:00:00. > :00:00.Hello, I m Matthew Wright. You are watching Inside Out.
:00:00. > :00:11.Here is what is coming up on tonight s health special.
:00:12. > :00:13.We are facing an epidemic of Type 2 diabetes.
:00:14. > :00:22.With the problem set to get worse, we ask, can the NHS cope?
:00:23. > :00:27.It is a dreadful, nasty disdase It takes no prisoners.
:00:28. > :00:34.And is radical gastric surgery the answer?
:00:35. > :00:38.This is the most effective intervention that we have today
:00:39. > :00:47.We meet the top chef transforming the diets of Hackney schoolchildren.
:00:48. > :00:53.Lower feis is brought fresh. Our vegetables are live TV. Ten minutes,
:00:54. > :01:03.everybody. The number of people
:01:04. > :01:05.in the UK with diabetes is now 4.5 million -
:01:06. > :01:07.and rising. Most have Type 2, which is linked
:01:08. > :01:10.to a person s lifestyle Yet, diabetic care still eats up
:01:11. > :01:15.nearly 10% of the health But with our expanding waistlines
:01:16. > :01:20.sending costs spiralling upwards, BBC Health Correspondent Dolinic
:01:21. > :01:28.Hughes went to find out. I should warn you that you lay
:01:29. > :01:31.find some of the images Today, I d like to invite you to
:01:32. > :01:47.a shoe-shop with a difference. So, what we ve got here are 140
:01:48. > :01:49.shoes and they represent thd 14 amputations that take place
:01:50. > :01:51.in England every week, We set up this shoe shop,
:01:52. > :02:11.to show just how serious Where you come from and your family
:02:12. > :02:25.history can increase your rhsk. But doctors say most
:02:26. > :02:28.of it is down to obesity. Now, new data given exclusively
:02:29. > :02:32.to the BBC by Public Health England estimates there will be an dxtra
:02:33. > :02:38.250,000 people with Type 2 diabetes by 2035,
:02:39. > :02:45.if we continue to get fatter. Diabetics are at greater
:02:46. > :02:48.risk of kidney failure, The NHS is spending ?10 billion
:02:49. > :02:55.a year on diabetic care. As things stand, we are certainly
:02:56. > :03:01.looking at a crisis in diabdtes which threatens to bankrupt
:03:02. > :03:03.the NHS, if we continue One of our shoes belongs
:03:04. > :03:15.to Steven Woodman. We caught up with him as he arrived
:03:16. > :03:19.at the Royal Shrewsbury Hospital for Like 90% of diabetics,
:03:20. > :03:29.Steven has the Type 2 version, which is linked to lifestyld and,
:03:30. > :03:31.so, largely preventable. But diagnosed as a young man,
:03:32. > :03:36.he ignored his GP s advice. I never took it that seriously,
:03:37. > :03:48.so I carried on eating, going to the pub, doing things
:03:49. > :03:52.people of my age did. Like many diabetics, Steven
:03:53. > :04:00.developed an ulcer on his toe. The ulcer would not heal
:04:01. > :04:11.and, in the end, he had to have his toe amputated.
:04:12. > :04:14.He has lost two more since then My surgeon did say to me,
:04:15. > :04:19.when he was taking my third toe off, "It s only a matter of time
:04:20. > :04:21.before you lose that one. "It s inevitable that
:04:22. > :04:25.will go the same way." I ve become an old man
:04:26. > :04:27.very very quickly and, Patients with Type 2 diabetds
:04:28. > :04:40.are not just losing their toes. Some have had to have a foot
:04:41. > :04:44.amputated or even a lower ldg. It is life changing
:04:45. > :04:50.and very expensive. It is approximately ?20,000
:04:51. > :04:52.for first six months, Even a basic prosthesis costs
:04:53. > :05:04.thousands of pounds. All of those aspects mean
:05:05. > :05:07.it is a very expensive Nick Hex is the health economist
:05:08. > :05:17.who worked out the current cost of diabetes care -
:05:18. > :05:21.that ?10 billion figure. Most of that is spent
:05:22. > :05:25.on complications. Foot ulcers and amputations cost
:05:26. > :05:31.nearly ?1 billion a year. Then, there is sight
:05:32. > :05:42.loss nerve damage. But the biggest cost of all
:05:43. > :05:45.is for heart attacks and strokes. With both obesity and Type
:05:46. > :05:47.2 diabetes affecting more and more of us,
:05:48. > :05:49.costs for diabetic care are expected There is a fixed amount
:05:50. > :05:59.of money for the NHS, so clearly, if one disease `rea
:06:00. > :06:01.like diabetes, is taking up more considerable amount of that cost,
:06:02. > :06:06.then there is less money to spend on cancer, so it is really hmportant
:06:07. > :06:10.that policy makers think about the ways costs can be
:06:11. > :06:16.mitigated over next few years, because there will not be enough
:06:17. > :06:23.to go round. Back at the Royal
:06:24. > :06:32.Shrewsbury Hospital, Losing three toes means he has
:06:33. > :06:36.to have specially-made shoes. Just out of interest,
:06:37. > :06:42.how much do they cost? We are facing a diabetic ephdemic
:06:43. > :06:57.and need to find ways of prdventing those patients from reaching
:06:58. > :06:58.surgeons, because the cost to the patient and the NHS
:06:59. > :07:09.is skyrocketing. A new problem is expected
:07:10. > :07:11.to put even more financial 16-year-old Aisha is one of a small,
:07:12. > :07:19.but growing, number of children I developed T2D by having
:07:20. > :07:29.a sweet tooth mostly. I used to try out every
:07:30. > :07:32.new sweet in the store. I used to drink quite
:07:33. > :07:35.a lot of sugary drinks. When I was taken to the hospital,
:07:36. > :07:39.it hit me then, because I started Aisha now has to rely on medicine
:07:40. > :07:52.to control her condition. But she has managed to lose a stone
:07:53. > :07:56.in weight and those fizzy drinks It s been really hard at tiles,
:07:57. > :08:01.but you can only have health once You have to keep changing your diet
:08:02. > :08:15.plan, to keep fit and healthy. New research shows the numbdr
:08:16. > :08:18.of children like Aisha with Type 2 diabetes has nearly doubled
:08:19. > :08:22.in the last ten years. And they are likely to develop
:08:23. > :08:27.complications much earlier. People who are getting T2D
:08:28. > :08:30.when they re 15 or 16 are lhkely to have significant problems maybe
:08:31. > :08:33.at the age of 35, 36 and that s really much
:08:34. > :08:43.younger than you d expect. These are things like renal failure
:08:44. > :08:45.and heart attacks and strokds and it is going to have a htge
:08:46. > :08:50.impact for them. Ultimately, tackling the rise
:08:51. > :08:52.in Type 2 diabetes will depdnd I believe we re facing a crhsis
:08:53. > :08:59.and we really need concerted action right across society,
:09:00. > :09:05.for us to fund more research, provide best possible care `nd,
:09:06. > :09:08.crucially, prevent so many cases We need to stem the tide,
:09:09. > :09:13.otherwise we could see crishs and there are issues
:09:14. > :09:15.of sustainability for the NHS Steven s diabetes has stabilised,
:09:16. > :09:30.but it is too late to save his job. The toe amputations have left him
:09:31. > :09:33.unsteady on his feet and he has been told by his employer that hd is no
:09:34. > :09:39.longer fit for work. For God s sake, take it serhously.
:09:40. > :09:42.Don t make the mistake I did. It s the biggest regret I vd ever
:09:43. > :09:45.made in my entire life. It takes no prisoners.
:09:46. > :09:59.It s a terrible thing. Now, still to come
:10:00. > :10:18.on tonight s show. When we first started, therd was a
:10:19. > :10:23.bit of resistance. The aver`ge seven-year-old wants to havd things
:10:24. > :10:25.that are fun, not things whhch are necessarily healthy.
:10:26. > :10:27.For patients with Type 2 diabetes, one drastic option
:10:28. > :10:31.Well, one leading London consultant argues that this type of opdration
:10:32. > :10:36.is the closest thing to a ctre and is now calling for many more
:10:37. > :10:39.Type 2 diabetics to be offered it. Dr Ranj Singh has the story.
:10:40. > :10:43.Once again, I should warn you that some of the images in the fhlm
:10:44. > :10:51.David Benge weighs 21 and a half stone and has Type 2 diabetds.
:10:52. > :10:53.I was diagnosed about seven years ago.
:10:54. > :10:58.It was just trying to control it through diet and weight control
:10:59. > :11:02.So, approximately five years ago, I was put on my first
:11:03. > :11:08.Since then, my diabetes has deteriorated.
:11:09. > :11:12.His blood sugar levels are no longer being controlled.
:11:13. > :11:15.My blood sugar levels have shot up to 10.2 and 12.2 on a regul`r basis
:11:16. > :11:18.and what we are trying to t`rget, really, is below eight
:11:19. > :11:26.Diabetes is beginning to impact on David s life.
:11:27. > :11:29.It affects my extremities, so my fingers and my toes
:11:30. > :11:32.I do have difficulty getting to sleep, because my toes
:11:33. > :11:44.David now takes 11 different types of medication and his health
:11:45. > :11:49.David used to be more posithve than he has been of late.
:11:50. > :11:51.I think, with the health issues and the weight gain,
:11:52. > :11:54.it drags you down and makes you feel less positive about yourself and how
:11:55. > :12:04.Today, here at Kings College Hospital, David
:12:05. > :12:06.is undergoing surgery, with the aim of putting his
:12:07. > :12:12.He is having a gastric bypass which, if successful, could see his life
:12:13. > :12:17.After this procedure, patients not only lose weight,
:12:18. > :12:22.but the majority will see ilmediate control of their diabetes.
:12:23. > :12:25.I ve just had a discussion with the professor, who has actually
:12:26. > :12:27.informed me that I come off my medication directly
:12:28. > :12:29.after the operation, because it should be
:12:30. > :12:37.Professor Francesco Rubino is carrying out the operation.
:12:38. > :12:39.He has been researching the effects of bariatric surgery on Typd 2
:12:40. > :12:48.This is the most effective intervention that we have today
:12:49. > :12:51.It is the closest thing we have to a cure of diabetes.
:12:52. > :12:53.The operation, a gastric bypass was originally used
:12:54. > :12:58.Then, it became an obesity treatment.
:12:59. > :13:05.Now, it is proving a lifesaving operation for Type 2 diabetds.
:13:06. > :13:12.David has Type 2 diabetes that now is clearly not well controlled,
:13:13. > :13:15.so the options would be either be to escalate medical
:13:16. > :13:17.therapy with insulin, which is the fate of many p`tients,
:13:18. > :13:19.or to do an operation like this, that could put
:13:20. > :13:27.The operation is all done bx keyhole surgery, which is safer and less
:13:28. > :13:33.Bariatric operations for di`betes are among the safest form
:13:34. > :13:36.of surgical operations we have today.
:13:37. > :13:40.Recovery could entail one or two days in the hospital and patients
:13:41. > :13:42.are able to go back to regular activity immediately
:13:43. > :13:51.During the operation, the stomach is permanently divided,
:13:52. > :13:55.using stitches, to create a new small stomach pouch.
:13:56. > :13:58.The small bowel is then measured, divided and brought up
:13:59. > :14:07.The redundant stomach and slall bowel are reattached further down.
:14:08. > :14:09.The stomach is now divided in two portions.
:14:10. > :14:12.The food will not be able to go anymore in this part
:14:13. > :14:16.of the stomach and this part is now completely bypassed.
:14:17. > :14:18.The operation puts diabetes into remission by altering
:14:19. > :14:20.the hormones in the gut which, in turn, influences
:14:21. > :14:28.The stomach and the intestine are an important organ for
:14:29. > :14:32.So, altering the anatomy of those resets the metabolism of gltcose
:14:33. > :14:34.and sugar and this is why we see such dramatic
:14:35. > :14:41.At the moment, around 90% of people who have this procedure will get
:14:42. > :14:46.Even more importantly, up to 60% will see a remisshon
:14:47. > :14:53.It is ?6,000 per operation, but that is a small cost,
:14:54. > :14:57.compared to a lifetime of treatment and related illness.
:14:58. > :15:02.Yet, despite this success, only 1% of eligible people are offered it.
:15:03. > :15:04.This is certainly a cost-effective operation.
:15:05. > :15:06.It is probably one of the most cost-effective interventions
:15:07. > :15:19.If it is that effective, why are only 1% of people eligible
:15:20. > :15:22.I think many GPs don t know this surgery is an excellent
:15:23. > :15:26.I don t think this is yet perceived as a life-saving
:15:27. > :15:30.But the biggest barrier we have is, primarily,
:15:31. > :15:38.Current recommendations state only Type 2 diabetes patients with a BMI
:15:39. > :15:43.of above 30 are suitable for this operation.
:15:44. > :15:47.However, not all patients whth this disease are overweight.
:15:48. > :15:50.At the moment, if you are not obese, the NHS will not
:15:51. > :15:54.Barbara was initially refused surgery because
:15:55. > :16:00.I suffer from a very rare, non-obese metabolic disease, called
:16:01. > :16:10.What that means is I have an inability to store fat,
:16:11. > :16:13.so it goes into the liver, pancreas and muscles which `re not
:16:14. > :16:17.capable of storing fat and causes complete disfunction in thel.
:16:18. > :16:19.Her condition caused her to develop Type 2 diabetes.
:16:20. > :16:22.Last year, she became so ill that she signed up
:16:23. > :16:30.Over 100 units of insulin a day made no change to the condition.
:16:31. > :16:45.But with a BMI of just 22, Barbara was told she could not
:16:46. > :16:51.have the operation on the NHS until she had a BMI of 30 or above.
:16:52. > :16:54.What would have happened if you had got your BMI up to 30?
:16:55. > :16:58.I don t think I would have been here.
:16:59. > :17:00.Barbara paid for a private consultation with Professor Rubino.
:17:01. > :17:06.She decided a gastric bypass was her only option.
:17:07. > :17:08.Eventually, the NHS agreed to fund it.
:17:09. > :17:16.Barbara is now one month after surgery and I think
:17:17. > :17:22.Most importantly, she has come off the insulin three or four d`ys
:17:23. > :17:24.after the operation and, ever since, she has maintained
:17:25. > :17:36.Professor Rubino is now calling for guidelines to change.
:17:37. > :17:38.He says BMI should not be the only consideration.
:17:39. > :17:41.Now we know surgery can also be a diabetes treatment and so,
:17:42. > :17:46.I think, there is a need for NICE to update the diabetes guiddlines.
:17:47. > :17:49.We put Professor Rubino s concerns to the Director of Policy for NICE,
:17:50. > :17:57.We hope NICE will update their guidelines to reflect
:17:58. > :18:02.When we started off our guidance on bariatric surgery,
:18:03. > :18:06.it was focused on the most severely-obese people,
:18:07. > :18:09.but it soon became clear th`t it had a distinctive role in peopld
:18:10. > :18:19.We do now have a standing committee continually updating our guhdelines
:18:20. > :18:24.and, as the evidence emerges for people with Type 2
:18:25. > :18:27.diabetes who are not obese, then we may well be able to look
:18:28. > :18:30.at whether this is a cost-effective use of bariatric surgery and it may
:18:31. > :18:40.NHS England told us that, "Bariatric surgery should only be
:18:41. > :18:42.considered for severe obesity, where other approaches have
:18:43. > :18:47.It may seem like a revolutionary treatment but not
:18:48. > :18:54.However, David is one of the lucky ones.
:18:55. > :18:56.It s now two weeks since the procedure.
:18:57. > :18:58.Since the operation, I ve come off medication colpletely.
:18:59. > :19:02.My sugar levels have come down, naturally, so it's been supdrb.
:19:03. > :19:18.With one in five children being classified as obese
:19:19. > :19:21.by the time they are 11, the quality of food that our
:19:22. > :19:23.primary schools serve up for lunch has never been more important.
:19:24. > :19:27.Well, last year, one top London chef gave up her work in a high-dnd
:19:28. > :19:33.restaurant to prepare gourmdt grub for pupils in Hackney.
:19:34. > :19:36.So, what do the kids make of swapping greasy
:19:37. > :20:07.Chef Nicole Pisani left her job at Ottolenhgi restaurant Nopi
:20:08. > :20:10.and came here to Gayhurst, after responding to a tweet
:20:11. > :20:26.You give up a high-profile career to come and work here. Why?
:20:27. > :20:28.With restaurants, you do run yourself to the ground,
:20:29. > :20:34.with the amount of hours th`t s expected in the catering industry.
:20:35. > :20:45.Plus, for me, being around the kids is a good box to tick.
:20:46. > :20:57.I treat this like my baby. Ht will be very hard for me to do anything
:20:58. > :21:08.else. Plus, being able to tdach the children about food is good.
:21:09. > :21:12.Previously, in school kitchdns, people were expected to just arrange
:21:13. > :21:18.the food and make sure it w`s well heated and the rest hygiene was OK.
:21:19. > :21:21.But there was never really `nything about nutrition or health.
:21:22. > :21:27.Now, everything is made from scratch.
:21:28. > :21:38.We have good-quality restaurant suppliers and then we don t have
:21:39. > :21:42.to do that much to it for it to have an amazing fish supplier.
:21:43. > :21:44.We have 25 kilos of veg each day, so lots of chopping.
:21:45. > :21:46.With 500 hungry children to feed, plus teachers,
:21:47. > :21:49.and a budget of just 90p a day, cooking and preparing meals
:21:50. > :21:52.here at Gayhurst Community School in East London is challenging,
:21:53. > :21:58.With just an hour to go before lunchtime, it s fast
:21:59. > :22:18.People think, because we ard in a school, we do not care so mtch about
:22:19. > :22:25.getting ready for the service. But we do. We are all working so much
:22:26. > :22:30.faster. What is on the outshde of the fishcake. We make our own bed
:22:31. > :22:34.every day. Sometimes, it looks like we re not
:22:35. > :22:40.going to make it, but it works out Today for lunch, they are e`ting
:22:41. > :22:44.fishcakes and calamari, pea fritters with couscous salad
:22:45. > :22:46.and humous with pansies. I have been dying to taste this
:22:47. > :22:49.since we arrived this morning. It is 11.45am and the
:22:50. > :23:34.first diners arrive. What is your favourite fish? I think
:23:35. > :23:41.the food is fantastic and it also encourages a lot of social
:23:42. > :23:51.interaction. I like what we are having today, the fishcakes. 60
:23:52. > :23:56.children in one hour. Somethmes it is not something the childrdn
:23:57. > :24:06.recognise. The logistics of it I'm a bit hazy.
:24:07. > :24:13.Display the changes, the budget has not changed. And that is not the
:24:14. > :24:18.only benefit. Behaviour has improved
:24:19. > :24:20.quite dramatically over Hopefully, the food
:24:21. > :24:25.is a big part of that. It is not just about feeding
:24:26. > :24:27.children a balanced meal. It is also about introducing schools
:24:28. > :24:30.to a whole new way of viewing food Who knows what I ll
:24:31. > :24:47.find in the middle? Every chef is excited about food and
:24:48. > :24:49.it is about passing that on to the children.
:24:50. > :24:50.Nicole s blueprint for healthy school meals
:24:51. > :24:52.has proved so popular that it is now been
:24:53. > :24:57.rolled out across three Hackney primary schools.
:24:58. > :24:59.Here at Mandeville School, more than half of children
:25:00. > :25:01.are entitled to free school meals, compared to one-quarter
:25:02. > :25:21.I remember beating in the dhnner all before. It was
:25:22. > :25:26.Menu was spaghetti hoops, sausages and mash.
:25:27. > :25:29.Trained by Nicole, Angela is also famous in
:25:30. > :25:31.her own right, having recently appeared on MasterChef.
:25:32. > :25:34.I met Nicole and I met Louise and I was taken
:25:35. > :25:48.It is the kind of thing that makes a difference.
:25:49. > :25:55.and is up everybody at the table who likes vegetables?
:25:56. > :26:01.When we started, it was hard to get rid of some things from the menu.
:26:02. > :26:07.It is hard to female seafood at first. It is hard to get th`t
:26:08. > :26:08.through to your average seven-year-old. They like ftn
:26:09. > :26:14.things, like chips and cake. These are still things
:26:15. > :26:28.children love. I did actually get the odd hearing
:26:29. > :26:34.who wanted improved by: spaghetti hoops and chips. But we said no I
:26:35. > :26:38.do not know what they are gdtting a home, but as far as I'm concerned, I
:26:39. > :26:51.am going to give them the bdst meal possible when error here. -, when
:26:52. > :26:57.they are here. The two of the meal transformed dinner time, but the
:26:58. > :27:03.vision does not stop here. There is no limit to the amount of schools
:27:04. > :27:13.this could impact on. The more schools we can get involved in the
:27:14. > :27:17.all: wider community, the bdtter. It would be ideal if we could get a
:27:18. > :27:24.space and get the kids throtgh to do a proper lesson, to teach and train.
:27:25. > :27:29.It is an exciting new venture which makes so much since. Chefs
:27:30. > :27:32.encouraging children to enjoy healthy and nutritious food at
:27:33. > :27:37.school is the perfect soluthon to the fight against obesity.
:27:38. > :27:38.Jo Good, there. That food looked yummy.
:27:39. > :27:40.Better than the dry spuds and semolina pudding
:27:41. > :27:45.Well, that is nearly all for tonight s programme.
:27:46. > :27:47.Before we go, though, we can have a quick look
:27:48. > :27:51.at what is coming up on next week s show.
:27:52. > :27:54.With the partridge season in full swing, we expose the cruel breeding
:27:55. > :28:01.practices these game birds are subjected to.
:28:02. > :28:09.The way that they are factory farmed and transported, is it morally
:28:10. > :28:11.acceptable any modern civilhsed society?
:28:12. > :28:15.We meet the Londoners in se`rch of a more affordable life, laking
:28:16. > :28:26.Here, you can purchase a colplete town house for the place th`t you
:28:27. > :28:28.could get a one-bedroom flat in Hackney. It is ridiculous.
:28:29. > :28:37.Can our throwaway culture be reversed?
:28:38. > :28:39.And that is it for this week s Inside Out London.
:28:40. > :28:42.Don t forget, if you missed any of tonight s programme
:28:43. > :28:45.and want to catch up on iPl`yer then just head to our website.
:28:46. > :28:47.The address is bbc.co.uk/insideout and just click on London.
:28:48. > :29:07.Thanks very much for watching. I will see you again next wdek.
:29:08. > :29:10.Hello, I'm Riz Lateef with your 90 second update.
:29:11. > :29:13.The first of an estimated 8,000 migrants