:00:00. > :00:08.At 50 stone Zac Smith was Wales? biggest slimmer.
:00:09. > :00:18.We filmed him when he went to India for surery.
:00:19. > :00:20.Once again he?s been forced to take drastic action,
:00:21. > :00:25.It can go wrong and I could die. There are thousands more in Wales
:00:26. > :00:34.You need to be aware they are going to be declining funding for it.
:00:35. > :00:39.That?s the issue, it doesn?t have the resources, isn?t
:00:40. > :00:45.But should we be tackling obesity earlier?
:00:46. > :00:50.Looking back at the photos, you can tell I was one of the biggest ones.
:00:51. > :01:00.Tonight is it time to get real about our obesity epidemic.
:01:01. > :01:05.We are going to find the NHS falling apart in the next 15 or 20 years if
:01:06. > :01:25.we do not do something about this. Three years ago Zac Smith was
:01:26. > :01:28.literally eating observant when early grave. So worried was he
:01:29. > :01:33.decided to go to India for a private operation. It was the beginning of
:01:34. > :01:34.an extraordinary personal journey. Today he has transformed himself
:01:35. > :01:41.from this. To this. It?s nuts ?
:01:42. > :01:44.my belly was coming out here.I forget I can bend down,
:01:45. > :01:47.I can do my toenails, whereas before it would have been a nightmare,
:01:48. > :01:51.trying to cut my toenails, just simple things like that, you
:01:52. > :02:03.don?t realise you take for granted. This is the third time
:02:04. > :02:06.we?ve filmed with Zac. We?ll find out just how
:02:07. > :02:12.much weight he has lost. Where he?s been,
:02:13. > :02:26.and the risks he took to bring The road that ultimately brought him
:02:27. > :02:32.here and the origin of Zac?s overeating is typical
:02:33. > :02:34.of many people with this condition. It began
:02:35. > :02:37.at a young age with depression. I was bullied because
:02:38. > :02:39.of the colour my skin, living in a very predominantly white town,
:02:40. > :02:47.coming from a single parent family. These things just accumulated and I
:02:48. > :02:51.was a happy go lucky kid and I would try to brush them off, but there
:02:52. > :02:55.were just some things which you Always the tallest boy
:02:56. > :03:03.in the class in the early years At 11, I was 12 stone, 12,
:03:04. > :03:10.I was 13 stone. When Zac stopped growing up he kept
:03:11. > :03:13.on growing out and in his late I was at my stepdad?s funeral and I
:03:14. > :03:21.was down to carry the coffin and couldn?t walk down the aisle
:03:22. > :03:26.in the church. All I kept thinking
:03:27. > :03:32.is ? you?re next. He tried dieting and exercise,
:03:33. > :03:35.but he couldn?t lose enough. He thought
:03:36. > :03:37.his only option was surgery ? to The solution, he thought,
:03:38. > :03:43.would come from the NHS. Every surgeon I went to see
:03:44. > :03:47.around the country said I was prime But yet I was still turned down,
:03:48. > :03:54.I appealed it ? I was turned down. And I appealed the appeal
:03:55. > :03:59.and I was still turned down. I even phoned up and offered to pay
:04:00. > :04:03.the majority of the bill and it was, no, it?s not about the money it?s
:04:04. > :04:08.about meeting the criteria. On a scale of ideal weight, Zac was
:04:09. > :04:12.almost three times over the limit. But he was told he wasn?t ill
:04:13. > :04:22.enough for the operation. We should be performing
:04:23. > :04:37.approximately 300 cases per year in a steady state, but it?s estimated
:04:38. > :04:40.there are 7,000 patients in Wales who need operations now and I think
:04:41. > :04:43.that?s a gross underestimate. Currently we?re only doing 67 for
:04:44. > :04:52.three million of the population. So, three years on
:04:53. > :04:54.since Zac was turned down for NHS He didn't qualify at the time -
:04:55. > :05:01.at moment he would not qualify No, he doesn?t qualify, Currently
:05:02. > :05:11.in Wales we?re only operating on patients with BMI greater than 50,
:05:12. > :05:15.so at least twice weight they should be and have a number of diseases
:05:16. > :05:18.associated, and the ones that are specified are diabetes,
:05:19. > :05:32.blood pressure and sleep apnoea. There is not enough money being put
:05:33. > :05:38.into this surgery. It doesn?t make you feel very good
:05:39. > :05:43.as a doctor, when your role really is to help people and
:05:44. > :05:46.at the moment you find you can?t. Alistair Preston was also told
:05:47. > :05:49.he couldn?t have NHS surgery. Like Zac, his obesity was rooted
:05:50. > :05:51.in depression. But he had to pay
:05:52. > :05:55.for surgery to lose weight. These are a 54, I could probably
:05:56. > :06:01.virtually get myself in one leg. Alistair?s mother re-mortgaged her
:06:02. > :06:12.house to pay for the operation. He was happy, in a relationship,
:06:13. > :06:19.and working. But six years on,
:06:20. > :06:23.he?s back where he began. Before I had the op the doctor
:06:24. > :06:27.said to me if you don?t have this My mum said I'll pay for the op,
:06:28. > :06:35.find the money. My mum can't do it again and I'm
:06:36. > :06:38.getting to that stage again, just got to accept that,
:06:39. > :06:43.wait for it to come. Well, not going to live forever, not
:06:44. > :06:58.going to live much longer like this. In 2011, Zac took what he believed
:06:59. > :07:01.to be his only option, using family savings to pay
:07:02. > :07:06.for a private operation in India. The procedure involved fitting
:07:07. > :07:08.a gastric sleeve on to After six weeks back in Wales,
:07:09. > :07:18.he was already seeing results. I lost a few more pounds I need to
:07:19. > :07:22.keep doing that for the next year. We caught up with him again in 2012,
:07:23. > :07:26.when he was working hard. Lots of exercise and an improved
:07:27. > :07:29.diet was all paying off. And by last Christmas,
:07:30. > :07:46.he was down to 27 stone. Merry Christmas. This is Christmas
:07:47. > :07:48.number three. Looking chic and trim. I'm going to have my Christmas
:07:49. > :07:55.dinner. Have a good Christmas. When people who are super obese
:07:56. > :07:58.lose a lot of weight they are The only way to get rid
:07:59. > :08:02.of it is through plastic surgery. Zac applied again to the the
:08:03. > :08:19.Welsh NHS. I went from a monthly weigh in. I
:08:20. > :08:28.lost nine kilos. Which is brilliant. I came home to have a letter from a
:08:29. > :08:32.referral for plastics. And yet again they have turned me down.
:08:33. > :08:37.After all his hard work, it was a bitter disappointment.
:08:38. > :08:42.I cannot believe that the same people who know what I have gone
:08:43. > :08:47.through on my own, to achieve what I am achieving, can justify saying
:08:48. > :08:55.that I don't deserve any help again. When he was told he couldn?t have
:08:56. > :08:58.an operation to remove excess skin, Alistair Preston fell back
:08:59. > :09:00.into his old depression with My mum and my girlfriend worked
:09:01. > :09:08.loggerheads. I just jumped into the car ? went
:09:09. > :09:12.to corner shop and spent it on He?d lost more than 80%
:09:13. > :09:19.of excess weight. But he was told that under Welsh
:09:20. > :09:22.rules, that still wasn?t enough. They reckon I was carrying four
:09:23. > :09:28.stone of skin, I?d have to be seven stone to qualify
:09:29. > :09:32.and my doctor said I shouldn?t do We know 10% patients put on weight
:09:33. > :09:48.after bariatric surgery, and it's generally as a consequence of them
:09:49. > :09:50.falling off dietetic information or And the fact they're turned down
:09:51. > :10:03.for cosmetic surgery is a form Alistair would qualify for
:10:04. > :10:15.an operation to remove excess skin under new guidelines issued by the
:10:16. > :10:17.Association of Plastic Surgeons. But that can?t happen here until
:10:18. > :10:19.the Welsh Government?s Committee There is potential to consider
:10:20. > :10:31.the patient you describe to consider But as a routine, plastic surgery
:10:32. > :10:44.doesn?t have the resources. That?s the point -
:10:45. > :10:46.you don?t have the resources. It?s about making choices within
:10:47. > :10:48.the budget allocated to NHS to Back home in Rhoose, Zac is
:10:49. > :11:06.getting ready for another trip. He?s already lost 27 stone,
:11:07. > :11:10.but to have his excess skin removed by the NHS in Wales,
:11:11. > :11:13.the rules say he?d need to lose I don?t know, with my height of six,
:11:14. > :11:26.five to under 22. So he thinks
:11:27. > :11:29.his only option is to go back to This time it will be to remove
:11:30. > :11:33.the excess weight which even the doctors accept he
:11:34. > :11:36.cannot lose any other way Three They?ll cut from there to there
:11:37. > :11:51.and that will be gone. I?m going half way
:11:52. > :12:11.around the world to have surgery The reality is it can go wrong and I
:12:12. > :12:18.could die. I have had to build up the courage to speak to each family
:12:19. > :12:26.member, to reassure them that I love them. This is my decision. The whole
:12:27. > :12:30.purpose of this was a new beginning. It is like winning the Grand
:12:31. > :12:32.National. There is no point in running the Grand National and being
:12:33. > :12:52.30 lengths in front and not bothering to jump the last fence.
:12:53. > :12:54.Back in Wales people who can?t afford private surgery have only
:12:55. > :12:58.hope and the health service, and the bariatric nurse is often
:12:59. > :13:06.You need to be aware in all likelihood they are going to
:13:07. > :13:14.be declining the funding for it and I don?t want to upset you.
:13:15. > :13:17.How many people like Catherine are there out there that would benefit
:13:18. > :13:19.that would benefit from the treatment that she?s received?
:13:20. > :13:22.Of the people that have bariatric surgery and go on to lose weight
:13:23. > :13:27.successfully like Catherine has, I would say at least 60% especially
:13:28. > :13:32.the women would like to have body re-contouring afterwards.
:13:33. > :13:43.Or fulfil the criteria set by the NHS Which are?
:13:44. > :13:49.A BMI of 25 or below and maintained that weight loss for two years.
:13:50. > :14:22.support of his friends and there is plenty of friendly banter. If that's
:14:23. > :14:31.the beauty spots, what happens? But keeping his spirits up is not easy.
:14:32. > :14:37.When he lost the weight, he was the life and soul of the party. Girls
:14:38. > :14:45.used to flock around him, but he could not see it. People are always
:14:46. > :14:53.texting meme to come out. The other day I was going to go over to
:14:54. > :14:57.Paul's house, but it took me three hours to get out of the house. He is
:14:58. > :15:06.trying to fight his depression with medication. If I go to the shop, it
:15:07. > :15:12.will be late shopping. He has panic attacks. He gets me to go with him.
:15:13. > :15:20.He can't help it. He'll be in the queue and he'll have a panic attack.
:15:21. > :15:29.This is where I am staying. I am going into surgery on Monday
:15:30. > :15:35.morning. So far in India, I have lost 3.5 kilos. I think it is down
:15:36. > :15:43.to the heat. In the UK, his operation would have cost ?12,000.
:15:44. > :15:50.Here, it is half the price. He is also making another saving. As the
:15:51. > :15:55.clinic's Star slimmer, he is given a special discount. In the years we
:15:56. > :16:07.have been in contact with them, he has lost over 100 kilos. At last it
:16:08. > :16:10.is time for the operation. Surgery takes seven hours to remove three
:16:11. > :16:32.stone of skin. Three days later, Zac is back on his
:16:33. > :16:44.feet. They removed so much skin and so much fat, if the camera can
:16:45. > :16:58.tell, that they lead that was there has gone. It is flat. That is my
:16:59. > :17:01.leg. There he goes, look. Hello! There is a big demand for surgery
:17:02. > :17:05.like this in Wales. There are thousands who want it, but are we as
:17:06. > :17:11.a society but the two fought the bill. What do you say to those
:17:12. > :17:18.people who look at your patience and say, I don't want to spend my tax
:17:19. > :17:21.money on giving them an operation, an expensive operation. What I want
:17:22. > :17:27.for them to do is just go out for a walk and stop eating the wrong food.
:17:28. > :17:37.I am slightly sympathetic to that argument, but to suggest this is
:17:38. > :17:42.expensive surgery is a fallacy. These operations paver themselves
:17:43. > :17:50.into .5 years. A lot of these people have diabetes and hypertension which
:17:51. > :18:00.go away. -- half years. Even those who control the money agreed it
:18:01. > :18:04.makes sense. We are certain that this is appropriate and it is good
:18:05. > :18:09.value for money. So why on earth do we make it so difficult for those
:18:10. > :18:16.who are more video beast to have bariatric surgery in Wales, more so
:18:17. > :18:22.than in England? The plan is to go from 80 operations a year to 300.
:18:23. > :18:26.Last month, guidance in England was up dated, so more people will
:18:27. > :18:31.qualify for surgery, but that does not apply in Wales. The government
:18:32. > :18:35.here believes surgery should be a last resort and it has drawn up a
:18:36. > :18:42.strategy that supplies three levels of support before an operation can
:18:43. > :18:47.be considered. Level one is based on advice, like this scheme for mothers
:18:48. > :18:55.and toddlers. On level two, a GP can before a patient to a spare
:18:56. > :19:02.specialists. This helps this family from Aberdare when their daughter
:19:03. > :19:05.started putting on weight. I was one of the biggest ones out of my
:19:06. > :19:10.friends and I did not look very nice. Every year you would do it on
:19:11. > :19:14.show and you would have a skimpy little outfits. She was getting
:19:15. > :19:21.uncomfortable because she was one of the bigger girls in dance and other
:19:22. > :19:25.girls were coming from other schools. Two girls called her flat
:19:26. > :19:33.in the toilet and she was really upset. We went to the doctor first
:19:34. > :19:37.of all and spoke to the doctor. I was trying to explain to her, but I
:19:38. > :19:43.thought she needed it as well, coming from somebody else. Wales has
:19:44. > :19:48.the highest childhood obesity rates in the UK. The health professionals
:19:49. > :19:53.on the front line it is a problem they face on a daily basis. I have
:19:54. > :19:59.been quite terrified with a number of morbidly obese children I have
:20:00. > :20:03.come across in the last nine to 12 months. We are talking about
:20:04. > :20:09.children in their teens being diagnosed with type two diabetes.
:20:10. > :20:13.For the Meredith family B level to advise they received on the NHS was
:20:14. > :20:24.good, up to a point. She maintained her weight June the time we were
:20:25. > :20:33.going there. I thought they bought we were doing OK. However, old
:20:34. > :20:38.habits crept back when Jasmine approached her teens. I could not
:20:39. > :20:45.stick to it. I wanted to lose it, but I couldn't. I just thought I was
:20:46. > :20:54.going to get bigger and bigger. Jasmine is not alone. At the city is
:20:55. > :21:00.already a problem for our children. -- obesity. It is predicted that by
:21:01. > :21:05.the time this generation reaches their parents age, half will be
:21:06. > :21:12.obese. Children and adults should be able to get level three advice -
:21:13. > :21:24.specialist advice from doctors and clinicians. There is anyone level
:21:25. > :21:28.three service in Wales are available for adults and not been for
:21:29. > :21:37.children. You concerned? Even more concerned. These level three
:21:38. > :21:43.services for children need to be established urgently. There are
:21:44. > :21:46.components of medical management that are available in part of all
:21:47. > :21:51.the health boards. One has a more fully formed arrangement and the
:21:52. > :21:58.other health boards are planning what they intend to do. They all are
:21:59. > :22:08.in the process of planning. A lot seems to be in the process. It
:22:09. > :22:15.doesn't seem that a lot is being done. I been unreasonable in asking
:22:16. > :22:23.that? You will have two ask at the health boards. That is what we did.
:22:24. > :22:29.There are no plans for an increase in services for children. A bit of
:22:30. > :22:40.bad news. I can't go home tomorrow as planned. I'm still in too much
:22:41. > :22:52.pain. Dr Shoreshank said I can't go home until they get it right. In
:22:53. > :22:55.India Zac suffered an infection after his operation. A week later he
:22:56. > :23:03.decided to risk the long journey home. It was a gamble that nearly
:23:04. > :23:11.didn't pay off. His condition termed critical and he was taken to
:23:12. > :23:22.Wales's biggest hospital and put into intensive care. His life was at
:23:23. > :23:28.risk. Two weeks later, Zac emerged after a close call. I went abroad
:23:29. > :23:34.and had it done. They weren't aware of how the surgery was done. I
:23:35. > :23:41.wasn't really. You know, I assumed that they opened me up like a
:23:42. > :23:45.curtain, but honestly they must have opened up one side and then what
:23:46. > :23:51.they have done is close that an open the other side. They assumed there
:23:52. > :24:02.would be one cavity and there were three or four. Home sweet home.
:24:03. > :24:08.Caring for Zac in a high dependency beds has cost the NHS more than the
:24:09. > :24:11.operation they refused to give him. Picking up the pieces from private
:24:12. > :24:21.operations overseas is becoming more common. We have an increase in
:24:22. > :24:27.sorting out surgeries that have been carried out elsewhere. So people
:24:28. > :24:31.have been turned down for NHS treatment and it has gone wrong.
:24:32. > :24:40.Exactly and there is a huge cost implication. It is not just the
:24:41. > :24:50.cost. Zach's obesity means he has not worked for over 20 years. --
:24:51. > :24:56.Zac's obesity. Alistair is also on benefits. If you gave me the
:24:57. > :25:03.operation, if you had helped me the first time, if you gave me the skin
:25:04. > :25:07.grafts, I would be helping to contribute to society. Several times
:25:08. > :25:14.in the course of this interview you have mentioned, yes, I know the NHS
:25:15. > :25:23.is strapped for cash. It seems as if you feel ill people approaching
:25:24. > :25:27.them. Of course I do. There is cancer, all these other illnesses,
:25:28. > :25:36.but in general society you have to realise that obesity is an illness
:25:37. > :25:39.in itself. There's this negative attitude of people just sitting down
:25:40. > :25:46.and gorging themselves into oblivion. That is the end result,
:25:47. > :25:51.but there are facts that lead people to that. If you had a message to the
:25:52. > :25:56.Welsh government, what would it be? You have to stop with the children.
:25:57. > :26:01.If you are waiting to recognise that there are is a problem with morbid
:26:02. > :26:07.obesity when they are adults, it is too late. In Aberdare, Jasmine is
:26:08. > :26:12.that on the right track. Her family have found support and advice, but
:26:13. > :26:17.not from the NHS. It's from a slimming club instead. She joined
:26:18. > :26:25.Slimming World. They don't encourage her to lose weight, it is just
:26:26. > :26:28.healthy eating. The Jasmine, the warnings have come at the right
:26:29. > :26:34.time. It's the right thing to lose weight. If I just kept eating and
:26:35. > :26:42.eating, I don't know how big I would be now. But Alistair, getting help
:26:43. > :26:51.is sometimes just a matter of speaking to someone who knows what
:26:52. > :27:08.it's like. Hello. How's it going? Zac. Seeing that... Wow, you look
:27:09. > :27:14.shop there. That was a T-shirt that used to hang on me. It will probably
:27:15. > :27:21.fit the perfectly now. You can do it again. Even if the system does not
:27:22. > :27:29.help you, you have it in you because you have done it before. If you keep
:27:30. > :27:36.knocking at the door, at some point someone will answer. It's great to
:27:37. > :27:44.get so much of my chest with someone who understands. Why should we as a
:27:45. > :27:49.society care? We should care. If we don't care about this, we are going
:27:50. > :27:59.to find our NHS falling apart within the next 15, 20 years. Because?
:28:00. > :28:07.Because the costs associated with treating obesity will spiral. The
:28:08. > :28:13.Health Secretary declined to be interviewed, but the course of
:28:14. > :28:22.action is being developed and it will deal with any gaps. Zac's
:28:23. > :28:26.journey back to a normal life is almost over. He is 30 stone lighter
:28:27. > :28:36.and he did it on his own. He will have more challenges of his -- he
:28:37. > :28:43.will have more challenges ahead, but today it's about fulfilling one of
:28:44. > :28:48.his goals. This has been a goal since day one, to get back into a
:28:49. > :29:02.Welsh top. To Bradley where my colours. -- to proudly wear my
:29:03. > :29:07.colours. I spent most of my adult life just living a lie. Walking
:29:08. > :29:13.around with this bubbly smile, but I was dead inside. Now I'm not walking
:29:14. > :29:21.around with a bubbly smile, but I am bursting inside the close I wonder
:29:22. > :29:30.what light is going to bring today? -- because I wander up what life is
:29:31. > :29:37.going to bring today. Yes, it is good.