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Tuesday, 5 December, 2000, 22:41 GMT
Fat Chance: Transcript
Frontline graphic
This is the full transcript of Frontline Scotland's Fat Chance programme broadcast on 5 December and presented by Ross McWilliam.

ROSS McWilliam: Linda Early is trapped in a body she doesn't want, a prisoner in a home she can't leave.

LINDA EARLY: You feel like a caged animal. You lose all self-respect. You lose all your dignity. It's like an open grave to me more or less. I feel entombed in this room.

ROSS: Scotland is in the grip of a growing epidemic. One in five of the population is obese, and the Health Service is failing to cope.

MALE: Obesity in this country is the number one public health problem of the new millennium.

MALE: We've been told for the last ten years to eat better food, and exercise more, and yet people are still getting fat. The time's come for a new solution I think.

ROSS: An overweight society. Is it down to greed, or a disease that isn't being taken seriously ?

Linda Early weighs 40 stones. She can't move from her bed, and hasn't left the house for years. Linda says people treat her as a fat freak.

LINDA EARLY: You are generally looked upon, if you're obese, as also mentally retarded. And people, I think, shy away. A lot of people will shy away because they're too embarrassed to speak to you. They don't talk to you like you're a human being, and a lot find you totally repulsive basically because of your size. And, so, there is a lot of discrimination against obese people, and some of it goes down to hatred. I know that for a fact.

ROSS: Growing up in Glasgow she was ridiculed and bullied as a child. As the years went by the pounds piled on - a victim some would say of her own gluttony.

LINDA: I'll not say I had the best diet in the world, I mean I was brought up on the normal Glasgow diet, which basically results in, like, mince and potatoes, pie and chips, you know, rolls and cold meat, and things like that. But I didnae eat it, like, in excess. I generally don't believe I did it through overeating. There's been a history of obesity in my family going back to my grandmother, and I believe that there's a connection, which has resulted in me becoming so massively overweight.

ROSS: With no family to help her, and very few visitors, Linda's lifeline is a small army of round-the-clock carers. They do everything from cooking, to cleaning, and keeping an eye on her medical problems that range from bed sores to high blood pressure.

LINDA: I've got two home helps, and five carers who work on shift work, and they're all very, very good at what they do.

ROSS: Could you survive without that help ?

LINDA: No, I couldn't survive in here without them. They're basically keeping me alive.

ROSS: It costs almost fifty thousand pounds a year to provide Linda's care. She says she's been asking the NHS for support in her fight to lose weight for the past ten years. Now she's battling with the health authorities to get treatment at the private Priory Clinic, which specialises in food addiction. Linda also wants to try surgery.

LINDA: Greater Glasgow Primary Health Care Trust, which is now responsible for her medical treatment says a whole range of services are being offered, and Linda's care is under review.

LINDA: Fat people are always going to be something to laugh at. Some people take it more serious but, and generally believe that fat people are a total waste of space, and a total drain on all services, and that they don't deserve any sort of help, you know.

And I don't believe that, I believe that I'm entitled to try and get some form of life, some quality of life back. To get back on my feet again I feel that I need constant care in a full-time facility, and it wasn't available to me. But, I generally feel that for the last 10 years my situation has been ignored by the Health Board, by Social Services, by everybody concerned really.

ROSS: Linda early says the thought of another winter alone at home terrifies her.

It seems we're all getting fatter. Scotland has the worst diet in the western world. That, and lack of exercise, are changing the shape of our society. Ten million of us in the UK are now clinically obese, and that figure is rising.

Hundreds of miles away from Linda Early, another woman who felt abandoned by the NHS. Jill Smith, a Swansea grandmother, got so desperate about her obesity she spent five thousand pounds of her own money on a private operation. Like Linda, Jill remembers jokes about her weight beginning at an early age.

JILL SMITH: I think there was only one boy in the school who actually called me by my original name of Jill, everyone else called me 'Jumbo'. And that was from, you know, the primary people right up to the sort of 16-year-olds.

ROSS: Jill Smith describes herself as a compulsive eater - someone who can't control the desire for food. But as the pounds added up so did the health problems. She began to fear for her future.

JILL: Firstly, my joints were giving way. My knee joints are not very good at all. I also felt that . . . what was I then . . . about 51, 52, that I wouldn't actually see 60, or if I did I would be so severely disabled through joint problems, or perhaps severe heart problems, that my quality of life would be pretty abysmal.

ROSS: Jill felt GPs were ill-informed, and not interested. She tried endless diets, and counselling with psychiatrists. Fed-up with feeling guilty about the amount of food she was eating Jill decided on drastic action - surgery.

JILL: Well I was expecting to be humiliated to be honest. I had been humiliated by people all my life who feel that it's all been my own fault, and my own greed. And it was very refreshing to find someone who actually thought that this obesity is a disease, and is not due to greed, gluttony.

ROSS: The private operation to staple Jill's stomach was carried out by an NHS surgeon, Professor John Baxter. He says for very obese patients it's the only answer, and he's angry that it isn't more widely available to National Health Service patients.

Prof. JOHN BAXTER: These peoples' appetites don't turn off like you or I. It is a real disease. And, therefore, because people don't understand this there's still the stigma around that they bring it on themselves. Even the surgeons who carry out the surgery are often stigmatised by their colleagues: 'Haven't you got something more useful to do than operate on those fat patients┐.' So we have to overcome the stigma that's attached to the people who allocate resources, and also amongst our colleagues before we're going to make any headway.

ROSS: The surgery involves stapling the stomach, and attaching a gortex band to make a smaller area. Less food is taken in and digested.

Prof. BAXTER: The sort of patients that are suitable for surgery are at the extreme end of the obesity spectrum. They have a body mass index greater than forty. And we know from bitter experience they have about a 98% failure rate from conservative management - that is diet, altering lifestyle, and sometimes drugs. That's just a fact, that most obesity physicians know and will not deny. So it's really a sign of desperation that they're getting nowhere when they turn to a surgeon to try and help them with their problem. We operate on these patients not to make them look good, and feel good, which they do when they eventually lose weight. But, we operate on them to save their life. It's not a cosmetic procedure.

ROSS: One in five of the population are obese. That means the combination of their weight and height, known as the body mass index, puts them at risk of developing diabetes, coronary heart disease, strokes, and cancer. Surgery can help prevent those diseases, but finding a surgeon to carry it out can be difficult. There are only 23 in Britain, way behind other countries. In an NHS that is constantly balancing budgets, and resources, training obesity surgeons isn't seen as a priority. Professor Baxter says that is short sighted.

Prof. BAXTER: We know, and I don't think anybody would deny, that surgery for obesity works. You never get down to a normal weight, but you're almost guaranteed to lose half of your excess weight, and any more is a bonus. Now, there's no medical treatment that will approach anything anywhere near that, and it's a very rare patient who can do it with just diet, and drugs, and natural means. So, I don't think there's any debate that obesity surgery is effective.

ROSS: Has it been worthwhile ?

JILL: Oh yes, yes. I feel much better. I've got more energy. I've got more stamina. And I have only, at the moment, lost four-and-a-half stones. I want to lose another six if I can. It's going to take some while, of course, but perhaps in a year or two I hope to be where I want to be. And I think it saved my life. I think Professor Baxter's surgery has saved my life.

ROSS: Jill Smith paid for private treatment, but the cost to the NHS of increasing obesity will continue to rise alarmingly. According to new research revealed to Frontline by health economists at St Andrews University.

So over the next decade what is the projected cost for obesity, and obesity related disease ?

MALE: (Health Economist, St Andrews University) : We have estimated the cost to be between fourteen to sixteen billion pounds. As a nation we're going to become more obese, and we're going to present more and more problems such as diabetes, and that means that the NHS will have to deal with evermore increasing numbers of ill people as a result of being obese with a limited budget.

ROSS: This obesity clinic in Aberdeen is one of only ten specialist centres in the UK. It can't hope to cope with the mounting health problems caused by obesity. For example, doctors are warning of an explosion in diabetes cases. It's predicted three million people in the UK will be diabetic within ten years.

Aberdeen Obesity Clinic

Doctor and Patient

: Is this your second visit here?

Male Patient: Yes, that's right.

Doctor: Your weight's gone up slightly since I saw you last.

Patient: Yes, it's went up a couple of kilos, been a bit of a delinquent this month?.

Doctor: Do you have difficulty keeping to it ?

Patient: Yes.

Doctor: What I'd like to do is persevere with the 600 calorie deficit diet that we've currently got you on.

Patient: Yes.

Doctor: And keep it as low fat as possible.

Patient: Yes.

Doctor: Bearing in mind that if you take a lot of fat on board you're going to take a lot more food on board, and a lot more energy on board, and consequently the weight does tend to go up. So fat in the diet is quite important in terms of tending to put weight on. And I understand from speaking of the dieticians that your fat in your diet is actually quite high.

Patient: Yes.

Doctor: And if we can get that down, then your weight will actually come down.

ROSS: And what would you hope to gain from coming to the clinic?

MALE PATIENT: Well, this runs in my family. My father's now got diabetes, so I'm going back and forth to the doctor getting checked is one of the things that I wanted to do . . . generally I didn't have it as well . . . And on a result of doing that the clinic has actually said well let's go with the programme as well, and try to get your weight down, you know.

ROSS: Was it something that you were aware of, not just that you were overweight, but the fact that it might pose you a health problem.

MALE PATIENT: Yes, well I'm 40-plus now, so I don't want to get any bigger as I get older. So it's time to come down as I get older as far as I'm concerned, yes.

MALE: We have ten specialist centres in the UK to deal with a disease, and I must impress upon you it is a disease that affects twenty per cent of the UK population. That is one million patients per specialist centre based in the hospital. We can't deal with that.

ROSS: Many patients who come to the Aberdeen clinic feel that they've been unfairly treated by society.

How long do you consider that you've been overweight.

FEMALE: Probably all my life in varying degrees.

ROSS: And have you been very conscious of that?

FEMALE: Yes, I was disabled for a long time when I was a child, and couldn't walk for about seven or eight years, which probably has a lot to do with it, starting off. But I am very conscious of it now.

ROSS: Do you think it's treated seriously enough as a health issue, or is it just a case of Oh eat less, and take more exercise ?

FEMALE: I think society has a problem with the overweight, and people have a problem . . . I have a problem with my own self-image, but it's not helped, you know, and other people share it.

ROSS: And doctors admit that there is even prejudice against fat people in the medical profession.

MALE: One of the biggest problems about obesity is the attitude of the population of individuals' friends perhaps, of health care workers, and including the medical profession. We really don't understand obesity. They put it down as a patient's own fault, you eat far too much, away you go and eat less and you'll get thinner, there were no fat people in Belsen etc.

ROSS: The worry is that the problem may be huge now, but if something isn't done the NHS will be swamped by the next generation of overweight adults.

MALE: If I go back to my primary class and look at the number of overweight children in that primary class, I can't, I think, remember any grossly overweight children in my primary class. You go into a primary class now and look round, and you'll see quite a large number of overweight children. So that obesity is starting very young.

ROSS: Already health researchers have found signs of obesity in three year olds, and heart disease in teenagers. In the last ten years the number of obese 15 year olds has risen from five to 17%. Consuming soft drinks high in sugar, fast foods high in fat, and making physical activity a low priority are being blamed. The role of advertisers in targeting vulnerable young consumers has been called into question. One major retailer - the Co-op - has banned advertisements that encourage young people to eat and drink unhealthy products.

Is it wrong in the first place to be aiming advertising at children ?


I feel it is both morally wrong, and a serious health issue for advertisers to be allowed to advertise to children. Some countries have outlawed it, and I feel it should be outlawed in this country. There's no reason that children should be in a position to make profound decisions about their diet. We certainly don't have any children in this country who are suffering from not enough junk food. We have a large number who are suffering from not having a healthy diet.

ROSS: In Glasgow, the Council's school meals service decided marketing brand names was the way to tempt children back into school dining halls. They went into partnership with soft drink giant Coca-Cola, and others, to launch fuel zones. They've been a resounding success. And the man behind the project says it stops children buying chips and drinks at nearby shops, and gets them into an environment where there are healthier options as well.

School dining hall

Female Pupil: It does give them the fast food option, but there is a lot of healthy options for them on the menu. There is a wide variety, a lot of them should take it.

Male Pupil: People are, in general, choosing more healthy meals such as soup and sandwiches, and baguettes, because I think people are starting to realise the message that is being put across about healthy eating. Even though it resembles a fast food place, it's not all fast food, and people realise this.

Female Pupil: I think it's a lot better than the old dinner school. It's more like a fast food place, and there's more variety, stuff that you like. The old dinner school used to be sort of chips and mince, and all that, a lot of pupils like eating that, so you get a choice of cheeseburgers and stuff like that that most young people like.

Male : I take different things each day. A lot of times I take chips, but I take different things like soup, I try baguettes, I try sandwiches. Just a total different variety.

ROSS: Opponents say offering that wide range of choice from burgers to baguettes is a mistake.

MALE: Children should not have too much choice when it comes to food. They have too much choice already and they're choosing foods which are killing them years later. For that reason the choice needs to be narrowed, and the range of foods available to children should only be healthy foods.

MALE: Today's youngsters are very sophisticated consumers. They learn from the high street very quickly. We know what they want, as they know what they want. I don't think they've giving too much of a choice at all. I think they're taking a responsible approach, giving a wide variety of choice, using high street marketing and merchandising techniques which I'm proud of to influence down a more healthy route. And at the end of the day the child will make their choice, but hopefully we have an opportunity to influence what they eat.

ROSS: Critics also attack the use of any brand names.

MALE: The fuel zone has some very unfortunate overtones to it. One of them, and the major principle they contravene here, is the idea of having to cater to whatever children want. A rather strange idea that children should be given what they want. The fuel zone shouldn't be giving them what they want, they should be giving them what's good for them. And that means they shouldn't be giving them product placement, advertising for Colas, and fast foods, and things that we all know the Government, and the World Health Organisation would not say are health foods for children, and necessary for them. This is precisely what children get all the time outside of school. The fuel zone should never be involved in bringing those things into the school.

MALE: We try and act very responsibly in promoting those items which are deemed to be much more health. A very good example would be a milk promotion we did with scratch cards recently which saw a seven-fold increase in the volume of milk sold. And I think that's a very good example of taking a responsible approach to what is a very serious problem, and one which we deal with very carefully indeed.

ROSS: And what drives you as a department, the health of the children and the food they're eating, or the money that they're bringing in with them ?

MALE: I think it's a combination of both because clearly we are a commercial organisation within the City Council, and we have to balance the books. But it's far more important to provide a valued service to thirty thousand of Glasgow's secondary school children on a daily basis. And we try and do that in a very responsible way, but clearly one which balances the books at the end of the day.

ROSS: So while Scotland gets fatter, what are those entrusted with the nation's health doing about it? The Scottish Executive's strategy has relied heavily on trying to persuade people to eat healthier foods, and take more exercise. They admit that's failing to stem the rising tide of obesity.

MALE: We're very concerned about obesity. It's one of the problems that we're not having the progress on that we'd like to see. And, basically, I think we understand the problem. There was an important report called the 'Scottish Diet', which showed that although we're eating less calories, we're taking less activity.

And, so, the challenges to help all Scots, not just those who are obese, or overweight, but all Scots to take more activity, and to make subtle, but important changes, in diet. That's the plan, em, but not enough progress has been made yet in having success in implementing that plan. I'm very encouraged by the progress much of Scotland's making in many dimensions of health.

So there's much to encourage us. But, one has to be honest, and one has to be realistic - obesity is one of the areas where we're having a real struggle to make progress, and in fact, things are getting worse in Scotland. So, although we understand the nature of the problem, although a strategy is in place, much more needs to be done.

ROSS: So the words of wisdom are failing. The NHS may have to bite the bullet and invest in more obesity surgeons, and more specialist clinics to try to reduce obesity. But perhaps an even more radical approach is needed for those unable to control their weight. Science may have the answer. At the Rowat Institute in Aberdeen research is being carried out on why some people get fatter than others. The aim is a medical treatment that can combat obesity.

MALE (at Rowat Institute, Aberdeen): We're all living in the same environment, and it's very clear that some people are fatter than other people. And, so there must be some other underlying cause there that makes the difference between a fat person and a thin person.

There's been lots and lots of research done on this recently just looking at the metabolic and genetic basis that underlies why one person gets fat, and why the other person stays thin. And the reasons behind that appears to be related to a sort of regulatory system that we have. So we know that our fat in our bodies sends a signal to our brains to tell us how fat we are, and that signal is decoded. And from that, we then regulate our food intake, and also our energy expenditure.

ROSS: But you'll actually be able to medically treat them for that?

MALE: Oh, I think absolutely. There's no doubt about that, because we'll have to do that. I mean if you think about what we've been doing for the last ten years, we're already telling people you must control what you eat, you must exercise more, and yet obesity is still going on. I don't think the problem is an educational problem.

The problem is that those types of interventions fight against a person's genetic make-up. And once you have those two things out of balance, which you're fighting against the genes, it's really destined to failure, I think. And so, what we need is another way of working with the problem, a way that works with the genes so that we can then say OK this person has a slight abnormality in this genetic part of the system, what can we give them to overcome that problem.

ROSS: Scientists are working on a genetic bullet that would control the brain's fat meter stopping those desires and impulses for unhealthy foods. That's some way off though. In the meantime the country's population continues to get fatter, and unhealthier, and desperate patients are taking desperate measures, even if it costs them large amounts of money.

JILL: I felt that life actually wasn't worth living. If I died during the surgery I wouldn't mind too much because the┐. I didn't want to live as I was any longer. I'd rather die trying to do something about it.

ROSS: Linda Early would love the freedom an operation could bring. At the moment she remains a prisoner.

LINDA: I suppose if I was a Lottery winner and could pay for it privately I would get a surgeon somewhere who would operate on me. I would go through it tomorrow because it would give me the chance of getting a better quality of life. So, if I died under the anaesthetic then at least I would have known that everything possible was done. If my life is . . . this is it . . .and that's what I've got for the next ten years, then I'd rather not have it. I'd like somebody just to come in and put a loaded gun in my bed, and I'd quite happily pull the trigger.

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