the British Obesity and Metabolic Surgery BBC Documentary

the British Obesity and Metabolic Surgery BBC Documentary

to obesity thank you is now so great it threatened the bankrupt our NHS but what if I were to tell you there is a treatment that could help tackle our obesity crisis I’ve never heaven lost like no magical one we’re not using because of an anti fat prejudice why is that any different for fat people why do they have all responsibility we don’t wake up in the morning think our celeries are a bias that may even extend to our health servant I think there is a deep-rooted prejudice in some quarters as well meaning many patients are getting the best available care I felt like I was completely dumped by the very people that were supposed to offer me all of the help that I needed a prejudice that has made the problem worse through all I’m ashamed to work in a health care professional that actually treats people in such a manner and we shouldn’t do [Music] I’m professor Rachel bottom a doctor and research scientist at UCL looking at differences in genes and body chemistry that means some people are more likely to put weight on than others what we’re learning in the lab should be shaping the future of obesity care in the UK but there’s a reluctance to accept what this could mean in terms of treatments there’s a battle brewing within our NHS about the best way to deal with our obesity crisis between those who view obesity and the lifestyle of shame wrong and those who see it as a disease that needs specialist treatment and even weight loss surgery no proof I know most people will disagree with this but I’m very much in the campus the obesity as a disease and I’ve long argued that we need to increase the number of weight loss surgeries funded by the NHS so then we can see the new egg sized stomach before I start to make my case let’s meet someone who’s had weight-loss surgery and is about to receive some life-changing news Roberts had weight-loss surgery yesterday and we’re running some tests on him it’s not to see if he’s lost any weight it’s too soon for that but it’s not too early to see if it’s had an impact on his diabetes hi good afternoon Evalia how you feeling Oh a lot now yeah it’s getting really well yes so we’ve been filled up I think I’d feel this well I’ll be honest with you so you have the diabetes for eight years all right yes yes and what they’ve been like how it affected you having it when you find certifying that you ever if it’s you really bad your stories of people lose meaning going blind and they know of a claim they kind of passed away week I diabetes of course so it’s been very funny yeah and what he should have been like since the operation but since the operation is blood sugar level has been even when he’s been having his soup and teas between five and six so your sugars normal it’s just truly amazingly just less than 24 hours after the operation you’re not going to need any more tablets when you go and today diabetes has gone into I had long-term remission this is just so much so life handy that’s an absolutely over welcome yeah I love you more we’ve known for over 20 years that weight-loss surgery can put type 2 diabetes into remission even before the patient has lost any weight I can’t understand why we’re not doing more of these operations it can transform someone’s life and help cut the mammoth bill of this disease to the NHS no medication 19 hours after the operation oh fuck out type 2 diabetes cost the NHS nearly 8.8 billion pounds each year in less than 20 years is estimated it will cost of 15.1 billion that’s 280 million pounds each week or a staggering 1.7 million every hour weight loss surgery puts over 60% of patients with type 2 diabetes into remission despite this Robert could only get his life-changing treatment on the NHS by chance being a taxi drivers driver man last September 2015 a gentleman puts his hand out getting end up explaining to me he was a surgeon from UCLH Ethan says would you be interested in having the surgery done to lqn and it all started from there so just if you picked up somebody else then you wouldn’t be sitting here I will be seeing it it was the right time right place your whole access to treatment for your diabetes in your weight just complete luck it’s really quite shocking yeah thank you thank you I find it really concerning that this is happening in today’s NHS robert’s access to treatment was not based on the medical pathway it was hot luck what’s been more worrying is that there’s thousands of other people just like Robert you don’t know that weight-loss surgery really could change their lives in the UK severe obesity rates have leveled over the last 30 years and type-2 diabetes has seen a similar rise but in the last five years there’s been a 30 percent fall in the number of weight loss surgeries on the NHS with only 6,000 undertaken last year I’ve come to teaches them to meet Chris Pring a bariatric surgeon at Richards Hospital Wawrinka Magazine to see if he knows where there’s been a drop in numbers and how many operations are you doing a year at the MoMA was probably doing about maybe 250 cases a year a few years ago we were probably doing about maybe 600 cases a year so in the last five years I’ve said we’ve seen quite a significant drop in a number of cases that we’re doing and what if the numbers come down it may be there’s a bit of prejudice out there you know it may be that people don’t feel this sort of treatment is not only worthwhile but deserved do you think there’s any prejudice within healthcare professionals unfortunately I have to say yes I think there is I think there is a deep-rooted prejudice in some quarters as well this is surgery to improve health diabetes blood pressure life expectancy this isn’t surgery to lose weight and if we can get that message across then I think we will start to see our numbers increasing again and rightly so and we will see I hope that latent prejudice that I know exists we will see that being eroded it’s shocking to think that people could be experiencing prejudice within the NHS but it’s something I’m hearing more and more can it be true that people are really discriminated against because of their weight hi good morning Richard hi Rachel how are you thanks for coming Kathy we sent out a survey to the UK members of LighterLife slimming group and asked them what their experience with patients than they access the NHS the treatment and Richard now has the results the 991 people get back to us and the response we got was staggering the first question that we asked was have I ever experienced any negative attitudes from somebody within the NHS because of my weight the upsetting topline figure is that 43% of the responders read with this so almost one in two people with a weight problem are experiencing a negative attitude towards them whilst engaging with the NHS in their area yes so over the course of the people who responded to the overall questionnaire we’re happy to take the time to share quite personal stories about the prejudice that data encountered within the NHS with us actually like to take a look I was refused a consultation with a view to knee surgery because of my age and my weight I went privately otherwise I would have ended up in a wheelchair for the rest of my life the operation was a success and I’m now able to work normally again just unbelievable I was refused as steroid injection in my hip as losing weight would be more beneficial so I remain in pain I was taught by my GP that my health problems were connected to my overweight I did not have the confidence to argue and did not go back for 3 years my diagnosis of multiple sclerosis was delayed by over four years due to this I suffered in silence that is just appalling [Music] working mum gemma is another patient who felt badly let down by the NHS i was referred by the GP to the NHS radar service i think it was the most distressing actual weight loss experience i’ve actually had [Music] they have the NHS eat well plate which is a guide to what you should have with every meal and the different food groups within them I know that a lot of triggering my weight gain of carbohydrates potatoes rice pasta bread they’re all really bad triggers and for me gaining weight I tried to explain this but I was told I need to conform to that place and the time from starting to actually leaving the service I’ve gained just over two so by the end of it and it was a horrific experience emotionally physically and has resulted in me being in a worse position than I was before I joined the service Gemma only found out that she was eligible for weight loss surgery on the NHS after seeing her surgeon in privately today the day I find out if I can go on the surgical lift will have an idea then of when my my surgery will be as I’m expected thanks telegram 38 BMI 47 and we want to bypass us on to a new careful management – totally Gemma’s future is now in the hands of Chris and his team of psychologists dietitians and nurses who will decide if she’s suitable for surgery fatigue to me just coming than not it’s just I mean sort of everything today to me kind of all my hopes are on yes today hello Joanna hi oh yeah kiss thank you feel good recommend thank you spraying fiberfix have a seat good good so certainly today the team have assessed you the surgery and you know we all agree that surgery is going to give you improved health and a better wait in better outcomes as a result happiness this is keyhole surgery we staple across the stomach to give you a small stomach pouch we then divide the bowel down here we bring it up to the stomach pouch and we stitch it on so the food goes down the gullet into the stomach pouch it passes down the bowel here thereby the food bypasses this part of the stomach about which we join on down here end of a long journey yes the end of one journey to start now when I hear the area so well organized some dates for you put it on the list everyone’s happy are you all sorted there we go I really so much for yeah that’s okay thanks I gotta go don’t have a safe trip home thank you very relieved under the moon I’m going to get the surgery the fantastic feeling and it’s a it’s going to be a new beginning for me I think gem ragazza frustrated with the system because she felt that she wasn’t getting anywhere she’s here now as an NHS patient and she’s like a lot of people I see they can’t find it very difficult to navigate towards a point where you will end up having a healthier way so those lucky enough to get on to the surgical list here introduced er weight loss surgery is a daunting prospect and far from the easy option many people believe it to be what’s happening here the surgeons actually dissecting a little bit of your stomach tissue off to make you a new pouch is about the size of an egg he cuts the bowel the bit of bowel that’s being cut is then re routed and pushed up to the new tummy pouch okay rest of this stomach here it stays there we don’t remove those I go to the joy to know you’re nothing perfectly fine and that’s why you can reverse in something for Christmas yes because everything is still there your first reaction to that is quite frightening this does frighten a lot of people now with this type of surgery post-surgery and getting back to eating you are on so the equivalent of around about two tablespoons of pureed food per meal if you try to eat any highly refined sugar items with this type of surgery you get a syndrome called dumping syndrome the food comes into the pouch it then hits a part of the bow where it’s not used to having large molecules of sugar it throws the body into a bit of a spin so what you then feel is faint sick sweaty nausea can give you upset stomach it’s not pleasant and it happens to most people any operation carries the risk so risk for the infection risk of bleed whisks of deep vein thrombosis risk of chest problems probably around about one in a hundred I will see my child grow up yes yes I am my dad died at 42 of pancreatic cancer which is a lifestyle cancer he was overweight for years he drunk yet what he wanted but in the end he died very young and I’m only two years away from my age and it frightened yeah and that’s the help that we can give you is to avoid you being in that position and it is giving you almost a control yeah yeah in terms of how your GP have helped you have you felt that they’ve been supported it took for me to find a very very lovely synthetic GP who had sat down one day with and I literally I did cry and I said this is all facing me I don’t know what to do and finally got a referral because doctor after doctor after doctor just refused to refer me I think today shows us that it’s really hard for people to access surgery even when they’re eligible and the current guidelines get a bit stiff sitting down in England the National Institute for Health and Care excellence recommends weight loss surgery for people with severe obesity or with a BMI of 35 or more with a significant disease like type 2 diabetes thank you see you later Wales and Scotland follow similar criteria but in Northern Ireland is policy to only provide surgery in extreme circumstances getting referred for weight loss surgery it’s hard enough but is another obstacle before anyone can be assessed for weight loss surgery patients are required to complete a dark and exercise program known as tier 3 for up to two years I have been more than greater face welcome to Mia let me give you a tour and show you what we do here I’d come to Rada room to meet dr. Matthew Kapaun who runs one of these programs we’ve got specialist equipment builds for patients with severe obesity and we can actually tailor exercises specifics at the end of a joint if they’ve got heart problems we start off very gently and build up not everyone here will want surgery but for those who have considered it like Carol tr3 will help return if it’s the best course of treatment my initial thought was maybe I should try bariatric surgery because I had done diet and they had failed that point I weighed 21 in the House dome okay and and that was quite horrific and my BMI was 49 and in the last 18 months have gone down to 15 stone and my BMI is now certified below it has been a very very read getting everything hopefully surgery won’t be necessary because I know what I’m doing now I know what I need to do it is so important to have the right mental attitude and to to develop a mental attitude because this effectively this is a lifelong change sometimes it’s the ups and downs as that weight loss diet and exercise is only part of the program to be effective patients attend therapy sessions and behavioral workshops so what we’ll do now is we’ll go into one of our group sessions which is our problem-solving session for patients finding it difficult or lose weight lots of people out there including healthcare professionals who say well weight loss is simple you just need to eat less exercise more never it don’t work for everybody I think it’s quite ignorant for people to think things like that unless you’ve been in the situation and you are finding yourself struggling as a single day I mean we don’t wake up in the morning and think our cell or the fat you don’t it happened over a period of time and usually by the time you found out it’s too late you’re already over way so you can do then is try and stop that and try and work your way backwards to the healthy people can binge drink liquor take drugs they can smoke and things that US or if you’re overweight oh you must be lazy you must be close and older then you have to when you credit it employable people that are overweight after we met people will nudge other people on you know I would wear and it don’t hurt because you know that you really time you and what I found was coming to Rio is it’s helping me realize that these people can you know they up they are ignorant and or agree with you for having those opinions because unfortunately through a mail ringing I didn’t know this is a good food this is bad food this is so now I’m going reactivating myself as to what goes in and what these foods will do to help myself look that way thank you so much for being so honest I really appreciate your time and where I’ll leave you to your session thank you thank you I’m impressed with what I’ve seen this service helps over a thousand people every year and I think it’s the ideal preparation for the small number that then go on to have surgery so the key thing is our electric surgery or weight-loss surgery is the most cost effective weight-loss intervention for certain people if it’s the right person but who’s doing that screening we need tier three centers likeness to identify the right person and also to treat the patients who for whatever reason aren’t suitable for the weight loss surgery what you’ve got fantastic service and facilities here if you’re funding going forward secure well no it isn’t and in the slightest is very frustrating we only have secured funding to July of 2017 and so we could end up despite all of the gate services that you’ve seen we could lose all of it that’s very how will our model and patients feel if they lose the one place where they know that they can come to where they get free NHS advice and support to actually help them lose the weight become more healthy and get them that surgery they must be like second-class citizens the services like this at risk of closure it’s clear to me that we’re just not taking the adversity crisis seriously if we’re not getting it right hailing robbery that has one of the highest obesity levels anywhere then what hope do we have without NHS diet and exercise program people will be left with no support to lose weight or a pathway to surgery surgical intervention is the most effective treatment for long-term weight loss and improved health but I’m concerned some patients don’t even have access to tier three last year professor John was carried out a report on the availability of NHS Tier three services across England good trip lovely yes I’m sorry about the weather horrible John you carried out this survey looking at Tier three provision on behalf of the Royal College of Physicians how comprehensive is access to treatment it’s far from comprehensive there’s only 67 percent of the country covered now so that there’s 30 more or more percent not covered and that means that there’s a real postcode lottery there is not adequate provision up and down the country to tier 3 and therefore surgery and I really do worry that the situation is going to get worse the NHS needs to be doing far more for people struggling with their weight but not everyone shares my opinion I am a fattest I find a bit people unappealing and they are a strain not only on their clothing but on NHS resources then your beast should pay for their treatments Amanda Patel is a well-known newspaper columnist her views are read by millions what this is doing its fueling a public anti-obesity agenda how are we going to even think of obesity as a real health problem if we’re saying it totally down to the individual as a professional who works with obesity every day I want to understand where Amanda’s prejudice I Rachel comes from it’s good to meet you thank you so much for agreeing well chat with me today I did have second thoughts about it because we do have quite different views on this whole subject so a person who is really struggling to lose weight to read something in the newspaper that actually it’s all their fault and that they should have no support from the NHS I think that’s quite a damaging for the stand point to take these are self inflicted conditions people stuff their faces with too much food and don’t get off the sofa you’ve spent all this money on wrecking your life and wrecking your body and now you expect us to pick up the tab I think that through very interesting view there lots of people not getting any treatment there are lots of all people are not getting meals provided for them because so much more so many billions now are going to treating people who are Fallot we know that actually weight loss surgery reduces the cost of the drugs reduces of chances of dying by 40% gastric bands basically those we’re talking about that kind of it’s not gastric back okay so it’s specifically not gastric bands its gastric bypass and it moves much more gaily right to me right well if they had surgery today they would most likely go home tomorrow off all their treatment and when people come back six months after surgery they’ve lost my body weight and more and that weight stays off for lifelong not that it restricts the ability to eat it changes the way their brain with one of the food but surely if someone’s face for something like here’s a drug that we can give to a young man with breast cancer so she can have five extra years of life compared to someone who comes in really overweight the sympathy is going to be in the other direction but you’ve highlighted some of the key knee problems that come with overweight and obesity as you increase your body fat mass then your chances of dying your chances of diabetes your chances of cancer really SMA first interesting thing that is said is even all of that you’re much more likely to get a whole range of cancers but that education is not that you know I can see on a pill calculation if you take someone who is not treated and is obese for their entire life there could be a huge burden on the NHS and on to the taxpayer and let us take the cold hard facts a really obese person an operation that we paid for by the cost of what will cost on the HIV treatment within a few years you know an outcome of this is that they will not go back to being honest again yeah it’s kind of a win-win it’s incredibly effective but we’re not using it in terms of the treatment the right information just isn’t out there but if I can sway Amanda I’m hopeful society’s views towards weight-loss surgery can also be changed prejudice against weight can leave people like Marc feeling unworthy of him I wish something had worked and I didn’t have to have the operation but I know that it’s the only way that I can go out the whole lot of Doug nice to meet you you can down many people would save myself and I accept that can never see thank you at the end of the day the only person to blame is myself so your weight is at the moment 196 kilograms you know that presents are a significant challenge to your health yeah not only justiceadvocate but your health in general life expectancy all this sort of things so there’s no doubt that moving for surgery to help you reduce your weight and get you to a healthier weight it’s going to be your best option so what sort of like worried a little bit because half of these thinking I really need the surgery but the other half is thinking well do I deserve okay [Music] this is the picture that gives me a little bit of inspiration because I would love to get back to the way I looked in I’m about 29 it’s not a good sight is it it’s not a good sight at all so I sit down mark has sciatica a trapped nerve that is restricting his mobility he has to take painkillers at 3:30 every morning so that he can work as a driver I got lost in the system and I then took matters into my own hands and phoned up they said well you’ve been in the system too long we need to move on now and get you the surgery as quickly as possible you know normally it’s about eighteen months to go through the program in my case it just ended up that it was about four years and I know that the only way now is to have that operation because I know that it will basically save my life and if I carry on the way that I am or if I’m left the way at the time I will die we know that the people in your situation an operation is going to give you the best health outcome 9 – only in the short term but in the long term yeah when we look at life expectancy when we look at the chance of you having a lower risk of heart attack a lower risk of stroke I mean look you’re young you know you’re only 56 so you’ve got all the time ahead of you so you need to have a healthy healthy times it and I would say to you over the course of the next six to eight months you will probably lose about one stone a month the most important thing is that it’s the right thing for you and it’s the treatment is going to make you healthy again I’ll see you again on the on the day that every operation especially you don’t know how much every way they do you look good on your mark thank you very much we’ll get let me show you how thank you I think of this as another health issue there’ll be more emphasis and determination in seeking effective treatments but I think of the health community we are tending to ignore this is a problem and this isn’t difficult on an individual level this is difficult on a global level and we are suffering in the Western world particularly from the health consequences of way let’s look at the bigger picture here in Britain how widespread has the obesity crisis become figures published by The Lancet show that there are 14 and a half million people with V City in the UK and it’s estimated that by 2030 this number will rise by a further 11 million new cases across Britain and what are the cost terribly the NHS and five point 1 billion pounds every year on a visa T this is expected to rise to 10 to 12 billion pounds by 2030 despite the rise in obesity the numbers of NHS surgeries are falling the European average is 50,000 operations each year but here in the UK we only do just over 6,000 the only option for some people is to go private 52 year-old Karen was so desperate she felt she had no option but to pay for her surgery two years ago that’s what I used to look like I was quite ill I was so bloated out with water retention and it was causing all my other organs to fail I was too young to die but I’m it would have been on the cards if it carried on you have useful lots of pictures being taken before no no no I haven’t get a picture of you the search actually cost me eleven thousand I had some inheritance from my mother as a state which led to the fact that I could have it done I was 25 stone now and this is me at 12 and a half stoned it’s just such a difference that’s my mom and he never got to see my transformation she always wanted you to lose weight yeah it is bittersweet leach never got to say it but [Music] so nicely taken risk going on the tier three system and the guys know I could have waited that long I don’t think I would have lasted in England there are 209 clinical commissioning groups CCGs you were given two thirds of the NHS budget CCG have the responsibility of how to spend that money and the situation for obese people in many parts of England is about to get worse they face being denied access to routine care like hip operations that are readily available to non obese patients if your availa your can you have a BMI of over 30 which is obese then you can’t have orthopaedic surgery to replace a knee the bottom line is that the money is not there and this means that this group of people is actually disenfranchised they’re actually illegitimately sort of victimized if you like there are some people that have been waiting for huge lengths of time so in certain areas of the country if you have a BMI over 30 then you’re discriminated against in that you can’t have access to surgery that other members of a population can have how can that be fair it’s not fair and it’s not just the Vale of York CCG delaying treatment based on a person’s BMI a recent report from the Royal College of Surgeons found that about one in three CPGs have a mandatory threshold to access surgery based on weight and smoking status we asked the Vale of York CCG for an interview but they declined our offer a number of CCGs of similar criteria also refused to explain the rationale behind the policy however all these Essex ECG will have a BMI threshold of below 35 for routine surgery did agree to speak to us this should really be seen as a cost-cutting exercise because what what we’re hoping for is that when we have patients over body mass index above 35 they’re able to put into place a change in their lifestyle that allows them to bring their body mass index below 35 we can still carry on and have that surgical procedure but through the process they may have gained a health advantage if you start discriminating on who should have treatment on the grounds that there are one lot perhaps who are seen as secondary citizens because they happen to be overweight compared with those that have led a more healthy life I think that’s creating a two-tier NHS now that’s not good that is rationing on grounds that really are not humane bear in mind this isn’t meant to be a punitive measure it’s meant to be around improving better health outcomes for our patients and so that’s why we put it in place NHS England issued a statement saying ultimately these are legally decisions for CCGs but informed by best evidence and national guidance where appropriate 69 year old Helen is waiting for a hip replacement which has been told to lose 5 stone before she can be referred for surgery I’ve struggled with weight and really since a child when I was there at ten I had osteomyelitis which caused my uncle to be really misshapen as the years have gone on it’s made my knee and my hip start to go it’s like the chicken or the egg which comes first the losing of weight which isn’t going very fast if at all or having the operation and being able to move around a little five years ago we went dancing I went to exercise classes can’t do any of that now because I can’t walk fastings I’ll get well if you bring it down for me okay then are you okay I just think in the field too if I don’t have anything done I will end up in a wheelchair but I used to do all this area of gardening so yes that area was my bit and I just can’t get down to it it hurt too much sounds only way out of it really with this hip it it’s going to get worse and and they keep on telling her that she’s got to lose this weight it’s quite hard to lose weight when you can’t exercise okey doke [Music] I am getting worse and I do feel as though I could be housebound I just yes I just find that it’s something that will probably never happen how hard is it to lose weight when going it alone a recent UK wide study of patients with simple obesity by King’s College London showed the annual chance for women returning to normal weight was one in 124 and one in 210 for men for those with severe obesity it was one in 677 for women and one in 1290 for men to make matters worse to the few who did lose weight 78 percent put it back on after five years Mark’s Road to surgery has taken four years and today he’s finally getting his treatment it’s like the lies at the end of the tunnel it’s a life-changing operation and it’s going to improve my life no end many people believe Mark’s treatment is too expensive and it’s true to say the NHS can’t afford to operate on everyone who qualifies a number of studies date that weight-loss surgery pays for itself within two to three years due to savings on drugs a recent more comprehensive study by King’s College found that despite the cost of weight-loss surgery between seven and ten thousand pounds it’s one of the most cost effective treatments that any kind available to the NHS there we go all done hazal finish our favourites we can’t say it will save money because marks life expectancy will increase and it’s impossible to predict what care he might need as he becomes older but with existing weight loss surgery centers we could increase surgery numbers to 25,000 each year and help more people live healthier and longer lives is a second chance just a little bothersome I’m on my way to her ago to meet 59 year old accountant Philippa like many people in the film she have multiple health problems and alas the weight loss surgery but has been refused at every turn however the chance I can help – a parallel meeting thank you very much little McKenzie when you went and asked about weight loss surgery can you remember what your BMI was my BMI is been over 50 for quite a while now and the overall impression that I was left with was that I wasn’t worthy of being considered and I’m sorry to have to tell you this but you did qualify for weight loss surgery because you had a BMI of over 50 so it’s even more pop settling that I was just dismissed so what happened since having had the family here at Christmas and some of them concerned about my general health I decided to go back to my GP and ask again about weight loss surgery he was saying that because of my cart condition I wouldn’t be referred for weight loss surgery what heart condition I’ve got atrial fibrillation which was diagnosed September 15 he’s had an irregular heartbeat grow over a year and a half really but the consultant said that because of my weight they won’t have had to operate to do even at least that heart so I seem to be in a catch-22 situation we commonly see people with your heart condition you can’t have the heart condition treated because of their weight who we operate on they lose the weight and have the heart condition treated potentially if you’d had the surgery five years ago then even have developed the heart condition because there’s a link between the two I’m ashamed to work in a health care professional that actually treats people in such a manner and we shouldn’t be doing I actually can’t believe that basically she’s been left she has severe obesity type 2 diabetes a heart condition and she’s stuck I just think that it’s terrible that we’re leaving people in the situation with effectively no way out and not supporting at all Phillipa needs surgery for health reasons I’m going to see what I can do to get the help she needs before it’s too late I’m really concerned that more people like Philippa will be denied access to weight-loss surgery because of the recent funding changes for this treatment switching from NHS England to CCGs the way that weight loss surgery is funded is going to change it’s going to go from being centrally funded to locally commissioned yeah what impact is that likely to have when the money comes down from NHS England I worry that it won’t get ring-fenced and so that it could easily be absorbed in the CCGs general financial pool and we already know that there are huge numbers of CCGs that are in financial difficulties which is a real worry if Philippa doesn’t get the help she needs her health is set to get worse I can’t stand by and let that happen her soul has been a real race against time and if I’ve seen it just a few weeks later and she wouldn’t have been able to access weight-loss surgery the CCG were arguing that she hadn’t been through clear very her CCG doesn’t offer carefree so effectively sort of stuff despite my intervention her CCG of still intent on refusing her treatment and this latest setback was hard for Philippa to take I received a copy of an email say that there was no funding available and that I wasn’t eligible I was numbed that evening I probably demolished more food in three hours the no normal person would have beaten on Monday we can offer her the tier 3 and the assessment for weight loss surgery at the same time so her CCG finally agreed that Philippa can go forward to be assessed for surgery without my intervention I very much doubt which Philippa would be alive in five years time I’m just one of the lucky ones that I’ve been given this opportunity if we’re serious about tackling obesity we need effective prevention and treatment including investing far more in surgery as the results speak for themselves 26 year old Michael had weight-loss surgery here at UCL H just nine months ago I like about twenty eight and a half stone and this was four or five weeks ago now we’re lost seven stone thirteen pounds where I’m now twenty-two stone which is quite quite big difference Michael is now helping us with our research to understand the benefits of surgery hey dude thank you feeling very well thank you yeah what makes this treatment successful long-term are the biological changes to the body so what taste changes have you noticed um realistically it just feels like everything’s been taken up a level and sensitivity saltier foods fatty or food they just you can bear them a lot less than the used to be able to and I think mainly it is an amplified sense of taste is why I’ve noticed and which ensures you have a greater balance and variety of what you have rather than having the same things and same textures and the same taste over and over again our research is helping us to understand why some people are more likely to put weight on than others so we’re giving you three samples and for each of everyone will be asked me to taste them and tell me which one tastes different to the other two okay what we’re seeing is that immediately after surgery the whole loans coming from the gut that are present in the blood completely change and we know that these hormones acts on the brain to control how hungry a person feels we also know that these gut hormones affect taste because they bind to the taste buds in the mouth and change what sort of food a person has craved for I’d say the first ones definitely different when a person has surgery what I research is really helping us to understand is why weight loss with dieting is so difficult for the vast majority of people whereas weight loss with surgery and the changes in their hormones actually really help them to continue to lose weight but more importantly to keep that weight off in the long term we know some people are predisposed to gain weight but the latest research doesn’t seem to be widely understood or accepted even amongst healthcare professionals [Music] if we’re going to increase the number of NHS weight loss surgeries we need to educate the wider medical profession on how the surgery work so I’ve invited a group of GPS and CCG commissioners to share my research with these are the people I have to convince thank you for coming today I really need your help to try and understand why GPS and commissioners not really pushing for more access to biotech surgery so how is it working if we come recognize that the gut plays a key role in regulating how hungry you feel and also your blood glucose now there is a gulf hormone called peptide YY and when a person in the levels in the blood go up and they stay elevated for several hours depending on what you think them children and adults with obesity has low levels of this hormone that tells your brain if you’ve eaten so when they eat the brain isn’t getting the right signal to say you’ve eaten enough food Karelin which has been dubbed the hunger hormone we know that this hormone again acts on your brain to tell you to eat after surgery pyy which is a fullness hormone they go up guellen which is a hunger hormone to is really down and why do we get the taste changes well in your saliva you have all these gut hormones and your taste buds have got receptors where these hormones bind to so when we change these hormones coming from the gut and change the saliva and we change taste perception and how people taste different foods patients no longer feel hungry and when we image their brain that brain now responds completely differently when we show them pictures of food by replumb in the gut we’re changing the nerves we’re changing the microbiome and it’s all of these things together which lead to the beneficial effect the thirdly I really like your comments as to why you think that sort of weight loss by actually surgery isn’t being more widely Commission’s or being made available well first of all I do confess that I wasn’t aware an impulse was more than misconception of the risk or less risk in terms of the surgical interventions so what’s missing in order to really facilitate the right treatment to the right person I guess guess I feel that there probably is lack of awareness of what is the outcomes that can be achieved at t of bariatric surgery t4 I wasn’t entirely aware of the hormones studies that you quoted as well and it’s interesting to see that I don’t think there’s any question that there is great benefit in managing a beastie and treating obesity the difficulty is it I think there probably is a lack of information out there at primary care level in terms of the benefits and balancing the risks and I don’t know whether there’s a great deal of public sympathy out there for obesity and I think that’s a barrier I completely agree that this kind of surgery is extremely effective impressively effective but for many people and we are influenced by society at large many people’s view is that morbid obesity is is a lifestyle choice it’s self-inflicted there’s a lack of sympathy and that impinges on the decisions that we make sometimes it’s a pity but I think it’s the case I think that as health care professionals we really need to instigate though see I think until doctors take it serious how can you expect patients to we’ve probably have got an unconscious bias over obesity thank you so much for crimes like you very appreciative something amazing that scientific justification for dieting surgery is the biggest take-home message the commissioner group we would be accountable to our population for our spending so it’s just about getting the country better informed as well as clinicians around the benefits and the merits for bariatric surgery I found it quite surprising that it seems to be a lack of understanding of the health benefits and also a complete lack of understanding of how the surgery works it tells me that we also need to do a lot more to actually get out to CCGs to talk to GPS about the health benefits that surgery can bring [Applause] [Music] it’s just over three weeks since Mark had his operation so what I’ve got here tonight is some potatoes boiled potatoes fish in a parsley sauce that’s basically it tonight’s dinner I’ve actually lost about one and a half stone I’ve never Heaven lost weight like that before in all of the diets all of the plans that I’ve been on I’ve never lost anywhere in the air as much as I have now it’s been a lot of change already and we’re we’re just three weeks in this meal here is going to take me at least 20 minutes to eat if not longer just right a little everything settle before I take another bite sometimes you feel it going down and there’s like a little button the best way to explaining that you sort of likely is that too much or did I do that right that’s what into – I try to use just – all right half a teaspoon at a time so I don’t don’t put too much in ever since the up I felt a different person to be honest I’ve been out for a meal not a problem I just thought differently cadiz kidneys menu so I’m a cheap date this is about done me to be honest and the other beautiful thing is since the operation I’ve actually off my meds as well completely my blood pressure has gone back to normal happy days we all know someone whose life is affected by their ways I began the program by asking who is to blame and why more is not being done to tackle our obesity crisis commissioning of obesity services to help people manage their weight is a postcode lottery worse still many of the people that we’ve met including health care professionals believe that is a prejudice within the NHS that is preventing people struggling with their weight from accessing healthcare services weight-loss surgery really can transform a person’s life but despite this I fear that the number of operations undertaken is going to fall even further this will effectively condemn thousands of people to years of a necessary ill health rather than adopting a postcode lottery approach to treatment we need to make sure that people can

3 thoughts on “the British Obesity and Metabolic Surgery BBC Documentary

  1. You know I exercise 4 to 5 times a week and I don't see many people who are over weight in the gym because they don't want to because they are lazy

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