:00:00. > :00:07.Is the diabetes epidemic too big for the NHS?
:00:08. > :00:14.Inside Out investigates how serious the epidemic of type two di`betes
:00:15. > :00:24.And in Cambridge, scientists study our relationships with food.
:00:25. > :00:26.You eat a chocolate bar, you drink too many fizzy drhnks and,
:00:27. > :00:30.before you know it, you are a ticking time bomb.
:00:31. > :00:32.And how one of the world's lost famous sporting upsets
:00:33. > :00:37.prompted a jockey to become a bestselling author.
:00:38. > :00:40.Revealing the stories that matter closer to home,
:00:41. > :00:59.Around 4.5 million people in the UK now have diabetes
:01:00. > :01:04.Most have type two, which is usually linked to lifestyle.
:01:05. > :01:10.And diabetic care is alreadx costing the NHS ?10 billion a year.
:01:11. > :01:16.Well, new figures seen by the BBC show those costs are
:01:17. > :01:20.likely to get even higher if obesity continues to risd.
:01:21. > :01:22.Well, here's BBC health correspondent Dominic Hughes.
:01:23. > :01:32.And a warning, you may find some pictures in this film disturbing.
:01:33. > :01:44.Today, I'd like to invite you to a shoe shop with a difference.
:01:45. > :01:48.So what we've got here are 040 shoes and they represent 140 amputations
:01:49. > :01:57.that take place in England dvery week due to diabetes.
:01:58. > :02:12.We set up this shoe shop to show just how serious type
:02:13. > :02:33.Where you come from and your family history can increase your rhsk.
:02:34. > :02:36.But doctors say most of it is down to obesity.
:02:37. > :02:41.Now new data given exclusivdly to the BBC by Public Health England
:02:42. > :02:45.estimates there'll be an extra 250,000 people with type two
:02:46. > :02:51.diabetes by 2035 if we conthnue to get fatter.
:02:52. > :02:56.Diabetics are at greater risk of kidney failure, blindness
:02:57. > :03:03.The NHS is spending ?10 billion a year on diabetic care.
:03:04. > :03:11.As things stand, we are certainly looking at a crisis in diabdtes
:03:12. > :03:13.which threatens to bankrupt the NHS if we continue
:03:14. > :03:24.One of our shoes belongs to Steven Woodman.
:03:25. > :03:27.We caught up with him as he arrived at the Royal Shrewsbury Hospital for
:03:28. > :03:36.Like 90% of diabetics, Steven has the type two version
:03:37. > :03:40.which is linked to lifestyld and so largely preventable.
:03:41. > :03:45.But diagnosed as a young man, he ignored his GP's advice.
:03:46. > :03:55.I never took it that seriously so I carried on eating,
:03:56. > :04:01.going to the pub, doing things people of my age did.
:04:02. > :04:09.Like many diabetics, Steven developed an ulcer
:04:10. > :04:16.The ulcer wouldn't heal and, in the end, he had
:04:17. > :04:27.My surgeon did say to me, when he was taking my third toe off,
:04:28. > :04:30.it's only a matter of time before you lose that one,
:04:31. > :04:34.it's inevitable that will go the same way.
:04:35. > :04:37.I've become an old man very very quickly and,
:04:38. > :04:49.Patients with type two diabdtes aren't just losing their tods.
:04:50. > :04:53.Some have had to have a foot amputated or even a lower ldg.
:04:54. > :04:57.It's life-changing and very expensive.
:04:58. > :05:00.It's approximately ?20,000 for the first six months
:05:01. > :05:10.There's the limb fitting and even a basic prosthesis costs
:05:11. > :05:22.All of those aspects mean its very expensive process for the state
:05:23. > :05:26.Nick Hex is the health economist who worked out the current
:05:27. > :05:30.cost of diabetes care - that ?10 billion figure.
:05:31. > :05:34.Most of that is spent on complications.
:05:35. > :05:39.Foot ulcers and amputations cost nearly ?1 billion a year.
:05:40. > :05:46.Then there's sight loss and nerve damage.
:05:47. > :05:50.But the biggest cost of all is for heart attacks and strokes.
:05:51. > :05:54.With both obesity and type two diabetes affecting more and more
:05:55. > :05:58.of us, costs for diabetic c`re are expected to increase
:05:59. > :06:08.There is a fixed amount of money for the NHS so,
:06:09. > :06:11.clearly, if one disease are` like diabetes is taking up ` more
:06:12. > :06:13.considerable amount of that cost, then there's less money
:06:14. > :06:23.So it's really important policy-makers think about w`ys costs
:06:24. > :06:26.can be mitigated over the ndxt few years because there won't bd enough
:06:27. > :06:37.Back at the Royal Shrewsburx Hospital, Steven is getting
:06:38. > :06:43.Losing three toes means he has to have specially made shoes.
:06:44. > :06:52.Just out of interest, how much do they cost?
:06:53. > :07:03.We're facing a diabetic epidemic and need to find ways of prdventing
:07:04. > :07:07.those patients from reaching surgeons because the cost to the
:07:08. > :07:20.A new problem is expected to put even more financial
:07:21. > :07:28.16-year-old Aisha is one of a small but growing number of children
:07:29. > :07:37.I developed type two diabetds by having a sweet tooth, mostly
:07:38. > :07:42.I used to try out every new sweet in the store and I used to drink
:07:43. > :07:50.When I was taken to the hospital, it hit me then because I st`rted
:07:51. > :08:01.Aisha now has to rely on medicine to control her condition.
:08:02. > :08:04.But she's managed to lose a stone in weight and those fizzy drinks
:08:05. > :08:12.It's been really hard at tiles but you can only have health once
:08:13. > :08:23.You have to keep changing your diet plan to keep fit and healthx.
:08:24. > :08:27.New research shows the numbdr of children like Aisha with type two
:08:28. > :08:31.diabetes has nearly doubled in the last ten years.
:08:32. > :08:37.And they're likely to develop complications much earlier.
:08:38. > :08:41.People who are getting type two diabetes when they're 15 or 16
:08:42. > :08:45.are likely to have signific`nt problems maybe at the age of 35
:08:46. > :08:51.36, and that's really much younger than you'd expect.
:08:52. > :08:54.These are things like renal failure and heart attacks and strokds
:08:55. > :08:58.and it's going to have a huge impact for them.
:08:59. > :09:01.Ultimately, tackling the rise in type two diabetes will ddpend
:09:02. > :09:09.I believe we're facing a crhsis and we really need concerted action
:09:10. > :09:13.right across society for us to fund more research, provide the best
:09:14. > :09:18.possible care and, cruciallx, prevent so many cases of type two
:09:19. > :09:28.We need to stem the tide otherwise we could see a crisis
:09:29. > :09:31.and there are issues of sustainability for the NHS
:09:32. > :09:46.Steven's diabetes has stabilised but it's too late to save hhs job.
:09:47. > :09:50.The toe amputations have left him unsteady on his feet and he's been
:09:51. > :09:52.told by his employer he's no longer fit for work.
:09:53. > :09:53.Given everything you've been through, Steve,
:09:54. > :09:57.what would your advice be to people being diagnosed now
:09:58. > :10:10.It's the biggest regret I'vd ever made in my entire life.
:10:11. > :10:22.Well, if there's something xou think we should be looking
:10:23. > :10:26.into on the programme, get in touch with me on Twitter
:10:27. > :10:34.This is Inside Out for the Dast of England here on BBC One.
:10:35. > :10:37.Later on, we are in Newmarkdt to find out why the town inspires
:10:38. > :10:46.so many of the world's popular thrillers.
:10:47. > :10:49.So, we now know what the problems are facing the NHS but,
:10:50. > :10:52.to help solve the problem wd need to know what to do to reducd
:10:53. > :10:56.the risks of developing typd two diabetes in the first place.
:10:57. > :10:59.One area is our relationships with food.
:11:00. > :11:09.It turns out our brains react differently to different foods.
:11:10. > :11:12.Mark Holland is 42 and lives just outside Ipswich in Kesgrave.
:11:13. > :11:16.He likes to run here in his local park.
:11:17. > :11:20.He wants to make sure he keeps his weight down.
:11:21. > :11:24.He used to be 16 stone but now he's just under 1two.
:11:25. > :11:27.But being overweight led hil to being diagnosed
:11:28. > :11:34.I was out and about with my job in the car all day, I'd stop
:11:35. > :11:39.to fill up, eat a pie, eat a chocolate bar,
:11:40. > :11:42.have a few fizzy drinks, before you knew it, you're
:11:43. > :11:56.I think before I was diagnosed I realised, I knew I was getting
:11:57. > :11:58.bigger, I was buying bigger trousers and shirts,
:11:59. > :12:00.which is quite an obvious shgn I was doing something wrong.
:12:01. > :12:03.I was very lethargic, I would often have to stop
:12:04. > :12:06.in the afternoon and kick b`ck in a layby, I wasn't sleeping very
:12:07. > :12:09.well, I was starting to get a lot of symptoms of diabetes,
:12:10. > :12:11.which I didn't realise were symptoms until I started googling it.
:12:12. > :12:15.And I think that's when I rdalised that I really had to do
:12:16. > :12:20.The first thing I did was cut down on high sugary
:12:21. > :12:22.foods so fizzy drinks, chocolate bars and high-fat foods.
:12:23. > :12:26.You've really had to change your lifestyle, haven't you?
:12:27. > :12:31.I started off baby steps, rdally, doing a mile or two.
:12:32. > :12:35.It was really good cos I got a lot of support from the family `s well,
:12:36. > :12:37.had a couple of friends comd running with me too,
:12:38. > :12:40.then started building it up and building it up and realhsed
:12:41. > :12:48.Type two diabetes is seen as a bit of a soft disease versus type one.
:12:49. > :12:50.They are different but it does have some massive consequences
:12:51. > :12:58.if you don't control it in the right way.
:12:59. > :13:01.Snacks and alcohol top the list of the things we most
:13:02. > :13:05.Of course, these things in moderation are fine.
:13:06. > :13:08.But too much and not enough exercise is leading to a rise in the number
:13:09. > :13:12.of people being told they'vd got type two diabetes.
:13:13. > :13:16.And the age of people being diagnosed with it is getting lower.
:13:17. > :13:20.More younger people have type two than ever before.
:13:21. > :13:23.But let's face it - we know that is going to be better
:13:24. > :13:30.And apparently, our brains literally light up when we see this khnd
:13:31. > :13:41.of food and dims again when we see this kind of thing.
:13:42. > :13:46.This is the Institute of Metabolic Science in Cambridge.
:13:47. > :13:48.The scientists working here are looking at our relationships
:13:49. > :13:54.with food and how our brains react when we see and eat certain things.
:13:55. > :13:56.Here, experts look at everything that leads to people
:13:57. > :14:03.Almost a quarter of all adults and one in five children in the UK
:14:04. > :14:07.are considered obese and obdsity significantly increases the risk
:14:08. > :14:10.of developing life-threatenhng conditions such
:14:11. > :14:15.Professor Sadaf Farooqi is conducting extensive resdarch
:14:16. > :14:19.at the institute and has made a startling discovery.
:14:20. > :14:22.Here at the institute, we try to understand why
:14:23. > :14:24.people gain weight and, when they do gain weight,
:14:25. > :14:27.why do some people but not all people develop diabetes.
:14:28. > :14:30.Weight problems are a clear driver of type two diabetes but not
:14:31. > :14:34.everybody who gains weight gets diabetes and not everyone who has
:14:35. > :14:39.So there's quite a lot more that we need to understand
:14:40. > :14:42.about what causes both condhtions and why they're linked.
:14:43. > :14:45.What kind of work do you and your team do here?
:14:46. > :14:48.My team is really interested to see why people gain weight and one
:14:49. > :14:51.of the particular things we're focussing on is could it be down
:14:52. > :14:57.Now we know sometimes that weight problems can run in families
:14:58. > :14:59.and we've been focussing on children who really gain a lot
:15:00. > :15:02.of weight at a young age and, using that approach,
:15:03. > :15:05.we've found quite a few gends that, if they're defective,
:15:06. > :15:10.So you've managed to pinpoint, identify defective genes th`t
:15:11. > :15:14.actually trigger something in the human body that
:15:15. > :15:19.That's right, and those gends are part of a clear pathway
:15:20. > :15:22.in the brain that seems to be present in all of us
:15:23. > :15:25.and controls our weight, but means we generally we kdep
:15:26. > :15:27.a fairly stable weight despite the fact some days we eat
:15:28. > :15:32.more than other days and we do less activity.
:15:33. > :15:34.For most people, weight stays relatively stable,
:15:35. > :15:37.but some people put on weight very easily and that can be
:15:38. > :15:44.They are also conducting unhque research at the institute which may
:15:45. > :15:51.go further in understanding why people eat the way they do.
:15:52. > :15:53.Here, what we're doing is using functional MRI,
:15:54. > :15:56.so this is like a regular MRI scanner where you get the anatomy
:15:57. > :15:58.of the brain but, in addition, when people are lying
:15:59. > :16:01.in the scanner, we can show them pictures of food and we see parts
:16:02. > :16:04.of their brain light up when they see certain
:16:05. > :16:09.Yeah, and it depends on what type of food you like,
:16:10. > :16:12.so if you really like a burger or really like broccoli,
:16:13. > :16:16.it'll be those foods that lhght up this key part of the brain.
:16:17. > :16:19.If, say, someone was more attracted to say a fatty burger
:16:20. > :16:22.or a large slice of cake, is there something that
:16:23. > :16:24.you could switch off that would change that perception
:16:25. > :16:30.So, we haven't got something like that yet, but that's the kind
:16:31. > :16:33.of thing we're working on wd need to understand why this happdns
:16:34. > :16:35.because the key thing we've now learned is that certain beh`viours,
:16:36. > :16:38.the things we thought were purely under voluntary control,
:16:39. > :16:44.And their research has also found that certain people are acttally
:16:45. > :16:48.attracted to more fatty foods than others.
:16:49. > :16:51.Even when the food looks and tastes the same, subconsciously,
:16:52. > :16:55.they are more likely to eat the fattier dish.
:16:56. > :16:58.What we have found very recdntly is that there appears to be
:16:59. > :17:02.a pathway in the brain that regulates how much we like fat.
:17:03. > :17:05.So, to do this study, what we actually did was we chose
:17:06. > :17:07.chicken korma and rice, which we can hide quite a lot
:17:08. > :17:10.of fat in chicken korma, you can make a low-fat,
:17:11. > :17:14.a medium-fat and a high-fat version, and we did that and we found people
:17:15. > :17:18.with a particular genetic problem at 95% more of the high fat food
:17:19. > :17:23.Even though it tastes exactly the same, they still ate
:17:24. > :17:30.Meanwhile, back at Mark's house, it's dinner time.
:17:31. > :17:36.And this is where the whole family has been helping Dad.
:17:37. > :17:40.Everything is now geared to being that bit more healthy.
:17:41. > :17:46.You're his wife, you must've been shocked?
:17:47. > :17:51.I was because to me he wasn't hugely overweight, he was a bit podgy,
:17:52. > :17:57.I mean, this looks like a pretty healthy meal you're doing now,
:17:58. > :17:59.has it changed your lifestyle as a family?
:18:00. > :18:02.Definitely, yeah, cos we trx and look at what we're eating
:18:03. > :18:05.and what we're feeding the children, try and make sure we're not eating
:18:06. > :18:09.The kids have their treats and sweets like any other
:18:10. > :18:13.We're certainly not going to deny them all that stuff.
:18:14. > :18:16.But they know now as well it's a little bit about moderation
:18:17. > :18:18.but we're not kind of taking their chocolate away
:18:19. > :18:20.and confiscating stuff but we try to make sure
:18:21. > :18:22.everything's in moderation, they go off and help themselves
:18:23. > :18:26.I think it's sunk in and it's really good as well,
:18:27. > :18:28.so we go round the supermarket, they're looking actively
:18:29. > :18:31.at what we're buying and I think they make some of the purch`sing
:18:32. > :18:34.decisions for my wife as well on the way round,
:18:35. > :18:35.so I think everyone's really embraced it.
:18:36. > :18:39.It was quite tough to start with so, obviously, I had to change ly diet
:18:40. > :18:41.quite significantly, it was a really noticeable change
:18:42. > :18:45.Mark will always be type two diabetic but, at the moment,
:18:46. > :18:48.he manages to control the sxmptoms with his diet and exercise.
:18:49. > :18:50.And if you or someone you know is affected by diabetes,
:18:51. > :18:53.details of organisations offering information and support are
:18:54. > :19:06.60 years ago, one of the most famous sporting upsets prompted a jockey
:19:07. > :19:12.Dick Francis set his novels in the world of horse racing
:19:13. > :19:16.Well, sadly, Dick Francis has since died but,
:19:17. > :19:20.every year, his son, Felix, publishes a new book.
:19:21. > :19:23.Well, we've been to Newmarkdt to meet Felix to talk about why
:19:24. > :19:31.the town inspired some of the world's popular books.
:19:32. > :19:34.Early morning in Newmarket and long lines of horses
:19:35. > :19:40.You really don't think of murder when you're here.
:19:41. > :19:43.But this is the backdrop usdd in many of Dick Francis'
:19:44. > :19:50.His descriptions of the place are spot on.
:19:51. > :19:53.No other town in England provided a special series of roads
:19:54. > :19:57.upon which the only traffic allowed was horses, but one could go
:19:58. > :20:01.from one end of Newmarket to the other, only yards
:20:02. > :20:03.behind its bustling high street, and spend only
:20:04. > :20:07.a fraction of the journey on the public highway.
:20:08. > :20:10.Dick Francis died in 2010 but his son, Felix, keeps the family
:20:11. > :20:13.business going and there's still a new Francis book
:20:14. > :20:20.Like his father, Felix has ` great love of Newmarket.
:20:21. > :20:23.It's the centre of horse racing, its headquarters.
:20:24. > :20:26.Racing itself is such a wonderful background to write
:20:27. > :20:45.It takes all economic and socio economic groups, from royalty to the
:20:46. > :20:51.man in the street, and of course where there is money, and lots of
:20:52. > :20:54.cash, there are always people trying to make a killing.
:20:55. > :20:56.Former champion jockey Dick Francis was an internationally bestselling
:20:57. > :21:00.He sold more than 60 million copies of his books in 35 languages.
:21:01. > :21:04.But Dick Francis is also relembered for an incredible sporting tpset
:21:05. > :21:18.What took place at the 1956 Grand National shocked all those
:21:19. > :21:22.Dick Francis was riding the Queen Mother's horse,
:21:23. > :21:26.He was favourite to win and it looked like he had the race
:21:27. > :21:45.It was a heart-breaking moment for Dick Francis.
:21:46. > :21:48.Dick Francis would never win the Grand National.
:21:49. > :21:51.A year later, he suffered a serious fall and retired from
:21:52. > :21:57.He then embarked on a very different career.
:21:58. > :22:12.Because of the Devon Loch incident. He was invited to write somd
:22:13. > :22:16.articles for a Sunday newsp`per and he went on to be Earth newspaperman
:22:17. > :22:22.for 16 years. He always said what taught him to write because they
:22:23. > :22:28.editor would scrub out anything that was unnecessary because thex did not
:22:29. > :22:36.have space because of the adverts. So, instead of being one of us, he
:22:37. > :22:39.became one of them. Nowadays, every sport as exports and as journalists,
:22:40. > :22:44.but in those days, it was vdry fresh. He was the first one to move
:22:45. > :22:46.from the jockey's changing room to the press room.
:22:47. > :22:48.It wasn't long before Dick turned his hand to crime fiction.
:22:49. > :22:52.It was a good move as he wotld go on to become one the world's
:22:53. > :22:55.Many of his stories featured the Cambridge town of Newmarket
:22:56. > :22:58.Over the years, the two namds have become intrinsically linked.
:22:59. > :23:01.It is the rolling hills, lovely green grass.
:23:02. > :23:10.It is perfect for training race horses and writing murder mxsteries.
:23:11. > :23:13.Racing is such a wonderful background.
:23:14. > :23:15.Just behind the gallops is ` special place which overlooks
:23:16. > :23:20.The cars and lorries that thunder by are unaware they're passhng just
:23:21. > :23:30.The real-life location feattres in Dick Francis's book Bonecrack.
:23:31. > :23:41.So this is the location my father used in his book.
:23:42. > :23:45.It's quite emotional to comd and see it. I have never been here before.
:23:46. > :23:49.In some ways, it is quite poignant. Legend has it the boy who's buried
:23:50. > :23:52.here was a shepherd who comlitted suicide after his sheep werd killed
:23:53. > :23:55.by a wolf. Every year, flowers are left
:23:56. > :23:57.anonymously on the grave. Dick Francis tells
:23:58. > :23:59.the story in his book. The grave is always looked
:24:00. > :24:02.after in a haphazard sort of way. It is never overgrown and fresh
:24:03. > :24:07.flowers are often put here. No-one knows exactly who puts them
:24:08. > :24:10.here but it is supposed And there is also a legend that
:24:11. > :24:18.in May, the flowers on the grave are in the colours that
:24:19. > :24:23.will win the derby. Felix says his father, Dick,
:24:24. > :24:26.drew from real-life experiences as a jockey to create a realistic
:24:27. > :24:32.background for his books. Racing stables are wonderful places
:24:33. > :24:58.to come to and to get ideas, You are dealing with living,
:24:59. > :25:03.breathing beings. They all have the personality. And they do give you
:25:04. > :25:08.inspiration. As with all horses you cannot repeat stories because your
:25:09. > :25:15.readers will complain, quitd rightly. By I have an added problem
:25:16. > :25:21.and that I am following on the franchise from my father. Hd wrote
:25:22. > :25:31.39 books I cannot use any of those stories either. We now have 50
:25:32. > :25:33.books, racing thrillers, and I have got the write the 51st, and I will
:25:34. > :25:51.think of the story not any other 50. It is always exciting being on a
:25:52. > :25:59.racecourse. Horses on the w`y to the start. The excitement level rises.
:26:00. > :26:01.Everyone has money on. Too dxciting for words!
:26:02. > :26:03.But what about the people working in the racing industry?
:26:04. > :26:06.Are they happy that the sport features in so many crime stories
:26:07. > :26:08.and perhaps doesn't show thdm in the best of lights?
:26:09. > :26:11.In fact, the racing industrx love the books, according to 1980
:26:12. > :26:28.The good entertainment. It gives you an insight into racing. It was a bit
:26:29. > :26:33.like that sometimes. But thdy are exciting books and there is always a
:26:34. > :26:39.story. It makes you wait until the end. The scams they used to have an
:26:40. > :26:43.old these touches. There is always a grain of truth in there somdwhere.
:26:44. > :26:49.They are all based on something that may have happened. I was asked
:26:50. > :26:54.earlier on today, what is the great untold story in racing? If they are
:26:55. > :26:59.untold, you do not know thel. That is true. But there is always a grain
:27:00. > :27:03.of truth in them. Do you relember the story of Tenby racecourse and
:27:04. > :27:08.how it closed down because someone cut the telegraph wires on the top
:27:09. > :27:12.of the Brecon Beacon and thdy could not get one back to the court? I
:27:13. > :27:17.wrote a story based around that I wrote a story based around that I
:27:18. > :27:19.think those sorts of things are good for racing. People love stories like
:27:20. > :27:21.that they love intrigue. 50 books and counting
:27:22. > :27:24.for the Francis family and Felix has The world of horse racing
:27:25. > :27:28.and Newmarket itself will continue to feature in some of the world s
:27:29. > :27:43.bestselling crime stories. Which did not do racing good. Even
:27:44. > :27:53.though I talk about things which break the rules, making a lddge here
:27:54. > :27:56.and there, trying to get extra money here and there, I've peeled for
:27:57. > :27:59.overall, racing is very happy with them. They certainly seem to be
:28:00. > :28:03.People have talked to me about them and they are very happy with the
:28:04. > :28:09.books. And the fact that it gives exposure. And there you are.
:28:10. > :28:11.Well, that's it from Cambridge, but don't forget
:28:12. > :28:14.It's the last programme and our current series.
:28:15. > :28:17.And it's Halloween on that Londay, so we've got a pumpkin
:28:18. > :28:19.on the programme, but not any old pumpkin.
:28:20. > :28:28.I find out what it takes to grow the biggest pumpkin in Britain. But in
:28:29. > :28:39.the meantime, get in touch with me on Twitter or e-mail. I will see you
:28:40. > :28:44.next week. Goodbye. Also next week, we find out what is being done about
:28:45. > :28:49.Traveller sites in Bedfordshire What Mark is trying to do hd is
:28:50. > :28:54.trying to do for other people what he did for me, and I thank him from
:28:55. > :28:58.the bottom of my heart. That is Inside Out, the last of the series,
:28:59. > :29:03.next Monday, 7:30pm, here on BBC One.