Obesity: The Post Mortem (2016) Movie Script
1
[Vinette] Obesity is an epidemic
happening right here
in the UK right now.
Honestly, the first thing
I'd say is that Im a big girl.
How my friends would describe me
would be large, fat probably.
I dont like to use the word fat.
But at the end of the day,
that is what I have inside me.
I have a large amount of extra fat.
[Vinette] We all know what fat
looks like on the outside.
[Chanel] I think of cellulite,
rolls, big thighs,
big arms.
If youre Kim Kardashian,
you can have a really fat arse.
Ive got a fat stomach,
shes got a fat arse.
[Vinette] But what if we could see
what fat looks like from the inside?
Do we have any idea of the damage
obesity is doing under our skin?
When you say to somebody,
well, it is affecting your health,
you know, show me, I cant see inside,
I cant see what is happening inside me.
[Vinette] BBC3 has secured the first
televised access to a full post-mortem
on an obese person whose body
was donated to medical science.
This summer, our pathology team assembled
to reveal, from the inside,
the dangers of us all getting too fat.
Post-mortems are tightly controlled
and access to them is strictly limited
to protect the privacy and dignity
of the deceased.
Filming is not usually allowed.
But for this post-mortem
we have been allowed in
to help understand a problem
that costs the nation billions and
ruins so many lives. Obesity.
Carla Valentine and Dr Mike Osborn
are the specialist team responsible
for carrying out the post-mortem.
Carla is an Anatomical
Pathology Technologist
and Technical Curator
of the Pathology Museum
at Londons Queen Mary University.
For this post-mortem,
I will be carrying out the evisceration,
which means removing all of the organs.
Being part of a filmed post-mortem
is a very unique opportunity.
Death terrifies some people,
but what it also does is it
eventually gives you a real sense
of the fragility of life.
The topic of obesity is a huge problem,
and its something that I get
to see quite a lot,
but its not something
I get to study in depth.
[Vinette] Mike is
a Consultant Pathologist
and Fellow of the
Royal College of Pathologists.
Hes been working with death and disease
for over 20 years.
Obesity is very much there,
it's seen, but I think its
very, very poorly understood.
It seemed that making this film
would be a way of exploring that
and allowing a broader public
to learn about the problems
that are associated with obesity.
[Vinette] Carla and Mike have performed
thousands of post-mortems,
but always behind closed doors.
Today, well witness what
really happens in an autopsy
and discover what the body of our donor
can tell us about the creeping effects
of obesity over time.
We dont know this woman's name,
but we do know a few details about her.
She was in her early 60s.
5'5". Almost 17 stone.
And, just like a quarter of people
in the UK, clinically obese.
But where did she come from?
And how did she end up here
on a post-mortem table in London?
Long Beach, on the West Coast
of the United States.
Glamorous, sunny, carefree California.
But away from the beach,
on an anonymous industrial estate
on the outskirts of the city,
is where our donor began her journey
to the post-mortem table.
This is a place where people
who donate their body
to essential medical science
are brought when they die.
Up to 20 donated bodies, or cadavers,
a day come through these doors
destined for thousands of medical research
projects all over the world.
[Randall] My name is Randall Delgado.
Im 29. My main role now
would be in charge of distribution.
Some days, you know, we have an order
for cadavers going to Lebanon
and so then we have to start checking
on them... How are they looking?
Are they firm?
Is there mould growing on them?
You gotta be a certain breed of person
to be able to do this.
At first, Id be like, "Ooh,"
but eventually you get used to it.
Im Kelsy, Im 32
and I live in Costa Mesa, California.
We perform a procurement
on each donor that comes in,
which entails us dissecting
different specimens from each donor.
We get to dissect the brain,
take certain parts of the brain,
internal organs, or taking
veins and arteries,
different parts of the eye...
The job itself can still be pretty taboo.
I mean, even when I first came here,
I wasnt exactly sure what they did.
I knew they recovered tissue,
but I didnt know like
to the extreme of like
really recovering almost everything.
[Vinette] Our donor was processed here,
in preparation for her final trip.
Her left arm was removed for cremation,
and its ashes returned to her
family in California.
The rest of her body was frozen,
placed in a body bag,
boxed and labelled for
transportation to London.
From here, she made her last car journey
through the streets of California.
She was loaded into the hold of a plane
and carried 5,000 miles from her home.
And finally she arrived in London.
Her body remained in a cool chamber
for ten days
to allow it to thaw completely
before it
was brought to the post-mortem table.
The first stage of every post-mortem,
before any cut is made to the flesh,
is an external examination of the body.
The donors ID number is confirmed
against her medical record,
which details the cause of her death,
heart disease,
and that shed only had minor surgery
and drank minimal alcohol.
But what will her body go on to reveal
about the way that she died?
[Michael] This lady has died
of heart disease,
which is one of the things that is
associated with obesity.
And interestingly already in this lady,
weve got signs of heart failure,
because if I press here,
particularly on this side,
you can see this dimpling there
and thats because theres youve
got too much fluid,
and thats the side effect
of heart failure.
[Vinette] The other obvious external
damage to our donor
are the blisters on her skin.
They are one of the earliest signs of her
body decomposing after death
and they're particularly noticeable
on larger bodies.
But they're not what Mike and Carla
are focusing on.
The most important thing about this lady
is that the obesity
that shes got is centred on her abdomen.
So this lady is carrying a lot of weight
around her tummy,
that's associated with more
of the complications
than if somebody weighs the same,
but they carry their weight
around the bottom and around the thighs.
So thats less associated
with complications,
thats more associated with complications.
So we can see the distribution of the fats
from the external exam,
but once we actually get inside,
well see more of how that has affected
the inside of her body,
and her internal organs as well.
[Michael] When we open this lady,
there may be other findings
that are less easy to diagnose
before somebody has died,
that wont have killed her,
but are examples of problems
that can get worse and lead to illness
and death in other people.
So we may find some of those, we may not.
[Vinette] To uncover if there are deadly
medical truths
lying beneath the skin,
Carla must first cut open the body.
The incision is a large and deep
single vertical cut,
beginning at the super sternal notch
at the base of the neck
and ending at the top of the pubis.
Its a skill that requires both great
precision and intense concentration
especially performed on someone
with so much fat.
[Carla] So what I can feel
at the moment is an
awful lot of yellow, very sort of greasy,
fatty tissue,
which is quite a thick layer
in a body this size.
I'm reflecting the skin back
from the rib cage here,
and what that means is I am just kind of
loosening it away with the muscle
to give me a bit of room to
manoeuvre within the body.
What we seem to have here
is a breast implant.
This is an incidental find.
Sometimes when we do post-mortems,
its not just about
what were expecting to find,
it's incidental.
There is a very large amount of fat here.
And the reason it makes it so difficult
is it actually is greasy,
it feels very much like butter.
So what Im doing here is just
trying to make sure that my knife
doesnt slip too much on it.
Mike, do you want to come
and take a look at this?
So we can immediately see the amount,
the thickness of fat that is here.
There is a large amount
on the anterior chest wall,
the front of the chest,
but theres also a very large amount
around the abdomen.
The abdominal fat, that is
the most dangerous associated
with the problems of obesity.
Theres quite a lot of fat
around the organs.
Theres fat around in the omentum.
It would appear that this lady is carrying
much of her weight in the abdominal fat,
and possibly around organs as well,
so theres lots of changes which
I think well get a better view of
when weve opened the rest of the body.
Everybody knows what obesity looks
like from the outside,
but unless you do a job like ours,
most people dont see what obesity
looks like inside.
I have done thousands of post-mortems.
It is always a fascinating procedure
even if it is a case where you have seen
lots and lots of similar cases
in the past,
that particular case will be individual
and you will certainly learn from that.
[Vinette] We'll never know exactly why
our donor became so overweight.
The reasons for obesity are multi-layered
and complicated,
a mixture of lifestyle and environment,
biology and psychology.
But now that overweight is the new
normal weight in the UK,
there is a whole new young generation
living with the consequences of obesity.
Fat, you know, fatty, fat bastard,
you know, whatever it might be.
I remember walking past my local pub once
and someone said, "Oh, Fat Bastard,
how are ya?"
It doesnt matter how old you are,
if you are fat,
you are marginalised by society.
Theres a lot of medical contributing
facts to peoples weight
that a lot of people dont realise
and all they see is somebody thats big
and they assume that they eat a lot.
Myself, I suffer from polycystic ovaries
and also under-active thyroids.
So as a child, I was always slim.
I come from a family that is quite slim.
Their build is quite slim.
You know, it was only when I hit puberty
that I started putting on this weight.
I was diagnosed with epilepsy
and the first medication they put me on,
I put on a lot of weight quite quickly.
I lost a lot of self-confidence,
which I think also led to me
putting on more weight.
The emotions and feelings
that I associate with eating
are quite difficult because
I... There is a part of me...
Because I have recovered from binge eating
disorder theres a part of me
that still if I have had a difficult day
wants to go home
and eat a lot of things in one go which
I wouldnt enjoy them, it would just be
because that is what I have done
in the past
and just seems to be something that,
that I have picked up as a way of coping,
which I have now moved away from,
but is still something I'm conscious of
and still occasionally want to go
and do that...
Sometimes, you know, I'm not going to...
I do eat some of the wrong kinds of food
and you know I dont go to the gym
as often as I should.
During my 20s, you know,
I partied a bit. I was going out with
my friends on the weekends, you know,
binge drinking all weekends,
not a good healthy lifestyle,
but at the time, I didnt care.
Food is pretty much central
to our existence.
Mum would always complain that we are
always thinking about our stomachs.
I suffer from a severe lack
of self-discipline.
So when I go to the supermarket,
I will generally walk through the door
and the first thing I will see is the
things on offer, biscuits two for one.
And then I will see the salad.
And its salad. And youve got carrots
and youve got hummus
and youve got Maltesers
and youve got Twirl
and youve got Buttons and Dairy Milk
this and Twix that and it is cheaper
and it is on deal,
so why wouldnt I?
It spirals and it gets out of control...
It's just quite sneaky really the way
that it creeps up on you
if you take your eye off the ball.
[Vinette] The next stage
of our post-mortem
is for Carla to go deeper into the body,
beyond the surface fat,
to get to the organs.
What will we discover from them
about the damage that fat has done?
[Carla] The organs come out in blocks
because they all fit together
in a certain way.
So, for example, with the
cardio-respiratory block,
which is the heart and the lungs,
these are specifically together
and above the diaphragm.
So you have a natural line there
that sort of makes them
into one block or pluck.
So if I remove those
and I give those to the pathologist,
he can then take a look at those organs
while I carry on with the next block.
[Vinette] To get to each block,
Carla must first remove the sternum,
the bony armour that protects
the major organs of the body.
Its not an easy job,
requiring skill perfected over years,
and a bit of brute force.
So Im going to take my rib shears,
we use these specifically for this job
as they can cut through bone.
And what Im going to do
is just make some very even cuts
right through all of these bones.
You can hear the bones are snapping.
This lady isn't exactly young.
The older people get, the more calcified
their bones become,
so they become very, very crunchy, whereas
younger people tend to have
much more soft bones.
In order to do this job, you have to be
strong of stomach to start with,
but thats something you either
know or you dont.
I never would have considered
doing this job if I didnt know
I had a strong stomach.
I'm now removing the breast bone
or the breast plate, or sternum,
with upward strokes and this way I
dont damage any of the pericardium,
which is the sack that keeps
the heart safe.
The first time I saw somebody
doing a post-mortem
I think I was just absolutely rapt,
I was fascinated and it is because
the human body is an incredibly
complex machine.
To open a human being, to see all of that
absolutely perfect jigsaw of organs
perfectly in place,
it really did make me feel very awed.
When you do an autopsy on
somebody whos very slim,
the organs are there
and theyre very evident.
Its like a game of Operation or like
one of those anatomical models
that you would use at school.
In a woman this size, a lot of it is
really hidden by this extra yellow fat,
it is making it quite difficult
to see the structures,
much more difficult than it would
if she was a thinner person.
[Vinette] Before Carla removes
the heart and lungs,
Mike wants to take a look at the organs
while theyre still in the body
to see if well discover any early
indications of trauma or damage.
You can see the heart here.
Theres a large amount of fat
around the heart.
Theres more here than you
would see normally,
quite considerably more.
Underneath the heart and lungs,
in this area here,
is what you call the diaphragm,
thats a big muscle
that helps you breathe.
[Carla] Even the diaphragm seems
very fatty to me.
Even on the surface where the heart fat
and the diaphragm are meeting,
there is more fat than usual.
And actually the thing that you can
see most is an extremely enlarged liver.
This is very, very large, and its got
what we call fatty liver change.
So this is a fatty liver.
And a fatty liver is very much associated
with obesity.
You can see, theres a lot of fat
around these organs,
so what would be between my hands now
would be the kidneys.
Now the kidneys always have
fat around them.
I think its important while we are
talking about the fat to realise
fat is a normal thing.
Everybody has fat in them. However
thin you are, there will be some fat
and fat has got very, very important roles
and one of those roles
is to protect things.
Its the too much fat that is the problem.
Fat is made up of cells called adipocytes,
which are fat cells,
and really for a long, long time
until very recently, people thought that
fat was just an inert substance
that just sort of sat there and
didnt really do anything,
but its becoming increasingly
understood now
that fat is actually a very
active substance.
Fat cells work almost like
an endocrine organ.
People will have heard
of some endocrine organs,
things like the thyroid gland
which is related to how much
energy you have, how cold you are
and so forth, the ovaries,
the testes, so obviously these hormones
related to the ovaries
and the testes define
whether you are going to be a man
or going to be a woman,
so those are the sorts of
activities hormones
have so they are very, very
powerful things.
Now it has become obvious
that the adipocytes, the fat cells,
do play an endocrine-type role
and so have some very powerful effects
that were previously unknown.
[Vinette] Exactly how fat works
and what it does is still far
from completely understood.
But the day-to-day reality of obesity
can be devastating.
I wish I hadnt left it till so late
to start trying to lose weight.
Its not good on your back,
its not good on your knees.
God knows what it is doing inside.
I thought, "All right, okay, Im 30,
lets try to start thinking about
trying to have a baby,"
but with the size that I am, you wont
even get any help with sort of IVF
and things like that because the answer is
you are too big.
I have always felt insecure thinking that
I would perhaps never find love
because I am fat.
Even if it is practical things such as
travelling, going to a fun fair
or going to a theme park and knowing
I have to sit in a seat that is tiny,
things like that and there are so
many things... My wedding day,
preparing for that, preparing my body
for that as to how it would
look in photos, and even social media,
in fact my whole life is surrounded by it.
I have got sleep apnoea because
of my weight
and what that means is when I lie down
to go to sleep at night,
the extra weight on my neck and on my face
actually compresses my airways
so that it stops me breathing properly
and therefore wakes me up.
It was waking me up about every
two minutes throughout the night.
So I wear a machine and it is essentially
a small air pump.
It just keeps pressured air going
into my airways through the night,
so I dont wake myself up so my sleep
is a lot better.
Very glad to have the machine,
but I would have been much gladder
to have not needed it at all.
When I first properly started
thinking of myself as overweight
was when I started looking
at wedding dresses.
It is meant to be a really, really
happy time
and I just felt uncomfortable
and just ugly and disgusting and
I didnt want to be there.
The woman said that they were going
to have to order me a size 20
and I thought it was going to
be like a size 16
and I was just absolutely out of my mind.
I had no idea I had got that big.
It was really, really awful.
I think I cried most of that night.
I was angry at myself to have got so big
and not have noticed. I just felt stupid.
[Vinette] The next stage
of the post-mortem
is the dissection of the heart and lungs.
For Mike to be able to do this,
Carla needs to remove the
cardio-respiratory block from the body.
I'm cutting through the diaphragm here
just to make sure that Ive freed
the lungs completely.
Free them along the spine here.
Im going to do the exact same thing
on the other side.
And then chop across the oesophagus
and the trachea here
and then all I need to do is basically
pull the organs towards me
at the same time as releasing
these sort of
white fibrous tissues that are holding
the organs to the spine,
and then well get to a point
where this block, the cardio-respiratory
block, is completely free.
And then we can take this out as one block
and weve got the heart and the lungs
and the heart sack, the pericardium.
When you initially carry out a post-mortem
and you hold an organ such as the heart
in your hands,
and the heart is very symbolic,
you know, we use it in all sorts of logos.
It has a sort of power
and a sort of agency
that makes you kind of stop and think.
Because it looks so mundane,
but then you realise that within it has
the electrical impulses to keep
a person alive.
[Vinette] With the cardio-respiratory
block removed from our donors body,
Mike can start his dissection
of her lungs.
Will we uncover any evidence of damage
linked to her obesity?
I am going to detach the lungs
from the heart,
so well start off with the right lung,
so just cutting through
where the lung is attached,
and thats the right lung detached.
This is the left lung
Im detaching there.
Im just going to make some cuts
across the lung
just to see what the surface
of the lung looks like.
These lungs actually look quite healthy,
theres no tumours or masses or anything
like that in these lungs.
What there does seem to be,
and which should be evident now
if I pick this lung up and squeeze it,
is you can see the fluid dripping out
of these lungs
and this is what we call pulmonary oedema,
that's essentially heart failure fluid,
this fluid is basically water.
I know it looks red,
thats because obviously it's within the
body and it's been mixed with blood.
This isnt... Blood is much, much
thicker than that.
This is really just a watery fluid,
and this has collected because
this lady has got heart failure.
This lady died from heart failure,
from hypertensive heart disease,
but this lady is also obese.
She did not die from the obesity.
The obesity increased the risk factors
and was associated with the problems
that led to her death.
Fluid has built up in this ladys lungs
because her heart isnt working properly.
Shed have probably been short of breath
and possibly had a cough.
But also because the fluid sits
in the chest when you lie flat,
and that would have given her a sensation
almost of drowning.
When you become a doctor,
one of the questions that they teach you
very early on is, how many pillows
do you sleep with?
And that tends not to because they are
asking how comfortable you are at night,
its because if somebody says, "Oh,
I cant sleep in a bed, Doctor,
I have to sleep in a chair or I have to
sleep with eight pillows sitting up,"
that is very indicative of heart failure.
[Vinette] From the startling discovery
Mike has made in our donor's lungs,
we now know that she would have
felt the impact of her obesity
and heart failure every single day.
[Michael] Heart failure is not the same
as a heart attack.
When a heart fails, it doesnt fail
immediately in this type of circumstance.
It fails over a long period of time,
so the symptoms are gradual,
so this lady may have been able to walk
up ten flights of stairs
three years ago,
then she suddenly found she got very
breathless after five flights of stairs,
then she found it very, very difficult to
even walk up one flight of stairs
or even carry her shopping.
It would have been a progressive disease
as the heart became worse and worse
and worse. Now the final event, obviously,
when this ladys heart stopped working,
that would have been
an instantaneous event
that led to her death.
[Vinette] Now its time for Mike
to examine
in detail the organ that catastrophically
failed in our donor.
What will we find out about how
and why she might have died?
You cant really see the heart yet because
the heart is sitting in a bag.
This is called the pericardial sack.
Just going to open that.
And so I can reflect that back,
and thats the heart there,
so the heart now is in my hand
and you can see all the fat
I was talking about earlier
really isnt around the heart,
it's really around the pericardium.
There is a bit of fat around the heart,
which is here,
this is absolutely typical
in everybodys heart,
even a thin persons heart
would have this,
and Im going to cut off
the pericardial sack.
This big blood vessel here is the aorta.
This is the vessel that takes all the
blood from the heart around the body.
When I feel this heart, it feels baggy.
The heart in somebody
who is very athletic,
their heart would be very tight,
very firm,
it would be like almost picking up a
piece of steak. This is more like a bag.
What Im going to do now
is weigh this heart.
So this heart is
449 grams.
That's a heavy heart. This lady
is, despite her weight,
this lady is actually
quite a petite person.
So you would expect her heart
to be perhaps 275 grams.
Something like that. So this is very
much heavier than you would expect.
And that is the sort of size heart
you would expect
in someone who has got
heart failure
due to high blood pressure
which is what this lady suffered from.
The heart basically has to pump
to keep up the pressure,
the heart gets bigger
and bigger and bigger,
but there becomes a point where
the heart cant get any bigger
and it basically exhausts itself.
[Vinette] Now that he has discovered
the shocking state of our donor's heart,
Mike wants to look at it from the inside.
He cuts some slices so he can
examine the ventricles, the walls
of the heart that pump the blood.
If youre a 6'8" All Black second row,
you're, you know,
one of the professional footballers
running around the pitch,
you need a lot of blood,
so the wall of the left ventricle
in a young, fit person,
is usually an inch-thick muscle
all the way around.
Now if you look at this lady,
this ladys left ventricle
is very, very thin. This is eight
millimetres, something like that.
That is because she developed high blood
pressure to start off with,
the heart had to pump harder and harder,
but in the end, what you get to is a state
where the muscle cant keep
the high blood pressure up
and it starts to get thinner and
thinner and thinner and basically
you go from a thick muscular pump
through to a paper bag that's not capable
of pumping blood adequately
around the body. And we see
a lot of these hearts.
We see them on a background
of hypertension.
This is a common finding and
becoming more common.
Hypertension is high blood pressure.
Obesity is well known to be one
of the major risk factors
for high blood pressure,
so in this lady
they were not able to control that
and that led to changes within the heart
which meant the heart failed,
it couldnt work properly
and that is what this lady died from.
[Vinette] Obesity is a killer.
Not by itself,
but in the many ways that it triggers
and accelerates disease.
But so much of the way that we think about
fat isn't medical at all, it's personal.
I have been fat all my life
and its never been a positive
thing for me.
Ive always associated it with something
negative to be honest.
I feel like fat is a filter
through which I'm seen because
there are certain stereotypes
that go alongside being fat,
being overweight,
that maybe people who are overweight
are lazy or not very clever.
I dont know where those have come from,
but I feel like I have to try extra hard
to prove those things wrong.
I don't think I necessarily would
associate my fat with being invited
to get together with friends or going out,
but, you know, if they were going to
play a game of football or rugby,
they might think twice.
Socially, in terms of relationships,
definitely has.
I mean, you go into a bar and you look
like a GQ cover model versus me,
the girl is always going to go
for the GQ cover model,
sadly, and try as I might
to be the funny fat guy.
You try to build this wall,
this wall that, you know,
you just sort of try to ignore it,
and from strangers you can because
you think, well, they dont know me,
but when somebody who is supposed
to love you and
somebody who supposed to care for you
and accept you for who you are,
when they call you fat, just to...
The feeling is just horrible.
Its not a nice feeling at all.
It makes you feel really low, sad, alone.
[Vinette] The next block of organs
to be removed
are the organs of the digestive system
called the coeliac block.
What I'm trying to do here is make sure
that I've got the stomach
and the lower bowel and the liver and
the spleen all together in one block
for Mike to take a look at,
and not to damage the kidneys,
but at this point, I dont think I am
going to be able to damage them anyway
because they are so surrounded
by such a large envelope of fat.
So we have got some faecal matter,
we have got some bile,
and then obviously a lot of blood.
The blood is mixed in with the fat
which is yellow, so that is giving us
some orangey fluids.
It is a multi-sensory rainbow
at the moment.
Every single thing that is in each of
these blocks is incredibly important,
and, you know, does amazing jobs
for our body.
Its just a case of... It's not very
pleasant once they have stopped working
and they have started to decompose
a little bit.
[Vinette] To completely free the organs,
Carla needs to cut through
the fibrous membrane
that holds them to the spine
at the back of the body.
So this is a huge coeliac block.
It is incredibly heavy and the liver,
as you can see, is taking up most of it.
You can just see the spleen there
and also the stomach
and a bit of the small bowel
is attached as well.
When I first encountered
a deceased person,
I think what really struck me
was just the stillness and the cold
because, of course, I had never,
at that point, felt flesh
that was so cold and it gave me
a real kind of sensation
of kind of dipping my toe
into very cold water.
And then once I had done it,
that feeling had never quite left.
It was like this other subterranean world.
[Vinette] In the next stage
of the post-mortem,
will we find any evidence of fat damage
in the organs of our donors
digestive system?
This is the organs that include the liver,
the spleen, the stomach and the pancreas.
Now this is much heavier than I would
expect it to be in a smaller individual.
Largely because the liver is so big.
[Vinette] First, Mike is going
to take a look at the organ
that most people associate with obesity.
This is the stomach.
Basically, just like a bag that holds the
food before the food goes through
into the bowel
where it is actually digested
and there are actually many
of the treatments associated
with obesity deal with the stomach
and what they try and do is reduce
the size of the stomach
so that people have a feeling
of being satisfied
from eating without eating so much.
There is a whole variety, gastric bands
fit around the stomach,
there is various bypass operations
and so forth.
The stomach is very good at dilating,
so if this lady had had
a very large meal before she died
and had not had opportunity to digest it,
the stomach would be much more obvious.
But this is a fairly typical
sized stomach.
[Vinette] Next Mike
will dissect the liver,
the organ he discovered showing
such dramatic change
when he saw it in the open body.
But what will it reveal to us
about the consequences of fat
building up where it shouldnt?
The first thing I saw
when we opened the abdomen
was the size of this liver and the fact
that this liver showed marked
fatty change.
I am going to make some slices
through the liver
just so I can see what the cut surface
of the liver looks like.
I am using a sponge so I dont cut myself.
So I have made some cuts across the liver
there, and you can see
that the surface of the liver
is this sort of pinky colour.
That is very characteristic of fatty liver
change. It is very soft.
It almost feels like pate in consistency.
Normal liver is quite soft,
but not as soft as this
and it has a much meatier,
much redder, bloody colour, dark red.
The lightness in this is caused
by the fat within the liver
and the fat is deposited
within the hepatocytes,
which are the liver cells,
and this fat would obviously
be pale in colour and the liver cells
themselves are
dark so the combination of the two gives
you this light sort of pink colour.
That's much, much lighter colour than
you would expect a normal liver to be.
That is a classic sign of fatty liver
disease and is becoming a major problem
and is one of the major reasons
for a liver transplant in the world.
The most common cause of fatty liver
at the moment is alcohol-related
fatty liver, but we know that this lady
drunk almost nothing,
so it is very unlikely that this change
is due to alcohol consumption.
It is almost certainly
an obesity-related change.
Fatty liver causes damage to the liver.
It can lead on to cirrhosis,
it can actually lead on to cancer as well.
But even if people do not develop
cancer or,
it can lead to liver failure, so there is
multiple ways it can lead to the death
of a patient. It didnt lead
to the death of this lady
really because her heart was
itself so bad,
but this is very dramatic change
within this liver.
[Vinette] Before the post-mortem,
we could never have known how dramatically
damaged our donors liver would be,
or that she'd be carrying a
second life-threatening disease.
But excess internal fat
doesnt have to be a death sentence.
The good news is the fight to beat the
dangerous invisible fat can be won.
It is a daily struggle,
but the prize is big.
Now I am trying to lose weight. I have
actually lost three and a half stone.
I am in a weight management clinic,
I get support from a dietician.
I get support through weekly weigh-in's
and I get support from a counsellor
which is really, really handy
to help with your mental frame
of mind as well.
So what I have been doing to lose weight
is cutting out the chocolate,
cutting out the biscuits,
cutting out the crisps,
all that sort stuff.
I am not perfect.
I still have the take aways,
I still have cheeky bar of chocolate,
but, you know, I have also been
exercising a lot more
and really pushing myself to exercise,
really pushing myself to get to the gym.
[Ben] Tons of activity. I struggle.
I try and get in an hour of walking a day,
but I dont always manage it.
Just walking around the park half a dozen
times doesnt really do it for me.
You know, I dont like running and
I have a problem with my knees.
To start jogging around a park is not only
just a physically difficult thing,
but it is an emotionally
difficult thing to do.
To get out there in running gear
for all the world to see
some parts of your body jiggling
that you just dont want
them to see sadly.
I have had gym memberships up the wazoo.
Ive done detoxes for 22 days,
just drinking lemon juice, cayenne pepper,
water and a bit of maple syrup.
Its disgusting, I can tell you.
I have tried a lot and I will
probably end up trying more,
but I think slowly getting better
and making better choices
is really where it is all about.
[Meg] My motivation to now
tackle my weight and to try and
reach a healthier weight
is because I have now recovered
from my binge-eating disorder.
It is a shame that it had to get this bad
for me, you know, to get to this point,
but I did need to access that
psychological health first in my case
You know, I have now seen the limits that
being overweight has put on my life
and I want to reverse those
and get back out there and
just live life to the full.
[Chanel] I am quite conscious these days
of what I eat.
I do go to the gym.
I do what I can to lose weight
or at least maintain it even if
I cant lose it drastically.
[photographer] Okay,
turn a little bit.
I am a plus-size style beauty
and lifestyle blogger.
People do get inspired
by those sort of things
so I think it is quite useful for me
to kind of get out there.
It actually helps me boost my confidence.
-Perfect. Yep.
-[shutter clicks]
Exercise is not my best friend.
Its quite a chore for me in a sense.
But I feel that in life with a lot
of things, youve just go to,
you know, make the effort to do things
that you dont necessarily love.
[Joey] In January,
I decided to join a running club
called Too Fat to Run and it was really,
really scary at first.
I went out and I ran for like ten minutes,
which doesnt sound long,
but when you havent run
and then you suddenly you can run
for ten minutes, you are like,
"Oh, crap, I can do that.
That was kind of cool."
Then I did my first 5K race.
Finishing a race feels
so much better than...
I dont know, it sounds really, really
cheesy, but it feels so much better
than finishing a pack of crisps.
Every race I do, I cant believe
that I have finished it.
[Vinette] Next, Carla will remove
the final group of organs.
But even in the last stages
of the post-mortem,
she takes nothing for granted.
People who donate their bodies to
medical science really are giving a gift.
It is the gift that keeps on
giving actually,
because as a patient I think we all would
prefer that our doctors and our surgeons
have learned on something realistic
to their job
before they are let loose
on a human patient.
You wouldnt really let a mechanic
take care of your car
if he had never touched an engine.
And it is very much
the same thing with this.
Real bodies are very unpredictable
and very chaotic
compared to anything fake, you know,
anything like virtual reality
or a fake cadaver.
Because if you look here, what
you should be able to see are the kidneys.
Granted, they always have
a tiny capsule of fat around them,
a bit like a sort of edamame
bean that you can pop out.
But these fatty capsules are
very, very large,
so all you can really see at this point is
a kind of yellow glistening mess.
So this again is indicative of the fact
that she has an awful lot of extra fat
around her organs.
So I am just slicing through the
fibrous tissues and the bits of muscle
that are keeping the kidneys attached
to the spine.
And it is really exactly the same thing
as I have been doing
with the rest of the organs
and that is releasing them from the spine
which is what anchors them in place
and then I can just reflect them all
the way down and pull them out
and this is the genito-urinary block.
And this is at least slightly smaller,
slightly easier to manage
because you have only got
the kidneys in this...
There is so much fat. It's just...
[Vinette] Mike needs to dissect the
kidneys to find out just how much damage
has been caused by all that excess fat.
[Mike] This is the right kidney,
this is the left kidney
and this in the middle is the big
blood vessel that carries blood
all the way down the body
and the most important and the
first thing I can see is,
theres an unusual amount of fat
around these kidneys.
Now the kidneys always
have fat around them.
The kidneys they are
not protected by bone,
which means that they can be bashed
and they can be hit
if you walk into something or something
hits you, so this fat protects them,
but this lady has much, much more fat
than I would expect.
What I am going to do first
is just cut through this fat,
which is called the perirenal fat.
And you can see quite clearly how
much fat there really is.
In a thin person, this would probably be
a half or a third as thick as
I can see here.
This is bad news for this lady,
as it means that she is more likely
to have the complications of obesity
because of the way
she is carrying the fat.
This pale area here is the kidney.
I am just going to cut into the kidney.
So the kidney has got a thick capsule
around it.
Now there is a small amount
of fat in the middle of the kidney
that is completely normal. That is where
basically the kidney is responsible for
filtering your blood and making the urine.
That urine has to go somewhere
so your kidneys got a funnel
that collects all the urine
from all the bits of the kidney,
takes it down through your urethra
into the bladder
and then when you want to go to the loo,
it goes out.
So this bit of fat sits around that
funnel area and is quite normal.
I am going to take the thick capsule
off of the kidney surface
to see what the surface of the kidney
looks like.
The surface of the kidney ideally
should be very, very smooth.
This kidney has got some
scarring on the surface.
Theres areas of indentation
and pock marking
and there is clear damage to this kidney
which would be associated
with high blood pressure.
And we know this lady had high
blood pressure,
which is what led to the changes within
her heart and which led to her death.
[Vinette] The visible scarring
and pock marking
weve discovered on our donors kidneys
are the last of the revelations
she will yield
before Carla completes the post-mortem
and closes the body forever.
When Mike has finished his examination,
I then begin the reconstruction
and in a way that is one of the most
important parts of the post-mortem.
What I do is place all of the organs
into a special viscera bag,
which will contain all of the elements
that we have removed
in the different blocks
and I place that into the body cavity.
And then I use very heavy post-mortem
twine to stitch as neatly as I can
right along the incision that I made and
we describe this as a baseball stitch.
It does look very much
like a zig-zaggy stitch.
[Vinette] Each post-mortem is unique
and everything they reveal valuable.
This donors gift was an opportunity
for Mike and Carla
to unveil the shocking truths
hidden inside one body
irreversibly damaged by too much fat.
The evisceration occurred
and it wasnt as easy to do
as it would be with a slightly
smaller patient.
It takes a lot more strength to cut
through this yellow adipose tissue,
which kind of blooms out of the abdomen
in this practically neon yellow
and it looks very much like butter
and it has a greasy feel
and it makes you suddenly very aware
of the fat in your own body.
Well, it made me aware
of the fat in my own body
and the effect that might have
on my organs,
the strain it might put on my heart.
The way it may affect my liver.
I think that doing a post-mortem such
as this is a really fantastic way
for people to consider their own health
and their own mortality.
[Mike] We never really know
what we are going to find
when we examine the patient.
The first thing I noticed
when the body had been opened
was the markedly fatty liver.
I know from the history that was provided
that this lady died from heart failure,
but the findings in her heart
are extremely marked
and the severity of them actually
surprises me.
But before we did the post-mortem
there was no indication
that this lady had a fatty liver
and it is a possibility that
even if this lady
had not developed heart failure,
that she may have gone on to
develop liver failure due to the
fatty change within the liver.
[Vinette] We already knew a little about
the way this woman lived and how she died.
What we couldnt have known before
the post-mortem
was the extent to which obesity
would have ravaged her internal organs.
From the suffocating fluid in her lungs,
to her scarred kidneys,
creating a potent mix of life-threatening
obesity-related disease.
[Jodie] I know that health-wise
being obese and being large
it just isnt good so
if I can do this documentary to help other
people to see what it is doing to them
internally for them to motivate
their self
so that they can lose the weight so that
maybe they can have a child
or maybe they can live
a little bit longer,
a little bit happier, that is why I am
doing this to help people.
It is fine to have
like, politicians like a health secretary
or whoever or like, doctors on TV saying,
"I want you to eat less and move
more" kind of thing,
but until you can actually
relate that to yourself,
then you can say, "Oh, well, that's not
me. That's not going to happen to me."
I think a post-mortem
of someone with obesity
is going to be quite shocking
for a lot of people,
who maybe think they can deal with it,
and I have been there,
I have been there as well.
"Deal with it tomorrow.
I am all right right now.
Its not affecting...
I dont need a machine to sleep,
I can get around fine," you know,
and just putting off those choices
until tomorrow.
Time goes by so quickly
and its really important to think about
what is going on inside you now
and where that might actually end up,
where you could end up.
[Vinette] Obesity is an epidemic
happening right here
in the UK right now.
Honestly, the first thing
I'd say is that Im a big girl.
How my friends would describe me
would be large, fat probably.
I dont like to use the word fat.
But at the end of the day,
that is what I have inside me.
I have a large amount of extra fat.
[Vinette] We all know what fat
looks like on the outside.
[Chanel] I think of cellulite,
rolls, big thighs,
big arms.
If youre Kim Kardashian,
you can have a really fat arse.
Ive got a fat stomach,
shes got a fat arse.
[Vinette] But what if we could see
what fat looks like from the inside?
Do we have any idea of the damage
obesity is doing under our skin?
When you say to somebody,
well, it is affecting your health,
you know, show me, I cant see inside,
I cant see what is happening inside me.
[Vinette] BBC3 has secured the first
televised access to a full post-mortem
on an obese person whose body
was donated to medical science.
This summer, our pathology team assembled
to reveal, from the inside,
the dangers of us all getting too fat.
Post-mortems are tightly controlled
and access to them is strictly limited
to protect the privacy and dignity
of the deceased.
Filming is not usually allowed.
But for this post-mortem
we have been allowed in
to help understand a problem
that costs the nation billions and
ruins so many lives. Obesity.
Carla Valentine and Dr Mike Osborn
are the specialist team responsible
for carrying out the post-mortem.
Carla is an Anatomical
Pathology Technologist
and Technical Curator
of the Pathology Museum
at Londons Queen Mary University.
For this post-mortem,
I will be carrying out the evisceration,
which means removing all of the organs.
Being part of a filmed post-mortem
is a very unique opportunity.
Death terrifies some people,
but what it also does is it
eventually gives you a real sense
of the fragility of life.
The topic of obesity is a huge problem,
and its something that I get
to see quite a lot,
but its not something
I get to study in depth.
[Vinette] Mike is
a Consultant Pathologist
and Fellow of the
Royal College of Pathologists.
Hes been working with death and disease
for over 20 years.
Obesity is very much there,
it's seen, but I think its
very, very poorly understood.
It seemed that making this film
would be a way of exploring that
and allowing a broader public
to learn about the problems
that are associated with obesity.
[Vinette] Carla and Mike have performed
thousands of post-mortems,
but always behind closed doors.
Today, well witness what
really happens in an autopsy
and discover what the body of our donor
can tell us about the creeping effects
of obesity over time.
We dont know this woman's name,
but we do know a few details about her.
She was in her early 60s.
5'5". Almost 17 stone.
And, just like a quarter of people
in the UK, clinically obese.
But where did she come from?
And how did she end up here
on a post-mortem table in London?
Long Beach, on the West Coast
of the United States.
Glamorous, sunny, carefree California.
But away from the beach,
on an anonymous industrial estate
on the outskirts of the city,
is where our donor began her journey
to the post-mortem table.
This is a place where people
who donate their body
to essential medical science
are brought when they die.
Up to 20 donated bodies, or cadavers,
a day come through these doors
destined for thousands of medical research
projects all over the world.
[Randall] My name is Randall Delgado.
Im 29. My main role now
would be in charge of distribution.
Some days, you know, we have an order
for cadavers going to Lebanon
and so then we have to start checking
on them... How are they looking?
Are they firm?
Is there mould growing on them?
You gotta be a certain breed of person
to be able to do this.
At first, Id be like, "Ooh,"
but eventually you get used to it.
Im Kelsy, Im 32
and I live in Costa Mesa, California.
We perform a procurement
on each donor that comes in,
which entails us dissecting
different specimens from each donor.
We get to dissect the brain,
take certain parts of the brain,
internal organs, or taking
veins and arteries,
different parts of the eye...
The job itself can still be pretty taboo.
I mean, even when I first came here,
I wasnt exactly sure what they did.
I knew they recovered tissue,
but I didnt know like
to the extreme of like
really recovering almost everything.
[Vinette] Our donor was processed here,
in preparation for her final trip.
Her left arm was removed for cremation,
and its ashes returned to her
family in California.
The rest of her body was frozen,
placed in a body bag,
boxed and labelled for
transportation to London.
From here, she made her last car journey
through the streets of California.
She was loaded into the hold of a plane
and carried 5,000 miles from her home.
And finally she arrived in London.
Her body remained in a cool chamber
for ten days
to allow it to thaw completely
before it
was brought to the post-mortem table.
The first stage of every post-mortem,
before any cut is made to the flesh,
is an external examination of the body.
The donors ID number is confirmed
against her medical record,
which details the cause of her death,
heart disease,
and that shed only had minor surgery
and drank minimal alcohol.
But what will her body go on to reveal
about the way that she died?
[Michael] This lady has died
of heart disease,
which is one of the things that is
associated with obesity.
And interestingly already in this lady,
weve got signs of heart failure,
because if I press here,
particularly on this side,
you can see this dimpling there
and thats because theres youve
got too much fluid,
and thats the side effect
of heart failure.
[Vinette] The other obvious external
damage to our donor
are the blisters on her skin.
They are one of the earliest signs of her
body decomposing after death
and they're particularly noticeable
on larger bodies.
But they're not what Mike and Carla
are focusing on.
The most important thing about this lady
is that the obesity
that shes got is centred on her abdomen.
So this lady is carrying a lot of weight
around her tummy,
that's associated with more
of the complications
than if somebody weighs the same,
but they carry their weight
around the bottom and around the thighs.
So thats less associated
with complications,
thats more associated with complications.
So we can see the distribution of the fats
from the external exam,
but once we actually get inside,
well see more of how that has affected
the inside of her body,
and her internal organs as well.
[Michael] When we open this lady,
there may be other findings
that are less easy to diagnose
before somebody has died,
that wont have killed her,
but are examples of problems
that can get worse and lead to illness
and death in other people.
So we may find some of those, we may not.
[Vinette] To uncover if there are deadly
medical truths
lying beneath the skin,
Carla must first cut open the body.
The incision is a large and deep
single vertical cut,
beginning at the super sternal notch
at the base of the neck
and ending at the top of the pubis.
Its a skill that requires both great
precision and intense concentration
especially performed on someone
with so much fat.
[Carla] So what I can feel
at the moment is an
awful lot of yellow, very sort of greasy,
fatty tissue,
which is quite a thick layer
in a body this size.
I'm reflecting the skin back
from the rib cage here,
and what that means is I am just kind of
loosening it away with the muscle
to give me a bit of room to
manoeuvre within the body.
What we seem to have here
is a breast implant.
This is an incidental find.
Sometimes when we do post-mortems,
its not just about
what were expecting to find,
it's incidental.
There is a very large amount of fat here.
And the reason it makes it so difficult
is it actually is greasy,
it feels very much like butter.
So what Im doing here is just
trying to make sure that my knife
doesnt slip too much on it.
Mike, do you want to come
and take a look at this?
So we can immediately see the amount,
the thickness of fat that is here.
There is a large amount
on the anterior chest wall,
the front of the chest,
but theres also a very large amount
around the abdomen.
The abdominal fat, that is
the most dangerous associated
with the problems of obesity.
Theres quite a lot of fat
around the organs.
Theres fat around in the omentum.
It would appear that this lady is carrying
much of her weight in the abdominal fat,
and possibly around organs as well,
so theres lots of changes which
I think well get a better view of
when weve opened the rest of the body.
Everybody knows what obesity looks
like from the outside,
but unless you do a job like ours,
most people dont see what obesity
looks like inside.
I have done thousands of post-mortems.
It is always a fascinating procedure
even if it is a case where you have seen
lots and lots of similar cases
in the past,
that particular case will be individual
and you will certainly learn from that.
[Vinette] We'll never know exactly why
our donor became so overweight.
The reasons for obesity are multi-layered
and complicated,
a mixture of lifestyle and environment,
biology and psychology.
But now that overweight is the new
normal weight in the UK,
there is a whole new young generation
living with the consequences of obesity.
Fat, you know, fatty, fat bastard,
you know, whatever it might be.
I remember walking past my local pub once
and someone said, "Oh, Fat Bastard,
how are ya?"
It doesnt matter how old you are,
if you are fat,
you are marginalised by society.
Theres a lot of medical contributing
facts to peoples weight
that a lot of people dont realise
and all they see is somebody thats big
and they assume that they eat a lot.
Myself, I suffer from polycystic ovaries
and also under-active thyroids.
So as a child, I was always slim.
I come from a family that is quite slim.
Their build is quite slim.
You know, it was only when I hit puberty
that I started putting on this weight.
I was diagnosed with epilepsy
and the first medication they put me on,
I put on a lot of weight quite quickly.
I lost a lot of self-confidence,
which I think also led to me
putting on more weight.
The emotions and feelings
that I associate with eating
are quite difficult because
I... There is a part of me...
Because I have recovered from binge eating
disorder theres a part of me
that still if I have had a difficult day
wants to go home
and eat a lot of things in one go which
I wouldnt enjoy them, it would just be
because that is what I have done
in the past
and just seems to be something that,
that I have picked up as a way of coping,
which I have now moved away from,
but is still something I'm conscious of
and still occasionally want to go
and do that...
Sometimes, you know, I'm not going to...
I do eat some of the wrong kinds of food
and you know I dont go to the gym
as often as I should.
During my 20s, you know,
I partied a bit. I was going out with
my friends on the weekends, you know,
binge drinking all weekends,
not a good healthy lifestyle,
but at the time, I didnt care.
Food is pretty much central
to our existence.
Mum would always complain that we are
always thinking about our stomachs.
I suffer from a severe lack
of self-discipline.
So when I go to the supermarket,
I will generally walk through the door
and the first thing I will see is the
things on offer, biscuits two for one.
And then I will see the salad.
And its salad. And youve got carrots
and youve got hummus
and youve got Maltesers
and youve got Twirl
and youve got Buttons and Dairy Milk
this and Twix that and it is cheaper
and it is on deal,
so why wouldnt I?
It spirals and it gets out of control...
It's just quite sneaky really the way
that it creeps up on you
if you take your eye off the ball.
[Vinette] The next stage
of our post-mortem
is for Carla to go deeper into the body,
beyond the surface fat,
to get to the organs.
What will we discover from them
about the damage that fat has done?
[Carla] The organs come out in blocks
because they all fit together
in a certain way.
So, for example, with the
cardio-respiratory block,
which is the heart and the lungs,
these are specifically together
and above the diaphragm.
So you have a natural line there
that sort of makes them
into one block or pluck.
So if I remove those
and I give those to the pathologist,
he can then take a look at those organs
while I carry on with the next block.
[Vinette] To get to each block,
Carla must first remove the sternum,
the bony armour that protects
the major organs of the body.
Its not an easy job,
requiring skill perfected over years,
and a bit of brute force.
So Im going to take my rib shears,
we use these specifically for this job
as they can cut through bone.
And what Im going to do
is just make some very even cuts
right through all of these bones.
You can hear the bones are snapping.
This lady isn't exactly young.
The older people get, the more calcified
their bones become,
so they become very, very crunchy, whereas
younger people tend to have
much more soft bones.
In order to do this job, you have to be
strong of stomach to start with,
but thats something you either
know or you dont.
I never would have considered
doing this job if I didnt know
I had a strong stomach.
I'm now removing the breast bone
or the breast plate, or sternum,
with upward strokes and this way I
dont damage any of the pericardium,
which is the sack that keeps
the heart safe.
The first time I saw somebody
doing a post-mortem
I think I was just absolutely rapt,
I was fascinated and it is because
the human body is an incredibly
complex machine.
To open a human being, to see all of that
absolutely perfect jigsaw of organs
perfectly in place,
it really did make me feel very awed.
When you do an autopsy on
somebody whos very slim,
the organs are there
and theyre very evident.
Its like a game of Operation or like
one of those anatomical models
that you would use at school.
In a woman this size, a lot of it is
really hidden by this extra yellow fat,
it is making it quite difficult
to see the structures,
much more difficult than it would
if she was a thinner person.
[Vinette] Before Carla removes
the heart and lungs,
Mike wants to take a look at the organs
while theyre still in the body
to see if well discover any early
indications of trauma or damage.
You can see the heart here.
Theres a large amount of fat
around the heart.
Theres more here than you
would see normally,
quite considerably more.
Underneath the heart and lungs,
in this area here,
is what you call the diaphragm,
thats a big muscle
that helps you breathe.
[Carla] Even the diaphragm seems
very fatty to me.
Even on the surface where the heart fat
and the diaphragm are meeting,
there is more fat than usual.
And actually the thing that you can
see most is an extremely enlarged liver.
This is very, very large, and its got
what we call fatty liver change.
So this is a fatty liver.
And a fatty liver is very much associated
with obesity.
You can see, theres a lot of fat
around these organs,
so what would be between my hands now
would be the kidneys.
Now the kidneys always have
fat around them.
I think its important while we are
talking about the fat to realise
fat is a normal thing.
Everybody has fat in them. However
thin you are, there will be some fat
and fat has got very, very important roles
and one of those roles
is to protect things.
Its the too much fat that is the problem.
Fat is made up of cells called adipocytes,
which are fat cells,
and really for a long, long time
until very recently, people thought that
fat was just an inert substance
that just sort of sat there and
didnt really do anything,
but its becoming increasingly
understood now
that fat is actually a very
active substance.
Fat cells work almost like
an endocrine organ.
People will have heard
of some endocrine organs,
things like the thyroid gland
which is related to how much
energy you have, how cold you are
and so forth, the ovaries,
the testes, so obviously these hormones
related to the ovaries
and the testes define
whether you are going to be a man
or going to be a woman,
so those are the sorts of
activities hormones
have so they are very, very
powerful things.
Now it has become obvious
that the adipocytes, the fat cells,
do play an endocrine-type role
and so have some very powerful effects
that were previously unknown.
[Vinette] Exactly how fat works
and what it does is still far
from completely understood.
But the day-to-day reality of obesity
can be devastating.
I wish I hadnt left it till so late
to start trying to lose weight.
Its not good on your back,
its not good on your knees.
God knows what it is doing inside.
I thought, "All right, okay, Im 30,
lets try to start thinking about
trying to have a baby,"
but with the size that I am, you wont
even get any help with sort of IVF
and things like that because the answer is
you are too big.
I have always felt insecure thinking that
I would perhaps never find love
because I am fat.
Even if it is practical things such as
travelling, going to a fun fair
or going to a theme park and knowing
I have to sit in a seat that is tiny,
things like that and there are so
many things... My wedding day,
preparing for that, preparing my body
for that as to how it would
look in photos, and even social media,
in fact my whole life is surrounded by it.
I have got sleep apnoea because
of my weight
and what that means is when I lie down
to go to sleep at night,
the extra weight on my neck and on my face
actually compresses my airways
so that it stops me breathing properly
and therefore wakes me up.
It was waking me up about every
two minutes throughout the night.
So I wear a machine and it is essentially
a small air pump.
It just keeps pressured air going
into my airways through the night,
so I dont wake myself up so my sleep
is a lot better.
Very glad to have the machine,
but I would have been much gladder
to have not needed it at all.
When I first properly started
thinking of myself as overweight
was when I started looking
at wedding dresses.
It is meant to be a really, really
happy time
and I just felt uncomfortable
and just ugly and disgusting and
I didnt want to be there.
The woman said that they were going
to have to order me a size 20
and I thought it was going to
be like a size 16
and I was just absolutely out of my mind.
I had no idea I had got that big.
It was really, really awful.
I think I cried most of that night.
I was angry at myself to have got so big
and not have noticed. I just felt stupid.
[Vinette] The next stage
of the post-mortem
is the dissection of the heart and lungs.
For Mike to be able to do this,
Carla needs to remove the
cardio-respiratory block from the body.
I'm cutting through the diaphragm here
just to make sure that Ive freed
the lungs completely.
Free them along the spine here.
Im going to do the exact same thing
on the other side.
And then chop across the oesophagus
and the trachea here
and then all I need to do is basically
pull the organs towards me
at the same time as releasing
these sort of
white fibrous tissues that are holding
the organs to the spine,
and then well get to a point
where this block, the cardio-respiratory
block, is completely free.
And then we can take this out as one block
and weve got the heart and the lungs
and the heart sack, the pericardium.
When you initially carry out a post-mortem
and you hold an organ such as the heart
in your hands,
and the heart is very symbolic,
you know, we use it in all sorts of logos.
It has a sort of power
and a sort of agency
that makes you kind of stop and think.
Because it looks so mundane,
but then you realise that within it has
the electrical impulses to keep
a person alive.
[Vinette] With the cardio-respiratory
block removed from our donors body,
Mike can start his dissection
of her lungs.
Will we uncover any evidence of damage
linked to her obesity?
I am going to detach the lungs
from the heart,
so well start off with the right lung,
so just cutting through
where the lung is attached,
and thats the right lung detached.
This is the left lung
Im detaching there.
Im just going to make some cuts
across the lung
just to see what the surface
of the lung looks like.
These lungs actually look quite healthy,
theres no tumours or masses or anything
like that in these lungs.
What there does seem to be,
and which should be evident now
if I pick this lung up and squeeze it,
is you can see the fluid dripping out
of these lungs
and this is what we call pulmonary oedema,
that's essentially heart failure fluid,
this fluid is basically water.
I know it looks red,
thats because obviously it's within the
body and it's been mixed with blood.
This isnt... Blood is much, much
thicker than that.
This is really just a watery fluid,
and this has collected because
this lady has got heart failure.
This lady died from heart failure,
from hypertensive heart disease,
but this lady is also obese.
She did not die from the obesity.
The obesity increased the risk factors
and was associated with the problems
that led to her death.
Fluid has built up in this ladys lungs
because her heart isnt working properly.
Shed have probably been short of breath
and possibly had a cough.
But also because the fluid sits
in the chest when you lie flat,
and that would have given her a sensation
almost of drowning.
When you become a doctor,
one of the questions that they teach you
very early on is, how many pillows
do you sleep with?
And that tends not to because they are
asking how comfortable you are at night,
its because if somebody says, "Oh,
I cant sleep in a bed, Doctor,
I have to sleep in a chair or I have to
sleep with eight pillows sitting up,"
that is very indicative of heart failure.
[Vinette] From the startling discovery
Mike has made in our donor's lungs,
we now know that she would have
felt the impact of her obesity
and heart failure every single day.
[Michael] Heart failure is not the same
as a heart attack.
When a heart fails, it doesnt fail
immediately in this type of circumstance.
It fails over a long period of time,
so the symptoms are gradual,
so this lady may have been able to walk
up ten flights of stairs
three years ago,
then she suddenly found she got very
breathless after five flights of stairs,
then she found it very, very difficult to
even walk up one flight of stairs
or even carry her shopping.
It would have been a progressive disease
as the heart became worse and worse
and worse. Now the final event, obviously,
when this ladys heart stopped working,
that would have been
an instantaneous event
that led to her death.
[Vinette] Now its time for Mike
to examine
in detail the organ that catastrophically
failed in our donor.
What will we find out about how
and why she might have died?
You cant really see the heart yet because
the heart is sitting in a bag.
This is called the pericardial sack.
Just going to open that.
And so I can reflect that back,
and thats the heart there,
so the heart now is in my hand
and you can see all the fat
I was talking about earlier
really isnt around the heart,
it's really around the pericardium.
There is a bit of fat around the heart,
which is here,
this is absolutely typical
in everybodys heart,
even a thin persons heart
would have this,
and Im going to cut off
the pericardial sack.
This big blood vessel here is the aorta.
This is the vessel that takes all the
blood from the heart around the body.
When I feel this heart, it feels baggy.
The heart in somebody
who is very athletic,
their heart would be very tight,
very firm,
it would be like almost picking up a
piece of steak. This is more like a bag.
What Im going to do now
is weigh this heart.
So this heart is
449 grams.
That's a heavy heart. This lady
is, despite her weight,
this lady is actually
quite a petite person.
So you would expect her heart
to be perhaps 275 grams.
Something like that. So this is very
much heavier than you would expect.
And that is the sort of size heart
you would expect
in someone who has got
heart failure
due to high blood pressure
which is what this lady suffered from.
The heart basically has to pump
to keep up the pressure,
the heart gets bigger
and bigger and bigger,
but there becomes a point where
the heart cant get any bigger
and it basically exhausts itself.
[Vinette] Now that he has discovered
the shocking state of our donor's heart,
Mike wants to look at it from the inside.
He cuts some slices so he can
examine the ventricles, the walls
of the heart that pump the blood.
If youre a 6'8" All Black second row,
you're, you know,
one of the professional footballers
running around the pitch,
you need a lot of blood,
so the wall of the left ventricle
in a young, fit person,
is usually an inch-thick muscle
all the way around.
Now if you look at this lady,
this ladys left ventricle
is very, very thin. This is eight
millimetres, something like that.
That is because she developed high blood
pressure to start off with,
the heart had to pump harder and harder,
but in the end, what you get to is a state
where the muscle cant keep
the high blood pressure up
and it starts to get thinner and
thinner and thinner and basically
you go from a thick muscular pump
through to a paper bag that's not capable
of pumping blood adequately
around the body. And we see
a lot of these hearts.
We see them on a background
of hypertension.
This is a common finding and
becoming more common.
Hypertension is high blood pressure.
Obesity is well known to be one
of the major risk factors
for high blood pressure,
so in this lady
they were not able to control that
and that led to changes within the heart
which meant the heart failed,
it couldnt work properly
and that is what this lady died from.
[Vinette] Obesity is a killer.
Not by itself,
but in the many ways that it triggers
and accelerates disease.
But so much of the way that we think about
fat isn't medical at all, it's personal.
I have been fat all my life
and its never been a positive
thing for me.
Ive always associated it with something
negative to be honest.
I feel like fat is a filter
through which I'm seen because
there are certain stereotypes
that go alongside being fat,
being overweight,
that maybe people who are overweight
are lazy or not very clever.
I dont know where those have come from,
but I feel like I have to try extra hard
to prove those things wrong.
I don't think I necessarily would
associate my fat with being invited
to get together with friends or going out,
but, you know, if they were going to
play a game of football or rugby,
they might think twice.
Socially, in terms of relationships,
definitely has.
I mean, you go into a bar and you look
like a GQ cover model versus me,
the girl is always going to go
for the GQ cover model,
sadly, and try as I might
to be the funny fat guy.
You try to build this wall,
this wall that, you know,
you just sort of try to ignore it,
and from strangers you can because
you think, well, they dont know me,
but when somebody who is supposed
to love you and
somebody who supposed to care for you
and accept you for who you are,
when they call you fat, just to...
The feeling is just horrible.
Its not a nice feeling at all.
It makes you feel really low, sad, alone.
[Vinette] The next block of organs
to be removed
are the organs of the digestive system
called the coeliac block.
What I'm trying to do here is make sure
that I've got the stomach
and the lower bowel and the liver and
the spleen all together in one block
for Mike to take a look at,
and not to damage the kidneys,
but at this point, I dont think I am
going to be able to damage them anyway
because they are so surrounded
by such a large envelope of fat.
So we have got some faecal matter,
we have got some bile,
and then obviously a lot of blood.
The blood is mixed in with the fat
which is yellow, so that is giving us
some orangey fluids.
It is a multi-sensory rainbow
at the moment.
Every single thing that is in each of
these blocks is incredibly important,
and, you know, does amazing jobs
for our body.
Its just a case of... It's not very
pleasant once they have stopped working
and they have started to decompose
a little bit.
[Vinette] To completely free the organs,
Carla needs to cut through
the fibrous membrane
that holds them to the spine
at the back of the body.
So this is a huge coeliac block.
It is incredibly heavy and the liver,
as you can see, is taking up most of it.
You can just see the spleen there
and also the stomach
and a bit of the small bowel
is attached as well.
When I first encountered
a deceased person,
I think what really struck me
was just the stillness and the cold
because, of course, I had never,
at that point, felt flesh
that was so cold and it gave me
a real kind of sensation
of kind of dipping my toe
into very cold water.
And then once I had done it,
that feeling had never quite left.
It was like this other subterranean world.
[Vinette] In the next stage
of the post-mortem,
will we find any evidence of fat damage
in the organs of our donors
digestive system?
This is the organs that include the liver,
the spleen, the stomach and the pancreas.
Now this is much heavier than I would
expect it to be in a smaller individual.
Largely because the liver is so big.
[Vinette] First, Mike is going
to take a look at the organ
that most people associate with obesity.
This is the stomach.
Basically, just like a bag that holds the
food before the food goes through
into the bowel
where it is actually digested
and there are actually many
of the treatments associated
with obesity deal with the stomach
and what they try and do is reduce
the size of the stomach
so that people have a feeling
of being satisfied
from eating without eating so much.
There is a whole variety, gastric bands
fit around the stomach,
there is various bypass operations
and so forth.
The stomach is very good at dilating,
so if this lady had had
a very large meal before she died
and had not had opportunity to digest it,
the stomach would be much more obvious.
But this is a fairly typical
sized stomach.
[Vinette] Next Mike
will dissect the liver,
the organ he discovered showing
such dramatic change
when he saw it in the open body.
But what will it reveal to us
about the consequences of fat
building up where it shouldnt?
The first thing I saw
when we opened the abdomen
was the size of this liver and the fact
that this liver showed marked
fatty change.
I am going to make some slices
through the liver
just so I can see what the cut surface
of the liver looks like.
I am using a sponge so I dont cut myself.
So I have made some cuts across the liver
there, and you can see
that the surface of the liver
is this sort of pinky colour.
That is very characteristic of fatty liver
change. It is very soft.
It almost feels like pate in consistency.
Normal liver is quite soft,
but not as soft as this
and it has a much meatier,
much redder, bloody colour, dark red.
The lightness in this is caused
by the fat within the liver
and the fat is deposited
within the hepatocytes,
which are the liver cells,
and this fat would obviously
be pale in colour and the liver cells
themselves are
dark so the combination of the two gives
you this light sort of pink colour.
That's much, much lighter colour than
you would expect a normal liver to be.
That is a classic sign of fatty liver
disease and is becoming a major problem
and is one of the major reasons
for a liver transplant in the world.
The most common cause of fatty liver
at the moment is alcohol-related
fatty liver, but we know that this lady
drunk almost nothing,
so it is very unlikely that this change
is due to alcohol consumption.
It is almost certainly
an obesity-related change.
Fatty liver causes damage to the liver.
It can lead on to cirrhosis,
it can actually lead on to cancer as well.
But even if people do not develop
cancer or,
it can lead to liver failure, so there is
multiple ways it can lead to the death
of a patient. It didnt lead
to the death of this lady
really because her heart was
itself so bad,
but this is very dramatic change
within this liver.
[Vinette] Before the post-mortem,
we could never have known how dramatically
damaged our donors liver would be,
or that she'd be carrying a
second life-threatening disease.
But excess internal fat
doesnt have to be a death sentence.
The good news is the fight to beat the
dangerous invisible fat can be won.
It is a daily struggle,
but the prize is big.
Now I am trying to lose weight. I have
actually lost three and a half stone.
I am in a weight management clinic,
I get support from a dietician.
I get support through weekly weigh-in's
and I get support from a counsellor
which is really, really handy
to help with your mental frame
of mind as well.
So what I have been doing to lose weight
is cutting out the chocolate,
cutting out the biscuits,
cutting out the crisps,
all that sort stuff.
I am not perfect.
I still have the take aways,
I still have cheeky bar of chocolate,
but, you know, I have also been
exercising a lot more
and really pushing myself to exercise,
really pushing myself to get to the gym.
[Ben] Tons of activity. I struggle.
I try and get in an hour of walking a day,
but I dont always manage it.
Just walking around the park half a dozen
times doesnt really do it for me.
You know, I dont like running and
I have a problem with my knees.
To start jogging around a park is not only
just a physically difficult thing,
but it is an emotionally
difficult thing to do.
To get out there in running gear
for all the world to see
some parts of your body jiggling
that you just dont want
them to see sadly.
I have had gym memberships up the wazoo.
Ive done detoxes for 22 days,
just drinking lemon juice, cayenne pepper,
water and a bit of maple syrup.
Its disgusting, I can tell you.
I have tried a lot and I will
probably end up trying more,
but I think slowly getting better
and making better choices
is really where it is all about.
[Meg] My motivation to now
tackle my weight and to try and
reach a healthier weight
is because I have now recovered
from my binge-eating disorder.
It is a shame that it had to get this bad
for me, you know, to get to this point,
but I did need to access that
psychological health first in my case
You know, I have now seen the limits that
being overweight has put on my life
and I want to reverse those
and get back out there and
just live life to the full.
[Chanel] I am quite conscious these days
of what I eat.
I do go to the gym.
I do what I can to lose weight
or at least maintain it even if
I cant lose it drastically.
[photographer] Okay,
turn a little bit.
I am a plus-size style beauty
and lifestyle blogger.
People do get inspired
by those sort of things
so I think it is quite useful for me
to kind of get out there.
It actually helps me boost my confidence.
-Perfect. Yep.
-[shutter clicks]
Exercise is not my best friend.
Its quite a chore for me in a sense.
But I feel that in life with a lot
of things, youve just go to,
you know, make the effort to do things
that you dont necessarily love.
[Joey] In January,
I decided to join a running club
called Too Fat to Run and it was really,
really scary at first.
I went out and I ran for like ten minutes,
which doesnt sound long,
but when you havent run
and then you suddenly you can run
for ten minutes, you are like,
"Oh, crap, I can do that.
That was kind of cool."
Then I did my first 5K race.
Finishing a race feels
so much better than...
I dont know, it sounds really, really
cheesy, but it feels so much better
than finishing a pack of crisps.
Every race I do, I cant believe
that I have finished it.
[Vinette] Next, Carla will remove
the final group of organs.
But even in the last stages
of the post-mortem,
she takes nothing for granted.
People who donate their bodies to
medical science really are giving a gift.
It is the gift that keeps on
giving actually,
because as a patient I think we all would
prefer that our doctors and our surgeons
have learned on something realistic
to their job
before they are let loose
on a human patient.
You wouldnt really let a mechanic
take care of your car
if he had never touched an engine.
And it is very much
the same thing with this.
Real bodies are very unpredictable
and very chaotic
compared to anything fake, you know,
anything like virtual reality
or a fake cadaver.
Because if you look here, what
you should be able to see are the kidneys.
Granted, they always have
a tiny capsule of fat around them,
a bit like a sort of edamame
bean that you can pop out.
But these fatty capsules are
very, very large,
so all you can really see at this point is
a kind of yellow glistening mess.
So this again is indicative of the fact
that she has an awful lot of extra fat
around her organs.
So I am just slicing through the
fibrous tissues and the bits of muscle
that are keeping the kidneys attached
to the spine.
And it is really exactly the same thing
as I have been doing
with the rest of the organs
and that is releasing them from the spine
which is what anchors them in place
and then I can just reflect them all
the way down and pull them out
and this is the genito-urinary block.
And this is at least slightly smaller,
slightly easier to manage
because you have only got
the kidneys in this...
There is so much fat. It's just...
[Vinette] Mike needs to dissect the
kidneys to find out just how much damage
has been caused by all that excess fat.
[Mike] This is the right kidney,
this is the left kidney
and this in the middle is the big
blood vessel that carries blood
all the way down the body
and the most important and the
first thing I can see is,
theres an unusual amount of fat
around these kidneys.
Now the kidneys always
have fat around them.
The kidneys they are
not protected by bone,
which means that they can be bashed
and they can be hit
if you walk into something or something
hits you, so this fat protects them,
but this lady has much, much more fat
than I would expect.
What I am going to do first
is just cut through this fat,
which is called the perirenal fat.
And you can see quite clearly how
much fat there really is.
In a thin person, this would probably be
a half or a third as thick as
I can see here.
This is bad news for this lady,
as it means that she is more likely
to have the complications of obesity
because of the way
she is carrying the fat.
This pale area here is the kidney.
I am just going to cut into the kidney.
So the kidney has got a thick capsule
around it.
Now there is a small amount
of fat in the middle of the kidney
that is completely normal. That is where
basically the kidney is responsible for
filtering your blood and making the urine.
That urine has to go somewhere
so your kidneys got a funnel
that collects all the urine
from all the bits of the kidney,
takes it down through your urethra
into the bladder
and then when you want to go to the loo,
it goes out.
So this bit of fat sits around that
funnel area and is quite normal.
I am going to take the thick capsule
off of the kidney surface
to see what the surface of the kidney
looks like.
The surface of the kidney ideally
should be very, very smooth.
This kidney has got some
scarring on the surface.
Theres areas of indentation
and pock marking
and there is clear damage to this kidney
which would be associated
with high blood pressure.
And we know this lady had high
blood pressure,
which is what led to the changes within
her heart and which led to her death.
[Vinette] The visible scarring
and pock marking
weve discovered on our donors kidneys
are the last of the revelations
she will yield
before Carla completes the post-mortem
and closes the body forever.
When Mike has finished his examination,
I then begin the reconstruction
and in a way that is one of the most
important parts of the post-mortem.
What I do is place all of the organs
into a special viscera bag,
which will contain all of the elements
that we have removed
in the different blocks
and I place that into the body cavity.
And then I use very heavy post-mortem
twine to stitch as neatly as I can
right along the incision that I made and
we describe this as a baseball stitch.
It does look very much
like a zig-zaggy stitch.
[Vinette] Each post-mortem is unique
and everything they reveal valuable.
This donors gift was an opportunity
for Mike and Carla
to unveil the shocking truths
hidden inside one body
irreversibly damaged by too much fat.
The evisceration occurred
and it wasnt as easy to do
as it would be with a slightly
smaller patient.
It takes a lot more strength to cut
through this yellow adipose tissue,
which kind of blooms out of the abdomen
in this practically neon yellow
and it looks very much like butter
and it has a greasy feel
and it makes you suddenly very aware
of the fat in your own body.
Well, it made me aware
of the fat in my own body
and the effect that might have
on my organs,
the strain it might put on my heart.
The way it may affect my liver.
I think that doing a post-mortem such
as this is a really fantastic way
for people to consider their own health
and their own mortality.
[Mike] We never really know
what we are going to find
when we examine the patient.
The first thing I noticed
when the body had been opened
was the markedly fatty liver.
I know from the history that was provided
that this lady died from heart failure,
but the findings in her heart
are extremely marked
and the severity of them actually
surprises me.
But before we did the post-mortem
there was no indication
that this lady had a fatty liver
and it is a possibility that
even if this lady
had not developed heart failure,
that she may have gone on to
develop liver failure due to the
fatty change within the liver.
[Vinette] We already knew a little about
the way this woman lived and how she died.
What we couldnt have known before
the post-mortem
was the extent to which obesity
would have ravaged her internal organs.
From the suffocating fluid in her lungs,
to her scarred kidneys,
creating a potent mix of life-threatening
obesity-related disease.
[Jodie] I know that health-wise
being obese and being large
it just isnt good so
if I can do this documentary to help other
people to see what it is doing to them
internally for them to motivate
their self
so that they can lose the weight so that
maybe they can have a child
or maybe they can live
a little bit longer,
a little bit happier, that is why I am
doing this to help people.
It is fine to have
like, politicians like a health secretary
or whoever or like, doctors on TV saying,
"I want you to eat less and move
more" kind of thing,
but until you can actually
relate that to yourself,
then you can say, "Oh, well, that's not
me. That's not going to happen to me."
I think a post-mortem
of someone with obesity
is going to be quite shocking
for a lot of people,
who maybe think they can deal with it,
and I have been there,
I have been there as well.
"Deal with it tomorrow.
I am all right right now.
Its not affecting...
I dont need a machine to sleep,
I can get around fine," you know,
and just putting off those choices
until tomorrow.
Time goes by so quickly
and its really important to think about
what is going on inside you now
and where that might actually end up,
where you could end up.