Wales's Biggest Slimmer - One Year On Week In Week Out

Wales's biggest slimmer is getting smaller.

Since his stomach operation in India,

we've been following Zac Smith's ups...

Down around 118 kilos, which is massive!

..and his downs.

You know, I look in the mirror sometimes, and I see THIS guy.

As obesity levels continue to rise,

are we all doing the right thing to keep our weight down?

We cannot exercise away

the junk that we are currently putting into the human body.

We need somebody to tell us what we should be putting in our mouths.

We ask whether there should be a radical change

in the dietary advice we get.

-58? Get lost!

-58, look!

And will Zac at last get into the clothes he wants to?

I'm on my journey, and nothing's stopping me.

It's a personal thing. You know, it's one year since my surgery.

I want to mark it, so I know exactly where I'm at

and, you know, go from there.

Zac Smith's off to his monthly weigh-in at Barry Hospital.

But today's a special day -

one year since his life-changing stomach operation.

I feel like a new man, I feel like I was a catalyst and I've been reborn.

It's an opportunity to reinvent yourself.

When we first met Zac more than a year ago,

he was just under 50 stone after a lifetime of overeating.

Food was nice. It was...

My association with love and values was round the table at home

and special occasions when you're with your family.

You know, when you're family's not around and you're feeling low,

you want that. That warmth, that feeling.

And I suppose, on some levels, I got it from food.

My hope for the future, first of all, is to have a future.

Second is to get healthy, you know, fit and lose this weight.

Third is to one day get out there and get a job.

The opportunities are now in my dreams.

And this is him now.

It's been a monumental year for me.

It's like, when I look back, it's like looking at a different person.

You know, I sometimes find it hard to...

imagine that I got to that point which I had done.

'Back at Barry Hospital,

'37-year-old Zac's just found out how much he's lost.'

How'd it go, Zac?

Yeah, all right.

'It's exactly a year after his op.'

I'm down to 199kg,

which is just over 31, well, 31.1.

So, that's... You know, that's 19 stone.

How does that represent as a loss, then?

-It's massive. It's like losing a whole person, isn't it?

-Yeah.

Where on your body would you say the weight's coming off?

From the top.

You can see, it's quite evident round here.

So here is where I want it to go, but, of course, it's gravity,

and everything drops.

So, this is where is going to be the last place for it to go,

but my legs - they're all fat-free, practically.

My arms have got the chicken wings! HE LAUGHS

But they're going.

It is such a long journey

and, yes, I knew in my mind that it would be a long journey,

but you don't always, you know, realise that as you're going.

Some days, I wake up and my head goes down and that's hard.

That is a hard thing to get through,

especially as I do a lot of this on my own.

Zac had to pay and go to India for a stomach operation.

The NHS had refused him because of rationing.

-Very good.

-I'm still here!

But bariatric procedures like these don't guarantee weight loss.

Zac knew it would be down to him,

and sometimes, he's been unsure he can keep it all up.

He's been keeping a diary.

I haven't come this far for it to fail.

It's not going to fail - this is what I want, this is my life.

This is the way I'm going to get to have my life.

But I've got to face reality, you know,

I suffered with depression for a long time and, you know,

there was links between depression and my emotional eating

and these are things that slowly I've got to work through.

Wales's top obesity surgeon says you need a lot of support

for bariatric procedures to work long-term.

When you look at every study that's ever been done,

when you look at their weight over time,

initial good weight loss,

but over time, there's a gradual creep up.

And that's largely because the patient learns little ruses for cheating.

The patient fails to adhere to their diet, or doesn't exercise.

But particularly the dietary thing,

because you haven't altered the primary problem in the brain.

-And our relationship with food.

-Yeah, exactly.

And maybe the need for a psychologist

to explore their relationship with food -

why they like eating so much - can also be helpful.

It's tough, but Zac is determined.

Erm, onwards and upwards.

Next year, I'd love nothing more than to lose, say,

another ten stone, if I can.

That would be brilliant.

You know, let's keep it real, though.

It does take a lot of focus, dedication and hard work.

Although Zac can't afford specialist aftercare,

he has been referred to a free 16-week exercise programme on the NHS.

He's been using it to the full.

It's one of my main sources of exercise.

It's good cardiovascular, and you burn a lot of calories.

Over a period of weeks, he's...

We had to set goals and reset goals, because he was achieving so quickly.

ZAC PUFFS

Since he came in, I've seen his confidence grow.

I've seen the smile on his face grow.

I've seen the man shrink.

You've shown me that it can be done. I can do it, and I am doing it.

You know, I do... When we've hit goals, I can see.

I sit down and I think, "Right, how to go forward?"

-I'll not set myself ridiculous goals - that's how you fail.

-Yeah.

It was like re-entering society, if you like, for me.

Cos I've segregated myself for so long

and resigned myself to, you know,

"This is it, I'm going to die this way."

So if I have to miss a session for various reasons,

I get frustrated, I get...

You know, I feel guilty, I get annoyed.

And it's like I have to go and do SOMETHING.

Telling people to eat less and exercise more

is the standard government advice to maintain a healthy weight.

Some argue it's clearly not working -

the percentage of obese Welsh adults

has gone up from 18% to 21% in recent years -

that's one in five of us.

HEART MONITOR BEEPS

It's why bariatric surgeons here at Morriston Hospital

are busier than ever.

They operate on 80 people a year.

The unit's leader says they'll never meet the demand.

It's now at epidemic proportions.

Right at this instant, there's 5,000 people in Wales

who satisfy the criteria for obesity surgery.

Of which, we're funded to do around about 80 a year.

And more disturbingly, they're coming on at 400 a year.

So you can see, as far as the numbers game goes,

we're never, ever going to reach a steady state.

He operates on the morbidly obese - people who could die soon

if they don't lose a large amount of weight fast.

This procedure, to reduce stomach size,

is what Zac had, but didn't qualify for, due to strict rationing.

You have to have a body mass index of at least 50

and have three associated life-threatening diseases, like diabetes.

Zac's BMI was a massive 73, but he just wasn't sick enough yet.

All we're doing is denying surgery to the less sick patients,

but, of course, three or four years later,

they then cross the line and then are eligible for surgery.

It's bizarre, I know.

The Welsh Government is looking at

whether we're rationing bariatric surgery too strictly.

Yes, we do need to review it in the light of recent evidence.

'Dr Tony Jewell is the Welsh Government's

'principal medical advisor.

'More money was put into bariatric surgery last year,

'but he recognises things may have changed.'

Sounds like you accept that it saves lives

and it will save the NHS money,

so we should probably be doing more of it.

Yes, and if we need to find the resources to support that,

we need to identify where they'll come from,

because as you know we're in a very tight financial situation,

so these decisions are easy to say,

quite difficult to deliver

if you've got a tight financial regime.

So the question to all of us is, what are we going to stop?

Any loosening of rationing has come too late for Zac

and he's still bitter about having to go private.

But for now, he's enjoying being slimmer.

Look see, I'm sat in a lovely cafe here,

which is something then I wouldn't even have dreamt of doing, for years.

Unless I could have found a spot right outside the door,

getting out the car and parking, it wouldn't happen.

-You were embarrassed, scared, or what?

-Yeah, a bit of both.

You know, the fact that I could hardly walk, you know,

and taking a tumble, I'm stuck on the floor. Nobody can help me up.

You're talking the fire brigade and things like that.

You know, it got to a point where I was that big

that it does become embarrassing.

You know, people looking, pointing, sniggering, all of these things.

I would have rather just sat in my house and...rotted away, if you like.

But Christmas is coming up fast. Zac is very nervous about it,

especially with his liking for sweet treats and processed food.

For someone who's on a weight-loss journey, like myself,

Christmas is not the greatest time to be going visiting everyone,

because everyone's got a big spread on everywhere.

So, you know...I'm still learning.

I'm still learning the mental elements

of eating what I need, what the body needs,

and not just because it's there and it's nice.

The smaller stomach's not going to let you eat too much, is it?

No, the stomach won't let me eat too much, but the mind can.

You know, if you're eating chocolate,

it melts in your stomach, you can pile loads of that in.

So it is all about, you know, keeping my mindset focused.

Last Xmas, Zac had a difficult time with his new smaller stomach.

Will it be different this year?

Ho ho ho! Merry Christmas!

I'm here just about to have my dinner.

Already got my plan straight in my head, and I'll keep you up to date.

Have a good one.

MUSIC: "Jingle Bells"

Hi. Well, Christmas is been and gone,

and I really enjoyed it, to be honest.

No problems like last year with my stomach or anything.

Had a good time, ate sensibly, ate well, enjoyed it,

lots of treats and trimmings.

Bring in the New Year.

It's now just after eight o'clock in the morning,

and I am off down the gym.

Get back on my plan, back on track, keep it going,

because this year is going to be the year.

I'm going to smash it. This weight is gone.

So it was an upbeat start to the New Year,

but just a few days later, Zac had his first weigh-in since Christmas,

and it was a big shock.

Just not losing any weight at all... You know, it crushed me.

Used to losing seven pounds every month,

this was now a dangerous time. It actually kept him up at night.

I've noticed on one or two occasions...

feeling overwhelmed by my emotions.

I've, er, reached for food, which is...

You know, which I haven't done,

this is the first time I've experienced it.

And I'm a little bit scared.

Without much back-up, Zac's been turning to the internet

to get him through his bad patches.

This is my favourite group which I'm a member of.

After Christmas, I know I must have put on at least half a pound,

a pound, and I was feeling very depressed,

and I went on here and I was saying, "I can't believe it,"

you know, "Christmas has been, I've lost no weight at my weigh-in."

You have lots of "Come on, chin up, it's not that bad."

Coming from people that are going through it

or have been through it, it... It registers.

On here, they're saying, "Look, it's Christmas.

"You're allowed to let your hair down.

"The fact that you've recognised that you did overindulge,

"a sign that you are aware of what you're doing

"and the journey you're on.

"The whole point of doing this is for you to be able to have a life,

"and go out and enjoy things."

The man who's gone from this... to this...in a year,

sometimes just can't see the huge progress he's made.

That's the weird thing.

Some days I walk in here and I have a little panic,

because I think I'm bigger.

It's a weird, horrible feeling, you know.

You know...and it's a genuine thing.

I look in that mirror sometimes and I see this guy.

Do you see what I'm...?

It's like, looking at these pictures,

you have a picture to compare one to the other.

But when I'm stood in that mirror, I'm just looking at myself,

and I still think I look as big as I ever did.

What d'you reckon, boy? Daddy losing weight?

Zac's dilemma is that he needs to get his social life back

without his old habits,

avoiding alcohol and processed or sugary snacks

that'll wreck his regime.

Since the start of the year...

it's nice that they welcomed me back in.

There's no question about it, really, I'm still one of the boys,

and...you know, we have a good laugh.

No-one had seen him for ten years, literally.

You know, I'm seeing him more and more often.

He's coming up to the snooker club, a match on Wednesday,

he's up for practice on a Monday.

I think...

But since you've got out and about...

I mean, even walking round the snooker table is like exercise for you, innit?

It is a social activity, and I love it.

Doing what society says, let your hair down, go out and have a drink.

My old lifestyle and my old way of thinking,

once I've had a drink, tries to take over.

If you like, it's the old me,

saying, "Come on, you can do all this. You can drink all this."

"Oh, yeah, it won't matter if you have had a few or a packet of crisps,

"or have a little snack here and a little snack there."

I really didn't like that.

Oooh! Thanks for that.

LAUGHTER

'It's a mark of the determination of the man,

'that as soon as he heard his weight was flat-lining,

'Zac hit the gym even harder.'

-What's driving him?

-He is.

We're just a support network.

He's obviously an example to others,

because I know that I'm inspired by him.

I think by seeing me it just encouraged him to get in more

and feel comfortable about doing it. Like we can come in, have a chat

and without that thinking everyone's looking

and doing that stupid stuff that people do, yeah.

-Just meeting Zac helped. You know, meeting Zac.

-I'm just me, innit?

-Yeah.

-And it's like, yeah, I encourage anyone.

Someone to work out with, and, you know...

And now he's, you know, he's on his way. On his way.

Look, there. You see there?

Total calorie expenditure, 79,792.

That's accumulative since I've been using the gym.

Er, today on the bike I've done 5.1K.

Another 2,200 calories gone. And they're not coming back.

-So you've used up more than 2,000 calories now.

-Yeah.

You've got to make sure that you don't put in 2,000 bad calories.

-Well, I know. That's...not going to happen.

-No. Why not?

By the choices I make

and the sheer fact that my stomach wouldn't allow me to anyway.

'The reason I asked about bad calories was that I'd noticed

'Zac having energy drinks and other sugary liquids.'

Sometimes I feel really low and just drained.

I don't do it all the time, you know,

but after training, I will have a can of something or bottle of Lucozade,

you know, and that seems to work.

Biscuits, chocolate, confectionary, ice cream, pastries, pies, savoury snacks.

Demonise all of those, please.

In Wales, there's a woman who has no time for sugar or any other carbohydrates in the diet.

Zoe Harcombe's one of a group of researchers and academics here

and in the US who have controversial views about current government thinking.

Our entire dietary advice is completely, 180 degrees wrong.

'We have made 1.5 billion people across the developed world overweight or obese

in about a 30-40 year period.

And we will not admit that we were wrong.

We used to believe floury and vegetable foods,

starchy foods are fattening and sugary foods even more so.

What do we tell people now? We tell them to base their meals on starchy foods -

the things we had always known made people fat.

She's particularly critical of the government's so-called

Eatwell Plate, a common sight in doctors' surgeries and clinics.

I'd tear down the Eatwell Plate from every school,

hospital and surgery across Wales.

If you look at it in detail - you can find it on the internet -

you'll see Corn Flakes, Weetabix, white bagels, white bread.

You won't believe this, but you'll see biscuits and sweets and Coca-Cola

and sugared baked beans and sugared yoghurt

and fruit juices that are just too sugary for the average human being.

If that's a role model of healthy eating,

to me that's an explanation of why we've got an obesity epidemic.

Confused? Zoe Harcombe says don't be.

Just avoid processed food if you want to stay slim, she says.

Is that possible on £25 - the amount Zac spends every week?

We sent her and Zac out shopping to compare purchases.

Now and then, I do like to have a treat.

I'll have one of them.

It's a lot of temptation.

I'm still learning.

-Hiya.

-Hiya.

Zoe Harcombe's a fan of single ingredients,

rather than processed food.

-They're kidney beans in chilli...

-And they've got sugar and maize starch.

The drinks. I mean, the ready-meal. This...

See the number of ingredients? Malt extract.

Sometimes, in the evening,

after I've been training, I crave something sweet.

You need about a teaspoon of sugar in your blood at any time.

When you've done your training session,

let's say your blood glucose level

is on the bottom of the normal range.

Let's say that's the top of the normal range.

That one teaspoon of sugar will get you from the bottom to the top.

Something like that - how many teaspoons do you think you've put in?

-That's about 15?

-The minute that happens,

you shoot out of the top of the normal range.

Then your body has to release insulin to get you back down,

and you'll then be on this blood-glucose roller-coaster.

Just have a cappuccino or something in the gym afterwards,

with one teaspoon of sugar, that'll get you right back to the top of the normal range.

Not ten teaspoons or whatever's in there.

Zoe Harcombe has views which challenge the very foundations of current government advice.

She says the Eatwell Plate is NOT balanced - there's too much

carbohydrate or starchy food - more than 60%

if you include fruit and veg.

We put all this to the Chief Medical Officer.

Well, it's a balanced plate, so at a glance, you'll see

the green area is pretty big, and that's full of vegetables and fruit.

Which are carbohydrates.

Well, the vegetables and fruit are what we want to encourage.

-There's the starch foods.

-Also carbohydrates.

-That's carbohydrates.

Then we've got milk and cheese products in it.

Which can have sugar in them.

-Yoghurts and things like that are often sugary.

-Indeed. Yeah.

The Eatwell Plate is based on UK-wide advice.

Some have questioned how good it is.

Food policy is complicated, because there are a variety

of stakeholders and interest groups that have to be taken account of.

-But government policy...

-Do they? Really? I mean, sugar?

The sugar industry - should we take account of the sugar industry

in our advice for healthy eating?

No, I mean, I think that...

I mean, sugar - naturally originating sugar -

is part of a diet, so...

-Empty calories, some would say.

-Ah, yes, indeed. White sugar. I know.

I know about...

Sugar in fizzy drinks is a problem for us,

and the UK has a very high consumption of those, so...

But they don't appear in that Eatwell Plate.

Well, if you look hard enough, a lot of those are processed foods

-and you can find sugar in them.

-Yes, I mean... Yeah, we would need to look at that and... But I think...

Would you? Would you tear up the Eatwell Plate, or change it?

It's not for me to do, and it's not for the Welsh Government to do,

because we participate in the advisory structures across the UK.

Could we not declare an independent line here?

Wales could go it alone and say, "Just eat real food, not processed."?

Yeah, we could, and we DO say that, in fact.

One way the Welsh Government is trying to do that

is with schemes like this.

We took Zac along to see the cooking bus.

It's what I call a one-pot wonder.

It visits schools, teaching children and their parents.

Cookery's dropped out of the curriculum over the years -

this is attempting to put some back, and tell people, if you cook,

real food needn't be expensive.

Fast food is full of calories. You don't know what's going in it.

When you're preparing your own food, you understand

what is going into it - the goodness -

and what not to put in.

In Wales, 21% of boys

and 18% of girls aged 15 are overweight or obese -

one of the highest percentages in the Western world.

Critics say we just aren't doing enough on food to tackle the crisis.

Nutrition is badly taught in medical schools.

It's not taught in a lot of post-graduate areas.

I think the average doctor in the NHS knows very little about nutrition.

In order to slow down the inexorable rise of patients coming our way,

I think a much greater emphasis should be put on good nutritional advice.

There's not much good advice coming out from the medical profession about it,

because they don't seem to be investing enough effort, in my view,

about public education, about what IS a good diet,

what people SHOULD be doing, and then once they give you advice,

five minutes later they change their mind about it.

But we do need almost like a nutrition tsar.

We need somebody to tell us what we should be putting in our mouths.

The Welsh government says a food tsar isn't needed.

Its so-called obesity pathway, it says,

is a comprehensive and joined-up approach.

Whatever the experts are saying, Zac has to get to grips

with his dietary demons on his own, and in the coming year.

But to show him how far he's come already, I took him back to this shop, where,

a year ago, he couldn't get into any of their button-up shirts.

-58.

-58? Get lost!

-Look.

-Last time, it was 70, 75?

-Yep.

You've lost a good 15, 16 inches.

-That's an enormous improvement, isn't it?

-Yeah.

Yeah. Feels good.

Three Xs next.

-That's the next programme, next year.

-Yeah!

-There you go, Zac.

-Brilliant. Thank you.

-Some outfits for you.

Right now...

my life is turned around.

It can only get better, God willing.

Speak to you soon.

Subtitles by Red Bee Media Ltd