We all know what fat looks like on the outside of our bodies. But do you understand what an unhealthy diet and lack of exercise could be doing to your inside?
Tonight you have the chance to find out, as BBC Three broadcasts a post-mortem examination of an obese woman whose body was donated to medical science.
It may attract controversy, but this groundbreaking documentary offers a graphic wake-up call for a society apparently sleepwalking towards a growing obesity crisis, with one in four adults in the UK now obese.
WHO’S ON THE TABLE?
At 5 ft 5 in and around 17 st, the centrepiece of the programme is a woman, aged just over 60, who died of heart failure.
To avoid her being recognised, the film makers chose the body of an American with no identifying marks.
Nothing was known about her diet or lifestyle except that she only drank socially.
Her body, which was frozen in California, was thawed in the UK over ten days, ready for a 12-hour dissection at the Royal College of Surgeons in London by veteran pathologist Dr Mike Osborn and his assistant technician Carla Valentine.
‘Unless you are a pathologist, you might never know about the changes within — or what it [obesity] does to your organs,’ says Dr Osborn.
‘Getting inside a body like this really explores the damage obesity does to the organs, the diseases it causes and why it’s placing so much stress on our healthcare system.’
THE BELLY
As the woman’s body lies on a slab, her mountainous stomach is the most obvious sign of her obesity.
As Carla inserts a scalpel to open it up, the first thing that can be seen is the layer of bright yellow fat under the skin — around 1.5 in thick.
Dr Osborn, who performs about 250 post-mortem examinations a year, says this colour is completely normal.
‘In some people the fat is bright yellow like this and in others a slightly creamier shade.’
To the touch, fat feels as slippery as butter. ‘The texture tends to be the same wherever it is on the body — you can’t tell where it’s come from,’ he says.
Everyone has some fat to protect their organs. And if someone gains weight, it does not mean the number of fat cells they have increases, says Dr Osborn.
‘In fact, the number of fat cells we have remains the same after our teenage years. But the cells expand and become larger, like balloons inflating.’
As your fat levels rise, it expands under the skin and can weave between the organs, reducing their blood and oxygen supply and altering your hormone balance.
In this woman, her huge tummy was a clear sign this was happening inside her body.
‘It’s not just about the amount of fat you’ve got. It’s also about where it is,’ says Dr Osborn.
‘If you have fat around your tummy, it’s more dangerous than just storing it around your thighs and bottom.
‘Ten or 15 years ago, we used to think that fat just sat there and didn’t really do anything.
Now we know that fat alters the balance of hormones, such as insulin, which can trigger diseases like diabetes and high blood pressure and bring on changes which can ultimately lead to organ failure.’
THE HEART
As Dr Osborn lifts out her heart, the impact of obesity becomes starkly apparent.
Instead of the tight, muscular ball it should be, it is more like a droopy bag — a clear indication she died of heart failure, which was brought on by high blood pressure triggered by her weight.
‘Like many people with high blood pressure, the heart has become floppy because, over time, the walls have become incredibly weak,’ says Dr Osborn.
‘This woman’s high blood pressure would have increased the volume of fluid the heart had to pump around the body, putting it under strain so the walls became thinner.
‘Her heart muscles would not have been contracting well and pumping the blood around the body efficiently.
‘So the blood flow to the other parts of her body would have been very weak. She would have likely have felt tired all the time, and found it difficult to exercise, making her problems worse.
‘Eventually, the changes to her heart would have been so great it would have suddenly stopped working altogether.’
However, although her heart was in the late stages of failure, Dr Osborn found no signs of her arteries narrowing.
‘Her heart was in a particularly bad way — especially considering she was hardly over 60 — but for some reason, maybe a combination of genes and lifestyle, her arteries weren’t furred up with fatty deposits.’
THE LUNGS
‘The liquid dripping out of her lungs told me she was suffering a very bad pulmonary oedema — where fluid builds because the heart is not strong enough to pump it through the body efficiently,’ he says.
‘It’s likely that before this woman died she would have started to feel like she was drowning and have had problems breathing.’
The lungs were also relatively small, a sign they might have been compressed by other organs, making breathing even more difficult.
THE STOMACH
Surprisingly, the stomach changes little in structure as a result of being overweight.
‘The stomach is a bag which expands to have food in it and then contracts. Just because someone is a larger person does not mean they are going to have a massive stomach,’ says Dr Osborn.
‘If you eat a lot, your stomach might become mildly larger but not a great deal.’
THE LIVER
The liver is one of the organs that gives the biggest clues to a person’s diet and lifestyle.
A healthy liver is deep red in colour and firm, with a smooth surface. However, with obesity it can change in many ways — by becoming enlarged, softer or scarred throughout.
This woman’s liver was a third bigger than it should have been — a sign of fatty liver disease, which is linked to being overweight.
A set of a lungs in a fit, healthy person of normal weight will look like dry, pink sponges.
However, as soon as Dr Osborn removed the lungs from the woman’s body, he found they were heavily waterlogged — a symptom that often goes hand-in-hand with heart failure.
It was so full of pale fat cells the colour had changed from red to weak pink.
Dr Osborn says: ‘This woman would not have known she had a fatty liver unless she had a scan.
‘You normally don’t have any symptoms of fatty liver disease until the organ starts to give up completely.’
THE KIDNEYS
Like many of the other major organs, the kidneys are encased in a protective sack and surrounded by fat for protection.
However, in this woman they were covered in a much thicker layer of fat — a result of her gaining considerable weight.
Healthy kidneys should look smooth, but hers had pockmarks, another sign of high blood pressure.
As Dr Osborn explains: ‘The kidneys act like micro-filters, filtering the blood and producing the urine.
‘However, if they are forced to handle too much fluid, you get damage to the small tubes and filters which will die off, leaving scarring and pockmarks.’
After the post-mortem examination, the organs were placed in a bag and sewn back into the body.
Information on the organs will then be used to help other doctors understand how obesity affects the body.
‘The major problems that obesity triggers are high blood pressure, fatty liver diseases, diabetes and increased risk of some cancers,’ says Dr Osborn.
‘But even with big changes like this, it is never too late for people to take charge of their health and lessen the impact on their bodies.’
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