitness is - nothing like that -

I'm doing it to help him,

but in order to help him

I need a baseline level from which to move forward.

He's got a stressful job -

he works shifts and they're very changeable,

and we have to work around that, like many other people do.

It's hard, but it's not impossible.

It's about incorporating movement and activity into his everyday life,

and I think that's the sort of thing I'm going to help him with.

The D'Arcy family have been following the diet the doctor set for them

for several days now.

Having diagnosed her with type II diabetes,

these changes are most important for mum, Dotti.

Rangan wants to see how she's getting on.

Obviously, I want to change my lifestyle

-and the way I look at food and eat.

-Yeah.

But yesterday I had a really bad migraine all day.

I sort of felt a bit...

..lacklustre and sort of felt a bit drained.

I literally could have just come home and gone to bed.

-You tend to go through some sort of withdrawal.

-Yeah.

-You know, you're kind of cleansing your body...

-Absolutely, yeah.

..from all the sort of junk and hyper-processed food

-that it's used to.

-Yeah.

You remember I spoke about a lot of these nutrients that were low?

One of them is vitamin B12.

Helps your metabolism,

-helps your muscle function, your nervous system...

-Yeah.

..and one way I can replace that quickly for you

-is by giving you B12 injections into your muscle.

-OK.

Dotti's blood test revealed low levels of vitamin B12,

naturally found in foods such as fish and eggs.

-You ready?

-Yeah. Okey doke.

Dotti's new diet should improve levels over time,

but an injection can give things a head start.

These should only ever be carried out by your doctor.

Thank you.

Rangan wants to spend a bit more time getting to know Dotti,

so they're off for a walk in a local park.

-So, you've not been here before?

-No, never. Never been.

Being more active may also help Dotti lower her blood sugar levels.

-It is nice to be in the countryside.

-It really is, isn't it?

We're actually really lucky to have all this around us.

-Yeah.

-Yeah.

Wonder what the kids would make of coming out here walking?

-Who, Brand and Den?

-Yeah.

We used to, we used to come out walking together all the time.

Would they like it, do you think?

-Yeah. You know, it's the initial...

-SHE GROANS

..but once you're out here, it's great.

Yeah, are we going down there?

I do actually feel my head's clearing as well.

-From being here?

-Yeah, just being in the fresh air.

Let's not stand in the nettles.

It might be something that's on your radar now.

-Next time...

-Yeah, absolutely.

-..the family are off together...

-Yeah.

-..instead of watching a film,

-get out and spend the afternoon here...

-Yeah.

..cos it's not far, is it?

Rangan wants to know more about

Dotti's unhealthy relationship with food.

UK studies have suggested that

emotions are the cause of 75% of all overeating.

When I first came into your front room

-you said you have...an emotional relationship with food, and...

-Yeah.

..was there anything going on, any event that happened,

anything that might have...?

We've had a lot of trauma in our family, you know?

I lost my sister six years ago,

and that was very quick.

We found out that she got breast cancer

and she was gone within three weeks.

And I think, I think maybe our eating habits

would have probably been really bad around that time,

cos obviously none of us were cooking

and, sort of, we were all sort of just grabbing what we could and...

Of course, yeah.

You know, that, that could have been

some sort of starting point, I suppose.

How old was your sister?

SHE CRIES

27.

-How old?

-27.

-27.

I'm so sorry.

So your younger sister?

Cancer in our family's rife.

-My nan died...

-Yeah.

-..when she was 38,

my brother died of throat cancer when he was eight months old...

..and, obviously, my sister, when she was 27, of breast cancer.

And my grandad also died of cancer.

It's, oh, it's just devastating.

-Does it worry you?

-Yeah.

Every day.

-Are you worried about a particular kind of cancer?

-Erm...

I was worried about breast cancer.

Or ovarian.

I can see that you're worried, and I don't blame you -

if I had that much cancer in my family, I think I'd be petrified.

It's basically wiped out my whole mum's side of my family.

Like, the only people that are left on my mum's side now

is my mum and her brother.

Five to 10% of breast cancers are linked to genetic factors.

Faults in two specific genes, known as BRCA1 and 2,

significantly increase the risks.

These faults are rare and can be tested for.

BRCA testing is,

I think people have heard about that now from Angelina Jolie.

-Yeah...

-It's everywhere.

-..it's massive, yeah.

It's the, you know, one of the genetic tests

that can determine whether you're predisposed

-to getting breast cancer or not.

-Yeah.

For me, I must be honest,

I don't know the ins and outs of who is eligible for BRCA testing.

Erm, it's something I can maybe look into for you, if you...

-Yeah, that would be great.

-..if you want to know.

I can maybe make some phone calls about that.

I just want to know whether I'm a high risk,

find out my options of what I'm going to do,

think about it and just move on with it.

Me knowing is going to lift this big black cloud...

-Mm.

-..because, to me, it's massive.

Honestly, it's massive.

It's even more massive than diabetes.

-Mm, I can see that.

-Yeah.

So knowing is definitely...

it's really important to me.

What really struck me from my conversation with Dot

is how much she's been through.

She's got this worry...

..about whether she's going to get breast cancer.

And absolutely this is a significant component

of how she's ended up in a downward spiral with her own health.

So I've got to take that seriously.

I'll need to get some specialist advice -

talk to a genetic unit -

and actually find out is she at high risk or is she at low risk?

Back at home in Manchester,

Rangan's making some calls to find out what he can do for Dotti.

'Hello, Vicki Kiesel speaking.'

I am phoning regarding one my patients

who has a family history of cancer

and I was hoping you might be able to provide me with some information.

'Yes, certainly...'

If a woman has a fault in one of her BRCA genes,

it could mean up to a 90% chance of developing breast cancer.

Thank you so much for your time. Thank you.

-'Thank you. Thanks.'

-Bye-bye.

Rangan's arranged a face-to-face meeting with a specialist

to have Dotti's risks assessed.

Having a genetic predisposition for cancer

could have serious implications,

not just for Dotti, but for her children too.

You know, I've got that dreaded feeling in the pit of me stomach.

SHE CRIES

I want to watch my kids grow up and have children...

..and that's why I'm doing this.

Rangan is travelling with Russ and Dotti

to the genetics clinic in London.

Knowing more about inherited cancer risks

could help relieve years of worry

that has affected the way the family live.

-RUSS:

-When Dot's sister passed away, how it affected Dot was massive.

I don't think it's ever out of her mind

because she's never got an escape from it.

Dotti's appointment is with Genetic Counsellor, Vicki Kiesel.

I understand you're concerned about your family history

and you're thinking about having some sort of genetic testing.

-Is that right?

-Yeah, that's right, yeah.

Her first step is to take a detailed family history.

How many brothers and sisters did you have in total?

Before Lucy, there was my brother.

He died of throat cancer.

-And you said your mum had genetic testing.

-Yeah, she did.

-And was that just for BRCA1 and BRCA2?

-Yeah.

By mapping out the cancer in Dotti's relatives

and taking her mum's tests into account,

Vicki is able to determine any cancer risk caused by faulty BRCA genes.

We know that your mum, from what you've said,

we know her BRCA1 and BRCA2 genes are normal.

So the only way that Lucy could have got an altered BRCA gene mutation

would be through your mum. There's always a tiny chance

about something on your dad's side, but we're not worried about that.

-OK.

-That also means that you will have got

-a normal BRCA gene from your mum.

-OK.

Hopefully this is quite reassuring in terms of BRCA1 and 2 in that...

-Yeah.

-..we know that your genes from your mum work normally

and it's not necessary to test you to know that.

BRCA1 and 2 aren't the only genes linked to cancer,

but testing for faults in other genes

would involve other members of Dotti's family.

Probably the most important thing is going to be

-to offer genetic testing to someone in the family who's had cancer.

-OK.

And then, depending on what we find,

it may be appropriate to test other people in the family.

We also know that most cancer happens by chance.

So about 90% of all breast cancer,

and all types of cancer, in fact, are not inherited.

-How do?

-How's it been?

-Yeah, all right.

So, what happened?

She's taken BRCA1 and 2 out the equation straightaway

which I found really reassuring, to be honest.

Well, great.

But it's brought up another gene.

-I don't feel disheartened in

-any way. No, no.

-Oh, I'm glad, I'm really glad.

-Yeah, yeah.

-It's all for the best, isn't it?

-It is, yeah, absolutely.

Dotti's taking some time to talk to her family

about the possibility of further genetic testing.

It's been two weeks since Rangan gave the D'Arcys

their healthy eating plan, cutting out all processed food.

This new lifestyle change that we've had with food is helping

but I just feel like everything's too much.

Like, you know, everything's a hassle.

After two weeks, it's starting to feel like hard work.

Dotti's sent me some photos of what the family are eating

and it's a little bit worrying.

The good news is, is they're actually sticking to

the list of foods I've asked them to eat from,

but there's no variety there. I think this way of eating

is unsustainable. They're going to get bored

and probably going to fall off the wagon.

I think I need to inject some excitement into their food

before that happens.

To inspire a more varied diet,

Rangan has brought round a few foods

the D'Arcys wouldn't normally cook or eat.

The whole point of tonight is

-to just try different things.

-Yeah, yeah.

I'm trying to take something that you think you don't like -

avocado, courgette -

-and try and do them in a way that you do like them.

-Yeah.

-These steaks do look good.

-Feel a lot of pressure.

-You're doing a great job.

-RANGAN LAUGHS

You've not tasted it yet.

That's all right, we're polite - we'll lie to you.

Grilling meat is generally healthier than frying

and tastes good too.

-Here we go.

-DENNY: I've never had steak, so...

I know it's chewy,

but I can't promise that I'll eat it.

Russ is a really good cook when he puts his mind to it...

..but he doesn't put his mind to it very often.

Whilst the food is cooking,

Rangan is keen to show the family

that they don't have to go to the gym to exercise.

-Like you guys, I've got a busy job...

-Yeah.

..I've got two young kids at home and it's hard to find time.

So I try and fit it in where I can.

Sometimes what I do, while things are boiling or frying at home...

-You do a dance.

-Well, you can dance if you want.

If you guys dance, dancing would be great. Or squats, lunges.

Do you fancy it?

-So, just... squat.

-Yeah.

Are you going to do it with me?

-That's it.

-Oh, my God. You click.

Strength training like that

absolutely improves your muscle insulin sensitivity

which is the whole point of the way you're eating, is to reduce insulin

and make yourselves more sensitive to insulin.

I'm just going to lunge my way to the barbecue.

THEY LAUGH

-I'm lunging away.

-He's still doing it.

See, he's getting into it.

Russ, you are getting into the spirit - I love that.

-Smells nice.

-Damn right it does.

-Does. Smells lush.

Oh, I can't wait for this. I'm excited.

The steak's not as chewy as I was expecting.

The courgette's nice.

Thinking back to when I had dinner with you guys last time,

when we were sat round the sofa,

-quite a big change, isn't it?

-Mm, it is a big change, yeah.

-But it's a change I'm enjoying.

-Mm.

-Really?

-Mm. I enjoy this.

-All of us are.

Yeah. Like, interacting.

-Just feels a bit more comfortable.

-Mm.

Feels more natural, doesn't it?

And you can concentrating on what you're eating as well.

And before I had to keep going and going and going

till I was like full up to here

and it was uncomfortable and horrible,

but I don't feel I need to have that much.

'I'm just truly amazed at the turnaround.

'They're very open-minded, they're trying new things.'

Will they keep going? I hope so.

This is going to be really important for them going forward.

It's easy to forget where they were a few weeks ago,

but they've come a long way already.

With the family feeling positive,

Rangan wants Russ to push himself and get fit again.

That's it, all the way down.

They've arranged a session with a personal trainer.

That's good, nice one.

Nine.

Well done, well done. 5.28.

Yes, mate. Yes, well done. 6.04, that's brilliant.

-He's not as fit as he thinks, is he?

-HE LAUGHS

I was only 30 seconds behind him.

I didn't get out of first gear, mate.

THEY LAUGH

Dotti's also building up her activity levels.

Normally when I get home, all I want to do is veg,

sit down on the sofa and veg, but I don't.

I feel, I feel like I've got more energy.

Instead of taking the bus, she's walking home from work.

Moving more will help lower her blood sugar

and burn a few extra calories.

With the mood in the house so upbeat,

Rangan is taking the opportunity to broach a touchy subject.

Shall we head into the living room for a little chat?

-Oh, great(!)

-DOTTI LAUGHS

I wonder who's this little bundle of joyous news for?

It's not for me.

I'm a little bit nervous, actually, about bringing this up.

It's the smoking.

At some point, I have to have the conversation about smoking with you.

I'm very, very conscious that you don't want to discuss it.

You're coming out the friendship zone, son.

But you have a.... Yeah, go on, then.

The doctor has brought with him a breathalyzer

that test the levels of carbon monoxide in Russ' body -

one of the many poisonous chemicals in cigarette smoke.

Carbon monoxide causes breathing difficulties

and makes blood more sticky,

increasing the risk of heart disease and other problems.

OK. So that's 36.

On this chart, under six is what we regard as normal -

that's a non-smoker.

Seven to ten, they're calling 'danger zone',

because that's when you're going to have nicotine addiction, OK?

36 is in the heavily addicted range.

I'll just read out what it says -

"This level is uncommon and is found in smokers

"who are rarely seen not smoking.

"Permanent damage and carbon monoxide poisoning

"can occur at this level."

-How do you feel about that?

-Am I supposed to cry?

Do I...? I don't...

Nobody's said to you, "Right, this is about you giving up."

-Yeah, but it is.

-No, it's not.

-That's what this whole convers...

-No, it's not.

-Russ, I promise you, it's not.

-But in a roundabout way, it is.

-No, no, no.

-No, no, Dorothy, in a roundabout way...

-"Dorothy."

..this is about me giving up smoking, in a roundabout way.

Cos what else is the point in this?

This is, in a roundabout way,

saying, "Look, this is where you're at -

"you need to stop it before you get to that."

That is what it is.

You know, otherwise there's no point in doing this, is it?

Evidently, you know, eventually you want to

get to the point of me giving up - that is what this is about.

And you're trying to help me, and I appreciate that...

but I know, and everybody that smokes knows, that it's bad.

And, you know, we're just going round in circles.

What I was trying to do, I'm not going to lie,

if you told me, "Yeah, I'm going to give up smoking tomorrow,"

I can't say I wouldn't be pleased about that.

But was I expecting it? No, I wasn't.

I know Dot and the kids, they go on because they care -

that's the main reason they go on at me, is they care,

but it's had the opposite effect now.

Yeah. Well, it's obvious you know smoking's bad for you, OK?

Erm... You know, everyone knows about the lung cancer risk,

the heart attack risk.

The great thing, Russ, when you do give up smoking,

if you choose to at some point,

is that you can reverse a lot of the effects.

You know, within a year,

your risk of having a heart attack is halved.

So you can undo a lot of these things,

and I think it's really important that people understand that.

So, if at some point...

Yeah, cos you've got to feel like you're not flogging a dead horse.

I'm not scared of failing,

I just don't feel ready to give it a go.

And I don't even know why. I can't say to you...

"I need a fag."

-Is it like an emotional attachment?

-Yeah, I think it is,

cos I think, for all my life,

the only thing I've ever had constant is smoking.

-I still love you, son.

-DR RANGAN AND DOTTI LAUGH

I've been a doctor for nearly 15 years now.

I don't think I've ever had a conversation like that before

with a patient with that level of emotion.

But I was just starting to get the impression,

towards the end, that maybe...

maybe he starts to think about things.

You OK?

-Yeah, I'm just reflecting, thinking.

-Oh.

No, I need to think about, like...

-Because you don't enjoy it.

-No, I don't.

I know you don't, cos you always say you don't.

You hate it...but you, but yet you keep doing it.

-But I need to think about it...

-It's a habit, isn't it?

..because, it's like I was saying, I've not really thought about it.

I've not thought, "Why do I do it?"

because it's just been that I smoke and that's it.

All I can say is, honestly, now,

I'm going to seriously think about things...

-Good.

-..and that's all I can do.

That's all you can do, at the end of the day.

Yeah.

Hope I didn't annoy you too much, all right?

No, honestly, it's fine. I'll let you off.

Take it easy, all right? See you later.

-See you later.

-Bye.

It's been two weeks since Rangan took Dotti to see the genetic specialist.

She left that meeting with the option of further tests

for inherited risks of cancer.

The process would involve her extended family.

Dotti and her relatives have come to a decision.

It's been really difficult,

because...when it was just me being tested

it was sort of like it was my, it was my issue, my problem,

but because...

..they obviously want to test me sisters,

I feel really sort of responsible.

So what will be will be, I think.

You just... I've sort of just got to

put that to the back of me mind and move on.

Sure.

You know, before, before I started changing...my whole life, really,

I was like on a one-tracked...

Everything I thought about was sort of negative and...

-Do you know what I mean?

-Yeah.

There was no sort of light at the end of the tunnel.

But now I, I sort of, I don't look like that any more - it's weird.

I'm really pleased to hear you say that,

because I totally agree with you,

-but it's nice to hear that that's how you're feeling now.

-Yeah.

Losing a bit of weight and being a bit fitter

and, you know...

..I'm feeling more energetic.

I think it's changed your mental state, your mental outlook.

-And now...

-It has completely changed my mental outlook.

'I'm a little bit surprised, actually,

'that she doesn't want any more genetic testing doing.'

But she's ready to let go, let go of the past.

It's almost as if she's now realised that she's in charge of her future.

That's going to have the most powerful impact

on the rest of her life, more than any genetic test would.

A month since Rangan first tested Russ' fitness,

he's keen to find out just what sort of progress he's made.

After you, mate.

Do you know why I've brought you here?

It's not to surprise me with a Ferrari, is it?

THEY LAUGH

-I've brought you here to do the bleep test.

-OK.

You've been working out a bit,

you're clearly, just looking at how you've been changing your body shape

from the way you're eating, which is amazing.

You got to level four last time -

where do you think you might get to today?

I'd like to think, you know, I'll do better than I did last time

but I can't, I can't promise anything.

-Let's see how far you get.

-Let's do it.

-These cones to those cones over there, OK?

-Yeah.

Go!

Doing well.

To have any hope of going back to being a firefighter,

Russ would need to get to level eight in this fitness test.

That's it, Russ. Come on.

Come on, Russ!

You're smashing this. A few more, mate.

Come on! Let's, let's get this.

Stage eight.

Stage eight! Well done. You all right?

-RUSS BREATHES HEAVILY

-You've doubled it.

-I never thought you'd get to stage eight.

-No, nor me.

That's all right. I'm happy with that.

I'm more than happy with that. I think from where you were,

probably just a couple of weeks ago, that is a huge improvement!

Not only physically, but even mentally.

You weren't going to just give up.

You were like, "Right, I can do this."

-Just think if you gave up smoking as well how far you'd get.

-Yeah.

No, it's, erm, like I said, it's something that,

although, when you ambushed me it wasn't,

it didn't put me in the best of moods but...

-That was a few weeks ago.

-Yeah.

-Yeah.

But it is something that I have thought about, you know?

And it has sort of played on my mind a bit.

-What played on your mind?

-About giving up.

It's something that before was just a no. You know, an outright no.

-About the smoking?

-Yeah. I'm not, you know, I'm not giving...

Now I'm thinking about it more and more. And...

..I think that, erm, yeah, it may be something that I do

-in the not too distant future.

-Oh, brilliant.

It's so good to hear that.

'I think that exceeded his expectations.

'There's nothing stopping Russ now.'

I think Russ is close now, fitness-wise,

to go back to being an active firefighter IF he chooses to do so.

It's been six weeks since the doctor first came to the house

and the family have made some big changes.

After cutting out all junk food,

they're following Rangan's eating plan and being more active.

You are in such a slump and a dump when you get to where we were at,

you do just feel like you're reborn,

cos you're feeling better, you've got more energy.

You're like, "I don't want to sit here and watch the telly."

I mean, it's took me years to realise,

but my actions all have consequences.

It's almost like a light bulb's gone on.

Now it's time to see how much the family's health has changed.

Step on.

All the D'Arcys are being assessed for their weight, fat percentage

and having their bodies scanned.

Dotti's also having another blood sugar test.

The lifestyle changes have been particularly important for her.

She hoped it could help her

turn round the diagnosis of type II diabetes

the doctor gave her just a few weeks ago.

Now, this is a big day for the D'Arcys.

They have put their heart and soul into this process.

If I think back to where Dotti was when I first met her,

on a sofa, eating fast food all the time,

embarrassed to go out and exercise...

and I just see how far she's come already,

I think that is truly amazing.

If the results aren't quite as good as they expect...

will they throw in the towel?

Will they go, "Hey, it's just not worth it.

"Let's go back to the way we were."

-How you all feeling?

-Yeah, excited, bit nervous.

What you nervous about?

Erm...

-Not doing as well as I think I have, maybe.

-OK.

Before he gets to Dotti,

Rangan has some results for the rest of the family.

I'm going to show you your 3D image

-of where you all were just a few weeks ago.

-OK.

I look like I'm about 12 months pregnant there,

back and front.

OK, Russ. So your body fat...

OK, was 41.1%.

That's clearly in our red zone, way too high.

Your new body fat...

-That's gone right down.

-34.9%. BRANDON:

-Well done, Russ.

That's really good.

-That's good.

-That's really good.

That's about 6%. A huge improvement.

At the start of the process,

Denny was distraught to learn that

her metabolic age was nearly double her actual age of 17.

So this is what your metabolic age was.

-This is what you've come down to.

-Yep.

Ooh!

26.

-Your metabolic age has dropped seven years.

-Yeah.

That's amazing!

That's really good.

Your weight at the start of this was 11st 13lb.

And this is where you've got to.

-DENNY LAUGHS IN CELEBRATION

-Boom!

Well done, well done.

Hey, you're down to 11st,

so you've pretty much lost a stone.

-How does that make you feel?

-Brilliant, brilliant.

-I'm pleased with that.

-Yeah, you look pleased with that.

OK, Brandon.

-Your weight was 11st 7.

-BRANDON:

-Yeah.

-OK?

Your new weight...

..10st 4lb.

-Well, he's smashed it out the park.

-Oh, my God! That's amazing.

-Right. We've saved the best till last, Dotti.

-Yeah, absolutely, yeah.

-You excited?

-I'm nervous, actually.

-So, Dotti - aged 36. Your weight...

-Ergh...

-..was 19st 10.

-OK.

Your new weight...

..is 17st 8lb.

Shut up!

You've lost over 2st in just a few weeks.

Oh, my God.

-Back at 17.

-I know.

Do you know what? I haven't been like 17 for years.

-Have you not?

-No.

-Well done.

-SHE LAUGHS

-That's amazing.

-Chuffed with that.

-Can't believe that.

For the last five weeks,

Dotti's been living with a diagnosis of type II diabetes,

a lifestyle-induced disease

which increases your chances of heart disease many times over.

Now, I've looked at a particular measure,

-which is your average blood sugar, for a few months.

-Yeah.

-OK?

It's what we call your HbA1c.

-So you were 56.

-Yeah.

48 or above...

-Is diabetic.

-..is diabetic.

-Yeah.

42 and under...is normal.

Your new blood sugar reading...

-Oh, my God!

-SHE LAUGHS

-That's really good.

-It's 40.

Oh, my God, I'm so chuffed with that. I really am chuffed.

-That's brilliant.

-I'm chuffed.

You have, effectively, reversed your type II diabetes...

-I can't believe that.

-..in just a few weeks.

That's amazing. Oh, my God, I can't believe it.

Honestly, I can't believe it.

Getting my results today was shocking, to be honest.

I was amazed at how much I've achieved

in such a short space of time.

One thing I have learnt out of this process

is that I'm stronger than I think I am.

I used to think that I couldn't do anything,

but now I know I can.

Really, in a few weeks, my attitude to life has changed complete...

I'm sort of going back to being a go-getter

which is what I used to be.

Thank you, mate. For everything.

Yeah, my pleasure, mate, my pleasure.

It's all to do with feeling better.

Like, mentally, physically.

Just having energy, just doing stuff - it's great.

-Thank you ever so much.

-Dotti.

I just think back to where they were,

just a few weeks ago, when I met them,

and I see where they are now.

It's like a different family.

OK, guys, guess I'll see you when I see you.

This has definitely been life-changing for me, definitely.

Huddle in.

-No, thank you for everything.

-Yeah.

-Hey, my pleasure.

-Keep it up, all right?

-Yeah, we will.

-Thank you.

-Definitely.

Honestly, that was one of the most rewarding experiences

I've ever had as a doctor.