Telford is the obesity surgery capital

Telford & Wrekin has England's highest rate of surgery for obesity, with 46 in every 100,000 people going under the knife to lose weight.

That is five times the national average and comes as the county is fighting a surge in weight-related diabetes. Stoke-on-Trent had the second highest surgery rate, with 41 in every 100,000 people receiving bariatric surgery. In North Staffordshire, the figure was 30 per 100,000.

While obesity is less of a problem in rural Shropshire, it soars in urban Telford & Wrekin, according to figures obtained through a Freedom of Information request. Today's figures relate to a 10-month period to February this year.

Bariatric surgery includes gastric bands, gastric bypass and gastric sleeves, which reduce the capacity of the stomach. It cost the NHS £33.8 million last year – but Shropshire-based consultant John Loy said the number of treatments should be welcomed as they save the NHS billions.

Mr Loy, of Royal Shrewsbury Hospital, said the NHS spent £10 billion a year treating diabetes and related illnesses. He said a gastric bypass operation typically cost the NHS £6,000, but paid for itself within three years.

Earlier this year a survey ranked Telford & Wrekin as the sixth worst place in the UK for obesity, with 32 per cent of the population said to be clinically overweight and many suffering type two diabetes.

The study showed that the rest of Shropshire fared better, with 23 per cent of people suffering from obesity. In Powys the rate was just 20 per cent.

Mr Loy said the West Midlands was the most obese area of the country, adding: "Our hospitals are full of patients with type two diabetes, usually caused by being overweight."

It's not pretty, but Steve Woodman wants people to see the effects diabetes can have.

Steve was just 34-years-old when he was diagnosed with the life-changing illness. And the keen musician thought he could carry on with his lifestyle, enjoying trips to the pub and eating whatever he wanted.

Little did he expect that, at the age of 59, he would have to use a mobility scooter and walk with sticks.

But that is what living with, and mismanaging, type 2 diabetes can do to you. In Steve's case he has lost three toes, his job and his independence.

"It is through my own ignorance that I am in this situation," said Steve, who lives in Castlefields, Shrewsbury.

"I was first diagnosed 25 years ago.

"But I thought I was lucky and that it was not serious as type 1. I was told to change my life style so I did alter my diet and go to the gym for a while but I was showing no outward signs of illness and I thought everything was working out so I went back to my regular ways.

"I began going to the pub again with my friends and eating all the wrong foods. I did that for about 20 years before things started to go wrong.

"I felt quite well but started to get numbness in my feet. That got worse until I began to get shooting pains up my legs.

"It was then that I realised that the diabetes side effects were kicking in." He later got an infection after tearing his Achilles tendon.

Doctors managed to halt the infection but were unable to save his toe, which had to be removed. Then months later, a second toe were lost followed swiftly by a third. Steve then developed two ulcers.

"I did not take it seriously. Now I am registered disabled, without a job and at the age of 59 see myself living on benefits. It is a very bleak outlook for me. I am aware of what I am costing the NHS because of my own stupidity."

Steve is calling on people to ask to have their glucose levels checked when they have a blood test.

"You do not know you have got diabetes until you have a blood test.

Fighting weight-loss battle

Across Shropshire as a whole, approximately 150 people are treated every year, and a cost of nearly £1 million.

It reflects a rising level of obesity that is putting enormous pressure on the NHS, particularly through weight-related type two diabetes and the devastating side-effects the illness can bring.

But far from being disturbed by Telford's position at the top of the league table, consultant Mr Loy says he would like to see more people coming forward for the treatment.

"At the moment we are treating less than one quarter of a per cent of the people who are eligible for bariatric surgery," he says.

Mr Loy, a specialist in bariatric or weight loss surgery at Royal Shrewsbury Hospital, says Telford & Wrekin's position at the top of the league the table is something the borough should actually take pride in as it means clinicians here are being pro-active.

While it is in part down to the fact that the West Midlands as a whole has the worst obesity rate in the country, one of the reasons why Telford figures so highly is down to the proactive approach of the borough's clinical commissioning group.

And he says the operations not only transform the quality of life of patients, but they also save the NHS millions of pounds in treatments in the long run.

"Our hospitals are full of patients with type two diabetes, which more often than not is caused by being overweight," he says.

"The complications that result from diabetes are quite stark. Kidney failure, the loss of limbs, the loss of sight and heart attacks.

"The cost to the NHS of dealing with diabetes is about £10 billion a year, that is the total of the NHS budget."

With his slim, athletic build, Peter Warren looks the picture of good health. His hobbies include mountaineering, playing cricket for Pontesbury and working out at the gym, so it is no surprise he weighs in at a healthy 12 stone, and has a slimline 34in waist.

But before he received a life-changing operation in July last year, it was a very different story indeed. Tipping the scales at 32 stone, his self-confidence hit rock bottom, he avoided socialising with friends, instead stopping at home to binge on takeaway meals.

"I could easily sink 20 pints of beer due to the size of my belly," he says.

"A typical meal at a fast food restaurant would consist of one large meal plus three extra portions of fries, an additional two double cheeseburgers, 20 chicken nuggets and two milkshakes. But I was never full and an hour later I'd probably eat a large bag of crisps or a tub of ice cream as a snack."

Peter, 35, from Hanwood, near Shrewsbury, saw his life-changed by a gastric bypass operation in July last year.

As a teenager, Peter had led an active and healthy lifestyle. But an injury at the age of 21 led to him piling on the pounds.

At one point his waistline ballooned to 66 inches, and after being diagnosed with sleep apnoea and depression, he was referred to consultant bariatric surgeon at Royal Shrewsbury Hospital.

Since his operation, Peter's weight has plummeted to just 12 stone, and he has started playing cricket again. He has climbed Snowdon several times, works out at the gym three times a week, and does regular three-mile runs.

The operation means that he only needs to eat small portions of food before feeling full.

"I never had the feeling of being full before the operation but I have now regained control of my life," he says. "I have had to re-educate myself. My eating habits have totally changed and I have not touched alcohol since the surgery.

My fitness levels are much better. People are always shocked when they see me, but I still want to improve my fitness levels and get stronger."

Which puts the £900,000 Shropshire spends on bariatric treatments into context. Mr Loy says each operation costs about £6,000, but the treatment pays for itself within three years as patients are weaned off expensive diabetic medications.

"Type two diabetes is a real epidemic that we, as surgeons, need to do something about. By helping patients lose weight we are also improving their diabetes. Quite often people are taken off their diabetes medication on the day of surgery.

"Our results are that instant due to the gut hormones being reset to a normal level after a gastric bypass.

"The beauty is that very often they can come off their medication even before they have started to lose weight."

Prior to arriving at Shropshire, Mr Loy worked at the internationally-renowned NYU Langone Bariatric surgery in New York. And he says the treatments have moved on a lot in recent years.

Most people associate weight loss surgery with the gastric bands fitted to celebrities such as Anne Diamond and Vanessa Feltz, but Mr Loy says this is out of date.

"Gastric bands work for a certain type of patient, but these days we're moving away from the gastric bands and towards the gastric-bypass operations," he says.

Gastric-bypass surgery involves keyhole surgery which reduces the patients' stomach to the size of an egg cup. The surgeon then plumbs the small bowel from where it normally is into the top of the stomach.

"This changes the hormone profile so they are released much quicker and tell the brain 'stop eating, you are full'," says Mr Loy.

"It makes them feel less hungry."

The surgery isn't available to everybody, although the Telford & Wrekin CCG has broadened its criteria. Typically, a patient whose body mass index is more than 30 and is suffering from type two diabetes is eligible. Sufferers of obesity-related conditions such as sleep apnea, hypertension, or hip and knee arthritis may also qualify.

Mr Loy says in many cases the patient will have spent a lifetime dieting without success.

"Some are even former Slimmer of the Year award winners," he says.

Mr Loy says while exercise and healthy eating is generally the best way to lose weight, once some people reach a certain weight it is no longer enough.

"Research shows that fat cells have memory so if you lose seven or eight stone the body's fat cells remember how many of them there were and therefore as soon as the diet stops the weight goes back on.

"For some people trying to resist that temptation is like trying to resist thirst, so while diet and exercise are great, once you are over a certain weight, these alone will not work."

But why are so many more people in need of surgery to reduce their weight compared to that of a generation ago?

"People in general are getting bigger, there's no doubt about that," he says.

"You only have to look around you to see that people are fatter than they used to be.

"We live in an obesogenic environment. Everywhere we go it is easy for us to get fat."

He says the causes of this go back decades, and in many respects it is simply the result of our developed, affluent society.

"Years ago, a lot of people worked outdoors, they cooked their own food, and it was good, simple food, which people could burn off by doing manual labour," he says.

"These days people have food delivered to their home, people don't do so much manual labour, there are takeaways everywhere.

"People exercise less because they don't go into town to buy their food. Everything is about convenience."

And he says the nature of the food on sale also has a considerable impact. We are offered extra shots in our latte, there are supersize meals on menus and places are selling grab bags instead of regular size packets of crisps.

"It is so easy for people in today's environment to get fat.

"I hear it said that people shouldn't give in to temptation but we are now working with what has happened over the last 20 or 30 years. It is easier for people to get fat these days, and ultimately it is harder for them to lose the weight once that happens."

As with all surgery there are risks attached to gastric bypass operations, but Mr Loy says they are some of the safest procedures around.

"Here at Royal Shrewsbury Hospital we have a very low complication rate and our weight loss results are comparable to the best in the country," he says.

"We would strongly urge anyone thinking of bariatric surgery to make the decision to talk to their GP or come along to one of our patient support evenings."

Mr Loy says the NHS spends £22,000 a minute treating diabetes, so the potential savings are huge. And at a time when ever-greater demands are being place on the NHS by an ageing population, such savings could prove crucial.

But while the financial savings are welcome, Mr Loy says the most rewarding thing is seeing the transformation in patients' lives.

He says: "I see patients the day after surgery and it is amazing, they are up and walking and asking 'are you sure you operated on my stomach and not my brain because I am not sore and I don't feel hungry?'

"For us this really is the most exciting outcome, we really enjoy seeing the great improvement in how our patients feel afterwards and the positive effect this has on their lives going forward."