Obesity: The Post Mortem

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-mortem table in London?

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,