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IN-DEPTH: OBESITY


“Everybody knows what it looks like on the outside, but not many people get to see the effects on the inside.”


Dr Mike Osborn, consultant histopathologist


Dr Mike Osborn in the post mortem room in the mortuary


THE LONG-TERM CONSEQUENCES The damaging effect obesity has on health should come as no surprise. But it’s not always clearly highlighted or understood. Unlike the disturbing images of lung disease and tracheostomies on cigarette packages, sweets and fast food are wrapped in colourful, appetising packaging. To raise awareness of what excess fat does to your body, Trust pathologist Dr Mike Osborn recently carried out a post mortem of an obese patient, a lady from America who weighed nearly 17 stone, as part of a BBC Three documentary.


“Everybody knows what it looks like on the outside, but not many people


Exposing the devastating impact of obesity To watch BBC Three’s documentary featuring a post mortem on the body of a 17-stone woman visit BBC iPlayer.


Imperial research Imperial College London is conducting a gut hormones in addiction (GHADD) study at Hammersmith Hospital, find out more by visiting their website: ghadd.co.uk


get to see the effects on the inside,” says Dr Osborn.


“The most significant change you see in an obese person is a fatty liver. This is where fat accumulates within the cells of the liver and can lead to liver failure, cirrhosis and also liver cancer. “It is becoming one of the major causes in the Western world for liver failure and transplantation. Fatty liver is mostly caused by alcohol, but its association with obesity is becoming more common.”


Dr Osborn also notes the high levels of fat that can be stored within a person’s abdominal wall and around the vital organs. “The lady in question also had a dilated heart with an extremely thin left ventricle. Basically, this meant that her heart had failed, probably because she had high blood pressure, meaning her ventricle had to work much harder. This is a very common finding.”


The fact is that with rising levels of obesity, more people are now facing and living with a seriously increased risk of diabetes, heart disease, sleep apnoea, arthritis and several cancers. So, what exactly needs to be done? “The current approach to education and public health is not having the impact it needs,” warns Mr Ahmed. “We are not doing enough as a nation to


14 /Pulse


address the tide of obesity that we’re facing, so there are going to be a lot of people who will need weight loss surgery.”


Dr Goldstone stresses that it is ultimately lifestyle choices that have to change. “In order to prevent obesity and to maintain weight loss, people need to make long-term changes in their lifestyle,” he concludes. “And not just short-term plans. The evidence shows that the diet that works best is the one that you can maintain.” As the NHS looks to have a much bigger role in helping people to stay healthy – and not just treating them when they become ill – how trusts like ours respond to the obesity epidemic will be increasingly important.


Further reading • Read more on the ncbi website about the link between increased gut hormones and reduced food reward after gastric bypass surgery.


• Read more on the ncbi website about whether obese patients who have undergone gastric bypass surgery have lower pleasure responses to food than those with gastric banding.


www.imperial.nhs.uk


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