Original subtitles

Obesity is an epidemic

happening right here in the UK right now.

Honestly, the first thing I'd say is that I’m a big girl.

How my friends would describe me would be large, fat probably.

I don’t 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.

We all know what fat looks like on the outside.

I think of cellulite,

rolls, big thighs,

big arms.

If you’re Kim Kardashian, you can have a really fat arse.

I’ve got a fat stomach,

she’s got a fat arse.

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 can’t see inside,

I can’t see what is happening inside me.

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 London’s 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 it’s something that I get to see quite a lot,

but it’s not something I get to study in depth.

Mike is a Consultant Pathologist

and Fellow of the Royal College of Pathologists.

He’s been working with death and disease for over 20 years.

Obesity is very much there,

it's seen, but I think it’s 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.

Carla and Mike have performed thousands of post-mortems,

but always behind closed doors.

Today, we’ll 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 don’t 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

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.

My name is Randall Delgado.

I’m 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, I’d be like, "Ooh,"

but eventually you get used to it.

I’m Kelsy, I’m 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 wasn’t exactly sure what they did.

I knew they recovered tissue,

but I didn’t know like to the extreme of like

really recovering almost everything.

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 donor’s ID number is confirmed against her medical record,

which details the cause of her death,

heart disease,

and that she’d only had minor surgery and drank minimal alcohol.

But what will her body go on to reveal about the way that she died?

This lady has died of heart disease,

which is one of the things that is associated with obesity.

And interestingly already in this lady, we’ve got signs of heart failure,

because if I press here, particularly on this side,

you can see this dimpling there

and that’s because there’s you’ve got too much fluid,

and that’s the side effect of heart failure.

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 she’s 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 that’s less associated with complications,

that’s more associated with complications.

So we can see the distribution of the fats

from the external exam, but once we actually get inside,

we’ll see more of how that has affected the inside of her body,

and her internal organs as well.

When we open this lady, there may be other findings

that are less easy to diagnose before somebody has died,

that won’t 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.

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.

It’s a skill that requires both great precision and intense concentration

especially performed on someone with so much fat.

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, it’s not just about

what we’re 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 I’m doing here is just

trying to make sure that my knife doesn’t 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 there’s also a very large amount around the abdomen.

The abdominal fat, that is the most dangerous associated

with the problems of obesity.

There’s quite a lot of fat around the organs.

There’s 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 there’s lots of changes which I think we’ll get a better view of

when we’ve 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 don’t 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.

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 doesn’t matter how old you are, if you are fat,

you are marginalised by society.

There’s a lot of medical contributing facts to people’s weight

that a lot of people don’t realise and all they see is somebody that’s 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 there’s 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 wouldn’t 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 don’t 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 didn’t 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 it’s salad. And you’ve got carrots

and you’ve got hummus

and you’ve got Maltesers and you’ve got Twirl

and you’ve got Buttons and Dairy Milk

this and Twix that and it is cheaper and it is on deal,

so why wouldn’t 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.

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?

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.

To get to each block,

Carla must first remove the sternum,

the bony armour that protects the major organs of the body.

It’s not an easy job,

requiring skill perfected over years,

and a bit of brute force.

So I’m going to take my rib shears, we use these specifically for this job

as they can cut through bone.

And what I’m 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 that’s something you either know or you don’t.

I never would have considered doing this job if I didn’t 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 don’t 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 who’s very slim,

the organs are there and they’re very evident.

It’s 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.

Before Carla removes the heart and lungs,

Mike wants to take a look at the organs while they’re still in the body

to see if we’ll discover any early indications of trauma or damage.

You can see the heart here.

There’s a large amount of fat around the heart.

There’s 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,

that’s a big muscle that helps you breathe.

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 it’s 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, there’s 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 it’s 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.

It’s 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 didn’t really do anything,

but it’s 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.

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 hadn’t left it till so late to start trying to lose weight.

It’s not good on your back, it’s not good on your knees.

God knows what it is doing inside.

I thought, "All right, okay, I’m 30,

let’s try to start thinking about trying to have a baby,"

but with the size that I am, you won’t

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 don’t 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 didn’t 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.

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 I’ve freed the lungs completely.

Free them along the spine here.

I’m 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 we’ll 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 we’ve 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.

With the cardio-respiratory block removed from our donor’s 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 we’ll start off with the right lung,

so just cutting through where the lung is attached,

and that’s the right lung detached. This is the left lung

I’m detaching there.

I’m 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,

there’s 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,

that’s because obviously it's within the body and it's been mixed with blood.

This isn’t... 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 lady’s lungs because her heart isn’t working properly.

She’d 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,

it’s because if somebody says, "Oh, I can’t 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.

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.

Heart failure is not the same as a heart attack.

When a heart fails, it doesn’t 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 lady’s heart stopped working, that would have been

an instantaneous event that led to her death.

Now it’s 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 can’t 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 that’s the heart there,

so the heart now is in my hand

and you can see all the fat I was talking about earlier

really isn’t 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 everybody’s heart,

even a thin person’s heart would have this,

and I’m 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 I’m 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 can’t get any bigger

and it basically exhausts itself.

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 you’re 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 lady’s 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 can’t 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 couldn’t work properly

and that is what this lady died from.

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 it’s never been a positive thing for me.

I’ve 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 don’t 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 don’t 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. It’s not a nice feeling at all.

It makes you feel really low, sad, alone.

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 don’t 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.

It’s just a case of... It's not very pleasant once they have stopped working

and they have started to decompose a little bit.

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.

In the next stage of the post-mortem,

will we find any evidence of fat damage in the organs of our donor’s 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.

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.

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 shouldn’t?

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 don’t 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 didn’t lead to the death of this lady

really because her heart was itself so bad,

but this is very dramatic change within this liver.

Before the post-mortem,

we could never have known how dramatically damaged our donor’s liver would be,

or that she'd be carrying a second life-threatening disease.

But excess internal fat doesn’t 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.

Tons of activity. I struggle.

I try and get in an hour of walking a day,

but I don’t always manage it.

Just walking around the park half a dozen times doesn’t really do it for me.

You know, I don’t 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 don’t want them to see sadly.

I have had gym memberships up the wazoo.

I’ve done detoxes for 22 days,

just drinking lemon juice, cayenne pepper, water and a bit of maple syrup.

It’s 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.

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.

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 can’t lose it drastically.

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.

Exercise is not my best friend. It’s quite a chore for me in a sense.

But I feel that in life with a lot of things, you’ve just go to,

you know, make the effort to do things that you don’t necessarily love.

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 doesn’t sound long,

but when you haven’t 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 don’t know, it sounds really, really cheesy, but it feels so much better

than finishing a pack of crisps.

Every race I do, I can’t believe that I have finished it.

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 wouldn’t 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...

Mike needs to dissect the kidneys to find out just how much damage

has been caused by all that excess fat.

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,

there’s 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 kidney’s 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.

There’s 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.

The visible scarring and pock marking

we’ve discovered on our donor’s 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.

Each post-mortem is unique and everything they reveal valuable.

This donor’s 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 wasn’t 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.

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.

We already knew a little about the way this woman lived and how she died.

What we couldn’t 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.

I know that health-wise being obese and being large

it just isn’t 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.

It’s not affecting... I don’t 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 it’s really important to think about what is going on inside you now