Transcript

MICHAEL MOSLEY (VOICEOVER)

I’m here at Charing Cross Hospital to watch Bob’s surgery.

[MONITORS BEEPING] His surgeon is leading bariatric consultant Mr Ahmed Ahmed.

AHMED AHMED

So I’ve gone through the skin, and the yellow stuff there is fat. We’ll go through the fat and then through the abdominal wall muscle there. First quick peek inside, we’re going to see – all the yellow stuff here you see is fat.

MICHAEL MOSLEY (VOICEOVER)

The first stage of the operation is to shrink the size of the stomach.

AHMED AHMED

That little pale pink organ coming up, that’s your stomach right there.

MICHAEL MOSLEY

And you’re essentially going to reduce the size of that, are you?

AHMED AHMED

Yes, absolutely.

MICHAEL MOSLEY

By what sort of amount?

AHMED AHMED

We’ll probably make it about a tenth of its normal size.

MICHAEL MOSLEY

Ten per cent of what it is at the moment. Wow, that’s quite radical, isn’t it?

AHMED AHMED

Yes. The total volume’s going to be about 20 mls, which is about three or four tablespoons.

MICHAEL MOSLEY

So 90 per cent of the stomach will just be kind of left there inactive.

AHMED AHMED

Exactly. It’s still going to have its blood supply, and it’s still going to make gastric juices, but it’ll never see food again.

MICHAEL MOSLEY (VOICEOVER)

And, surprisingly enough, it’s not just Bob’s stomach they’re affecting.

MICHAEL MOSLEY

Now, you might think that just by reducing the size of his stomach, that’s how he’s going to sort out Bob’s problems, because smaller stomach, you eat less – it’s sort of straightforward. But actually, the mechanism by which it works is completely different. And it’s only relatively recently that they’ve discovered why doing gastric bypass is so effective.

AHMED AHMED

The modern thinking actually is that by making a smaller stomach, you’re actually inducing the changes in various chemical messengers, which in turn affect hunger levels and fullness levels, which in turn cause the weight loss.

INSTRUCTOR

Mm.

MICHAEL MOSLEY (VOICEOVER)

So as well as reducing the size of Bob’s stomach, the point of the operation is to change the levels of certain gut hormones. These chemical messengers are released by the gut in response to food and tell the brain when to eat or stop eating. One of the hormones, ghrelin, makes you feel hungry.

AHMED AHMED

We think that ghrelin is actually being produced from this part of the stomach, up here, this fundus. This is called the fundus of the stomach. And this is where all the cells that produce ghrelin are sort of based. Now, what we think we’re doing is we’re actually separating that part of the stomach completely from ever seeing food. So the food will never touch those cells that make the ghrelin.

MICHAEL MOSLEY (VOICEOVER)

Once they’re isolated, the ghrelin cells no longer function normally.

Hormone production will be reduced, and Bob should feel less hungry.

MICHAEL MOSLEY

Extraordinary, isn’t it? That little area of the stomach could be responsible for how hungry you feel.

MICHAEL MOSLEY (VOICEOVER):

The next stage of the operation is to reattach Bob’s smaller stomach back to his intestine.

AHMED AHMED

Good. There you go, thanks.

MICHAEL MOSLEY (VOICEOVER)

From now on, it will be right next to the part of his intestine that produces the gut hormone PYY that makes him feel full.

MICHAEL MOSLEY

How long does food normally take to get there?

AHMED AHMED

At this point, only about 20, 30 minutes, I would imagine.

MICHAEL MOSLEY

Right. So instead of taking, say, 20 minutes for your brain to get the message ‘You’re full; stop eating’, it might take what, five minutes?

AHMED AHMED

Yeah, about five minutes.