Episode 2 Inside the Body Beautiful

This programme contains some scenes which some viewers may find upsetting

For many having a perfect body is the most important thing in life.

What Josh has got is what I'd like. You can see all the cuts,

you can see his shoulders, his arms.

It's quite a big stress to have that, sort of, perfect body.

But as obesity rockets many of us are fighting against one thing...

..fat.

I want a body to be proud of.

Going on the beach and taking your top off and not thinking, "My belly's hanging over my shorts."

This is a film about what happens to our bodies and brains

as we battle the bulge.

You can see I'm right down deep.

Using computer graphics we'll explore why we get fat...

..what it is, and how hard it is to shift.

And now I'd just rather eat.

We'll follow the emotional challenges weight brings...

You feel horrible. There's nothing really pleasant about a binge.

..and the extremes some will go in the pursuit for perfection.

I can't believe that something so similar to speed was in the pills.

Through the highs...

There's just no fat there whatsoever.

..and the lows.

You couldn't have a worse relationship with your body.

This is inside story of how fat works.

18-year-old Ebonie is a student from Maidstone.

Mortified. I weigh just over 11 stone

and I really want to go back to ten stone.

So she's decided to go on a crash diet to lose weight fast.

# You say it's all in my head... #

I've got about four weeks. I haven't got long

but hopefully I'll get it done to the weight I want to be.

Like 60% of woman on diets, she wants to shape up for her holiday.

I'm going to Malia and everyone there is young.

Everywhere you look, people are going to have bikinis on and stuff.

It's, like, always in the back of your mind that someone is

going to take a photo and put it on Facebook so everyone can see it.

For her crash diet to work

she'll have to drastically cut down the calories,

which means a massive change in her eating habits.

I snack a lot on packets of crisps and chocolate bars

or I'll go to McDonald's with my friends.

Sometimes I will go out for a Nando's just for something to do

and at the end of the day it's not the best thing I could be eating.

Because it's all the junk food that's made her pile on the pounds.

Once the food leaves her mouth

it takes just 10 seconds for it to reach her stomach.

Gastric juices, powerful enough to dissolve bone, help digest it.

In hours it turns to a gloopy liquid,

making it's way to her small intestine

where chemical reactions break the food down.

Carbs are converted to glucose, proteins to amino acids

and fats to fatty acids.

These nutrients, carried in blood to her cells, fuel her body.

But if she doesn't burn all the fats and sugars from this food,

any left over are stored in the billions of fat cells inside her body.

# Nobody knows what I'm feeling inside... #

Well, I'm having a red carpet theme

so if you just come looking smart-ish.

Although desperate to slim down, Ebonie's crash diet

is on hold for one more day.

It s my birthday party tonight. My 18th birthday party,

I've got loads of people coming.

I think my friends worry about their appearance, I think everyone does.

Especially in our society now.

We always put in a lot of effort, it takes ages.

Cos everyone cares what everyone thinks about what you look like.

Yeah. It's quite a big stress to, sort of, have that perfect body.

Or if you put weight on, they'll be like, "She's got fat."

Everyone talks about you.

-I think weight's a big issue.

-Yeah, weight is a very big issue.

-For everyone.

-Definitely now cos everyone's going on holiday.

-Yeah, everyone just wants that beach body.

And for her diet to work

Ebonie knows it's not just the junk food she'll have to cut out.

I think alcohol's what made me put on so much weight, to be fair.

-Even though I've just turned 18!

-You've got it all to come!

I don't think you realise what you're drinking is fattening.

Vodka has hardly anything in it.

No, vodka's good for you, it's one of the good ones.

Well, I'd hardly say it's good for you! Like, recommended.

What the girls may not know is that alcohol stops the body burning fat.

# Hey, I just met you

# And this is crazy

# But here's my number

# So call me, maybe. #

As alcohol passes through Ebonie's body,

it's soon absorbed into her bloodstream.

Once in her liver it's converted to acetate,

a substance her body uses for fuel.

While her body works hard to process acetate,

the breakdown of other nutrients decreases.

So while Ebonie is burning her vodkas off on the dance floor,

her body's ability to burn fat slows down by 70%.

'I'll be scared because this is, like, my main alcohol night.'

But after that I should be drinking water and starting on my diet

so yeah, it's quite exciting, really.

But the next four weeks isn't going to be easy.

The diet will drastically cut back her calories

and with less energy, her body may struggle to function properly.

# So call me, maybe. #

MUSIC: "Runaway Baby" by Bruno Mars

Women are not the only ones who worry about their shape.

# Well, looky here, looky here What do we have? #

Research shows almost 60% of men are anxious about their appearance.

# At the end of the night It is her I'll be holding.

# I love you so. #

And today one of the most popular looks,

enhanced muscles with low body fat.

I've always thought I'd have the perfect body by now. I'm 27 years of age.

always dreamt of this perfect physique, the six-pack,

the cut arms, the big chest, the broad shoulders.

Essex boy Joe is an electrician.

'I've had personal trainers, I've played football, go down the gym

'three or four times a week, for a good 15 or 16 years.'

I've always had this image in my head of what I'd like to look like

and I've not been able to gain it.

I want a body to be proud of.

Going on the beach, taking your top off, and not thinking,

"My belly's hanging over my shorts."

A recent Government report shows a key influence on body image

is from family and friends.

Sometimes you look at someone who's got their top off, you think,

"They've got a six-pack, they look cut, ripped. I'd like to look like that."

Joe is envious of some of his football mates' physiques.

Look at the size of him. What Josh has got is what I'd like.

You can see all the cuts,

you can see his shoulders, his arms, his chest.

Basically that's what I'm after.

You can do it, just come to the gym more or something, I don't know.

His brother, Mike, is also a bit jealous.

When we're down the gym, we hit the weights, do the cardio, everything.

But for some reason, we can't get the physique like what he's got.

THEY LAUGH

Too many pies, that's what it is!

-Too many pies.

-Too many pies and beers.

Men start to develop their classic V-shape during adolescence

and can put on over a stone in muscle.

As puberty kicks in, the brain sends messages to the testicles

signalling them to release a surge of sex hormones.

These flood the body,

triggering fat deposits to develop in the abdomen and buttocks

as well as broadening the muscles in the chest and shoulders.

Unhappy with his shape, Joe began doing some research.

I started thinking about it about a year ago.

I was mucking around on the internet one time,

just started putting in different scenarios like instant six-pack,

see what would come up and then I come across this procedure.

Joe has decided to undergo a major surgical procedure.

An advanced type of liposuction where fat isn't only removed

but sculpted away to create his ideal physique.

It's not the size that matters, it's the definition.

Once you have all that body fat removed,

the stomach goes, all the extra weight,

or the sides like your love handles.

THEY SNIGGER

Seriously it's going to be that V-shape, he's doing my shoulders

where you can see on Josh, you can see that V?

-Not really, no!

-You can't see it!

-You CAN see it.

As your shoulder comes down you can see your bicep and your triceps.

That's basically what they're going to do to me.

Take away all that and then that will push up.

Can't you just get it from working out more?

You can do, but like I was saying to you earlier,

I've worked towards that and it's to a certain size that I'm reaching

and I'm not getting past that, you know?

It's hard work putting in a whole year's worth of gym work

for the two weeks you might have your top off at the beach in the summer!

For me, I'd rather just enjoy beers and carbs

than worry about being ultra-dedicated to a diet

or anything like that, personally.

When's our season start up again?

Start of September, first game.

It's closing up.

With only a week to go before his operation,

Joe's hoping it's not only his body that will improve.

'It's just something to give me self esteem.

'When I go out, I like to feel good, I like to look good and I think'

having the nice body,

that's the greatest confidence boost you could have.

It's day one of Ebonie's diet.

She's trying to lose a stone before her summer holiday in four weeks.

I'm doing my first shake. I haven't actually done one before.

Her crash diet will restrict her to one evening meal,

three healthy snacks and two milkshakes a day.

You have to use skimmed milk as well to do this

because it's the best one to use for it, it's the healthiest one.

The diet will give her 1,200 calories -

just over half the recommended daily amount.

Although this will trigger the weight loss,

it may leave her hungry and tired.

I'm hoping it might taste of ice cream.

The shake is bulked up with fibre to help Ebonie feel full for longer,

though this cause bloating.

It's actually quite thick, so it is actually quite filling.

I've actually drunk quite a lot of this and I already feel sick.

As the liquid passes to her small intestine

nutrients are absorbed into her bloodstream.

The shake alone only gives her a third of the nutritional value

her body needs to function properly,

so she must make this up in other ways.

I hope I can stick it out with it and obviously I'm going to really want to eat a lot

and I won't be able to but they're all right.

# For goodness' sake

# I got the hippy-hippy shakes. #

Crash diets exploded in the '60s when slimness stood for freedom

and sophistication.

# Ooh, I can't sit still... #

As women began counting the calories diets became the quick fix solution

to achieve this body ideal.

Mmm, Diet Pepsi did.

From low-carb to low-fat,

fad diets offered the generations that followed

instant and rapid weight loss.

# The hippy-hippy shake. #

Today the UK diet industry is worth over £1 billion

but despite the promises, research shows that 70% of all diet

and health claims are not proven.

Ebonie has been on her crash diet a few days

and has agreed to have her progress checked

by weight and metabolism expert, James Collins.

# You shouted, "Hello"... #

-Hi.

-Hello.

-Nice to meet you, how are you?

-I'm good, thank you.

Good, please have a seat.

He first sends her for a scan,

to calculate how much body fat she's carrying.

We've now got the results from your DEXA scan.

This is basically how it's made up. As you can see, it's colour-coded.

The stuff in red is her fat and the yellow, her lean tissue.

What does "lean" mean ?

-That's your muscle.

-Oh, right.

-So anything that's not your fat tissue.

-There's not a lot of that, is there!

-Brings it to life a little bit.

So the areas in red here are our fat areas

and we can see here, we can see these mainly around the buttocks

and around the thighs a heavy distribution of fat.

-That's why women have what we call this pear-shape.

-Mm-hmm.

Because they're more prone to depositing fat around the buttocks and thighs.

And for Ebonie, like all girls,

these curves kick-start during adolescence.

As puberty begins,

the brain triggers the release of the sex hormone, oestrogen.

This races though the blood to the fat cells,

and signals them to get bigger.

Fat deposits are laid down in the buttocks, hips and breasts.

This prepares girls' bodies for pregnancy

and during this time they can gain around 50% more fat than boys.

So we have this figure of 42.6% so that's your current body fat.

Actually if we look at that absolutely, we've got that at about

27 kilograms of fat in your body.

Now, that's slightly over, so you're slightly overweight at the moment.

Was that what you expected?

Yeah, it's the sort of thing I was expecting to see.

I did know I was, sort of, over that mark anyway.

Ebonie is carrying seven kilos more fat than is healthy.

This is about 28 packs of butter.

Are there any dangers of me being in that sort of tissue fat range?

There is risk of this longer term,

being overweight, of having high blood pressure

which is something that can start relatively young as well.

Obviously, in older age it's linked to heart disease.

But also things like Type 2 diabetes is actually starting

at a lot younger age now.

What approach are you going to do, diet-wise?

I'm going to use a meal replacement diet.

Right. What's the key motivator to lose the weight, what's driving you?

-The key motivator to help me lose weight is I'm going on holiday.

-Right, OK.

I'm going on a girls' holiday with my friends.

Great. So you have some motivation for the next four weeks?

-Yeah, I need to reduce that!

-OK.

So next time we come back, I think that picture there's going to look quite different.

Yeah, hopefully anyway. I hope it would look different to that.

Ebonie will find out how successful her diet has been

when she comes back for another scan in four weeks.

But like all crash diets, it's going to be tough.

'With Ebonie the first three days will be extremely difficult because'

she's going from her normal energy intake which is higher

and this is suddenly dropping quite considerably

and this will really cause a shift in her metabolism.

This will affect her concentration in the short term,

she's going to feel very hungry over the first two or three days

and also that's going to affect her mood status.

I think if I try and diet this way and I don't manage to do it

I think it'll make me upset because I don't want to stay at this weight.

I know that I'm uncomfortable at this weight so I think I'll feel

just disappointed that I couldn't manage to get rid of some of the weight.

SLURPING

Finished!

Our desire to be slim can often damage our relationship with food.

Today over half of 15-24-year-olds comfort-eat

with chocolate or fast food when feeling anxious or stressed.

MUSIC: "The Fix" by Elbow ft Richard Hawley

In Bristol, 22-year-old Hayley has taken this to the extreme.

'I think I started binging and overeating

'probably when I was about eight.

'Someone called me fat, basically, in class.'

I remember looking down at my school jumper

and thinking, "Oh, I'm different, I'm fat."

From that age Hayley's been caught in an extreme cycle

of dieting and binge-eating.

Research shows girls who diet are 12 times more likely to binge-eat

which can lead to eating disorders.

I was working at a supermarket and the house was completely empty,

my parents were away. I ended up getting a big bag of Doritos

that are meant to be shared and dip,

and two big slabs of Diary Milk chocolate.

And I'd eat it all within about three hours

and then I'd wait and then I'd start again.

After that, unsurprisingly, I was sick for quite a few hours.

Hayley is one of the 2% of people in the UK

who suffers from binge-eating disorder...

..a condition now recognised to be as serious as bulimia and anorexia.

Scientists believe binge-eating is a way of blocking emotions.

'I was using food as a coping mechanism'

for my...hatred of my body,

and dissatisfaction of myself.

For Hayley, food became a distraction from her problems.

As you start to eat it's a feeling of relief that you've finally

got the food, you can finally do what you want to do.

And there's a good biological reason for this.

Eating fatty and sweet food

can trigger a huge surge of endorphins and dopamine,

our bodies' feel-good chemicals.

When these are released they travel quickly through nerve cells

to the pleasure centres in our brain,

inducing a natural high.

But soon after the high, comes the low.

As the rush of these chemicals drop off, the feelings of pleasure subside causing our moods to slump.

After a binge, it's very guilt-ridden.

You feel awful, physically and mentally,

you've just sabotaged yourself again, you've just binged.

'You feel greedy, disgusting, horrible.

'There's nothing really pleasant about a binge.'

You couldn't have a worse relationship with your body.

Hayley is among the one in five people who are victimised

because of their size.

'Bigger people do tend to be chastised for their weight,

'made fun of'

and there's this stereotype of being greedy and lazy

and it's your fault that you're fat.

'It's really not the case.'

I don't know what to get. I'll go for that one. Think I might get...

-Hi, guys.

-Hi.

-Can I have a coconut smoothie and a Very Berry, please?

With the help of therapy she's slowing overcoming her condition

and feels more confident being out with her mates.

Do you find yourself bingeing less at the moment?

Yeah, I think so.

The supermarkets are still quite challenging

but I find areas like this, it's sort of a bit different.

And binge food isn't really... For me, it's not the same food

-as I would eat on a day-to-day basis.

-Yeah.

-I guess it'll only just get better.

-Yeah.

Hayley now writes her own blog

so others can better understand her condition.

'I'm definitely moving forwards trying to combat it.

'I haven't really binged for a couple of months now'

so that's good.

Today, 27-year-old Joe is in London for his operation.

I've got an image in my head of the physique I'm going to have when I come out.

If I get anywhere near that result, I'll be a happy man.

For over £15,000 his surgery won't just suck fat out

but sculpt it to reveal his muscles underneath.

Hey, Joe.

His consultant is Grant Hamlet.

OK. In terms of your expectations, what do you want at the end of this?

Just the whole chiselled, defined look.

You know, the stomach area,

I find it very difficult to establish a six-pack.

I've never been able to accomplish a six-pack.

I'm not making you a six-pack,

-I'm just showing off the one you already have.

-Good.

-Great.

-I'm excited.

-OK.

First the before shots.

# I'm sexy and I know it. #

Fat removal treatments are one of the fasting-growing cosmetic procedures today.

In 2011 there was an increase of 8% of men having this done.

Next, Joe's body is marked up

making sure fat is taken from the correct areas.

It is very important that this gets done properly.

You are carrying a little bit around

what we call the muffin top area, so that will be thinned out nicely.

-So if we choose blue...

-If the surgeon is just 2mm out

Joe could end up with bumpy lines on his body.

The fat Joe's having reduced is his subcutaneous fat -

fat that lies under the surface of his skin.

This fat is crucial for survival, protects us during starvation

and provides insulation from heat and cold.

This is the love handle which is the bane of most men's lives,

and to get that V-shape, we have to remove this.

But we all carry another type of fat

which liposuction cannot touch - visceral fat.

This fat is deep inside our body and wraps around our internal organs.

Too much of it can be dangerous

and has been linked to heart disease and some forms of cancer.

Joe will have to be careful.

If he puts on weight he's still at risk of gaining visceral fat.

Although studies show this can be prevented by exercise.

Let me just take a photo of that so we can have a representation.

Say you stop training, what's the chance of the fat coming back?

Fat cells are like sponges, OK? And because they can absorb fat,

they can get bigger. You've already got the right lifestyle,

you know what you want to do what to get and how to keep it. It's all about maintenance.

-That's it.

-You don't buy a Ferrari and not clean it.

-Of course, you don't.

-All right? So that's what we're doing here.

See you after. Thank you.

Four hours' time. All right, mate, cheers.

My friends and family have supported me all the way through this.

They're obviously worried but they're all happy for me,

I've had a few text messages wishing me good luck,

give them a text or phone call once I'm out.

If I'm available, I'll do it.

Back in Maidstone it's day five of Ebonie's crash diet.

And she can already see results.

Yeah, it's going good. It's hard but I am sticking at it

and I have faced demons such Nando's and McDonald's

and I haven't eaten them so, yeah, I'm doing well.

She's lost almost two kilos.

At least I know this is actually working

so I can see signs already of it working, that's good.

Although her weight's gone down,

Ebonie might think the two kilos she's lost is fat - but it isn't.

The crash diet is forcing her body to use up

its carbohydrate stores found in her muscles.

This is mainly made up of water so as Ebonie slim downs

it's mostly water and muscle she's losing, not fat.

And that's why the weight is dropping off so quickly.

# Gangnam Style. #

It's two days later and Ebonie's carbohydrate stores are running low.

This is taking its toll on her body and her brain.

I literally get up as late as possible for work

because I'm, like, tired so I just want to sleep in as much as possible

and then I'll just go to work, come home, have my dinner

and be, like, "Nah, I can't be arsed to do anything."

The diet is also affecting her moods.

'I get quite fed up.

'I'm not sure if that's just my body getting used to it

'and I have been quite miserable.'

With her carb stores almost empty,

her body now has to eat into its emergency energy supplies - her fat.

Hormones head to her fat cells and trigger the breakdown

of fatty acids, which her body will now use for fuel.

As this makes Ebonie's fat cells shrink, she slims down.

I burnt ten calories in that, which isn't a lot.

# Oppan Gangnam Style. #

MUSIC: "Crystalised" by The xx

While over a quarter of Brits are on a diet

not everyone opts for a quick-fix solution to fight the flab.

26-year-old Steven's low levels of fat

are due to an extremely active lifestyle.

But it wasn't always like that.

During sort of more the teenage years

I started to try the food that you weren't previously allowed before.

A lot of sweets, chips, ready meals, pizza, that sort of thing.

I'd overindulge, really. Put on quite a bit of weight through that.

His recreational habits also didn't help his weight.

When I was about 15 or 16, I started smoking a lot of weed,

skunk, that sort of thing,

and really you're not doing too much exercise

because you are pretty much out of it all the time.

Then a back payment from social security

left him with a difficult choice.

Either I go out and buy a lot of skunk here

or I do something else with it so I bought a bike

and that's basically how it started, at that point there.

Steven clocks up over 300 kilometres a week cycling.

This has had a massive impact on his body,

including his levels of fat.

Like all of us, Steven gets his main source of energy

from burning calories, or more simply, sugars.

As he pedals, sugar-rich blood from his major organs

is diverted to his muscles.

As this enters each cell, mitochondria - tiny power stations -

combine the sugar with oxygen to produce the energy he needs.

The cells burn this energy in seconds but, being fit,

his heart is strong enough to pump more blood to the muscles for hours.

This is also how he burns fat.

But despite what we all think,

exercise alone is not a great fat-burner.

After two hours on the track,

Steven has burnt around 1,000 calories,

or just over two large chocolate muffins.

So his 4% body fat is also down to something else...

..his diet.

-Hi, guys.

-Hey, Steve. How are you?

-I'm fine, thank you.

Great. Are you going to be making your lunch now?

Yeah. What's good for me today?

We've actually made all salads today.

And most of what Steven eats is low fat.

I eat a healthy, well-balanced diet.

When I go cycling, obviously, I top up my energy levels

with a lot of different sources,

so I take some dried fruit, something like that,

or some natural energy bars, some homemade cake, something like that,

or just something like a bit of bread with peanut butter on it.

That sort of thing can help sustain your energy levels.

While our size is influenced by diet and exercise,

our DNA also has a massive impact.

In 2007, the FTO gene was discovered

and, for those of us who carry variations in both copies,

this can add around three kilos to our weight.

Scientists now believe over 600 genes can

influence things like appetite and metabolism,

and these, combined with our lifestyle,

will ultimately determine our shape.

You look at Steve and I just cannot imagine you being overweight,

in any way at all.

That's what everyone says.

I don't think it's hard to lead a healthy lifestyle.

It's, like, how long does it take you to make a salad?

It's doesn't take you very long.

It's the same amount of time as it would to wait for the microwave

to go ping for your ready meal to be done.

So it's not hard in any way. People just make excuses.

27-year-old Joe has always wanted to change his physique.

He's about to undergo five hours of surgery for Vaser liposuction,

a procedure that uses ultrasound technology.

There are always operational risks,

there are anaesthetic risks.

We just have to bear in mind that there can be complications.

We break the barrier that is the skin,

so we need to protect against infection.

Nerves ain't kicked in yet, funnily enough,

but can't wait to get under, get it all done, and get into recovery.

Joe has been put under general anaesthetic.

To begin,

a saline solution is injected into the layer of fat beneath his skin.

This liquid, which contains a local anaesthetic,

expands his fatty layer.

It also contracts the blood vessels,

reducing the risk of damage and bleeding.

Apart from making the area numb,

it will take away a lot of the pain

that can common in these types of procedures.

Next, small incisions are made in Joe's body.

He will hear a little bit of the ultrasound.

As high-frequency ultrasound waves are fired into the fatty layer,

they create tiny bubbles in the solution.

These bubbles expand to nearly 2cm

and act as mini crowbars, forcing the fat cells apart.

And you can see I'm right down, right down deep.

I mean, I can feel the tip of my probe down there.

With the fat cells now broken apart,

they're carefully sucked out of Joe's body.

But not all Joe's fat is being removed.

How do I know how much to leave?

The way it feels, the way it looks, we do a skin thickness test.

So we roll the skin between our fingers, like that.

Side effects associated with the treatment

can include bleeding, bruising and,

if the ultrasound probe is not used properly, skin burns.

We've just uncovered the muscles that he has underneath there.

Now everything will shift into place and be in the right place.

In just hours,

Joe is on the way to achieving the body he has always dreamt of.

I don't think it's cheating.

Is brushing your hair in the morning cheating?

You're making yourself look better.

OK, in this instance, the five years it would take you in the gym

has taken me five hours on table,

but that's the nature of things as they are happening at the moment.

Joe has almost had three litres of pure fat taken from his body.

It's not a massive amount but for somebody like Joe,

that probably is going to make a huge difference.

But some of this fat is going back inside.

We're going to take 60mls and we're going to do

the fat transfer to the deltoid area.

Just hang on to the arm there.

I can feel myself in the muscle

and it's lots of little, shallow layers.

The fat taken from Joe's love handles

is slowly injected in between his muscle fibres to bulk them up.

Fat will also be injected to enhance his chest.

With the operation over,

Joe will now have to go through weeks of recovery.

I think Joe will be impressed.

I think we've done all we can.

Almost 40% of men would sacrifice a year of their life

in exchange for the perfect body.

MUSIC: "Run The World" by Beyonce

And psychologists believe a reason for this

is because woman are now more financially independent.

Men feel they can no longer rely on

money and status to attract a partner,

and in the '90s, the metrosexual emerged - the modern man,

who was in touch with his feminine side,

willing to spend time and money on his appearance.

It's week three of Ebonie's crash diet.

But things aren't going too well and she's hit a plateau.

I'm not impressed.

It just irritates me cos I just think, "What have I done wrong?"

Now I'd just rather eat, cos if it's not going to work,

then I don't want to do it.

The diet is making her feel irritable and tired,

causing her brain to crave fatty and sweet foods.

This week, I've done a bit more cheating, so yesterday

I had a Crunchie bar instead because I didn't have one of my shakes,

so that sort of stood in for it.

And it's not just chocolate that's replacing the shakes.

Quavers! These have been a godsend to me, to be honest,

so these have only got 88 calories in a bag, so I already knew that!

Ebonie may lack willpower, but it's not really her fault.

We evolved when food was scarce,

so our bodies are programmed to hold onto fat at all times.

Her crash diet has forced her body into starvation mode,

and will do everything to top up her fat stores.

MUSIC: "Sweet Like Chocolate" by Shanks & Bigfoot

So, a picnic out with her mates isn't going to be easy.

Oh, that looks nice.

It does, actually.

What is the hardest part of being on a diet,

Smelling food!

LAUGHTER

That is the most hardest part,

because you know you can't eat it, especially when it's, like...

I love Chinese. I could eat Chinese every day of the week,

when I smell it and I know that's really good.

The sight and smell of food triggers nerve impulses to race to

the hypothalamus - the control centre for hunger in our brain.

On her diet, Ebonie's brain now has heightened sensitivities to

these cues which is tempting her to eat even more.

My hungriest times is when I get in from work

and it's going to be dinner time,

and I can smell my dinner cooking and I'm like, "I'm now really hungry."

You usually do eat a lot of crap and you haven't,

and I actually thought you would have. I'm not going to lie!

LAUGHTER

Yeah, I know.

I think you've done well though.

That picture on your BBM of you and Emma - I thought you'd lost weight.

It's really hard, like now.

Yeah, temptation!

But it's not just Ebonie's senses that are enticing her to eat.

Her hunger hormones are as well,

and one of these is leptin.

Produced in her fat cells,

it signals to her brain she no longer needs to eat.

But as Ebonie loses weight, and her fat cells shrink,

so do her levels of leptin.

This increases her appetite, making the crash diet even harder.

Changes in other hormones can also affect women's periods.

So, on her diet, Ebonie is constantly fighting her biology.

It's so much better to sit in the shade. I feel better already.

I'm just happy I'm only on it for a short period of time.

If I was on it for a long period of time,

I don't think I would stick it out as much as I do.

As Ebonie knows, we are surrounded by food 24/7.

With one in four Brits now obese,

some of us are eating 200 more calories a day than we need.

With today's body ideal being slim and fat-free,

this can drive some people to dangerous measures,

just to shed the pounds.

30-year-old Sam is just married and living in Greece.

But, five years ago,

the promise of quick and easy weight loss

turned her life upside down.

I first started worrying about my weight when I was in college

and I was training to be a dancer,

and my teacher told me that I'd never make it because I was too fat.

It really affected my confidence.

Since then, Sam's struggled with her weight.

She tried ever diet imaginable

but, as a last resort, opted for diet pills.

It said they were herbal, natural ingredients.

You think vitamins - it can't do any harm,

and so I decided to buy them.

The slimming pills she ordered online

contained the herbal extract Ephedra.

But, unknown to Sam, two years earlier,

the US Government had banned the sale of diet pills

containing the substance because of its dangerous side effects.

The first day, I didn't really notice any difference,

but the second day, I was up early

and I just felt like I'd got so much energy,

and I decided, "Right, I'll clean the house."

I pulled everything out,

I cleaned all the fridge, all the cooker, all the books,

I put them in alphabetical order!

Sam lost over 12 kilos in a month,

but her weight was not the only change to her body.

I can't remember a lot from that time,

but my mum said that I'd sleep maybe a couple of hours

and stay awake for days.

On a trip to London to visit friends, things got worse.

I said, "Jessica, I can't breathe. I can't breathe.

"Call an ambulance, I can't breathe"

and I ran into the living room and got my phone out of my bag

and called myself an ambulance.

I told them what was happening to me and they said,

"Oh, you might be having a heart attack,

"you might be having a heart attack,"

cos I could feel, like, my heart was beating out of my chest.

Most diet pills available online today

have been banned from the UK market

because scientific testing has shown them to cause serious side effects.

And, like the ones Sam took,

many diet pills works on the body in a similar way to amphetamines.

Once the diet pill is absorbed into the bloodstream,

it rushes to the brain

where it triggers the release of the chemical noradrenaline.

This chemical narrows the blood vessels,

forcing the heart to beat faster,

so more blood can be pumped through the body.

Noradrenaline also works on regions of the brain

that suppress appetite, cause insomnia and anxiety.

I would shout at my mum for no reason,

and I've never been like that with my mum. We've always been so close.

I was ill, I didn't even connect it to the diet pills.

I was ill and I just wanted to get better,

but I just kept getting worse and worse and worse.

Public health specialist Jim McVeigh

is one of the county's leading experts in illegal drugs,

and has studied Ephedra,

one of the main ingredients in the pills Sam was taking.

Ephedra - it's been around for thousands of years.

It's a traditional herbal medicine from China.

More recently, it's been synthesised.

Certainly in the short term, there's been cases of

people having acute episodes of psychiatric problems.

Today in the UK,

there are hundreds of illegal weight loss pills available online.

You can never believe anything that you see on the Internet,

and that's particularly true

when it comes to buying something like drugs.

Many of these tablets have been made in makeshift chemistry labs,

both in the UK and overseas.

There's been deaths associated with these drugs,

in particular the ones that have been banned.

They're banned for good reason -

that's because there's been adverse health consequences.

Despite the dangers, a recent survey showed more than

one in ten teenagers would take pills to alter their appearance.

For Sam, the worst aspect of taking the pills

were the psychological effects,

and she was finally admitted to a mental health unit for two weeks.

It took her another 18 months to recover from her experience.

In retrospect, it was idiotic, it was crazy that I did that,

and now I've accepted myself, I've accepted who I am,

I no longer try to change things.

Out of the hundreds of diet pills developed to fight obesity,

only one remains legal in the UK.

It's the day after Joe's fat removal operation.

I'm really happy this morning.

I've got no aches. I've got a little bit of pain,

there's a bit of bruising on the arms,

and there's a bit of swelling.

You can see the V. It's very numb still,

but you can sort of see the biceps and the triceps,

and there's just a lot more shape to it.

I think the reason why my arm looks so big is it's a little bit...

It's swelled a little bit, but if it stays like that, I would love it!

Hi, Joe. How are you feeling today?

Now, 48 hours after his operation,

Joe is about to see his new body for the first time.

Tell me now how you feel.

It feels better already. So tight!

Wow! Look at that!

HE CHUCKLES

It's tender, it's very numb,

but there's just no fat there whatsoever, you know, just...

In a couple of days, the sensation will start to come back,

so it will feel more like your skin again.

-Do you want to go...? We have a mirror.

-Yeah, please.

That's incredible. That looks fantastic.

The V, the stomach - still there.

That is amazing.

I feel confident already.

Looking in the mirror there, I feel proud of my body.

It feels amazing.

Joe will have ten sessions of physio to help his new body recover.

Collection of fluids in his tissues could lead to infection,

which, in severe cases, may need hospitalisation.

And we can start.

It's more superficial swelling at the moment.

It's sore round those sort of areas,

round the sides and...stomach area.

-So, around here?

-Yeah.

-Around there.

But it will be at least six weeks until Joe can find out

what his football pals think of his new physique.

Once all the... As much fluid is drained, the skin's retracted

and it's healed, then I'll do the big reveal and show my mates.

After four weeks on her crash diet,

Ebonie is back in Harley Street,

curious to find out how successful it's been.

-So, the day's here, finally.

-Yeah.

This is our scan here.

Now, I think the most important thing we want to look at

is that we've gone from 69 kilograms to 66.

That's not very good.

It's not very good, is it? Is that what you expected?

No.

So you've lost three kilos. That's getting up towards seven pounds.

Oh.

Although Ebonie has lost weight, the overall results aren't so good.

Now, where's that loss?

You've actually lost up to around about a kilo in just pure fat,

so where's the rest of it come from, do you think?

Dunno!

Well, it's a really interesting one

-because we've actually lost 1.5 kilos in muscle.

-Mm-hmm.

Is that what you expected?

No, not really.

I'd have thought when you lose weight, it's just straightaway fat.

I wouldn't have even thought muscle.

On her crash diet,

Ebonie has used up her carbohydrate stores in her muscles.

But a lot of this is water,

which her body will suck up like a sponge

once she starts eating normally again.

Do you think it would have improved anyway

if I was as strict as I could have been?

Do you think that would be any different?

Being really honest, I think the weight loss would have increased

and we would have seen more of that come from fat storage as well.

Would you recommend this diet?

Honestly, no.

The reason I say that is

it's an extreme diet and a short-term approach,

-and, unfortunately, with that, they're doomed to failure.

-Mm-hmm.

Whereas if you actually had an approach - for example,

eating healthily, or reducing the fat content in your diet,

that's where we see a lot of success.

'It has been a good experience, but I wouldn't do the shakes again.'

Like James has said as well,

it's only a short-term diet, so it's not best in the long run.

Research shows that after long periods on a crash diet,

your body can start to eat away at protein in your vital organs,

which can cause irreversible damage.

MUSIC: "Bang Bang Bang" by Mark Ronson

Having lost three kilos on her crash diet,

Ebonie is finally in Greece with her new beach bod.

But how long will the weight stay off?

Sleep, eat, drink, eat...

-Get in the pool!

-Get in the pool, yeah!

Eat, have a nap, drink...

But you don't eat healthy stuff cos even though you try to,

all it is is, like, fry-ups.

Because it's washed in their water, like, the salad and stuff.

Yeah, and it's horrible. It's not the same as back home.

But to be fair, that's all there is, so...

But any concerns about her weight are now on hold.

To be honest, I'd rather enjoy myself than think, "I can't eat this."

But I'm still happy I dieted. At least I lost a bit of weight.

Better than being in the state I was in. Ha!

You were skinny the first day!

Yeah, at least I was skinny one day of the holiday!

On the crash diet,

Ebonie's metabolism may have slowed right down to preserve energy.

So she'll have to be careful.

As she starts to eat more again,

any extra calories will be stored as fat,

and she could end up putting on more weight than before she started.

From now on, Ebonie has decided to do things a little differently.

My goal when I get back is to keep healthy

and not snack and eat so much crap.

So, just to keep a healthy lifestyle as well.

It's not just losing weight, you want to keep normal.

Which is probably not a bad idea,

as studies show that in the long term,

95% of crash diets don't work.

MUSIC: "Mama Do The Hump" by Rizzle Kicks

It's been seven weeks since Joe's operation

and it's time for the big reveal to his football mates.

Come on, then, Joe, get your kit off, mate! Let's have a look.

-Are you ready for this?

-Yeah.

Looking good, mate, looking good!

Are you going to tense? Hulk pose!

Hurrrgh! Yeah!

THEY LAUGH

Do you want a feel? You can have a feel of my abs and arms and that.

Solid, rock hard. Like a washboard!

Is that still swollen or...?

Let me test it! Hurgh! Only joking!

-Is that still swollen or...?

-Round the side.

Was it quite bruised, then, afterwards?

I was swollen, yeah, a lot. A hell of a lot.

Do you feel happy with the result?

I didn't imagine this procedure to make me feel this good

and look this good, you know. I am ecstatic with the outcome.

You know, the definition, the look - this is more than I thought.

-No, it looks good, man. It's good.

-It does look good, man.

As your football manager, how's your mobility?

Are you going to be slower? Are you going to be all right?

You feel mobile, feel good?

Lightning! Usain Bolt, you better watch out!

LAUGHTER

But if Joe doesn't keep up the exercise,

the thousands of pounds he spent on his surgery will all be in vain.

I don't regret the decision, you know. It's money well spent.

I'm so motivated, I've got the buzz for it,

I'm going to get back in the gym. My heart's back in it now.

I just want to feel and look great forever now, you know, so I'm happy.

-It's a good look, man. It's good.

-Cheers.

MUSIC: "Express Yourself" by Labrinth

Many of us strive for a slender shape, the perfect body.

But weight is a complex issue, linked to our genes,

our hormones and even our brains.

LAUGHTER AND SHOUTING

And while some of us opt for quick-fix solutions,

a healthy lifestyle can be just as effective for fighting our fat.

# Express yourself

# Express yourself

# Oh, do it!

# See, it's not what you look like when you're doin' what you're doin'

# Express yourself

# Oh, do it!

# Here we go now

# I don't make the papers

# I'm far from JLS... #

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