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 ruin so many lives

obesity

Carla Valentine and Dr.. Mike Osborne are the specialist team responsible for carrying out the postmortem?

Carla is an anatomical Pathology technologist and technical curator of the Pathology Museum at London's, Queen Mary University

For this postmortem. I'll be carrying out the evisceration which means we're moving all of the organs

Being part of a filmed postmortem 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 that I get study in depth

Mind is a consultant pathologist and fellow of the Royal college of Pathologist

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

Caller and Mike have performed thousands of Post-Mortems, but always behind closed doors

today

we will 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

to within our only

65 foot size

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?

and

Finally she arrived in London her body remains in a pool chamber for ten days to allow it to fall completely

Before it was brought to the post-mortem table

The first stage of every Post-Mortem before any cuts is made to the flesh is an external examination of the body

the donors Id number is confirmed against her medical records which details the cause of her death heart disease and

That you'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's 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 say I'm very demanding there, and that's because 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 centered on her abdomen, so this lady's 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's 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 leads 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 calamus first cut open the body

The incision is a large and deep single vertical cuts

Beginning at the suprasternal 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 the body to size?

Reflecting the skin back from the ribcage here, and what that means is. I'm just kind of loosening it away with the muscle and

Give me a bit of room to Maneuver 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 and 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 did you want to come and take a look at it okay?

so

We can see immediately the thickness of fat that is here and even though 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

It's quite a lot of fat around the organs

It's fatter in the amendment

It would appear that this lady is carrying much of her way 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've done thousands of Post-Mortems

It's always a fascinating procedure even if it's a case where you've seen lots and lots of similar cases in the past

That particular case will be individual and you'll 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

I'm going to take my rib shears, and we use these specifically for this job as they can cut through bone and

What I'm going to do is just make some very

Even cuts right through all of these bones

you can hear the bones of snapping this lady isn't exactly young and

The older people get the more calcified their bones become so they become very very

crunchy Whereas younger people ten have much more

soft Bones

In order to do this job you have to be

stronger stomach to start with but I think that's just something you even know or don't and

I never would have considered doing this job. If I didn't know I had a strong stomach

I'm now removing the breast bone or the breast plate

sternum with

upward strokes, and this way I don't damage any of the

Pericardium which is the Sac 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's because the human body is an

Incredibly complex machine to open human being to see all of that

Absolutely perfect sort of Jigsaw of organs and perfectly in place. It really did make me feel very we

would

When you do an autopsy on somebody who's very slim the organs are there and they're very evidence?

It's like a game of of operate should all like one of those anatomical models that you would use at school

In a woman this size a lot of it is really hidden by this extra yellow bar

it is making it quite difficult to see the structures and much more difficult than it would if she was a

person

before color removes the heart and lungs

Mike want to take a look at the organs while they're still in the body

To see if we will discover any early indications of trauma or damage

You can see the heart here

There's a large amount of fat around the heart

There's more here than you would see normally quite considerably more

Underneath the heart and lungs in this area here is what you call the diaphragm

It's a big muscle that helps you breathe

Evenly and the diaphragm I was going to ask you very fatty for me right even even on the surface with a heart fat in

the diaphragm I'm eating there's more fat than usual and actually the thing you can see most is an

extremely, enlarged liver this is very very large and

It's got what we call fatty liver change, so this is a fatty liver and fatty liver is very much associated

with obesity

you can see there's a lot of fat around these organs, so

What would be between my hands now would be the kidneys now the kidneys always have fat around them

I think it's important while we're talking about the fat to realize that is a normal thing

Everybody has fat in however thin you are there will be some fat and fat

It's got very very important roles and one of those roles is to protect things is that too much fat

That is the problem

five is made up of cells called adipocytes which are fat cells and

Really for a long long time until very recently people thought that that was

Just an inert substance that just sort of sat bone didn't really do anything, but it's becoming increasingly

Understood now that that is actually a very active substance

Fat cells work almost like an Endocrine organ the people would have heard of some endocrine organs things like the thyroid gland which

Related to how much energy you have how cold you are?

And so forth the ovaries the testes so obviously these hormones

Related to the ovary in the testes define whether you're going to be a man or you're going to be a woman so those are

the Sorts of activities Hormones have so they're very very powerful things they become obvious that the adipocytes the fat cells duclair an

Endocrine type Role, and so have some very powerful effects that were previously unknown

The next stage of the Post-Mortem is the dissection of the heart and lungs

For might to be able to do this carla needs to remove the cardiorespiratory block from the body

I'm cutting through the diaphragm here just to make sure that I freeze the lungs completely

See them along Spine here

I'm going to do the exact same thing on the other side

And chop across the esophagus metric area here

And then all I need to do is basically pull the organs towards me at the same time as releasing these sort of white fibrous

Tissues that holding the organs for spine and then we'll get to a point

Where this blocks the cardiorespiratory block is completely free

Then we can take this out as one block

and we've got the heart and the lungs and the heart Sac the

pericardium

When you initially carry out post mortem?

and you hold an organs such as the heart in your hands and the heart is very symbolic and

You know using all sorts of logos. It's it has a sort of power and a sort of

agency that makes you kind of stop and think because it looks, so

Mundane, but then you realize that within it has the electrical impulses to keep a person alive

With the cardiorespiratory block removed from our donors body Mike can start his dissection of her lungs

Will we uncover any evidence of damage linked to her obesity?

I'm going to Detach the lungs

From the heart so we'll start off with the right lung

So just cutting through

Where the lung is attached, and that's the right lung detached to the left lung. I'm detaching

there

I'm just going to make some cuts across the lung just to see what the surface of the lung looks like these lungs actually look

quite healthy

There's no tumors or masses or anything like that in these lungs

But what there does seem to be and which should be evident now if I pick this lung up and squeeze it is

You can see the fluid dripping out of these lungs, and this is what we call pulmonary edema. That's

Essentially heart failure fluid this fluid is basically water. I know it looks red

That's because obviously it's within the body, and it's been mixed with blood. It isn't blood is much much thicker than that

This is really just a watery fluid and this is collected because this lady's got heart failure

this lady died from Heart failure from Hypertensive heart disease

But this lady is also obese she did not die from the obesity the obesity

increased the risk factors and

Was associated with the problems that led to her death?

Fluid has built up in this lady's lungs because her heart isn't working properly

She'd have probably been short of breath and had possibly had a cough

but also because the fluid sits in the chest when you lie flat

And that would have given her a sensation almost of drowning

When you become a doctor one of the questions that they teach you very early on is

How many pillows do you sleep with and that tends not to be because they're asking how comfortable you are at night?

It's because if somebody says oh, I can't sleep in a bed doctor

I have to sleep in a chair or I have to sleep with eight pillows sitting up that is very indicative of heart failure

And the startling discovery Mike has made in our donors lands