Episode 3 Doctor in the House

What would a doctor discover if they lived with you 24 hours a day?

-Hello!

-Hello.

Come and meet the doctor.

How much would you be willing to reveal?

I'm scared that I may get bullied for how I look and my weight.

I feel like I'm drugged.

But, Nicola, you're right, you are drugged.

Would they be shocked by what they find?

Nobody's explained to her,

in language that she understands,

how to manage her condition.

It's not acceptable.

Most GPs only get about ten minutes with each patient.

Dr Rangan Chatterjee wants to try a different approach.

All the time in my consultation room,

I'm seeing problems that are lifestyle problems,

and they don't need a pill. They need a lifestyle change.

He's about to spend time

with families who struggle with their health.

Everything we've tried has basically failed.

SHE WAILS

He'll gain insight into every aspect of his patients' lives.

How do they eat? How do they sleep?

How do they move and exercise?

And how do they switch off and relax?

He'll detect undiagnosed illnesses...

It probably puts you at high risk of early death.

..deliver some home truths...

I think this fear is holding you back.

Please, don't turn it into... this is a...

This is because I'm mentally fearful.

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

It's amazing how many times, when you get those basics right,

all of the other problems get so much better.

Feeling good, energy up, I can even dance.

Shall we have a dance?

What is it doing, though? What's the purpose of it?

This week, Rangan will attempt to help two families

struggling with very different relationships with food.

It's really hard.

First is the Phillips family from north London.

-Like this?

-Yes.

50-year-old mum Rebecca works part time in a cafe.

That's how I dance.

42-year-old dad Mark works in retail.

And their sports-mad 11-year-old son Kiki

is still at primary school.

The first sport that I actually done was mixed martial arts

and the second sport that I done was football,

and then it was basketball.

I think I'm good.

Kiki is a very active child who's been overweight his whole life.

His GP and his family have tried him on various diets,

but nothing has worked.

'He is active,

'and I can't understand how he hasn't lost the weight.'

But as he's developing, he's realising that he's a big kid,

his body's different.

I want him to feel confident in himself, so if we can get him

sorted right now, that would be fabulous.

For the next two months,

Rangan will try to find the cause and cure for Kiki's obesity.

-Hello.

-Hello, hi.

-How are you doing?

Today he is meeting Mark, Rebecca and Kiki,

as well as Kiki's 22-year-old brother Cesar.

You've come to sort out our ailments?

I've come to certainly try and sort out your ailments.

It depends what the ailments are, I guess.

-Kiki?

-OK. So, with me, it's my weight.

I was like this since I was a baby

and all of a sudden, I'm trying to lose the weight,

but it seems like I'm just gaining more weight, and it's really

frustrating because I'm scared that when I'm in high school

I may get bullied for how I look and my weight.

So, if I could lose quite a lot of the weight, I'll be so happy,

so that I may not get bullied about my weight and how I look,

I may get bullied about other reasons.

OTHERS LAUGH

But at least...

No, I'm just saying, at least the other reason would be

because I'm smart or how I dress,

because they may be jealous.

OK. Have you been bullied so far because of your weight?

-Um...

-REBECCA:

-Mm-hm.

I want to say no, but, yeah.

Kiki's now self-conscious about changing when he's at school

because he has a bit of a belly.

You know, being told that he's a fat kid isn't the nicest thing

and, you know, kids nowadays aren't too nice with their insults.

-REBECCA:

-Kids in general...

-Yeah.

But it's not just Kiki who's battling health issues

in this family.

I have missed time off work due to a bad back,

or I've gone to work with a bad back,

to the point that I've had to go home or go to the hospital

because the pain's been that bad.

You've had to go to the hospital

from work because the pain's been that bad?

Yes. Obviously I've got a family to look after,

I go to work anyway, and there's been odd times where my back's been

so bad, I'm laying down in the office

and if I hear customers come in, I roll up, serve a customer,

wait till they're gone, then I'd roll back down onto the floor

until the next time.

Mark's back pain means he's losing days at work, and it's

affecting the family's financial situation.

I don't know nothing else apart from working

and, financially, I still can't meet that demand

-of trying to look after my family.

-It's fine.

It pisses me off, pardon my French.

But it pisses me off. Get them well,

and if you could get me partially healthy afterwards, that's fine.

As you keep reminding us, you're the head of the family,

so if you're not right then we're not right.

OK, just stand in front of me.

Rangan begins to investigate the cause of Mark's back pain

by looking at the position of his feet.

-The important thing, for me, is that it's not symmetrical.

-Yeah.

If they're not symmetrical, it's not going to be symmetrical further up.

-Yeah.

-Does that seem reasonable?

-Mm-hm.

-Is it OK?

-I guess so.

He then wants to look for any clues in their blood

and test their saliva...

Basically, it's a spit test.

..as part of a thorough examination.

It's 98 over 65,

-which is well within what I would regard as normal.

-OK.

-So, no need to be concerned about that at all.

-OK.

But for Kiki, the most important thing is to measure his weight.

So, your weight is 70.4kg,

it's about 11st 1 lb.

That is how much I weigh!

That's a lot.

That's really heavy for your age.

His BMI was 33.

What?!

No. That's not good, babes.

-OK?

-Yes.

Yeah? Do you know what the good thing is?

The good thing is, now I'm coming in, I'm hearing what's going on,

I've got a baseline measurement,

now I've got something to work with and something to help you guys with.

-Are you OK?

-Yes.

-Yeah?

I was shocked. I actually was wondering, "Is that scale right?"

because an 11-year-old kid being over 11 stone?

If we don't get on top of this now, he's going to be an overweight adult

and he's going to have all the health problems

that is associated with that.

It's dinner time, and it's the first chance for Rangan

to see for himself exactly what Kiki's diet is like.

Is this a typical meal?

-Yeah, more or less.

-Yeah? Great. Tasty and healthy.

Thank you. This is why I don't understand

why Kiki is so overweight.

If we are having our five-a-day,

-and some...

-Yeah.

-..how does that work?

With no real clues coming from his diet at home...

All right, is that bedtime?

..Rangan is keen to see what Kiki eats at school,

away from Mum's watchful eye.

I've come to Kiki's school to get an idea of what he actually does

at lunchtime, because he spends a lot of time here at school,

he's having five meals a week here at school.

If his friends are having sweet things and fizzy drinks,

and I tell him not to have it,

it's pretty hard for an 11-year-old, I think.

So I need to really tread carefully, I think.

Hey, Kiki. How are you doing? Good to see you. Are you all right?

-Yes.

-Good. Very, very nice to see you again.

You go in here? OK. Have you brought your lunch with you?

-Yes.

-Can I sit with you guys? Is that all right?

-Yeah.

What have you got with you today, Kiki?

I've got plum, chicken and rice.

Plum, chicken, rice and...?

-Peas.

-OK. What do you have to drink?

Usually, I have water from the water fountain.

OK. Do you ever bring anything else?

-No?

-No.

-OK, so you had some cereal at 7.30?

It's, you know, 1.20 now,

and you didn't eat anything in the morning?

Were you hungry in the morning?

-Not really.

-No?

Wow, so that's a good five, five-and-a-half hours

-you didn't eat for and you didn't feel that hungry?

-Hmm.

-OK.

Oh, Kiki? He is my favourite, he always comes and says hello to me.

-Does he? He's a nice...

-Yeah, he used to be on school dinners.

What would Kiki eat before?

Oh, everything. He was a big fan of vegetables. He always ate...

He often went for the vegetarian option.

What do the kids drink here? Is it water, is it juice?

It is milk or water, they have a choice of milk or water.

With the kids on packed lunch, they can bring what they want?

They're allowed to have a fruit juice or a milk,

as long as it's not high sugar, nothing fizzy.

-No glass bottles, obviously.

-Yeah, sure.

After a day at school, Rangan has drawn a blank.

Kiki isn't a secret snacker

and isn't gorging on sweets or fizzy drinks.

His diet is... Frankly, it's not that bad. From what I've seen,

it's actually looking pretty good.

And it may not actually be his fault.

There's kids who eat that way,

and they're stick thin, no problem at all.

But for Kiki, for some reason, he's not,

and that's really, really hard.

A few days later,

Kiki's blood test results are back

and they've given Rangan even more to worry about.

Guys, can I sit there so you can...

so you can see them?

So, we did an insulin level with Kiki.

You really want it under 15, some people say ideally under six.

Kiki's insulin is 32.6.

That's high.

It's not just high, it's through-the-roof high, OK?

-Hmm.

-I don't tend to see them that high.

You know, really,

this is the sort of thing that, unless we get on top of,

-at some point...

-He'd be diabetic.

-It can go to type 2 diabetes.

I'm not saying that lightly, I'm not trying to scare you.

-I know.

-I'm just trying to be upfront.

I can see the results there.

-Are you a bit shocked by that?

-Yes.

I'm actually really worried about Kiki.

He's got a condition called insulin resistance.

Now, Kiki's body is needing about three to four times

the amount of insulin that a regular kid's body would need

just to keep his blood sugar under control.

But, you know, I don't think that's the whole story here.

There's many different causes of insulin resistance -

poor sleep, stress, a problem inside your gut.

There's so many different things

that I need to keep looking for the root cause.

So, I think that's where the key to Kiki's obesity lies.

In the meantime, Rangan puts Kiki on a strict elimination diet.

No...

My bread...

White bread raises your blood sugar significantly.

The diet is not about restricting calories.

No!

It pinpoints food that Kiki might be sensitive or allergic to.

But the good news is,

there's plenty of great, yummy foods that you can eat.

Meat and fish that look like meat and fish,

fruit and veg that looks like fruit and veg,

nuts that look like nuts, eggs that look like eggs.

So, for Kiki and the family,

staple foods like bread and pasta are off the list.

It's essential that we get you sorted.

You have just got to make a conscious effort,

and you know if you pinkie promise, that's...

..that's a bond that can't be broken.

Come on, pinkie promise.

Yeah?

OK.

Kiki's insulin result, his blood sugar result, it's really worrying.

I think the softly-softly approach is not going to work any more.

We need to really go hard at it,

but there's still a big part of this picture that I'm missing.

What is actually driving Kiki's insulin resistance?

I don't know yet, but I need to figure it out.

-Go on.

-Have you got keys to get back in?

With Kiki's diet plan under way,

Rangan travels to meet his next family,

the Garratts from the Wirral.

44-year-old care home worker Lisa and her partner Adam

have called in the doctor

to help with their daughter Hoshi's eating disorder.

I'm 16 now and I still eat like I'm a five-year-old.

I'm scared of trying new foods.

Would you not even like any egg? Scrambled egg?

-Poached?

-No, I just don't want it.

When was the last time you even tried egg?

I'm not sure if I've tried it or not, but, like, I wouldn't want to.

Hoshi's mum began noticing her unusual eating habits

when she started school.

Half the things you're saying now you don't like,

you don't even know why.

It rules your life, Hosh, it rules ours.

Can I have a grilled-cheese sandwich, please?

-Yeah.

-Without the salad.

-Yeah.

I do want to change, and change for the better,

because I know I can't carry on the way I'm carrying on,

with this inside me all the time.

It's not so healthy.

-Good morning.

-Hi.

-Hi.

-How are you?

-I'm fine, come on in.

-I'm Dr Chatterjee, nice to meet you.

-I'm Lisa.

Morning, Hosh!

-Hey! How are you doing?

-Good. Hi.

-Hi, I'm Rangan, nice to meet you. How are you?

-Nice to meet you too.

-Yeah, I'm good.

-And what is it now? Is it breakfast time for you?

-Yeah, I'm dying for breakfast.

-Are you?

-Yeah, I want my shake.

Is this a special diet, or is it...?

Yeah, I'm quite obsessed with weight,

so then I think, if I have this of a morning,

I'm not eating, like, a bacon butty,

which could add to the ballooning feeling and, mentally,

I think I've done something quite good.

And that's breakfast.

-Hoshi doesn't have breakfast at all.

-Right.

We tend just to let Hoshi have Hoshi-food, we call it.

-What she likes.

-I'd love to know what...

-Hoshi-food is?

-Yeah. Hoshi's list.

So, the last two weeks, what have you eaten?

-Chicken.

-Chicken.

What kind of chicken would you have?

Plain chicken, that's not been seasoned or has stuffing in it.

-Yeah.

-Bread.

-Bread.

-Crisps, chocolate.

All chocolate, or specific chocolates, again?

Chocolate that doesn't have stuff in it, plain chocolate.

Duck.

Ham sandwiches.

-Ham sandwich? OK.

-Sausage rolls.

-Sausage roll. One, two, three, four, five... Yeah, seven things.

-Hmm.

So, you're just having them over and over again, really, aren't you?

Just cos they're safe and boring.

And it is quite stark, because I probably have more than seven foods

in one day.

-Wow!

-Yeah.

Having seen Lisa's breakfast and investigated Hoshi's diet,

Rangan brings the whole family together to talk about food.

Why don't you just tell me what you feel

I should know about? Then I'll add in what I need to.

OK. Issues with food started when I was much younger,

before having Hoshi,

just a girl growing up thinking I should be a certain size.

I was bulimic for a while.

It's awful to say this in front of a teenage daughter

because I probably try and hide it all from her,

but I probably think happiness comes if you're littler,

which is awful, to be 44 and still feel like that but, probably, I do.

-Did you make yourself sick?

-Yeah.

-Sorry, Hosh.

-Have you ever made yourself sick?

-No, not at all.

Ever been tempted? No?

What do you think's causing your...

..is it fair to say anxiety about food?

Do you feel nervous about food, do you feel nervous before food time?

What's up?

Just that I'm anxious about food, that's all.

It's all right. It's allowed.

SHE SOBS

What is it that makes you anxious, do you know?

Do you remember when it started?

I know it's upsetting talking about it.

Do you think about it most days,

in terms of how it makes you feel, or is it just your normal life now?

No, I don't think about it until I have to talk about it,

and then it makes me upset.

Do you know, what are you scared of? What are you anxious about?

It's stupid, just that I won't like it, which isn't a bad thing,

-I know it's not.

-Yeah.

But when I actually have it in front of me, I think...

-Yeah.

-Yeah.

This is a huge, huge problem.

You know? You're saying you've got issues with eating.

It's definitely not just you,

but it's your age group, actually, that get most of these problems.

So it is emotional, but don't feel bad.

It helps.

I think it does.

You really don't want to see a teenager have to go through that.

You don't want to see anyone go through that,

but you wouldn't expect that.

When I first met her, you know, she's quite smiley, quite chatty,

but once you start probing...

..she's struggling on the inside, and I don't think her family

even knew how much she was struggling.

I actually think it's a really, really good thing

that we did it as a family,

because it's going to be as a family that they get out of this.

Hoshi's limited diet means she avoids eating out

and she'll only buy her food from a handful of shops.

Do you buy different things when you're here or is it the same thing?

It's the same thing.

-Every time?

-Yeah.

-OK, well, let's go and have a look.

Two large sausage rolls, please.

-Would you like me to warm them up a bit?

-Just cold, please.

-Cold? OK.

I can taste them already.

Sometimes, if they change it, I can, like, taste the difference.

-Really?

-Mm-hm.

-So, when they last changed it, what happened?

I kind of tried it and I was like, "Oh, that's not what I was expecting."

-Did you get used to it?

-Yeah, yeah.

Then they changed it back and I was like,

"I'm glad they've changed it back."

If I knew it was different, I wouldn't buy it.

Shall we sit here?

SHE GIGGLES

-Good?

-Mm-hm.

As always.

Did you know that your mum had an eating disorder

when she was a teenager?

Yeah, but she never really spoke about it in much detail.

It was just kind of, like, brushed aside.

So, were you hearing stuff this morning from your mum

-that you'd never heard before?

-Mmm.

Back at home, Rangan wants to know more about Lisa's own history

of eating disorders.

I see a lot of similarities between you and Hoshi.

-Yeah.

-I mean, it's amazing, actually.

We were on our own for quite a bit, as well,

because Adam's only been with us the past five years,

so we are pretty close.

So, it was a long time that you guys were together?

Yeah, me and her. Her real father's never been in the picture.

But it's remarkable for me that some of the patterns

-you were probably showing...

-She's showing in her.

-She's showing.

-Yeah.

-And...

Yeah. I'm trying to figure that out, because...

Break the cycle, because I wouldn't want her to have that.

-No.

-That's probably the only thing I have never wanted her to have,

yet she's ended up with that.

Yeah.

-It's bizarre.

-How does that make you feel?

-Awful.

When you have children,

you just want them to be happy inside,

and feel good

and enjoy life,

where I feel... Obviously she's had that and dealt with it herself,

-not really told me.

-No.

-That's remarkable, isn't it?

-Yeah.

Yeah. I've just probably shielded her.

-Yeah.

-Because I didn't know what else to do.

-You never know as a parent, do you?

-No, I'm just winging it. Yeah.

-Don't know.

-Everyone's trying to figure out what's the...

-The best thing to do.

-You never know if you've done the right thing.

-No.

Rangan gives Hoshi a full health check,

as a lack of nutrition in her diet

means she's at risk of suffering from fatigue,

poor bone density and immune deficiencies.

This will affect the whole of her life.

We've got to tackle it now.

In two years, she might go to university.

How's it going to be then? She's sheltered here now.

She's sheltered in school now.

Wait till she gets out. And that's a lot of pressure, actually,

because she's not really trying to tackle this

and I don't want to botch this up.

I really don't want to mess it up.

Rangan researches to find an expert in Hoshi's type of eating disorder.

I'm actually going to take her this morning to see a specialist

to see, can we get a diagnosis,

and can we get some more specific guidance

in terms of how I can help her going forward?

She's a clinical psychologist.

She's used to seeing loads of patients

who've got anxiety around food like you do. Nerve-racking?

-A little bit.

-Yeah. I thought she looks a little bit nervous.

-But I'll be OK.

-Yeah.

-I've got thick skin.

Rangan has brought her to see Dr Liz Shea.

So, I heard you might have brought some of your foods with you?

Can we put them out on the table and I can have a look at them?

Anything else that you would normally have for your tea?

-Like, chicken nuggets.

-Yeah.

Which sounds, like, really boring,

but I know I'll always enjoy it, so...

-Yeah. Is it boring to you?

-Yeah.

-Is it?

OK. Do you get bored of your foods?

-Really bored of them.

-Yeah.

OK. That's really common with people. You're doing really well.

That's really common with people I see, Hoshi, OK?

Almost everyone I talk to says the same thing.

This is the sort of foods

that people bring to show me all the time.

I'm going to show you something else.

These are the sorts of categories

that we see in the pattern of eating that Hoshi has, OK?

There is your carbohydrates.

-This is so weird.

-LISA:

-Isn't it!

I'm just speechless.

-That's, like, all the foods that I could eat.

-Hmm.

Yeah. I hope that makes you feel like you're not on your own with it,

Hoshi, yeah? OK? Yeah, OK.

Yeah. All right.

-So...

-These are happy tears now.

-Good.

-We're going through all types of tears.

I'm going to show you this as well.

A new label that we have for the pattern of eating that Hoshi has.

It's called avoidant and restrictive food intake disorder.

We call it ARFID for short.

It's a lot easier to say that.

OK. So, at what point did this range of foods start to get smaller?

-LISA:

-Starting school.

OK.

I let her have packed lunch.

Hmm. Brilliant.

See, now I don't know if that was brilliant or not,

because it was maybe...

Cos I know the dinner ladies knew that Hoshi wouldn't really

-eat these dinners and...

-I think what you're actually asking me,

-is, "Did I do anything wrong and could I have stopped...?"

-Yeah.

Yeah. I don't think there's anything you could have done to prevent it.

Right, OK.

-RANGAN:

-It would be really good to have a clear understanding

of what we can all do to start moving on.

Choose two new foods. For babies, very small babies,

they only need to try a food once or twice and they'll learn to like it.

When you're 16 or over,

you might have to try it as many as ten to 14 times.

It's the second taste that's the hardest, not the first one.

Because the second one,

you've got a bit of a sense of what it's going to be like

and you might have to work a bit harder.

Yeah, take the foods.

See you now, bye-bye.

I feel like we've got so much more, like,

to work with and know what we're doing

-and where to go with it and stuff.

-Yeah.

How do you feel, Hoshi?

Yeah, exactly the same.

It's nice to actually know that there's people out there like me.

I think Hoshi now has got a few days just to let it settle in.

I hope she comes up with these two foods.

Can we try a new food not once, but maybe three, four, five times?

And maybe get to that magic ten to 14 times,

where it actually goes from being a novelty food

to actually being in her diet.

Yeah, I'm very hopeful at the moment. Very hopeful.

It's been a week since Kiki began his elimination diet,

and he's starting to get used to it.

So the doctor said I should eliminate wheat and dairy.

So I'm going to make a chorizo omelette.

I'm being good.

But he's still not losing much weight.

Rangan is researching possible causes of Kiki's obesity.

Hi, Professor Spector?

-'Hi, there.'

-I'm looking after an 11-year-old.

He's been exploring the latest research

about the bacteria that lives in our gut, known as the microbiome.

A sense that there is something more at play here

than just diet and exercise.

Hey. How are you doing?

But to test this theory,

Rangan needs to ask Kiki for another more intimate sample.

The composition of the bugs in here...

in your gut, in my gut, in your gut, in everyone's gut,

can have a big impact on someone's weight.

I want to get an analysis done of Kiki's gut.

Basically, it's a stool test.

-Mm-hm.

-And see if it gives us some answers.

That would be so great, if you can help him.

Kiki will need to collect a stool sample once a day for three days.

Eight o'clock in the morning.

Yeah. So first test done.

Kiki's.

-Felt weird.

-Yeah.

-I don't think that's a profession we want to take up.

-No.

While Rangan waits to find out Kiki's gut bacteria results,

he turns his attention to dad Mark and his chronic back pain.

Hi, James.

Rangan has brought Mark

to see movement and back specialist James Jowsey.

James, this is Mark. Mark, James.

First of all, we're going to go through your sporting history.

I was doing a lot of athletics.

I eventually went on a school trip

and popped my right knee out of socket.

Right, OK. Let me write that.

Yeah. I couldn't bend my knee properly.

I think at one stage, it could only go that far.

A broken leg when he was just five

and a damaged right knee could be the cause of Mark's back pain.

He's lost a range of motion in that leg.

As soon as we stand him on the right leg, he's...

-He's just like that.

-Your pain's down the left,

but your left is being used more.

You've got two legs, you need to have two players rather than...

-OK.

-..rather than one player.

Right, first exercise of the day.

What we want to do is, I want you to get to your point

-where your hip has this range.

-Yeah.

Through targeted repetitive exercises,

it's possible to retrain our muscles and limbs

and change years of bad habits and alleviate pain.

-His foot's better, but...

-It's much... It's definitely better.

-Yeah.

-Appreciate it.

-Down to you now, mate.

-Definitely.

-Definitely.

-Down to you.

But treating Mark's back pain is only part of the solution.

Rangan has discovered worrying results from the saliva sample which

measured Mark's stress levels.

So, if you remember, when you did the saliva test,

you did it at four times during the day.

-Yeah.

-The idea is to give me a snapshot of what

your stress hormone cortisol is doing.

I want to see it at around 20 in the morning.

Yours is 43.

OK. That's really, really high.

And to put it in context for you, this graph only goes up to 35.

So this is actually up here, but the graph's got no room for it.

I haven't actually seen one in the last few years

-where every single level is high.

-Really?

-And I do this test a lot.

Yay...

OK. All right.

-Do you understand that?

-Yeah.

Yeah? So, I'm saying to you that your body is chronically stressed.

OK.

I don't pay attention to me in that way.

I don't... I don't care.

I know it's a negative thing to say, but I don't care about how I feel.

As long as my wife, my kids are cool, I'm not bothered.

So I can't really say I really pay that much attention.

I know there's times that I'm unhappy,

or there's times that I feel slightly depressed,

but I have to get on with it because it's all about my family.

You say you need to work for your family, I get that.

I need to work for my family, I understand that.

But if this keeps going,

I'm foreseeing a time in the not-too-distant future

where you won't be able to work for your family.

And then who looks after them then?

-Sorry. Are you OK?

-No.

No.

I don't know what more to do.

It is stress of the family, it is the stress of money.

You know, it is stress.

I don't know.

I'm not saying everything's going to magically disappear.

-I can't remove...

-Yeah.

-..your anxiety.

-I can't remove your financial situation.

-Hmm.

I can't do that. But what I can do is help you manage it,

help you switch off from it,

help you do things around it, so that you've got more energy,

you're sleeping better, maybe even get you out of pain.

-Are you OK?

-Yeah, my head's spinning.

-Is it?

Mm-hm.

Yeah, my head's spinning.

Actually giving yourself time can actually help you give others time.

And I really see that with you.

You need to give yourself something, something you love.

You need to carve out some time for you.

And I think that will allow you to give more to your family.

To tackle Mark's stress,

Rangan wants him to try a relaxation technique that combines

controlled breathing with his love of martial arts.

OK. Follow me.

T'ai chi is a martial art originating in China over 700 years ago.

It's sometimes called moving meditation, as it focuses on

gentle, flowing physical movements and the control of the breath,

both of which are proven to help stress.

I'm going to look at your feet

and check...

Relax here. Feel stronger.

There's a yin...yang.

We'll use the yin-yang service.

Yes. That's OK.

Relax. That's very important.

-I thoroughly enjoyed that.

-Oh, fantastic.

I understand how it can be very relaxing,

even though you're trying to concentrate,

but you still feel quite relaxed,

knowing that you're going through a very slow motion

and it's very controlled, and I really enjoyed that.

Let's see if we can come up with a plan for a daily practice.

In the Wirral, Rangan is tackling Hoshi's eating disorder.

He's following the advice of the psychologist

and trying to move Hoshi away from sausage rolls and chicken.

When was the last time you were in a fruit and veg shop?

I don't think I've ever been in a fruit and veg shop.

-Really?

-I don't really go food shopping

with my family, they kind of just go and then bring stuff back.

So they bring back stuff...

Hoshi-food.

Yeah.

One of the first steps the psychologist suggested

is to touch and smell different foods.

Is there anything in particular you think, "Do you know what,

"I wonder what that tastes like"?

-Watermelon.

-Watermelon.

-Hmm.

-Right, so pick it...

-Shall I get it?

Yeah, yeah, get it, absolutely.

-What is it about it?

-I think it's the fact it smells really sweet.

-It smells sweet?

-Yeah.

Or like, I wouldn't really like those. They just look dirty.

Is that me being...?

Like, I do wash them, but they just look gross.

OK, so, I think you're right.

That is crazy, in front of me, isn't it?

Like, it looks cool, but I don't know how you'd eat it.

After an hour in the market,

Hoshi has chosen a bag full of new foods that she wants to try.

I never thought we'd come out with one, two...

seven new foods.

Me neither.

Hoshi may be trying to please me.

Hoshi may be aware that this doctor's here,

he's trying to help me,

I'm going to say all the right things.

I don't think that's happening here.

But I've got to be aware and alert to that possibility.

But I don't know, it gives me a lot of hope, actually.

I reckon I can get her eating this week.

I really do.

Why don't you see if, at least once this week,

you can have one of those foods?

Maybe once or twice or three... You know, as many times as you can.

-Yeah.

-I don't mind if I come back in seven days and you say,

"I just couldn't do it." That's OK.

-OK.

-That's cool.

I don't want you to do it out of an obligation to me.

-Do it if you want to do it, if you feel it.

-Yeah, I think I do,

cos I've actually gone out and picked them myself.

It kind of feels exciting to try them.

-Yeah.

-I don't know why, but...

-I really do think you can do it.

I think I can, too.

Yeah. I think you're stronger than you think and I think you can do it.

This is the chance to do it.

If I'm going to help Hoshi,

I need to look at the whole household, because Hoshi's mum Lisa,

she's had bulimia, she has diet shakes for breakfast and, actually,

she's always had a really difficult relationship with food.

At the moment, in this house, food is surrounded by anxiety and stress.

If I can make it a pleasurable experience,

it's going to help all of them, not just Lisa but Hoshi as well.

So, I've brought a book for you to help you,

just to give you a bit of guidance, OK,

in terms of recipes and things like that.

What you can have as much as you want is sort of good-quality meats,

-good-quality fish, good-quality eggs, OK?

-Yeah.

Fruit, vegetables, nuts, seeds,

-and there's no calorie control on this.

-OK.

-At all.

OK? Cos I know you've had issues with food and weight

-and all that kind of stuff before.

-Yeah.

-You can eat as much of this as you want.

-OK, yeah.

-OK?

And you won't put weight on.

-All right.

-Right? Because it's about the quality of the food

that you're having, rather than what calories.

Probably where I've only just ever looked at food as,

-will it make me fat or will it make me thin?

-Yeah.

Never beneficial.

Ideally, I'd love you guys to sit here and eat together.

-Yeah.

-Ideally, not eating in front of the telly.

That can really help get you back into food,

really nourishing your body.

Maybe Hoshi might join you the odd time? Maybe.

-Yeah.

-I think, with Hoshi, we've got a very individual case

and although my instinct is to throw you into something all together,

I think I've just got to make sure I'm careful with Hoshi.

-It's not too uncomfortable for her all in one go?

-Yeah.

Over the next week, Lisa leaps headfirst into her new diet.

I'm really getting into it now.

I'm making a chilli.

This morning, I was up quite early.

I made some breakfast muffins and then, after I've done this,

I'm going to be making a chicken dish.

We've been having fresh fruit.

-All good!

-Are you done, Nigella(?)

Done, Nigella.

Hi, I just thought I'd check in.

I'm actually going to put some dinner in.

Hoshi is sticking to what she knows best.

It's just a load of chicken nuggets, which is boring,

but I know I'll enjoy it, so...

Yeah.

But Lisa keeps on trying to tempt her.

We've got the cucumber, in case you want to try.

We've got some plums, got a pomegranate.

In that top one, there will be loads of mixed fruit already done,

cut up ready.

So have you thought about trying anything new?

You've not tried anything yet.

Erm... No.

It's just not really come up.

When I've asked you, you've been quite short about it,

-as if...

-It feels like you keep getting on me and it just makes me

-not want to.

-I've only asked a few times.

You've not! You've not.

I just say, when I'm out shopping, "Do you want to think about stuff?"

No, it'll be like, we're in the car

coming home from school, I'll be tired and you'll be like,

"What have you been thinking about this?"

and it makes me not want to do it.

OK. Probably the best plan is, now, the agreement between me and you,

I won't mention it...

-Yeah.

-You say to me, "Oh, Mum, I might have..."

You know, "I think I might want to try..."

Whatever it is, X, Y or Z,

then you can tell me if you either want me to pick it up

or you want me to take you to go and pick it yourself.

-That's what I wanted.

-You're totally in control of it, then, now,

and I'll just do what you kind of say.

-Thank you.

-It's all right.

Do you want a bit of chicken?

-No.

-No?

PHONE RINGS

-Hi!

-'Hey, guys. So, how are you guys getting on?'

-Really good.

-'Oh, brill.'

Absolutely love cooking.

-Like...

-'Oh, fantastic.'

-Yeah.

-Hey, Rangan.

'So, have you managed to try any yet or not yet?'

-No, not yet.

-'No? OK.'

I've not really been thinking about it too much.

We've had this discussion with my mum, like...

-'Have you?'

-The fact...

I've kind of felt like she's been pressuring me.

'Oh, really?'

I think Lisa's putting a lot of pressure on Hoshi

without realising it.

And, actually, it's stopping Hoshi from trying new foods,

so I've got an idea that may just help.

Hey, guys. How are you doing?

Hi.

I'd like you guys to close your eyes.

OK.

OK, you can open your eyes now.

-Oh, my God.

-Oh!

-Do you know what these are?

-No.

Crickets, edible bugs, insects.

Are you OK? You look a bit sort of...

-It's just disgusting, really.

-So you wouldn't eat it?

-No, never.

-It's amazing, the body language in many of you has changed.

You've closed up a bit,

you've sat back and you're just really looking uncomfortable.

-Is that the sort of thing you would eat?

-No.

-Why not?

-Because it's unknown.

-Yeah, I backed away.

-Yeah.

-Cos it's unknown?

-Yeah.

-Yeah!

Yeah, yeah!

Hoshi, is that a fair reflection of how you feel?

Yeah, exactly how I feel.

But it's about normal foods, not... maggots.

A lot of people would freak out when they saw this food, right?

-Yeah.

-But Hoshi feels similar to that with everyday foods.

And when we say, "Just put it in your mouth,

-"just try it..."

-It would be like...

Yeah, it's just like saying, "Go on, pick that up,

"put it in your mouth," but then the thought of me

putting that in my mouth...

But maybe I should because I'm asking my daughter to do something.

Yeah.

Go on, have one. Do it.

Delicious(!)

See, now... I'm doing what I say to Hosh don't do.

"Why are you smelling it? Why...?"

But in my head, I'm thinking...

I'm not mentally prepared to put that in my mouth.

And I get it now, because my heart is...

Although I'm trying to be dead calm and be, like, a role model,

my heart's beating.

-It's horrible, isn't it?

-Yeah, it's awful.

How you do it is beyond me.

Would you like me to eat this so I know?

Not particularly. It's all right.

If you want to experience what it's like, yeah, go. I think...

You're, like, shaking.

CRUNCHING

-Can you not even look? No?

-It's disgusting.

-What's it like?

-I can honestly say it's not as bad as holding it.

Exactly. That's... Whenever, like...

It's that step of...

Completely, because I'll try foods and I'll like them,

it's just actually having it in my hand and, like,

seeing it on my plate and having to actually do that...

-And the build-up.

-Yep.

-But I felt that

and to know that you do that every day, hats off to you, kid.

-Ta.

-No, it is. It's brave.

It's brave, Hosh.

I'm not putting you guys on the spot,

-but would any of you two have any of this?

-No.

No way?

I'm actually a bit nervous about how pale you're looking

with this in front of you. Honestly.

Is this the first time that people around you have actually...?

Understood properly.

-Yeah.

-Yeah. Because they can be like,

"Oh, yeah, you're just nervous about trying it."

But it's more than that.

It's like having that on my plate every day.

I couldn't put it any better myself.

That was critical, for her mum to see that.

I think that's quite hard for a mum, you know?

I think there's a bit of guilt there.

There doesn't need to be guilt there but I think there is guilt there.

She was welling up

because that's what her daughter has been going through

for over ten years.

Rangan has worked hard with Hoshi,

teaching her to pick up and smell different food

and helping her friends and family understand her condition.

But he's still struggling to get her to eat something new,

so he's asked her to return to see Dr Liz Shea.

The thing to remember is that ARFID

is caused by these sensory hypersensitivities, you know?

And those are things that Hoshi has had her whole life

and they probably won't go away, OK?

Because that's just you and your make-up.

So it's finding a way round those,

and that's why, you know, it doesn't just disappear.

-OK.

-Yeah. So I'm going to put my finger really high.

So what you have to do...

Dr Shea is teaching Hoshi a technique called food visualisation,

where imagining food brings you one step closer to eating it.

And in this room, because you're feeling safe and calm and relaxed,

you'll be able to eat if you want to

and perhaps you've brought some foods with you.

Maybe they're foods that you eat and enjoy.

Maybe there's even one or two foods that you haven't tried before.

Three, two,

one.

So, did you eat something?

I did, and it wasn't yellow.

-Ah! What was it?

-It was an egg.

-An egg?

-A fried egg.

A fried egg. I wasn't expecting that.

I wasn't either!

We went in my dream world and I, like, tried an egg.

It'll help me try stuff in real life.

Wow.

Rangan has the result of Kiki's gut bacteria test.

He hopes it holds the secret to why Kiki is obese

and his insulin levels are so dangerously high.

-How are you doing, Doc?

-Hey, good to see you.

I've got some new information for you, some results for you.

We know about our liver, our heart, kidneys, our brain.

-Our skin.

-Our skin.

Exactly. But not many people think about our gut bugs.

Inside us, inside our guts, live trillions of bugs.

-Yeah.

-And actually they've evolved with us

over millions of years, and the balance of those bugs

is critical for many things in our body - our mood,

how our gut is, maybe our skin.

-OK.

-But also our weight.

Rangan believes these gut bugs may help decide how much of our food is

turned into fat and how much is used as energy.

And the more varied bugs, the better.

These beans inside

represent your gut bugs.

What I want to see...

-..is a gut that looks like this.

-REBECCA:

-Mm-hm.

We want to see it all the way up here, with lots of diversity.

Kiki, your results are down here.

That's crazy. How come he has no bugs?

In some people, a single course of antibiotics can cause this.

-In some people.

-OK.

The diet impacts this. There's all kinds of things.

Stress levels impact this.

Rangan thinks that having a smaller variety of gut bugs may mean

Kiki's body is less efficient at processing fat.

The fastest way you can get from that to that...

..is with food.

The more diverse the food you're eating,

the more diverse your gut bugs.

So look at these red foods that you've got here...

Rangan wants Kiki to grow a variety of gut bugs

through a daily rainbow diet of colourful fruit and veg.

Strawberries, beetroots, cherries, cranberries, guava, red peppers.

-Guava?

-Tomatoes, watermelon,

guava, carrot.

Every day, can you get every colour of the rainbow in?

In addition to the rainbow, he wants Kiki to focus on specific foods.

There's a study which shows that two apples a day in two weeks

change the composition of your gut dramatically.

But there's a way of actually cooking it.

I'm going to show you now.

-Oh, you need to cook it?

-Yeah, and you can have it every day

-and that in itself will start to make these changes.

-OK.

Increasing the fibre from fruit and veg

may enable Kiki's gut bacteria

to produce beneficial compounds that could help him lose weight.

-So it's not one apple a day.

-It's two apples a day.

It's two apples a day!

-Exactly!

-Keeps the doctor away, hopefully.

You can add raisins or sultanas.

And then these and apples can spike your blood sugar a bit,

so that's why we give cinnamon, because cinnamon helps reduce that.

-Oh, really?

-Yeah.

And you can just eat an apple, right?

But actually, we find that when you heat it,

it releases a lot of these compounds quicker.

-Oh, OK.

-And that's the point, really, of heating it.

Rangan is also using targeted nutritional supplements

to supercharge the process.

You can put the skin to the side.

-Good?

-Doc, are you going to try some?

-Yeah, I'd love some.

-This is good. Just tastes like baked apples.

-Next time, do you reckon I can see that all filled in?

-Yeah!

It's going to be very competitive and very difficult

but just a little bit of encouragement and I'll be there.

I think that went really well. Kiki's up for it, you know?

I think he's seeing it as a bit of a competition,

and if that's what it needs to get him to do it, I'm OK with that.

Two months ago, the Garratt family were struggling with their food.

Lisa lived off diet shakes for breakfast,

and 16-year-old Hoshi was limited to just seven foods.

-Do you want me to get up extra early and make you a bacon roll?

-No.

-Hi!

-Hey!

-How are you doing?

-I'm good.

-How are you doing?

-Some breakfast?

-Breakfast sounds good, yeah.

-Brilliant.

-Banana pancakes?

Yeah... Not the diet shake any more?

-No, no.

-No?

Pancakes made with just banana, and fresh eggs from the farmers' market.

-That's it.

-Let's do it.

-The only ingredients.

Let's go.

-It's proper food with proper nutrients.

-I like breakfast.

I can't tell you how happy I am to hear you say that.

-I know.

-You like breakfast.

-I like breakfast.

It's probably my favourite meal.

That is so great.

I just think I'm getting up and I'm ready for something.

What a turnaround.

I know. Breakfast in a tin - we don't think like that now.

We just think, "It's time to give your body something good."

It's just about food and nutrition

and it doesn't matter how you eat it or when you eat it,

-as long as it's doing you good.

-Yeah.

-It's like...

There's such a big change from a few weeks ago,

-what you're telling me.

-Yeah.

Rangan wants to know if Hoshi has introduced any new foods

into her diet.

So, Hoshi, I thought we might try and see if we can piece together

-what's in your diet now...

-OK.

-..compared to the start.

I can't think.

-I can help.

-You can help.

Yeah, yeah.

-Yeah.

-So she has Southern fried spicy chicken.

And then that's on the bone and then I have it off the bone as well.

Yeah. She has different bread rolls and croissants.

-Yeah, there's that kind of...

-Yeah, brioche, normal bread rolls,

like a sub roll.

Chapatis. She's had a pancake.

-Didn't you, that Adam done?

-Yeah.

-That's a new food, isn't it?

-Yeah.

-Different duck.

We used to only have one type of duck

but now she'll have a different duck, won't you, with pancakes?

You've had watermelon.

You had cucumber.

You don't know about this, but with Gem,

like, dried cranberries.

-Have you?

-Yeah.

-Wow. How was that?

-Really nice.

-Was that at school?

-Yeah.

-Pomegranate. You've had pomegranate.

Yeah. This is more than seven.

This is a lot more than seven.

I suspect there's more there.

-Yeah. I'm trying to think.

-I just can't remember.

Just in your first pass, I've put 12 different things down.

So add that on to the seven of last time, you know,

you're pretty much 19, 20 foods, compared to seven at the start.

I'm kind of proud of myself.

Yeah, it's a big, big change, that.

I'm pretty sure soon that, you know, we'll...

-We'll fill a whole book.

-Fill a whole book, exactly!

Fill a whole book.

To celebrate Hoshi's growing appetite for new foods,

everyone heads out for lunch.

I'm going to get the all-American chicken burger.

That's quite a quick decision.

Yeah, I saw it and I instantly thought that.

-That's really good, isn't it?

-Yeah, it's fantastic.

We're not saying,

"Can we have a side order of goujons to make it, like, a meal?"

-Cheers.

-And then another medium with salad.

That'll be for me, yeah.

You're ploughing through that.

-Is it that good?

-Yeah, it's amazing.

-Do you like it?

-Isn't it?

-Amazing.

Can you remember the last time you guys went out

-and it was a stress-free experience?

-Never.

-It's never happened?

-No.

-This is the first time?

-Yeah, first time.

-Brilliant.

-Yeah, it is, it's fab.

I can see the smile coming out...

-Yeah.

-Not from your mouth, it's coming out from everywhere.

I'm trying to contain it. I'm trying to be

cool and laid-back about it but, yeah, it's amazing.

Really, really good.

So proud of her.

I think Lisa and Hoshi are on the right road now.

Yeah, Hoshi's done a lot of hard work

but at the same time, I think Lisa changing her relationship with food

is actually impacting Hoshi.

And that's what I always say to people,

you've got to make changes as a family.

Try and do these things in isolation, no chance.

You've got to all get on board, all do it together.

You can see you get results like this.

Eight weeks ago, when Rangan first met the Phillips family,

they were struggling with their diet and lifestyle.

Two.

Three.

Four.

-What's it like, watching these guys again?

-I love it.

I love seeing them doing stuff together.

They look like different people.

Definitely.

It's pretty...

I'm hoping that the scales will tell us the truth later.

Yeah, we'll see.

Mark's back pain is feeling significantly better

and he's able to start doing mixed martial arts with Kiki again.

Yeah, look at the smiles on their faces.

It's just so nice to see, isn't it?

I love you.

But the bigger issue is Kiki and his weight.

Rangan first met him when he was over 11 stone.

What do you reckon? Shall we do the weight?

Yes, please.

Time to get on there.

I need to see if it says fat or not.

Last time you were 11st 1 lb.

Everyone was really worried how much that was.

It was pretty much the same weight as your mum.

And I think that alarmed all of you.

-Yeah.

-Your new weight...

..is 9st 7lb.

-No!

-What?!

-What?

-So that's pretty much a stone-and-a-half.

-Well done, Kiki.

-Get out of here, Doc.

I'm not kidding you.

Are you serious?

Deadly serious. Same machine as last time.

You can visually see a change.

That's good.

It's not good, that is just fantastic.

I've rarely seen stuff like that.

-That's amazing.

-Kiki, seriously, come on.

That is just super good.

That's good.

We're close together!

ALL LAUGH

Kiki's weight is down,

but it's his insulin level that's most important for his health.

-What do you think? Do you think it'll be good?

-Yes.

-Sure?

-Yes.

All right, I'll tell you what they are.

So your initial insulin was 32.6.

OK?

Your new insulin is 10.

What?! High-five.

MARK LAUGHS

-OK.

-Do you know how good that is?

-That's so good.

That's pretty much normal.

Oh, my gosh, that's fabulous.

That means your body is needing just a little bit of insulin

to do basic functions. That's the way it should be.

-MARK:

-That's good.

-Put it there, son.

-Hey! Feel good?

-Yes!

-Cos he was an active kid, right?

-Yeah.

-He was already an active kid.

So I was thinking, "Hold on, he's active, what's going on here?"

-Yeah.

-And the diet...

-REBECCA:

-Football, swimming...

-MARK:

-Basketball.

Are you OK?

-REBECCA:

-Basketball. Even just walking with me to work.

-Hmm.

Walking to Harlesden, not taking the bus.

Walking back. Cos we walk a lot.

If we didn't have Doc, can you imagine?

-We would have just gone on...

-I would have been diabetic.

That's just crazy.

-Do you want some tissue?

-No, I'm good.

-Are you OK?

We did it.

But we did it as a family, which is good.

I'm chuffed. I'm really, really pleased.

What Kiki has done in under two months is frankly phenomenal.

I didn't think I've had that kind of response from a child before.

And, yeah, really...

It makes you feel good, you know?

It makes you feel good as a doctor, as a person.

But as a dad myself, that feels fantastic.

You know, everyone's excited about the weight,

I get that, because that's the headline news, isn't it?

But, actually, what makes me happier,

he was on the road to getting type 2 diabetes

and he's not any more.

It's really that stark.

And that's not going to have just consequences for now,

the way he feels today, and what happens at secondary school.

If he can keep it up,

this is going to have consequences for the rest of his life.

-Hello.

-Hello!

Next time, Rangan tries to help a mother and daughter...

I obviously can't go on like this, can I?

..who are battling the same life-threatening issue.

It probably puts you at high risk of early death.

Hellish, hellish, hellish, hellish.

And he tries to help a lady

who lives with extreme pain and exhaustion.

I think this fear is holding you back.

Please don't turn it into, this is a...

This is because I'm mentally fearful.