Obesity: The Post Mortem Page #2

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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

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