The fat doctor will see you now

Britain’s busiest gastric-band surgeon fears that obesity could break the health service, Helen Rumbelow spends a day in his operating theatre.

The towering dome of flesh on the operating tabletakes on the appearance of some thing unconquerable. With its owner, a 30st man, lying unconscious and unidentifiable under drapes, the exposed belly looks like a meter high.
Shaw Somers is not daunted. The surgeon pushes his palms deep into the jellified stomach, which ripples away as he skewers it with his keyhole surgery probes. Within half an hour he will have fitted this man with gastric band, within a day the patient will be eating his first – tiny – mouthful. Within a week diabetes will be cured and within a year it is hoped that his giant girth will be down to normal.

Later that day, the man, spilling over a 3ft-wide chair, is tearfully grateful. Finally, he thinks he may be able to stop eating the penut butter on the toast that is his “downfall”. “I just want to be able to buy some cloths in a shop. Or walk to the other side of the room- That was real struggle. My girlfriend was really worried. She heard my breathing at night. She thought I was going to die.”

A day spent with Somers is a glimpse into the future of the NHS. Not for nothing does this bariatric surgeon have a nickname among Britain’s obese: “the fat Doctor”. He is One of only half a dozen British specialists in obesity surgery, and it is believed that He has performed more gastric band and stomach bypass operations than any of them: 2000 in all, the number rising by ten or so a week. This, though, is a small compared with the scale of the problem. Obesity surgery has Gone from being a “freakish” American idea to one of the only last-ditch treatments That works. It even cures diabetes almost immediately-no one quite knows why.

A recent report suggested that one adult in a 12 is now obese enough to qualify for surgery, Yet last year only about 6,000 obesity operations were performed in the U.K. By contrast, In the U.S. obesity surgery is the most common form surgical procedure, far outrunning Operations on the appendix or gallbladder. “In Britain we are only scratching the surface,” says Somers, delving his blade in to a Yellow vat of human fat. Yet his working life shows the problems that the NHS is ups against. Even though thousands of people qualify for obesity surgery under NHS guidelines, only a few lucky
Ones will receive it. Primary care trust simply can’t afford the outlay for more, even though, by reducing their chronic illness costs, they could recoup the money spent in a few years. So about a third of Somers’s patients pay privately, at £12,000 a time.

Celebrities are notoriously evasive about their gastric surgery, although Anne diamond Thank him emotionally in public for fixing her botched gastric band. He is the pain-up of the internet’s obese community. And one woman in the media, dramatically slimmed by her gastric band, “confided that her friends knew him as St Shaw, who holds the keys to the king of the thin”.

So, in the first minute of his working day, we encounter thorny moral issues. Should we pay for fatpeople to get thin? Should they? At 8 am he bounds down the corridor of the NHS’s largest obesity surgery unit, at St Richard’s Hospital in Chichester, which cover the whole of the South East. He is, of course, thin-“I want to be the fat Doctor, not a fat Doctor,” he says, scrubbing up for surgery. And the launches straight in to the debate and his first patient.

“We are just realizing that we will have to have national debate about now to treat the obesity problem and how to found it,” he says, digging his probes in. “The diseases caused by obesity already cost the NHS £500 million a year. If we don’t tackle it now, it will break the NHS.”

Once we are in the operation theatre, I notice that the “f-word” curiously absent from the Fat doctor’s vocabulary. “I try to be polite,” he says. He calls people who are overweight “fluffies” and obese women are big girls”. Big panty girls? “Yes-isn’t that a song?” He appeals to one of the nurses, who just laughs and shakes her hand. Even the 60th man whom he will visit at home the next day is “so big it would need a fire engine to get him out”.

Somers does an equal number of gastric bands bypasses-a team of specialists, including psychologists and dietians, makes the judgment between the two. Put simply, a band will work best on a bulk enter who can keep to a healthy diet, such as our 30st man on the operating table, while the more invasive bypass is used for those whose who eat both badly and in bulk.

The fat doctor’s camera probes show not the internal organs that you would expect, but A pale moonscape of fat under the man’s skin. Yellow, frilly pillow of it surround everything; white ropes of it snake towards his heart; an octopus of fat clamps around his stomach. It is one of those moments when you vow to go on a diet. “If this was a woman it would look quite neat,” he says. “The problem is that men have big round tummies, they carry the fat internally. That’s what kills them. You don’t get big old men, they just die. Whereas big panty girls, their fat is all on the outside.”

Most of his patients are women, even though obesity is more evenly split between the sexes. “That’s because women tend to come forward. Men put up with it and die. By the time men come to see us it is offen too late; their hearts are knackered.” The first surgical step is to lift the liver out of the way –no mean fat, since the fatter the patient is, the fatter the liver will be. “I have three sizes of liver retractor,” Somer’s says, showing me a tray metal hoops, the largest of which could be a part of a croquet set, “Normal human, big human and veterinary. When people get this big the fat surrounds all their organs; the whole physiology of the body starts to crumble.” These means that nearly all his patients, like this man will have type two diabetes and high blood pressure, many will also have heart disease. Before he can insert the gastric band, he has to cut through the fat around the stomach. It is dangerous work.

Like most surgeons, I don’t like the sight of blood,” he says. “But imagine cutting through a slab of butter with blood vessels running through it- it’s very tricky to do it without bleeding. That is why very few surgeons take such big patients.” Then he carefully tears open the packaging on the gastric band: a white plastic ring that cost £1,000. It is positioning is crucial: “Too far down and they’ll just be sick all the time, too high and they’ll have pain on swallowing. It has to be spot-on every time.”

The anaesthetist inserts a ballon in to the stomach and inflates it. Somers locks the band in place once the stomach tube is inflated to about a golf ball’s width. This is the amount of the room that the patient will have for food. It’s acts like a funnel- liquid will go down quickly; mashed potatoes will slip through. But an apple or a pork pie will feel very uncomfortable.”

When banding fails, it is because bingers switch their diet to high calorie “slops”- milkshakes or chocolate- or even liquid–ice their favorite junk food. That is the Achilles’ heel of banding: that rubbish will always go down. That’s where the work from the patients comes in.” Is that the worst part of the job, those who sabotage his work and themselves?

The worst part about this job is turning people down. They know that I’m their last stop and if I can’t do it, they are destroyed. It’s as hard as telling that they are going to die of cancer. It will kill them.” He sews the band in place and a attaches a little tube from the band of a plastic port just under the skin on the man’s right side. From here, he can adjust the tightness of the band with a saline injection at an outpatient appointment.

His next patient is 52 year-old who is in for a gastric bypass: If we left him, he would be lucky to see his 60th birthday.” The next one is a “big panty girl”, the one after that a “fluffy” woman who has having the operation mainly to cure her diabetes. As he plunges in to the belly of the gastric bypass man, he is almost lost in tunnels of fat. His task is to short-circuit the digestive system, rewiring the intestines so that fewer calories are absorbed from food. I have to keep a little anatomical satnav in my head. It is quite easy to disorientate with the giblets. There is so much fat in the way…”

Does he never feel disgusted, or at least exasperated, with his patients who have got themselves into this state? The problem with obesity is that modern man and food do not seem to be mixing very well. When the food industry is determined to sell us as much food as possible, most of the public don’t stand a chance.” But, I say, why can’t they avoid this self inflicted illness? He refuses to be judgmental. “A lot of big people do have a limited ability to deal with it in a logical way. They are addicted to food. We could lock them up in prison and take control of every aspect of their lives. We could clone Gillian McKeith for everyone and force them to do what she says. Unfortunately, this is cheaper. Surgery is much more effective then paying them to be fat through mobility support, unemployment and disability allowance.” Can the solution to our ballooning obesity problem really be surgical? “No. But we have a lost generation hear gone too far already. Once they are really obese, telling them to eat less and move more does not work.” All this cutting through fat is hungry work. Yet at 2pm, the first break of the day, Somers snatches a slice of toast. When he started doing obesity surgery ten years ago, he was affected enough by what he saw to stop snacking, the major weakness of most of this clients – “human do not need snacks”. Does his work also put him off lunch? “No. I just have too much to do.”