BBC Panorama - Obesity: Who cares if I'm Bigger?

My name's Claire Norris and I'm an actress in EastEnders. Like one in four people in Britain, I'm living with obesity. This is where it kind of all started, school dinners, cake and custard, you know, all of them things. Obesity puts our health at risk and the Covid pandemic has made it worse. I still get out of breath easily when I do too much walking around. The government says we should slim down but that's easier said than done. I've been obese for most of my life regardless of how much exercise I did, what I ate, it just seemed to pile the weight on. Our relationship with food can be complicated. It kind of made me just go just eat my feelings, eat my feelings, they'll go away, they'll go away. But are people struggling with obesity getting the right support and care? Obesity is a complex, relapsing, long-term condition. It requires a lifelong support. I'm 24 years old and I've been overweight for most of my life. I play a character in EastEnders called Bernadette who struggled with her weight too. What's that? Breakfast. Who thought of 5,000? Hello, don't be shy, it's fab to see some new faces. In one of my storylines Bernadette goes to a weight loss group. Um well, I'm Bernadette. The pressure to lose weight didn't work for her. Oh well you tried love, I mean maybe it ain't worth the effort. People like us ain't meant to be skinny. I've tried losing weight too and it hasn't worked for me either. This is Thamesmead, South East London where I grew up. So we've come back to my old primary school. So this is where it kind of all started. I went into nursery, very fussy eater. By the time I got to reception I was eating turkey twizzlers at school dinners, cake and things. That's kind of where the weight kind of started to pile on as I went through the primary school years. I was actually skinny. Other kids were eating the same school meals so why did I put on the weight? I've come to see my mum Sam to see if she has any answers. I was slim there, how old was I there? You would have been about six, seven there. Yeah so I don't even, I wonder what changed in that time for me to then go like to that and being chubby. I never even noticed that you know, you look back now and you see it and you think why did that not be obvious? Because I was just happy. As a parent all you worry about is feeding your child and not having them be starving. So if you find something they like you carry on, you don't necessarily worry about whether it's particularly healthy or not. When I was a teenager mum and I both tried slimming classes but we never managed to keep the weight off. I know exactly what I need to do to be able to lose weight. It needs to be your decision to do that. You've got to make the choice for yourself, no one can make it for you. The reasons behind obesity are complex. We know that there's over a hundred different factors that impact on someone's body weight including our genes, our food environment, also the amount of money that we have for food and our mental health. I know I'm heavier than I should be and it won't be doing me any good but I want to know more about the health risks. Dr Vasiliki Bravis is a consultant specialising in diabetes and obesity. People that are overweight or obese have got an increased risk of cardiometabolic disease so things like type 2 diabetes, high cholesterol levels, risk of heart attacks, risk of strokes, risk of developing high blood pressure, things like fatty liver disease that can later in life even evolve into things like liver cirrhosis and also increased risk of developing different types of cancers. Being severely obese can reduce your life expectancy by 10 years and you can expect to spend nearly 20 more years in poorer health. I've kind of accepted that this is my body, this is how I look. I've learnt to adapt to it rather than trying to change it. I think that's why I am intrigued to find out what's going on in the inside. Dr Bravis is going to do a series of tests on me so I can find out if my weight is damaging my health. It's quite overwhelming hearing about all the risks and I know that I don't do a lot of exercise and I don't always eat the right food so it's scary waiting to see whether that's affecting my health. I'll get my results later. The number of people living with obesity has been rising for the last 30 years. The pandemic made things worse. In the last two years one in five people gained more than a stone. We went really really long shifts within the NHS which just means my stress levels were pushed much much higher. Maddy Lazarus is a midwife living in Nantwich. She put on two stone during the pandemic. I used food as sort of a stress reliever and my way of coping. I found myself sort of hiding food packets and things like that for my other half so he wouldn't find out. So yeah the pandemic's not been the best for my weight loss or my mental health which go really hand in hand. The pandemic has been hard for everyone but new research suggests that it's been particularly difficult for people struggling with their weight. From our data over the last two years looking at people living with obesity around 50 percent of individuals reported that their mental health had come worse or much worse since the first lockdown. When we look at depression and well-being again they were significantly worse compared to the general population. This is 12 year old Bailey. Before the pandemic one in five kids his age were living with obesity. Now it's one in four. Are you good yeah? Good thank you. Do you think people understand how it feels to be bigger? No they don't really understand what it feels like. They just take one look at you and you think lazy or just they eat too much. How does that make you feel? It makes me feel like bad about myself because you think what can you do to lose all this. Last year Bailey got Covid and ended up in intensive care. They were there for like five days in intensive care and then another four days and he looked so young just to even be in a hospital bed. It was very very frightening you don't know whether you're going to lose him. People living with obesity were 70 percent more likely to be admitted to intensive care with Covid. I still get out of breath easily because when I go upstairs at school it like makes me tired and when I do too much walking around it just makes me too tired. Why do you think Bailey is overweight? He tends to use food as a comfort. Yeah same as me. So as a family like what sort of foods do you eat? I cook all meals I cook from scratch. I don't use processed foods. Possibly my probably downside would be portion sizes. Yeah. Do you feel guilty about Bailey being overweight? Yeah. You do. You think have I done it and then could I have done something more? The Prime Minister also ended up in intensive care with Covid. He went on a diet and encouraged us all to do the same. My friends I was too fat and I've since lost 26 pounds and you can imagine that in bags of sugar and I'm going to continue that diet because you've got to search for the hero inside yourself and hope that individual is considerably slimmer. His government's come up with a plan to tackle obesity. Junk food ads on TV before 9pm will be banned by the end of the year and we're all being told to take more personal responsibility. Search better health. Let's do this. The government provided 70 million pounds for adult weight loss services in England including 30 million to local councils for 12-week weight management programmes. This one's in Norfolk. It's called Man B Fat. Simon's recently been told he has type 2 diabetes. When I was first diagnosed it's a bit of a shock because you hear about it and see people and you think well it's never going to happen to you but unfortunately it does and you've got to got to deal with it but the best way is diet and losing weight. Every week Simon comes here to play football and get weighed. It's great, great camaraderie, new friendships that I didn't have before I came to this, a network of people that are there to help support you. After three months if they want to keep playing they have to foot the Some guys might find that a stretch too far which is going to be a shame if they stop coming. Simon's now paying. After five months he's lost two and a half stone, that's 16 kilos. That's 2.3 kilos off mate. Well done mate. Thank you. The government's anti-obesity strategy is helping some but are 12-week programmes enough? We know from the data that 12-week programmes on average people lose around five kilos however they're not long enough. They help people for a short period of time but obesity is a complex relapsing long-term condition that needs lifelong support. But even this short-term support is under threat. Local authorities say they've been told by government they will no longer get specific funding for weight management programmes. Do you remember the section box that we did and we counted the sugar? Do you remember how many teaspoons of sugar was in one selection box? I think there were like 21. Yeah 21 teaspoons of sugar in one selection box. You weren't far off Bailey, that's a good guess. I've come to Shine Health Academy in Sheffield where Bailey and 10 other kids attend sessions for up to a year. Hi nice to meet you. To help with their weight. We don't tell the children what to eat what to do it's this is the knowledge behind it. You know if you can educate people about portion control, how to read a label, how to make foods cheaply, if you can get those messages out then I think we can do a lot in preventing the epidemic the obesity epidemics that we've got Shine was set up with charitable funding and last year got some money from government. After a year here children lose an average of 10 centimetres from around their waist. Boosting the kids self-esteem is also important. How do you think the public sort of see people I'd say lazy as well. So lazy, greedy, worthless that's a good one yeah. We've noticed that children with weight issues have lots of mental and emotional difficulties so they may have got low self-esteem, high levels of anxiety, depression and a part of our program is helping children and young people cope with that element as well as the nutrition and exercise because they're glove in hand really. If you could say to the professionals this is what we need what what message would that be? Mental health support because you feel shameful for being overweight but at the same time it's hard to control it's not something you can like turn off with like the flick of a switch. One in five children in South Yorkshire has obesity but very few get access to help like this. Just to give an example for where we live in Sheffield we've got a region of South Yorkshire and the funding there is for around 100 children per year and in the last four months we've seen about 60 children already. I think there's a gross underestimation of how much a demand these services will be in. In other parts of the country there's even less support. We've asked 105 councils in England whether they run weight management services for children. Of the 85 that responded 38 said that they don't have any specific programs for children with excess weight. The availability of specialist services is absolutely pitiful. If we had greater funding into specialist weight management services I think we might be in a different situation. It's estimated that NHS England spends more than six billion pounds a year treating illnesses linked to obesity. If we don't actually at least stem this tide then we're going to end up with you know huge amounts of disease. The money the government has pledged to try and solve obesity is a drop in the bucket you know compared to the amount of money now costing the NHS. The government says that because of the continuing cost of dealing with Covid it's had to make some challenging decisions so has reduced the funding for healthy weight activities for this financial year. Back in Nantwich midwife Maddy has decided to take drastic action to help her lose weight. I've tried everything you can think underneath the sun in terms of trying weight loss, different regimes, slim fast, weight watchers, exercising, calorie counting and nothing's worked if it has. I haven't been able to sustain that weight so I've made the decision to do a gastric sleeve surgery. Gastric sleeve surgery will reduce her stomach to the size of an egg helping her to lose weight. She was struggling to get referred on the NHS so she's spending an £8,000 inheritance to go private. I spoke to my GP about it and because I am still young they were very very hesitant to referring me. It was more well you know you're still young you've still got time so I decided to self-fund before it gets any worse really. It's the night before Maddy's up so this is her last proper meal in a while. So this is actually quite a large meal in comparison to what I will be able to eat post-op. I won't be having any form of sort of hard food for at least six weeks, six to eight weeks really so it'll be more puree and softer food. More than three million people would qualify for weight loss surgery on the NHS in England but in the last five years fewer than 30,000 have had it. Weight loss surgery is highly effective however less than one percent of the eligible population in the UK currently have access to weight loss surgery. We believe that stigma plays a role here from the patient not actually going to their GP to get help but also from the healthcare professionals believing that weight is personal responsibility and it's simply eat less and exercise more. The government says NHS England funds obesity surgery for its core budget. Hearing about the stigma of being overweight got me thinking about how I've been affected over the years. So this is probably where most like the name calling probably would have happened. I don't say it's bullying that's just my own personal thing. I don't remember specific names I don't remember it very clearly but I suppose it's because if it happens every day it just kind of blurs into one. My mum remembers it more clearly. You didn't even see it as bullying because people were calling you names and it wasn't until other people pointed out and said but they're calling her this and then it was like you were like yeah but that's that's just you know they call me chubby but that's that's a spare nickname for me and you never ever. It worried me that you never thought that was an issue that it was okay for people to call you names and you just accepted it. Maybe mum's right. When I look back it feels like the name calling did hurt more than I realised at the time. If you comment on someone's race, ethnicity, someone's sexuality, someone's age, you get into trouble. But yet you can freely comment about someone's body weight, body size, you know, and get away with it. In Sheffield, Bailey and the kids from Shine are going bowling. Kath always books the lanes nearest the wall to try and protect them from name calling. Bailey tells me that last week he was bullied by a group of kids at school. They didn't know my name so they just said that f*** you over there so that like that got me angry and I felt like saying to them that's not my name though so why do you have to say it? Do you feel like if you didn't have Shine how do you feel like you would be? Do you think you would be a bit lost? I'm probably just not the way I am right now probably like losing a lot of weight and then like doing stuff with other people like helping them out as well and I feel a lot better in myself coming here as well. And it's just it's something like where you meet new people who are all in the same boat so you relate to everyone and it's like so non-judgmental. It's just really good. Meeting these kids has made me realise that building self-esteem has to be the first step towards improving our health. There's multiple studies that now show that people who internalise the stigma so people believing that they're lazy or they're gluttonous it actually negatively impacts on mental health. It also impacts on eating behaviour. It makes people eat more calories. It makes people avoid physical activity. I've come to East London to meet a group of women who definitely aren't avoiding physical activity. Today's class is a jiggle your beauty class. I say that intentionally because we're gonna be moving we're gonna be grooving all that good stuff. Trina Nicole who's 29 runs this dance class. She calls it the curved catwalk. When I was younger I think I definitely again going growing up like not happy in the body that I was in and having to like change that but now I genuinely have gone on a whole journey where I can now comfortably say like I do love myself and I am comfortable with how I am. The dancers here want to challenge the way society sees them. What do you think of the word fat? I wouldn't describe somebody in that way but for me personally I don't take offence by it because of the way in which people use it it has a lot of like negative connotations like you know you're ugly. And it's that stigma and the assumption that people that are overweight are lazy. Yeah. That isn't the case. That isn't the case and there's a lot of like blaming like it was your fault and when people come at me with like oh you're overweight you're lazy I'm like have you seen the curved catwalk? Like I do believe that just to kind of change the narrative and that fat shouldn't always like be equate being ugly and stuff like that I feel like it's just important to be seen. These women are part of a movement trying to redefine what a fit and healthy body can look like. I would still be technically called overweight and obese I've been told to lose weight my whole life. I think what is so good about this conversation that we're starting to have is unpicking what healthy means, unpicking what overweight means, unpicking what fitness is. I think you can see by what people can do that they're healthy because not everyone could do this. I can see that being bigger doesn't mean you can't be fit but can classes like this protect against the longer-term impact of being overweight? We do have this phrase metabolically healthy obesity. These individuals tend to be younger, they tend to be fitter, they tend to carry their body weight around the lower part of their bodies as opposed to their stomachs. What we know from the evidence is this tends to be a temporary state. Although they're healthier at the moment they tend to develop an additional risk factor within three to ten years such as high blood pressure or type 2 diabetes. So what about the risk factors for me? I'm back to get the results of my health check. What we've checked for is actually a number of things that we looked at and that is to try and stratify your own personalised risk. As you can see this value falls in the normal range. What that value tells us about you is that currently you don't have pre-diabetes and you don't have diabetes which is fantastic news. So far so good but the results do flag up a warning. We do know that you have a risk of type 2 diabetes later on in life and this gives us an opportunity to think about how we can modify that, how we can decrease that, postpone that or even eliminate it. Hearing the word diabetes is scary. I've tried losing weight many times before but it always slips back on. I've got age on my side but I know I shouldn't leave it too long before I try again. It's four months since Maddie's weight loss surgery. I've lost about four and a half stone. That equates to about 50% of my excess sort of body fat that I've lost which still doesn't quite feel that real. For a month after her op Maddie could only have liquids and pureed food. Now she can eat whatever she wants but only in small portions. So we go for a miniature afternoon tea. There's like a 20-20 rule they say so you take like a mouthful that's the same size as a 20p piece, chew it for 20 seconds and then wait 20 seconds before your next bite then as well to let it go down. Your surgery was pretty invasive, do you feel like the risk was worth it? 100% for me the risks outweighed the other risks that I was doing to myself really. This has allowed me to kind of look at my relationship with my body on a lot deeper level. What I've discovered is that mental health does play a big part and I don't think I even realised how much it did. So you know me going home and just eating food that wasn't me eating food that was me getting out my stress or my anger. Just eat my feelings eat my feelings they'll go away they'll go away. I've seen that in a lot more people. For me the mental health benefits and actually learning about my relationship with food has been huge that in itself has been fab really. I can't help admiring Maddy and she looks great but I don't think surgery is for me. The truth is we're all different we've all got different reasons for having excess weight and we all need help in working out what's best for us. I think my eyes are more open to what everyone else is going through and that just shows how much work that there still needs to be done. You know you could throw money at something but I think it comes from people understanding why people are overweight or understanding that it's not just one size fits all. I know exercise and healthy eating are important but for many of us the help we need is not just about our bodies. We need to be offering people living with obesity better support to help with their mental health. People think that it is a choice it is a result of bad habits. No one blames anyone if they have asthma no one blames someone if they've got cancer why are we blaming people when they have obesity. I know that being told to lose weight by people who don't understand the challenges really doesn't help. The government says tackling obesity is a priority but people living with obesity need long-term support and for millions of us that's still not available. Details of organisations offering information and support with mental health are available on the BBC Action Line website or you can call for free at any time to hear recorded information on 08000 155 998.