Scotland the Fat BBC Scotland Investigates

We're fat. Very fat.

Would you feel sick after eating all this?

I never feel full.

Only America is fatter.

Go.

It's deep-fried Mars Bars.

And it's taking its toll.

You feel like you're dying a slow death.

Today's fat teenagers will become tomorrow's diabetic 30-year-olds.

Tonight, I go on a quest to investigate Scotland The Fat.

You could say this is Scotland's public enemy number one - fat.

We're storing more and more of it in our bodies

and it's weighing us down.

We, Scotland, are now the second fattest country in the world.

I want to investigate exactly why we're so fat and getting fatter.

And find out if it's too late to fix.

Can I just have a bit of that sausage roll there? Thanks.

This is Glasgow's East End.

Now, we're not picking on the East End, it's just statistically,

it's one of the unhealthiest areas in the country.

And it's match day. So that's a good opportunity for me

to speak to those in high spirits about what they eat.

Can these football fans unlock the secret of our bulging bellies?

Why do you think people in Scotland are so large?

It's deep-fried Mars Bars.

-Do we have a problem with our diet?

-No' really.

Do you know how many calories are in that?

-About 3,000.

-Do you care?

No' really.

How often would you eat a takeaway a week?

Nearly every night.

Maybe once during the week but definitely all weekend.

The East End is also the birthplace of the deep-fried Mars Bar.

We probably sell about a box a weekend

and there's about 48 in a box.

You will sell about 48 deep-fried Mars Bars in a weekend?

Two days. Yeah.

You know, that's not that bad.

Now, a deep-fried Mars Bar a weekend does not a fat nation make.

There's got to be more to it than that and I'm going to find out what.

We wanted a more scientific view of the problem

so we asked 1,000 Scots what they make of their diet.

And the results were, well, surprising.

80% of Scots believe they have a healthy diet.

So how come we're all so fat, then?

Looking at the statistics, it seems that the extent of the problem

varies according to where you live.

So here's my fat map.

One of those obesity hot spots is the Highlands,

where less than a third of people are a healthy weight.

I've come to the northern town of Thurso to meet a woman who

may help me in my quest to find out why.

What would you eat in a day?

Well, I would have...

That before a McDonalds. And I'd have that as a snack in the afternoon.

I could easily eat two bars of chocolate.

A packet of Maltesers.

-That's a lot of chocolate.

-It is. It's a massive amount.

That kind of food led to this...

39 stone.

No clothes would fit her 7ft-wide waist.

She resorted instead to making her own clothes

out of bed sheets and sofa covers.

Jennifer became so large, she had to rely on her daughter to help her

with basic personal care.

When I was at my biggest, I had to literally squeeze the fat

each side of me to get through the shower door.

I got to the stage where I couldn't wipe my own backside.

That was quite humiliating.

Morbidly obese, and having had her heart stop twice,

Jennifer was told - diet or die.

I thought, you know, they're right. I've got to do something about this.

I've got to take control, otherwise I'm not going to be here.

But it's a daily struggle.

Living on benefits,

she found it easier to snack on cheap high-calorie food.

Do you know that you can go into a local supermarket

and you can buy 24 packets of crisps for 69p?

But you cannot buy a healthy cereal bar that people promote

that are healthy for that price. Let alone 24 cereal bars for 69p.

It's just crazy.

What's it like being the size that you were and

living in a small community?

The diet in this area means that people are amongst the fattest.

Why do you think that is?

There's nothing to do here.

I think, the winters are long and people just get bored.

'Hold on. We all get bored and we're not all 39 stone.

'Surely there must be a bit more to it than that?'

If anyone's going to be able to give me an insight into why

Scotland is so fat, and getting fatter, it's this man.

Professor Hanlon has been studying our diet

since I was knee high to an empire biscuit.

He believes we could be getting fat because it's in our nature.

You can imagine the scenario, there's the hunter gatherer,

they've come back from the hunt, the venison is spitting on the fire,

there's this lovely fat oozing out of it

and this guy says, aw, no, thanks, erm, I'll have berries tonight.

Well, he died in the winter and didn't give rise to any children.

But the chap who sat on his backside and gathered his strength survived.

So we are the offspring of people who identify high-calorie food

with exquisite taste, eat it greedily

and sit on their backsides when they can.

Professor Hanlon told me

obesity only became significant from the 1980s.

It's now an epidemic, he says, unprecedented in human history.

It arises because almost all of us are slowly putting on weight.

You leave an average Scotsman to his own devices for a year

and he puts on a kilogram, 2.2lb.

And that's a very small energy imbalance -

only about 30, or 25 calories a day. Less than a digestive biscuit.

So the whole population is slightly out of balance

and is moving towards obesity.

Hold on, half a biscuit a day has caused this obesity epidemic?

OK. So Professor Hanlon isn't saying exactly that

but his message is this -

we are almost hard-wired to eat fatty food.

Which basically means it's genetic, therefore, not our fault.

But surely that's true for everyone?

It doesn't explain why it's people in Scotland in particular

who are so fat.

-# Just eat it

-Eat it

-# Just eat it

-Eat it

-# Just eat it

-Eat it... #

Just flip it over.

There's no getting away from the fact we are all eating much

more fatty food and ignoring the healthy food.

But some of us are turning it into a sport.

# All you can eat... #

At this Glasgow bar, they run a regular monster burger challenge.

That's, on your plate, 3lb of meat

and 1.5lb of bread, cheese and lettuce.

It needs more meat. THEY LAUGH

It's pretty tough. Just looking at it, you're thinking,

"no way," but I'm going to give it my all.

For some challengers, it's not just a race against the burger.

One, two, three, go.

These hardy food athletes have got two hours to eat the entire

5lb burger and bun.

If successful, for their efforts, they will win...a T-shirt.

It's colossally huge beyond even the realms of sanity.

I'm happy to say, I'm struggling. I don't feel particularly well.

I can't go on any further.

You're not going to win your T-shirt now.

Yeah, I know. Pretty sad.

Chris, how are you getting on?

Yeah, I think I'm ready to throw the towel in as well.

That's all a bit of fun and we are not suggesting for a second that

people eat meals like that - 5lb weight of food on their plate -

every single day.

But it does make you question whether or not we are starting to

lose sight of what food is meant to be.

If Professor Hanlon's right and we've always been pre-destined

to be fat, then that means our ancestors were.

It's just, when I think of footage of bygone times,

I don't recall seeing fat people.

You know, the days before the housewife got her Hoover

and the postman got his van.

The reality is, we looked more like this.

The late 1940s.

It's post-Second World War, food was still scarce

and we valued what little we had.

Those running the home knew how to shop for cheap cuts of meat

and fish - essentially whatever they could get their hands on.

It might have required a strong stomach.

'Pig haven't a leg to stand on.

'And black pudding is no mystery if you know what to do with it.'

OK. Some of it might not seem that appetising today.

But people were making the most of Scotland's natural larder.

That larder hasn't changed - the way we use it has.

Take fish, for example.

'It's said there are 10,000 lobsters in this part of the coast.'

Our seas are teeming with them.

Last year, Scottish skippers netted almost 358,000 tonnes of the stuff -

worth around £500 million - the highest value in a decade.

But there's a catch. And it's not a fishy one.

This is Peterhead Fish Market.

It's the biggest fish market in the whole of the UK,

actually, possibly even in Europe.

Every day they sell 160,000kg of fish.

INDISTINCT SHOUTS

'I hooked up with one of the fish market's oldest customers -

'and I don't mean in age.

'He's been buying fish here for almost 30 years.'

Do we hold our hands up or do we hold a card up or anything to bid?

No, no. You wink your eye.

What's the wink like? Show me?

HE CHUCKLES

Have I just bought some fish?

Now you may have spotted that Fermin Lasa here isn't local.

He's from Spain. And that's the catch.

He, along with most other customers here,

is taking what he buys overseas.

Everything we buy here is for Spain, everything.

-Oh, everything will all leave this country?

-Yeah.

Traditionally, the French and Spanish are big fish eaters.

I would love the Scottish people or English people to be

-big fish eaters as well.

-But why aren't we?

It's traditional.

I don't find the demand in our country, in the UK.

So if you took some of the monkfish or the hake, put it on a plate and

took it to somewhere, Edinburgh or Glasgow and said, what's this fish?

I believe most people wouldn't even know what it is

or even what to do with it.

The main export markets for our seafood are generally

France, Spain, and Italy - the three thinnest nations in the world.

A happy coincidence?

From what the fish guys are telling me,

Scotland simply isn't eating its own fish.

We're stuck on haddock.

We don't eat the hake, the monkfish, the megrims, it's the French,

it's the Spanish, it's the Italians that are getting our fish.

Maybe if we started to follow their diet, would we be healthier?

Would we be less fat?

We did used to eat fish.

Herring, pickled or rolled in healthy oatmeal,

was part of our staple diet and the picking of it, a massive industry.

When stocks collapsed in the '70s,

we turned our attentions to another fish.

It's just, we like this one battered.

Last year, we ate 13 million fish suppers in Scotland alone.

No oatmeal in sight and the only thing pickled now is the onion.

Is it this shift away from traditional, less healthy ways

of cooking which is making us the second fattest country in the world?

Food writer Catherine Brown has spent years studying

traditional cooking methods used by Scottish housewives.

They would've had a great big, black iron cauldron

which would've hung over the peat fire.

They would've put their haggis and their dumplings and their vegetables

and big chunks of meat and everything would've gone into it.

And they hung it over the fire, on a chain,

which hung over the old peat fire, which is a very slow, gentle heat.

So everything simmered slowly and developed flavour.

But many of these traditional Scottish dishes

aren't making it into our kitchens. Take Scotch broth, for example.

A thick soup of meat, potatoes, vegetables, barley and lentils.

Would you say this was a nutritious plate of food?

I would. I mean, that is an entire meal in one bowl.

And I don't see, if you ate like this two or three times a week,

how anybody could have weight issues eating food like that.

No, because it's very sustaining because it's got everything in it.

Now, that traditional food,

which Catherine has very kindly just made for me,

is very nutritious. But what's interesting is,

the people who used to eat that kind of diet, they didn't get fat.

There were very few obese people in those days.

To find out the true nutritional value of a meal like this,

I've had it analysed at one of the world's top centres

for the study of food nutrition.

Sylvia Stephen has compared our bowl of Scotch broth with

four of our most popular snacks.

-The thing in common is they all contain the same calories.

-No?!

Each plate contains 267 calories.

-That chocolate is 267 calories?

-Correct. Yes. 267 calories.

-Is it?

-So how long would it take you to eat that?

-Seconds.

-Exactly.

-I'm sorry, but seconds.

And how long would it take you to get through your bowl of soup?

That would be my meal.

And I think just the attitude to that is that it is just a snack.

That's a quarter of a pizza.

-Most people would probably eat the whole pizza.

-That's right.

'In fact, that whole pizza is the equivalent of three

'of our bowls of Scotch broth.'

Now if I said to you, would you sit down

-and have three bowls of soup, please, this lunchtime?

-No, no.

But if I said to you, would you sit down and have this pizza?

-I could.

-Yeah, and I think most people could as well.

'I want to know what would happen if you put one modern Scot

'on a traditionally Scottish diet for one week.

'Would they lose weight?'

And behind that door is my guinea pig.

Someone who's struggled with her weight her entire life.

She is now prepared to undergo a traditional diet

to see if it could help shed those pounds.

How much has weight been a part of your life and who you are?

I've been overweight my whole life.

I've been right up at 25 stone. I don't exercise an awful lot.

I don't eat badly. But I can, I can go all day without eating.

Then I snack when I come in.

Then have my dinner and then still don't feel full, so keep going.

I never feel full.

Tracey says her size has led to some rather uncomfortable situations,

like the day her doctor told her she needed a CT scan.

He said, the first thing we'll have to do is send you for a CT scan.

And I was like, oh, right. That's fine.

And he goes, oh, but see your size, you might not fit in it and you

might have to go to Edinburgh Zoo where they scan the elephants.

I was mortified. I came out and that's all I thought.

That's all I could remember from that day. I came out.

SHE LAUGHS I looked at the nurse...

I just came out.

I went home with my dad, just like that, how did you get on?

I was like, I may need to go to Edinburgh Zoo for a scan.

I was absolutely petrified to tell anybody on the day that

I was going for my scan in case I didn't fit in the scan machine.

But it was fine. I did. I had plenty of room, actually.

The 41-year-old now wants to get bariatric surgery

to curb her weight.

'But could a traditional Scottish diet save her

'from the surgeon's knife?

'I'm giving her a traditional diet we've created

'and I'm asking her to film how she gets on.'

It's day one of the traditional Scottish diet and I'm just about

to weigh myself so I can see how much I actually lose this week.

Wait till we see what happens.

I weigh exactly 18 stone.

Breakfast for Tracey is porridge with a choice of milk or cream.

So here goes. My first time ever eating porridge.

Lunch would have been the main meal of the day.

A choice of stovies, herring in oatmeal, or Scotch broth.

Mmm, tastes lovely.

The evening meal would traditionally have been a lighter affair,

such as kippers, pickled herring, or more Scotch broth.

I'm about to tuck in to my kipper with my oatcakes.

I have to say though, my whole house stinks of fish.

Not very pleasant.

I spent hours this afternoon cooking,

something that I don't do often.

It's not long before the high volume of oats

and lentils starts to take its toll.

I feel quite bloated and the

constipation's been really bad this week.

How did you get on?

-I struggled towards the end, I have to say.

-Did you?

Yeah, uh-huh. It took a lot of organising to get the, you know,

because the meals were switched around.

So your dinner was at lunchtime

and what you would maybe have for lunch was at dinner time.

So that took a lot of organising when I was working.

And oh, my goodness, I'm so fed up of the same food after a week.

All I wanted was a slice of toast.

The million dollar question is,

the people who ate the traditional diet, they were not fat. OK.

Did you lose weight?

No. SHE LAUGHS

-You didn't?

-No, I didn't.

-Really?

I didn't lose weight, however, I finished the diet on the Friday

and between Friday and Monday, I lost 4lb.

So I'm not going to say I didn't lose any weight

as a result of the diet, because you don't know.

Well, it was certainly an interesting experiment.

And by all accounts, a pretty healthy experiment.

But for Tracey's busy lifestyle, sadly, it's a no.

The traditional Scottish diet seems to be a bit of a contradiction -

lean meat, vegetables, pulses on the one hand,

and fatty foods like cream, milk and butter on the other.

Yet, despite eating some stodge, people back then weren't fat.

So what's the missing link? What's making modern Scots so fat?

I'm back at the world-renowned Rowett Institute to find out.

People used to eat an awful lot more than we do now, in terms of calories.

But the reason why they didn't become obese was

because they had so much higher levels of exercise.

You would walk everywhere. Physical labour was much, much more common.

Is it true that we're actually eating fewer calories today

than our ancestors were?

-Yes. Substantial amounts.

-Really?

I mean, yeah. If you look at some of the diaries that we have

from the 1940s, 1930s/1940s, we've got the diary - a food diary,

it's not an accurate one - but a food diary of a medical doctor.

And he would be eating on average somewhere round about

-3,000 calories a day.

-OK.

-Our recommendations now are round about 2,000, 2,500.

-Yeah.

So he would've been eating substantially more.

But he wouldn't have been overweight

because he would've been walking everywhere.

You know, the general level of exercise was much higher

than it is today.

Now, at this point in the film, you're probably expecting me to film

some healthy people working it off in the gym.

That's just a bit too obvious.

I'm going to meet some people who can eat what they want,

as much as they want, and as often as they want.

Oh, and they don't get fat.

They say an army marches on its stomach.

So what better place to come to understand the importance of food

than here - the home of the Third Battalion

of the Royal Regiment of Scotland at Fort George near Inverness.

They've kindly agreed to let me join in a typical training exercise.

Which means I need a uniform.

Come on, get a move on!

One top. Trousers. Hat. Jacket. Badge. Shirt. And a red hackle.

Sign here. Come on, hurry up.

On operation, these guys will carry anything up to 95lb in weight

on their backs.

A single foot patrol, like this one, can see them cover more than

a dozen miles, sometimes carrying casualties - in this case, me.

Add into the mix the Iraqi desert heat, the close combat fighting

in Afghanistan and it's easy to see how these guys need to fuel

their bodies with as much energy as possible to deal with it all.

This is one day's food?

-Yeah, this is one day's food.

-How many calories is in this box?

Well, you'd probably usually find that for instance,

in the mainland UK, when we're conducting training,

it'd probably be about 4,000 calories.

Whereas in Afghanistan, because the guys are burning out

an awful lot more calories,

you'd probably find that it's up to about 6,000 calories in a meal.

-That is huge.

-Operational meal. Yeah, it is.

If you were eating this kind of food back home, civvy street,

this amount of food, this amount of calories.

The normal civilian's no' going to be able to burn that off.

So if you were going to eat food like this, you would put on weight.

-A lot of weight?

-Of course you would, aye.

That's three times the amount a man, a civilian male, should be eating.

On civvy street, people are eating hundreds or even thousands

of extra calories a day.

Without the exercise,

it means they're simply storing that excess fuel as body fat.

My friends all have day-time jobs.

So during the day, they'll probably go to a burger bar

at lunchtime because it's on the site.

So they're eating fatty, greasy foods.

My friends are getting fat. It's simple as.

I notice it, they notice it.

So how many calories would you say you're eating in a day?

About 4,500, 4,000.

If you were eating those 4,500 calories a day

back on civvy street, do you think you'd put the weight on?

Probably be close to death. That would be sheer obesity.

Somebody my size to eat that many calories.

OK, then, gents. Power back and then straight up.

Come on. Flat on the floor.

If you don't have fuel in the machine, you can't work.

That doesn't matter if you're sedentary, sat at a terminal,

or a computer terminal or at a desk or

if you're running around with 50lb of weight on your back.

You need to eat. Food is fuel. So it's massively important.

The relationship between what you eat and the ability for you

to perform can probably never be more important than to you guys?

Yeah, absolutely. Using the machine analogy again,

if you put diesel in a petrol car, it won't go anywhere.

So if you put the wrong fuel in the human body, it isn't going to

work to the full capacity it could do if you put the right fuel in it.

So the right diet is imperative.

Now these guys are eating anything between 4,000 and 6,000 calories a day,

but they're burning off between 4,000 and 6,000 calories a day.

And that's why they're not getting fat.

It's beginning to sound to me like we might be the second

fattest nation in the world because we've forgotten the basics.

Do you think we've lost sight of what food is supposed to be for?

Food is for many things, and always has been.

I mean, its basic function is to nourish the body.

It provides us with solace, it alleviates boredom.

It performs multiple functions that have nothing to do

with its nutritional quality.

But it's a bit like football. It's mostly a spectator sport.

So, we all have shelves of cookery books, and we may have

wonderful gadgets in our kitchen that we could make anything with.

But, you know, how often do we actually drag them out and use them?

You know, I can recognise that shelf of books.

I've got one just like it. And it's got me thinking.

Have we not only lost sight of what food is actually for -

to sustain us - but have we lost sight of what food is, full stop?

Have our meals become so processed that we no longer recognise

simple basic ingredients?

I want to know exactly how much people know about their fruit and

vegetables - vegetables like this very traditional Scottish turnip.

And to do that, I'm going to need a little bit of help.

'I am back in the East End of Glasgow.

'How much do these football fans know about their five a day?

'And I'm not talking about goals.'

Who wants to do Sam's fruity challenge?

'Statistics show that people in Scotland eat less fruit

'and vegetables than anywhere else in the UK.'

Do you know your pineapples from your melons?

-Eh...no.

-Would you like to?

'A quarter of young people eat no fruit or vegetables at all.'

I've got my banana friend here.

I want you to tell me if you know what that is.

-Aubergine.

-You think that's an aubergine?

-Mm-hmm.

-That's a courgette.

-Courgette, sorry.

You are telling me you don't know what that is.

I don't know.

-What do you think that is?

-Asparagus.

-Asparagus?

If I said the second word was apple, would that give you a clue?

-Apple tree?

-It's not an apple tree. No.

Come on. It begins with B.

-It begins with a B.

-The next letter is U.

-Butter...

-Butterscotch?

Not butterscotch, good try.

-If I told you first part of the word was pine.

-Apple pine.

It's not apple pine, no.

Do you know the fruits and vegetables in that box?

-Um...

-That one there, look. What's that?

-Pineapple.

-That's a pineapple.

Sorry, I don't know.

-It's a pineapple.

-A pineapple, aye?

-Have you ever had pineapple?

-Yes, I take a lot of the chunks.

-Yeah, that's a pineapple.

That's what it looks like before you cut it up. Did you know that?

-No, I didn't know that.

-Wow.

-Butternut squash.

-Butternut squash, that's the one.

I knew it was that. Happy days. HE LAUGHS

'Now, that was clearly not a very scientific examination

'of our knowledge of food.'

For a more accurate picture, let's go back to our MORI poll.

We may say we have a healthy diet but when it comes to dinner,

less than a third of working age people

cook for themselves every night.

For those Scots living in the most deprived areas,

17% say they don't cook a single evening meal from scratch.

And generally more than half of us have three ready meals

or takeaways in a week. Is this why we're fat?

That question takes me back on my journey across my fat map.

I am heading to another of Scotland's heaviest areas.

This time, North Ayrshire.

It's home to a rather interesting experiment.

It's nice to see everybody today.

Today, we're going to actually make some potato wedges.

And then we're going to make a pot of chilli.

This cookery class is being run and funded by the NHS.

It hopes that if people are taught how to cook,

it might help lower those obesity figures.

A lot of the students are single parents

and each week they're taught a cheap and healthy recipe, which they

make for themselves and then take home to feed the family.

Were your cooking skills really quite basic before you

-started coming here?

-Yeah.

What kind of things would you have struggled with?

-Cutting an onion.

-Cutting an onion?

-Yeah.

-Yeah...

-I mean, that's just common.

A lot of people have never peeled a carrot.

That's why we start - we always start with soup and onions.

People have never actually handled them.

-So there are people who have never cut a vegetable up?

-Absolutely.

Do you like garlic?

Yes. But I've never used it before.

This is the first time I've stripped a bit and known how to do it.

Do you do a lot of cooking then at home? Sugar.

-I was always just basic.

-Really?

-Uh-huh.

I didn't eat as healthy as I should have until I came here.

Of the seven meals, potential seven evening meals in a week,

how many of them would have been ready meals?

-Five or six, anyway.

-Nearly every night? Yeah.

Would you eat one every night?

-Every night.

-Really? Every night ready-made meals.

Probably Sunday, I would sit down to a cooked meal.

Will you work with families who have never cooked

a meal from scratch before?

Absolutely. We've worked with very vulnerable teenagers who've

become parents at 16 and they have no skills.

'And that can be down to more than just ignorance of basic foodstuffs.

'One in five people in this area live in poverty.'

Gillian says she sees first-hand the impact that has on what people eat.

This is quite basic equipment we're using.

-But, presumably, that's the point?

-Absolutely, because we've found that

lack of equipment can be a barrier to people cooking.

Have you got some clients who wouldn't even have

the basic cooking...I mean, even an oven?

Absolutely. Even an oven.

We have some families that all they have is a microwave.

Which is quite shocking, isn't it?

Because all they can do is processed meals.

We've worked with families that work with electricity cards

and they're metered. It's about cost.

So when you see recipes that say, switch on an oven

and cook for an hour-and-a-half, that just wouldn't happen.

Public health officials here started the cooking classes

because they made a direct link between poverty and obesity.

And obesity's a big problem in this particular area?

It is, it's a huge problem.

The figures in Ayrshire for overweight and obesity

in primary one children are about one-in-four.

So one-in-four of our five-year-olds is not a healthy weight.

We do find when children come into nursery,

they've maybe never tried a slice of pineapple.

They've never had a piece of carrot raw.

They might never have seen a kiwi fruit.

And never used cutlery before?

There's lots of children who don't use cutlery

because meals often come in a box.

Being fat used to be a sign of wealth.

Tribal leaders, statesmen, royalty - the bigger you were,

the more money you had.

But could the opposite now be true?

Does being poor now mean you're more likely to be fat?

Is this why Scotland has such high levels of obesity,

because we have such high levels of poverty?

I met a GP whose patch includes one of the most

deprived areas of Scotland.

He's worked here for more than 30 years.

I think all classes have got heavier, but I think in

more deprived areas there is probably more obesity.

Food is cheaper and fat, sweet foods are the cheapest

that you can get.

And people just stuff their faces with that sort of stuff.

How bad is the situation? Do we take it seriously enough?

I think that food is becoming a bit of a mystery to people.

When I was being brought up as a child, we got home-produced food

all the time. And I think that over the years, as we've allowed,

you know, the multinationals to take control of our diet,

we've lost control of that.

Dr Spence has got me thinking.

What would happen if people did have control?

What if money wasn't an issue?

Would they make the healthier choice?

Time for another unscientific experiment.

I can see you're eating a fried egg roll.

Could I tempt you with a piece of fruit?

I'm back in the East End with a tray full of delicious

yet incredibly cheap mini pork pies

as well as some healthy but expensive pre-cut fruit salads.

Can I tempt you with some free healthy fruit or a pork pie?

'I'm going to be handing them out for nothing.

'I wonder which people will choose? Fruit or pie?'

-You take as many as you like.

-That one's lonely. It's saying to me.

-I don't like pies.

-You don't like pies?

-No.

-Do you like fruit?

-I like fruit.

-Would you like some free fruit?

Yeah, OK.

'Two pies for every fruit so far.

'What do these Canadian tourists think of our diet?'

It's very hard to find anything nutritious to eat.

It's surprisingly difficult.

Can I stop you and see if you would like some free fruit or a free pie?

I'd like some free fruit.

Would you like a pie? You want the fruit! Good girl.

You don't want anything? OK. As you were.

So that's all the fruit gone and the pies are the ones that are left.

That surprises me.

The processed pies, at 60 pence for three,

were certainly cheaper than the healthy option here.

The fruit came from packs which cost £2 each from the supermarket.

A price which would be regarded as an unnecessary luxury

by families on a low income.

Yet, take money out of the picture, and fruit was what they chose.

So maybe there is something to this theory

that poverty leads to obesity.

'I've come to Edinburgh to the New Town Cookery School

'where I've decided to set chef Fiona Burrell a challenge.'

This is a supermarket value meal.

Spaghetti Bolognese - 60 pence. Which if you're on a fixed income,

that's a pretty difficult price to try and beat.

Actually, it doesn't look that unhealthy.

Would you be able to make this for the same price

or even beat it, do you think?

I think...I mean, that is a very cheap price,

but I think you can beat it.

But you have to buy more than just enough for one person.

I noticed on the ingredients of our supermarket value dish

that they have beef stock, beef gelatine.

Well, the gelatine I think is in there to make it look...

It sits on the pasta better.

So it's just like a packing agent almost, just to fill it up?

I think it's to fill it up

and make it feel a little more full in the mouth.

So it looks like it's very meaty and saucy and all the rest of it.

But actually, there's not as much meat in there as you might think.

My meal doesn't take as long as yours to prepare.

You need a knife. Stab. Put in...

Is this the right time to tell you I am vegetarian?

-Ah.

-THEY LAUGH

Our sound man is tasting it for me.

Was that the ready meal

or was that the freshly cooked spaghetti Bolognese?

Without doubt, I suspect, that was the ready meal.

Well done. This cost me 60 pence to buy in the supermarket, OK?

How much did it cost you to make that?

With the extra meat, which was almost double the meat, not quite

double but nearly, that one cost, I think it was about 54, 55p.

-So cheaper? With double the meat?

-Yeah.

-Incredible.

OK, so it takes twice as long, twice as much effort

to make a meal from scratch, but you know what,

it's actually cheaper and healthier.

So in answer to the question of whether poverty is what's making us

unhealthy, it's poverty making us fat,

I think today's proven that it's not actually true.

It's not just the price at the checkout

that we need to be looking at.

The cost to public health of obesity is massive.

In Scotland, the NHS bill is around £200 million a year.

And that's a conservative estimate.

Experts say the number of people in Scotland getting weight-loss surgery

has increased fourfold over the last ten years.

This is surgeon Mr Majid Ali. Based in Ayrshire,

he carries out bariatric surgery like this every week.

This patient is having the size of his stomach reduced

with a gastric sleeve.

What it does is basically restrict the capacity of the stomach to

accommodate large volumes of food.

The yellow stuff you can see is fat.

Mr Ali has to burn through a lot of it just to get to the stomach.

Today's operation has cost the NHS £7,000.

Mr Ali says demand for his services is huge.

When I started in Ayrshire and Arran, I had an influx of patients,

a huge number of patients, wanting the operation.

So I had to ration the operation to the people who will benefit the most.

Some people argue that this operation is seen as a quick fix.

It is not a quick fix by all means, you know.

This is a dangerous surgery, very expensive.

What's the youngest aged patient you've operated on?

-I think the youngest is about 18.

-18?

-18. Something like a 45 BMI.

Obesity in itself is associated with increased incidence of cancer,

heart diseases, metabolic syndrome.

To be honest, I think that the NHS is struggling.

If we don't do anything about the morbidly obese patient,

then we have to pay more than the price of the surgery.

Have you caught a fish?

This man is one of Mr Ali's patients.

Once morbidly obese, David McAtee

he had a stomach bypass to reduce the amount he is able to eat.

'His meal sizes are now a fraction of what they were.'

And that's what I can eat now, the inside of that.

-You use this as your dinner plate?

-That's my dinner plate.

That's all you can eat?

That's all I can eat and I'm full up.

At his heaviest three years ago, David weighed 28 stone.

He's lost a lot of his family to obesity.

My mum died from being obese, my step-sister died from being obese.

That, that was really hard.

You saw this happen and yet you just carried on eating, getting bigger.

-Mm-hmm.

-If you hadn't had the gastric surgery,

what would have happened?

I'd have died. I would have died.

No doubt?

(TEARFULLY) I'd have been where my mum was.

-She died through obesity?

-Uh-huh.

How close do you think you were to that?

Really, really close.

Really close.

'David and his wife take me to their local supermarket

'to show me what they used to buy.'

-Would this have been an area you'd have avoided?

-No.

-You'd have walked right past that?

-Right past that and to here.

'David told me his choice of what to buy was heavily influenced

'by what was on special offer. And those offers were

'nearly always for high-calorie, high-fat processed food.'

How long would it take you to eat your way through that 22 pack?

-22 pack, a day and a half.

-Would it?

-Mm-hmm.

'Research suggests the choices we make in the supermarket

'are influenced by where a product is placed,

'how easy it is to reach, even the colours of the packaging.

'Is this what's helping us get so fat?

'I've come to the leafy suburbs of Bearsden

'to meet a woman dubbed the "food psychologist,"

'who's spent years studying why we buy what we buy and eat what we do.'

Companies pay a lot of money to get into particular locations

in the supermarket because they know that those locations are what sells.

So usually, one of the first instances is when you walk in,

whatever's right in front of you.

As you're leaving, you know, to pay, they're prime spots as well

because people tend to pick things up and grab them at the same time.

'Dr Ferguson has studied the biological effects of what

'we eat on our bodies.

'She says we can become

'hooked on some of the common ingredients added to processed food.

'One of them is MSG.'

MSG switches off that little trigger that tells your body that

you're full but it makes you want more and more

because it makes food taste really, really good.

Dairy, gluten, they contain glutomorphines

and kesomorphines and they have that sort of opiate... opium effect

on the brain so they lock into your opiate receptors.

We become quite hooked on these.

'And addicted to chocolate? Well, it might not be your fault.'

Chocolate has got phenylethylamine, which is mood boosting.

So again, there's a lot of things in food that

we don't necessarily think about.

Often, to get the food cheap, we have to add in the fillers,

the preservatives, the flavourings, the enhancers.

Our body doesn't recognise this stuff.

It's not natural for us to be eating these foods

and it confuses our system.

I think a lot of times that's why we're piling on the weight.

So, it seems, listening to Dr Ferguson,

that it isn't actually our fault we're so fat.

We're being tricked, she says, into buying what we buy.

And when we eat it, we're tricked into wanting more.

The finger of blame, it would appear, is being pointed

very firmly at the automatic doors of the supermarket.

'The ready meals market is worth more than £2.5 billion a year.

'The voice of the major supermarkets,

'who didn't want to be filmed,

'is the British Retail Consortium.'

You just need to walk into a supermarket

and the very first thing you are confronted with

at the barriers are the promotional offers. It's not the healthy stuff.

I would slightly disagree with that.

About 40% of products in a supermarket are on promotion,

so you can imagine how many different varieties of fruit

and vegetables are on promotion.

Alongside, you know, some of the cakes and biscuits.

We make no bones about that.

But what I am saying is, it is absolutely possible to buy

a very affordable, nutritious diet at any supermarket.

I can go into a supermarket this afternoon

and I can buy a 24-packet of crisps multi-pack in for less than £2.

-You could.

-I can't buy the equivalent in healthy food.

-I just don't...

-24 blueberries just doesn't cut it.

-I just do not agree with this.

It's actually cheaper to eat good nutritious food, fresh fruit

and vegetables, as it is to buy processed food but

there's nothing wrong with buying some of those products on promotion,

provided that you eat them as part of a healthy diet.

The ready meal market is massive and it's growing.

Bearing this in mind, do you think you are doing enough

to make them as healthy as they can be?

They are one of the few products that has absolutely clear

front-of-pack labelling on them.

So you can see exactly what's in that product.

The difference is, if you buy your curry in the supermarket,

you know exactly what you're getting.

You buy your curry from the local Indian takeaway,

do you know what you're getting in that?

You know, regardless of who we blame for this obesity epidemic,

one thing is certain -

the consequences of all of this are not only life-changing

but life-threatening.

For many, it really is a case of diet or die.

They informed us that they gave you the all-clear...six months ago.

-Uh-huh.

-And yet you...

Ten years ago, Edinburgh man Ricky Callan

was a successful character actor.

We've stopped your money until such times as we recoup the overpayments.

-What?

-We've stopped your money, Mr Ingram.

He's always been big.

He was more than 20 stone at just 16 years of age.

There was me and a couple of mates, every lunchtime

in secondary school, we went to the chippy.

We used to walk, it was about half a mile away from the school,

to get something from the chippy and then walk back.

Ricky's obesity led to a diagnosis of type II diabetes.

Often a weight-related condition, it's where the body doesn't

produce enough insulin to maintain normal blood sugar levels.

Left untreated, it can damage blood vessels, nerves and internal organs.

When a small blister on his foot became infected,

Ricky's doctor told him they would need to operate.

He said, we're going to try and do this bit of surgery where we

take so much away and stuff like that and see how it

goes from there.

But we could be looking at a below-knee amputation.

I thought, is he telling me that I'm going to lose part of my leg?

The infection was worse than first thought

and Ricky had to have a below the knee amputation.

I've lost half a leg. I've got three toes amputated on the other foot.

I've had both eyes operated on. I've had cataracts done.

I've recently had kidney failure. There's only bits of me here now.

Because the thing about diabetes is, it's like...it just eats

away at you and you feel like you're dying a slow death and that

you're being pulled apart like, like, you know, like an Action Man.

They're taking a bit of you at a time until there's nothing left.

And it's torturous and it's sometimes painful

and it feels never-ending, you know.

Sounds like hell.

(TEARFULLY) Yeah.

-Sorry.

-No.

Did you think life would be like this?

No. And it's my fault, it's my responsibility.

It's only down to me, you know.

But like I said, it's because maybe the message isnae serious enough.

'More than 1,350 people in Scotland

'have had a foot or leg amputated as a result of diabetes.

'Most of them were obese.'

So, if I can give you an idea of the scale of the number of patients

we see in this clinic.

'Dr Young is Ricky Callan's consultant at the

'diabetic clinic at Edinburgh's Royal Infirmary.

'Not only has he watched the majority of his patients

'lose their fight against the disease,

'but he's also seen the recent rise in the number of newly diagnosed.'

The numbers of people with diabetes in Scotland go up

by about 10,000 a year and have done now for certainly a decade.

That increase in type II diabetes is driven in turn

by the significant increase in the number of obese individuals

in the Scottish population.

Dr Young is now seeing patients in their 30s getting amputations

because of type II diabetes.

And even after such drastic measures, the prognosis isn't good.

The chance of surviving more than five years,

which is considerably less than half,

and in many cases some studies have said that

three-quarters or more can die five years after an amputation.

Sorry, the life span of someone who undergoes

an amputation like this is around...?

-Less than five years.

-Less than five years?

Less than five years.

Today's fat teenagers will become tomorrow's diabetic 30-year-olds.

Or even diabetic 20-year-olds, in many cases.

And so, it will take a generation really of change before we will see

the numbers going down.

And that will be certainly and potentially too late for many

of the people that we see around us on our high streets at the moment.

'It's a stark warning

'and yet some doctors I spoke to said it was one which they felt

'was either not strong enough, or, in some cases,

'not being voiced at all.

'Professor Mike Lean is a consultant at Glasgow's Royal Infirmary.

'He believes part of the problems lies in the mixed messages

'coming from those whom he says should know better.'

With all our efforts for health promotion

and campaigns for healthy eating, if you walk into the main

outpatient entrance at Glasgow Royal Infirmary you will see a

wall-sized banner, perhaps 15 metres by 4 metres, advertising Irn Bru.

It's colossal. It's the first thing people see.

There's a little tiny healthy eating thing hidden away.

'Professor Lean is also critical of the vending machines

'dotting hospital corridors.

'He says they could sell healthy snacks, but don't.'

Foods which can be kept in vending machines tend to be high in sugar,

high in fat and very low in everything else.

So a good example of exactly what we should not be giving to,

certainly to patients or to anybody who has health concerns.

'But most damning for him are the meals sometimes served up

'to his patients.'

A patient this morning who came in with angina, chest pains,

had stents in his arteries.

What was he given for lunch - macaroni and mashed potato.

Our health board has got double values.

'We asked several health boards if we could film in their hospitals.

'They said no.

'But I wanted to see for myself what Professor Mike Lean has told me.

'My first stop is Glasgow's Royal Infirmary.

'The Irn Bru advert has been taken down, but I want to see how

'seriously hospitals like this one

'are taking their healthy living message.'

Have you got any healthy options? What would be a healthy option?

-Baked potato with fillings.

-Baked potato with cheese or tuna?

-Big greasy sausages.

-A what, sorry?

-Big greasy sausages.

-I know. It's a bit early for a big greasy sausage.

Chips.

-Is this the trolley for the ward round?

-Uh-huh.

Is there any fruit? Do you have any fruit?

-Eh?

-Fruit. Like an apple or a banana.

Aye, up the stairs in the other shop. We don't have that at all.

-It doesn't go on the ward round?

-No.

-What if you wanted a piece of fruit?

-From the trolley, in the ward?

-We don't have it.

-You don't have it?

-No.

'Next stop, Greenock's Inverclyde Hospital.

'Nice cakes. A sign on the wall says only nine types of cake

'are allowed on display - to encourage healthy eating.

'Like all the hospitals I visit,

'the vending machines are stocked full of high-calorie, high-fat

'crisps and chocolate, as well as water and fizzy drinks.

'Finally, the Royal Alexandra Hospital in Paisley.'

-Have you got any healthy option? Salads?

-No, we don't have salads.

Have you got any baked potatoes?

-No, we don't have baked potatoes.

-You do hot pies?

We've got pies, macaroni pies and scotch pies.

What's a macaroni pie?

It's like potato and cheese.

So it's like a scotch pie with macaroni cheese in?

You can buy scotch egg bars. It's like a chocolate bar but meat.

See all the other hospitals we've been to, it's almost as if

the fruit has been something of an afterthought.

But actually, this isn't that bad.

In a statement, Greater Glasgow and Clyde Health Board said

half of vending machine products were healthy

and high-sugar drinks replaced with water, fruit juice and diet drinks.

They say £10 million has been spent on completely

redesigning their hospital food.

Following assessment,

some patients do require high calorie or high-carbohydrate food.

Hospital trolleys had to be 50% healthy and include fresh fruit.

The hospital cafes were run by volunteer organisations

and so the health board has no control over what they sell.

However, they should comply with the healthy eating policy.

So, a questionable level of healthy promotions in supermarkets

and confusing food messages from hospitals.

'Experts say Scotland is going to keep on getting fatter.

'Unless we see some radical change.'

When you walk round the hospitals,

it's vending machine after vending machine,

with fizzy drinks, chocolate bars, crisps.

You go to the canteen and try and get something healthy,

it's virtually impossible.

The patient trolleys that we looked at, no fruit.

It's all chocolate, all crisps, fizzy drinks.

You can't be happy with that?

I would be worried if that was happening on a consistent basis.

That we were finding more on a situation where

some of our NHS facilities didn't have a healthy eating choice

for people to choose from.

And boards have a responsibility to make sure that that is happening.

If it isn't, then the boards need to take action to make

sure that it does happen.

A consultant surgeon told me that one of his heart patients,

for a meal, was given mashed potato with macaroni cheese.

Would you say this was double standards by health boards?

It suggests to me that the boards may have got some of

their priorities wrong in this area.

And if there is an issue where some of our boards are giving out

mixed messages around healthy eating and are not giving

sufficient prominence to issues around healthy eating,

then I think they should look at taking action around that.

'But I've found this problem goes far beyond confusing messages

'coming from hospitals.

'The Minister says supermarkets and manufacturers have to do much

'more to make food, and promotions, healthier.'

The industry have to recognise that they've got

a part to play in causing this problem

but they've also got a part to play in solving this issue as well.

And if they think they're doing enough at the present moment,

then the message from government is, I'm sorry, it's not adequate.

And that's why we're taking forward a range of measures that we

want to see them taking action on, and if they don't,

then we're prepared to legislate where necessary.

'The government says more details of that legislative framework

'will be revealed in the autumn.

'There's no doubt Scotland's obesity epidemic is complex.

'There are no quick fixes.

'So it looks like we'll be holding on to the dubious honour

'of being the second fattest country in the world for some time to come.'

Perhaps there is a glimmer of hope in all this.

Remember Jennifer Bodek from Thurso?

At 39 stone, she decided it was time to do something about her weight.

She went swimming.

I thought, well, I've got two choices. I just carry on

and don't do any exercise and I will be dead.

Or I get in that pool.

Jennifer now swims two miles every day.

Her swimsuit decorated with the stark message doctors gave her

which she says saved her life.

She's now lost a staggering 17 stone.

But perhaps the last word should go to my favourite football fan

back in Glasgow's East End.

Now this is a staple part of Scotland's diet, OK.

This is something you will have eaten

and I will promise you, you will have eaten this.

Do you know what it is?

-What? This morning?

-Do you know what this is?

-A cabbage.

-It's not a cabbage.

-Turnip.

-It's a turnip! You got one out of three. Well done.

-No problem.

# I'm huge, I'm fat

# You know it

-# You know I'm fat, you know

-Really, really fat

# You know I'm fat, I'm fat, you know it

# Really, really fat... #

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