24/10/2016 Inside Out London

Hello, I m Matthew Wright. You are watching Inside Out.

Here is what is coming up on tonight s health special.

We are facing an epidemic of Type 2 diabetes.

With the problem set to get worse, we ask, can the NHS cope?

It is a dreadful, nasty disdase It takes no prisoners.

And is radical gastric surgery the answer?

This is the most effective intervention that we have today

We meet the top chef transforming the diets of Hackney schoolchildren.

Lower feis is brought fresh. Our vegetables are live TV. Ten minutes,

everybody. The number of people

in the UK with diabetes is now 4.5 million -

and rising. Most have Type 2, which is linked

to a person s lifestyle Yet, diabetic care still eats up

nearly 10% of the health But with our expanding waistlines

sending costs spiralling upwards, BBC Health Correspondent Dolinic

Hughes went to find out. I should warn you that you lay

find some of the images Today, I d like to invite you to

a shoe-shop with a difference. So, what we ve got here are 140

shoes and they represent thd 14 amputations that take place

in England every week, We set up this shoe shop,

to show just how serious Where you come from and your family

history can increase your rhsk. But doctors say most

of it is down to obesity. Now, new data given exclusively

to the BBC by Public Health England estimates there will be an dxtra

250,000 people with Type 2 diabetes by 2035,

if we continue to get fatter. Diabetics are at greater

risk of kidney failure, The NHS is spending ?10 billion

a year on diabetic care. As things stand, we are certainly

looking at a crisis in diabdtes which threatens to bankrupt

the NHS, if we continue One of our shoes belongs

to Steven Woodman. We caught up with him as he arrived

at the Royal Shrewsbury Hospital for Like 90% of diabetics,

Steven has the Type 2 version, which is linked to lifestyld and,

so, largely preventable. But diagnosed as a young man,

he ignored his GP s advice. I never took it that seriously,

so I carried on eating, going to the pub, doing things

people of my age did. Like many diabetics, Steven

developed an ulcer on his toe. The ulcer would not heal

and, in the end, he had to have his toe amputated.

He has lost two more since then My surgeon did say to me,

when he was taking my third toe off, "It s only a matter of time

before you lose that one. "It s inevitable that

will go the same way." I ve become an old man

very very quickly and, Patients with Type 2 diabetds

are not just losing their toes. Some have had to have a foot

amputated or even a lower ldg. It is life changing

and very expensive. It is approximately ?20,000

for first six months, Even a basic prosthesis costs

thousands of pounds. All of those aspects mean

it is a very expensive Nick Hex is the health economist

who worked out the current cost of diabetes care -

that ?10 billion figure. Most of that is spent

on complications. Foot ulcers and amputations cost

nearly ?1 billion a year. Then, there is sight

loss nerve damage. But the biggest cost of all

is for heart attacks and strokes. With both obesity and Type

2 diabetes affecting more and more of us,

costs for diabetic care are expected There is a fixed amount

of money for the NHS, so clearly, if one disease `rea

like diabetes, is taking up more considerable amount of that cost,

then there is less money to spend on cancer, so it is really hmportant

that policy makers think about the ways costs can be

mitigated over next few years, because there will not be enough

to go round. Back at the Royal

Shrewsbury Hospital, Losing three toes means he has

to have specially-made shoes. Just out of interest,

how much do they cost? We are facing a diabetic ephdemic

and need to find ways of prdventing those patients from reaching

surgeons, because the cost to the patient and the NHS

is skyrocketing. A new problem is expected

to put even more financial 16-year-old Aisha is one of a small,

but growing, number of children I developed T2D by having

a sweet tooth mostly. I used to try out every

new sweet in the store. I used to drink quite

a lot of sugary drinks. When I was taken to the hospital,

it hit me then, because I started Aisha now has to rely on medicine

to control her condition. But she has managed to lose a stone

in weight and those fizzy drinks It s been really hard at tiles,

but you can only have health once You have to keep changing your diet

plan, to keep fit and healthy. New research shows the numbdr

of children like Aisha with Type 2 diabetes has nearly doubled

in the last ten years. And they are likely to develop

complications much earlier. People who are getting T2D

when they re 15 or 16 are lhkely to have significant problems maybe

at the age of 35, 36 and that s really much

younger than you d expect. These are things like renal failure

and heart attacks and strokds and it is going to have a htge

impact for them. Ultimately, tackling the rise

in Type 2 diabetes will depdnd I believe we re facing a crhsis

and we really need concerted action right across society,

for us to fund more research, provide best possible care `nd,

crucially, prevent so many cases We need to stem the tide,

otherwise we could see crishs and there are issues

of sustainability for the NHS Steven s diabetes has stabilised,

but it is too late to save his job. The toe amputations have left him

unsteady on his feet and he has been told by his employer that hd is no

longer fit for work. For God s sake, take it serhously.

Don t make the mistake I did. It s the biggest regret I vd ever

made in my entire life. It takes no prisoners.

It s a terrible thing. Now, still to come

on tonight s show. When we first started, therd was a

bit of resistance. The aver`ge seven-year-old wants to havd things

that are fun, not things whhch are necessarily healthy.

For patients with Type 2 diabetes, one drastic option

Well, one leading London consultant argues that this type of opdration

is the closest thing to a ctre and is now calling for many more

Type 2 diabetics to be offered it. Dr Ranj Singh has the story.

Once again, I should warn you that some of the images in the fhlm

David Benge weighs 21 and a half stone and has Type 2 diabetds.

I was diagnosed about seven years ago.

It was just trying to control it through diet and weight control

So, approximately five years ago, I was put on my first

Since then, my diabetes has deteriorated.

His blood sugar levels are no longer being controlled.

My blood sugar levels have shot up to 10.2 and 12.2 on a regul`r basis

and what we are trying to t`rget, really, is below eight

Diabetes is beginning to impact on David s life.

It affects my extremities, so my fingers and my toes

I do have difficulty getting to sleep, because my toes

David now takes 11 different types of medication and his health

David used to be more posithve than he has been of late.

I think, with the health issues and the weight gain,

it drags you down and makes you feel less positive about yourself and how

Today, here at Kings College Hospital, David

is undergoing surgery, with the aim of putting his

He is having a gastric bypass which, if successful, could see his life

After this procedure, patients not only lose weight,

but the majority will see ilmediate control of their diabetes.

I ve just had a discussion with the professor, who has actually

informed me that I come off my medication directly

after the operation, because it should be

Professor Francesco Rubino is carrying out the operation.

He has been researching the effects of bariatric surgery on Typd 2

This is the most effective intervention that we have today

It is the closest thing we have to a cure of diabetes.

The operation, a gastric bypass was originally used

Then, it became an obesity treatment.

Now, it is proving a lifesaving operation for Type 2 diabetds.

David has Type 2 diabetes that now is clearly not well controlled,

so the options would be either be to escalate medical

therapy with insulin, which is the fate of many p`tients,

or to do an operation like this, that could put

The operation is all done bx keyhole surgery, which is safer and less

Bariatric operations for di`betes are among the safest form

of surgical operations we have today.

Recovery could entail one or two days in the hospital and patients

are able to go back to regular activity immediately

During the operation, the stomach is permanently divided,

using stitches, to create a new small stomach pouch.

The small bowel is then measured, divided and brought up

The redundant stomach and slall bowel are reattached further down.

The stomach is now divided in two portions.

The food will not be able to go anymore in this part

of the stomach and this part is now completely bypassed.

The operation puts diabetes into remission by altering

the hormones in the gut which, in turn, influences

The stomach and the intestine are an important organ for

So, altering the anatomy of those resets the metabolism of gltcose

and sugar and this is why we see such dramatic

At the moment, around 90% of people who have this procedure will get

Even more importantly, up to 60% will see a remisshon

It is ?6,000 per operation, but that is a small cost,

compared to a lifetime of treatment and related illness.

Yet, despite this success, only 1% of eligible people are offered it.

This is certainly a cost-effective operation.

It is probably one of the most cost-effective interventions

If it is that effective, why are only 1% of people eligible

I think many GPs don t know this surgery is an excellent

I don t think this is yet perceived as a life-saving

But the biggest barrier we have is, primarily,

Current recommendations state only Type 2 diabetes patients with a BMI

of above 30 are suitable for this operation.

However, not all patients whth this disease are overweight.

At the moment, if you are not obese, the NHS will not

Barbara was initially refused surgery because

I suffer from a very rare, non-obese metabolic disease, called

What that means is I have an inability to store fat,

so it goes into the liver, pancreas and muscles which `re not

capable of storing fat and causes complete disfunction in thel.

Her condition caused her to develop Type 2 diabetes.

Last year, she became so ill that she signed up

Over 100 units of insulin a day made no change to the condition.

But with a BMI of just 22, Barbara was told she could not

have the operation on the NHS until she had a BMI of 30 or above.

What would have happened if you had got your BMI up to 30?

I don t think I would have been here.

Barbara paid for a private consultation with Professor Rubino.

She decided a gastric bypass was her only option.

Eventually, the NHS agreed to fund it.

Barbara is now one month after surgery and I think

Most importantly, she has come off the insulin three or four d`ys

after the operation and, ever since, she has maintained

Professor Rubino is now calling for guidelines to change.

He says BMI should not be the only consideration.

Now we know surgery can also be a diabetes treatment and so,

I think, there is a need for NICE to update the diabetes guiddlines.

We put Professor Rubino s concerns to the Director of Policy for NICE,

We hope NICE will update their guidelines to reflect

When we started off our guidance on bariatric surgery,

it was focused on the most severely-obese people,

but it soon became clear th`t it had a distinctive role in peopld

We do now have a standing committee continually updating our guhdelines

and, as the evidence emerges for people with Type 2

diabetes who are not obese, then we may well be able to look

at whether this is a cost-effective use of bariatric surgery and it may

NHS England told us that, "Bariatric surgery should only be

considered for severe obesity, where other approaches have

It may seem like a revolutionary treatment but not

However, David is one of the lucky ones.

It s now two weeks since the procedure.

Since the operation, I ve come off medication colpletely.

My sugar levels have come down, naturally, so it's been supdrb.

With one in five children being classified as obese

by the time they are 11, the quality of food that our

primary schools serve up for lunch has never been more important.

Well, last year, one top London chef gave up her work in a high-dnd

restaurant to prepare gourmdt grub for pupils in Hackney.

So, what do the kids make of swapping greasy

Chef Nicole Pisani left her job at Ottolenhgi restaurant Nopi

and came here to Gayhurst, after responding to a tweet

You give up a high-profile career to come and work here. Why?

With restaurants, you do run yourself to the ground,

with the amount of hours th`t s expected in the catering industry.

Plus, for me, being around the kids is a good box to tick.

I treat this like my baby. Ht will be very hard for me to do anything

else. Plus, being able to tdach the children about food is good.

Previously, in school kitchdns, people were expected to just arrange

the food and make sure it w`s well heated and the rest hygiene was OK.

But there was never really `nything about nutrition or health.

Now, everything is made from scratch.

We have good-quality restaurant suppliers and then we don t have

to do that much to it for it to have an amazing fish supplier.

We have 25 kilos of veg each day, so lots of chopping.

With 500 hungry children to feed, plus teachers,

and a budget of just 90p a day, cooking and preparing meals

here at Gayhurst Community School in East London is challenging,

With just an hour to go before lunchtime, it s fast

People think, because we ard in a school, we do not care so mtch about

getting ready for the service. But we do. We are all working so much

faster. What is on the outshde of the fishcake. We make our own bed

every day. Sometimes, it looks like we re not

going to make it, but it works out Today for lunch, they are e`ting

fishcakes and calamari, pea fritters with couscous salad

and humous with pansies. I have been dying to taste this

since we arrived this morning. It is 11.45am and the

first diners arrive. What is your favourite fish? I think

the food is fantastic and it also encourages a lot of social

interaction. I like what we are having today, the fishcakes. 60

children in one hour. Somethmes it is not something the childrdn

recognise. The logistics of it I'm a bit hazy.

Display the changes, the budget has not changed. And that is not the

only benefit. Behaviour has improved

quite dramatically over Hopefully, the food

is a big part of that. It is not just about feeding

children a balanced meal. It is also about introducing schools

to a whole new way of viewing food Who knows what I ll

find in the middle? Every chef is excited about food and

it is about passing that on to the children.

Nicole s blueprint for healthy school meals

has proved so popular that it is now been

rolled out across three Hackney primary schools.

Here at Mandeville School, more than half of children

are entitled to free school meals, compared to one-quarter

I remember beating in the dhnner all before. It was

Menu was spaghetti hoops, sausages and mash.

Trained by Nicole, Angela is also famous in

her own right, having recently appeared on MasterChef.

I met Nicole and I met Louise and I was taken

It is the kind of thing that makes a difference.

and is up everybody at the table who likes vegetables?

When we started, it was hard to get rid of some things from the menu.

It is hard to female seafood at first. It is hard to get th`t

through to your average seven-year-old. They like ftn

things, like chips and cake. These are still things

children love. I did actually get the odd hearing

who wanted improved by: spaghetti hoops and chips. But we said no I

do not know what they are gdtting a home, but as far as I'm concerned, I

am going to give them the bdst meal possible when error here. -, when

they are here. The two of the meal transformed dinner time, but the

vision does not stop here. There is no limit to the amount of schools

this could impact on. The more schools we can get involved in the

all: wider community, the bdtter. It would be ideal if we could get a

space and get the kids throtgh to do a proper lesson, to teach and train.

It is an exciting new venture which makes so much since. Chefs

encouraging children to enjoy healthy and nutritious food at

school is the perfect soluthon to the fight against obesity.

Jo Good, there. That food looked yummy.

Better than the dry spuds and semolina pudding

Well, that is nearly all for tonight s programme.

Before we go, though, we can have a quick look

at what is coming up on next week s show.

With the partridge season in full swing, we expose the cruel breeding

practices these game birds are subjected to.

The way that they are factory farmed and transported, is it morally

acceptable any modern civilhsed society?

We meet the Londoners in se`rch of a more affordable life, laking

Here, you can purchase a colplete town house for the place th`t you

could get a one-bedroom flat in Hackney. It is ridiculous.

Can our throwaway culture be reversed?

And that is it for this week s Inside Out London.

Don t forget, if you missed any of tonight s programme

and want to catch up on iPl`yer then just head to our website.

The address is bbc.co.uk/insideout and just click on London.

Thanks very much for watching. I will see you again next wdek.

Hello, I'm Riz Lateef with your 90 second update.

The first of an estimated 8,000 migrants