Inside a clinic taking on childhood obesity

0:00This BBC podcast is supported by ads outside the UK. Get more with BBC podcasts wherever you listen. Be the first to listen to your favourite shows like Evil Genius, Good Bad Billionaire and You're Dead to Me with a subscription to BBC Podcasts Premium on Apple Podcasts. You can also enjoy a range of our podcasts ad-free with an Amazon Music subscription. Hello, I'm James Kimarasamy. Thank you for downloading the BBC's World Tonight podcast for Wednesday 2nd September. In the first week of a new school year, we have a special report on the problem of child obesity in England. We've had exclusive access to a special NHS child weight loss clinic in Cambridge.

0:45Also on the programme, he was the youthful face of the Hong Kong pro-democracy movement. Today, Joshua Wong has admitted to a crime that could result in a life sentence. We speak to one of his close friends and fellow pro-democracy campaigners now in exile. Plus the royal sneak peek of the bio-tapestry, the composer who's turned the comings and goings of London tube trains into music, and as 5 ,000 American sailors who've been on an aircraft carrier in the Gulf for nine months finally get to dry land, we hear about the attraction and the distractions of shore leave. With thousands of children across England starting primary school for the first time this week, we've decided to focus on one of the less reported challenges that many of them are facing.

1:30While the government's focus on breakfast clubs, 1 ,400 new ones are opening this term, has highlighted the problem of hungry school kids. One in ten pupils who begin primary school in England is considered obese. Among those leaving for secondary school, that figure jumps to one in five. And there is one group of children, who number in their thousands, who live with such severe levels of obesity that they're at risk of dying before the age of 40. Among the few places able to treat these children who often have complex needs is a network of specialist NHS weight loss centres called Complications of Excess Weight or Q Clinics.

2:10The Waltonite's Alice Aylett-Roberts gained exclusive access to one Q Clinic in Cambridge where she met parents, medical practitioners and a six-year-old patient. Be careful, it's got to put your stuff on. What's your name? I can't remember. You can't remember your name. This is Theo. He is one of a few thousand primary school-aged children to be treated at a pioneering type of obesity clinic in England. So he's six now, when he was six earlier in the year, and he's just reached Nine Stone, just over Nine Stone now. Theo's mum Rachel and his dad Perry noticed that he started putting on weight rapidly when he was just a toddler.

2:53More toys. There are a lot of toys there, aren't there? Yeah. So he actually was born quite a small child in particular, so he was just under seven pounds, and he started to get bigger, and it come on quite quickly. It was like from around two years, it started to see the big jumps in weight, and within six months of the year, he almost doubled in size, height, and in weight. Yeah, just almost overnight sort of thing. It just went big. Theo's parents were referred to a specialist NHS weight loss service called a Complications of Excess Weights Clinic. Each Q Clinic around the country will see on average 100 new patients each year.

3:34That is really just the tip of the iceberg. This is Professor Ken Ong. He is the lead clinician at Cambridge University Hospital's Q Clinic. He told me that Theo is one of the youngest children they are treating at the moment. but he has seen children as young as four. So a normal body mass index or weight for your height, for an adult, a healthy body mass index would be less than 25. Normal children have a healthy range body mass index less than that, often between 15 to 20. Many of the children who attend our clinic have body mass index ranging 30, 40, 50, sometimes well above that. they are at a very extreme level of weight.

4:21So just relax that arm and I know it's going to squeeze a little bit. What makes these clinics different from traditional weight loss services are the number of specialists all treating the child under one roof. Not only doctors and nurses and dieticians, but also psychologists, family support workers and family therapists. Hi, I'm Tessa Saunders, I'm a family therapist. My role is to try and help the parents to think about what they might be able to do in order to help their child on this journey. Your job as a parent is that it's not about children being happy 24-7. You know, it's about preparing your children to cope with life and in life there are going to be rewards and consequences.

5:00If you have the whole family approach, it's a team approach and that team approach is what's going to make a difference. Can you be as still as you can, please? Thank you very much. And hold. Yeah. And for Thea's parents, it's the psychological support that has been key to managing his obesity and controlling his appetite, especially because his overeating is closely linked with his autism diagnosis. We all eat a bit more chocolate when we're sad or mad or whatever, but for him, he's got so many emotions that he doesn't understand, so for him, it's just, I don't know what I'm feeling, I need this, I need this.

5:37It's just what he's found, isn't it? I think as well, for a child with autism that has such a restrictive diet, so they're not happy to sit there and eat bowls of vegetables and five a day, it makes it even more difficult. You said about his diet is very limited. What are we talking about? How limited? A beige diet with a hint of fruit. I'd say it's the limit. Nuggets and chips. Nuggets and chips. Where has it come from? Plain food, so bread, butter, no sauces, nothing with vegetables in, nothing... Nothing new, nothing unknown. Nothing colourful. Nothing, yeah. Nothing that smells. Yeah. So I think for a lot of autistic children, having different smells, textures, colours are quite overstimulating, especially when we notice that in Theo.

6:24So safe foods become such a heavily reliable thing, don't they, because of that. Another challenge for the family has been dealing with the judgement from other people and the assumption that they are to blame for Theo being obese. It's quite upsetting I think as a family because there is a lot of judgement, there is a lot of speculation that it is our fault and we are the reason that he is the way he is. I think it would be nice to have wider education to everyday people just so they understand that it's not always black and white. I think we have the same issues along with his autism and if he was to have a meltdown it's like a spoiled child.

7:01It's the same sort of concept of that. And it is quite harmful to us as a family to actually go out in society and be around people and have that level of judgement there. But I think it is genuinely a lack of education and of understanding why things are the way they are. Many parents come into the clinic assume their children will be prescribed weight loss drugs. But Professor Ong says that for most, the treatment isn't available. Some families are looking for an easier option for weight medication that will help reduce their child's appetite and weight. We don't have access to these. NHS doesn't fund these medications routinely for children.

7:41Families, not just of young children, but adults, we know see weight loss medication as a quick fix, as the only solution that's needed. The families who come to our clinic are in this position often because they have very complex needs. and if those aren't addressed, then either the weight will come back on very quickly when they stop medication or weight loss medication simply papering over many other needs of these children.

8:12The funding for this pilot scheme of Q Clinics will end in March next year and it's not yet clear if the highly specialised service will be able to continue. But for Theo's parents, it has been a life-changing experience. The support has been so valuable to us that it's just scary to think, I mean, when we're parents and we'll continue to do the right thing for them, but to have that specialist input is just so powerful and so helpful to families in our situation, I think. There could be people out there that are struggling, not knowing that something like this could be potential for them. Please mind the doors.

8:48Doors closing. And that report was from Alice Aylett-Roberts. Well, that was one family's experience of a Kew clinic in Cambridge. There are 39 of the clinics across England offering slightly different services. Some do treat children with weight loss drugs. It's the only part of the NHS that currently does so. Professor Simon Kenney is National Clinical Director for Children and Young People at NHS England. He is a bariatric surgeon at Alder Hay Children's Hospital in Liverpool, and he first spotted the need for these obesity clinics after seeing a large rise in the number of children being referred to him for weight loss surgery.

9:26Earlier I spoke to him about giving weight loss drugs to children. We began though with the scale of the problem of severely obese children. I think what we've learned is the prevalence is very high. These are just pilot clinics. We've got 39 of them running at the moment. When you start to look at exactly what the need is across the country, the needs considerably greater than that. And that then starts to sort of mean that if we do bring these clinics on board, the impact they will have in terms of bringing children back, both in terms of their physical health, so what we see is things like diabetes and hypertension, those risks start to drop as they go through the clinics.

10:07We also see mental health and quality of life improve. So what the potential is, is that the return on investment from taxpayers' money in terms of NHS services is that we can see a future reduction in demand for both health services, but also, and probably most importantly, we've got children and families who are happier, healthier, they can engage in society, and they can ultimately pay tax. I guess people at some point have assumed that there's something genetic, that overweight children come from overweight parents. Is that the kind of received idea that you have to fight against? I think we've got to fight against various misconceptions and that's one of it is that there's a genetic disposition.

10:55As part of the workup that children going through the clinic and young people going through the clinic go through, they do get genetic profiling because there are a small number of conditions which do have a genetic predisposition. there may be some more general genetic predispositions which we're not in a position yet to identify but might be helpful in terms of guiding treatment in future i think probably the more corrosive narrative is blaming the parents which is something which is quite prevalent and i can understand why people might feel like that but what we've learned and what i've learned is that actually the parents don't really stand a chance when they've got the industrial complex that pushes low nutritional value, high calorie food into the system.

11:43And if you think at the moment, every time you try and leave a motorway exit service station, there's several fast food outlets that are between you and getting home. And if you can see, we've got food deserts across the country where there are just fast food outlets and nowhere you can buy healthy food. You can see why parents are up against it, particularly when they've got hard pressed, busy lives. One thing that I guess must have changed over the years that you've been involved in this is the availability of weight loss drugs. And we hear that some parents going to these clinics assume that their child is going to get given one of these drugs.

12:21But I think it's only one in 20 who actually do. What is the role for weight loss drugs in treating child obesity? The good news is that the data that we're generating is showing that the weight loss drugs are a potentially useful addition, but they're not needed to see the meaningful improvements that we've seen. And that's why most children don't actually need it. I think when you've got particular health conditions such as liver disease, high blood pressure or incipient diabetes, sometimes what's needed is an additional spur to generate weight loss and to see those diseases resolve. And any decision is made within the multidisciplinary team very carefully about which children should go on those.

13:09And it's helpful to have them as an adjunct. we're still learning the role that glp1s will have in children and i think the caution we have to have about that is that children obviously if they get those drugs early in life what is the long-term impact in terms of muscle development etc so we have to watch that very carefully and weigh it against the negative impacts of the high weight in children themselves and the stark message behind this is that life expectancy which is the tip of the iceberg is really lowered if you're in this group of children so when you're dealing with a condition which can carry a life expectancy of 40 years which we know that the quality of life that those children experience is about the same as them suffering from cancer you have to take it extremely seriously that we that we potentially have to use every weapon we have in our arsenal to treat it and that was Professor Simon Kenny, who's National Clinical Director for Children and Young People at NHS England.

14:13And you can find much more on Alice's report from the Kew Clinic in Cambridge if you go to the BBC News Online's in-depth section. They're posting her piece on it there in the next couple of hours. You can, of course, read it at your leisure. Now, the King, Queen and Prime Minister joined President Macron and his wife Brigitte at the British Museum this evening for a sneak peek of the Bayou Tapestry. The medieval work of embroidery, believed to show the death of King Harold at the Battle of Hastings, has returned to these shores for the first time since it was created almost a thousand years ago.

14:48It is on loan from France and it goes on display to the public next week. Our culture editor, Katie Razzle, was also there. And here is the absolute iconic moment of the tapestry where we see Harold standing, holding the shaft of an arrow that is pierced in through the right eye. It is an astonishing sight, nearly 70 metres long, and I'm standing looking down over the tapestry with the King and Queen, the President, the Prime Minister and all sorts of other dignitaries standing and being led along it. The lighting is incredibly low, that's to protect this fragile artwork, but there is enough light to see the drama of it, this epic story of Anglo-French relations back in 1066.

15:36The arrow is quite faint. The arrow is sort of a very pale yellow kind of... Experts debate whether the arrow was actually added much later by 19th century restorers. But as they toured the Bayer Tapestry nearly 1 ,000 years after the death of the English king and the Norman Conquest, the message was that the loan of the work to the UK is a sign of Anglo-French reconciliation, not enmity. This is the French president, Emmanuel Macron. A thousand years ago, this work depicted a crossing that changed history. And today it crosses the channel through a tunnel that we built together, a reminder of what our two countries can achieve when they join forces.

16:19If anyone remembers what we did here today, decades or even centuries from now, I would like to believe that they will remember not only the story told by Bayeux Tapistri, but also the tale of two countries, which after centuries of shared history, choose to forge a bond as close as the threads of this thousand-year-old embroidery. Long live culture. Long live the friendship between France and the United Kingdom. Longue vie à l 'entente cordiale et longue vie à l 'entente amicale. A loan to Britain was first requested back in 1931. Nearly 100 years on, it was pushed through to the opposition of some by the French president who is believed to have wanted a reset in Anglo-French relations after Brexit.

17:12King Charles reminded guests that Windsor Castle was built by William the Conqueror and echoed the warm words about the two countries' shared history, adding a joke about the tapestry's heritage. Commissioned in Normandy, yet most likely to have been embroidered in Canterbury by English cross-people. The Bayer Tapestry, or the Canterbury Embroidery, as it might just have been called, recounts a conflict, yet here it is today, nearly a thousand years later, as a precious symbol of trust, at a time when trust seems sadly to be in short supply between nations. The 58 scenes, embroidered on linen, are a medieval blockbuster about the build-up to 1066, a defining moment in English history.

18:07The king last viewed the tapestry in Bayer in the 1980s, but tonight he saw it laid flat. It's a stipulation from the French to protect it. Curator of the tapestry at the museum, Michael Lewis, showed the king and queen around. It was great fun, actually, looking at different scenes, obviously thinking a little bit how they're relevant to the king. So, for example, we saw the coronation quite recently, in a way. The king was crowned. So, yeah, he could obviously reflect on that. We also saw the meeting, the first meeting, if you like, between Harold and William, and I kind of reminded the king that he is in the Channel Islands, known as the Duke.

18:43He sees that French ancestry as much as the English ancestry, if you like, in his heritage. Trust and friendship were on show, with an embrace from President Macron to the king as they left the British Museum. Members of the public, lucky enough to have snapped up tickets, will be able to view the exhibition from next week, with more tickets to be released next month. And that was Katie Razzle reporting, And just to let you know, Nick Robinson and the Today programme will be broadcasting live from the British Museum tomorrow morning, starting, of course, at six o 'clock.

19:36You can book your first visit with a clinician right away. It's not you. It's your hormones. Visit joinmidi.com to book your first visit. That's joinmidi.com. Insurance coverage varies. Check with your plan for coverage. Get more with BBC Podcasts, wherever you listen. Be the first to listen to your favourite shows, like Evil Genius, Good Bad Billionaire, and You're Dead to Me, with a subscription to BBC Podcasts Premium on Apple Podcasts. You can also enjoy a range of our podcasts ad-free with an Amazon Music subscription.

20:15Those are the sounds from the middle of the last decade as young activists in Hong Kong took on the idea of being ruled from Beijing in what became known as the Umbrella Movement. Among those wielding umbrellas against police pepper spray was one young man called Joshua Wong who had begun his activism as a teenager. He became the face of the Umbrella Movement and he was hailed as one of the world's most influential figures by Time magazine. On a visit to London in 2015, he conceded to the BBC that his activism came with risks. Being the student representative of the Umbrella Movement, I have already expected to pay the price.

20:51But I just think that even facing this kind of political prosecution, next year I may need to be put into jail. But I just hope to keep fighting for democracy and to help to raise the general public awareness, not only Hong Kong, but also the people and UK to know that Hong Kong being the former colony of British, we're still fighting for the promise in the joint declaration and also fight for the future. Well, now that future looks rather gloomy. Five years after that interview, China introduced a new national security law to the territory, which became the pretext to slowly crush the democracy movement.

21:26And today, Joshua Wong, who has already been in prison for nearly five years, pleaded guilty in a Hong Kong court to collusion with foreign entities, a charge that carries a maximum life sentence. I've been discussing his case with a friend and fellow democracy campaigner, Frances Hoy. She often appears beside Joshua in photos from those headier days of protest. She was granted political asylum in the United States in 2020 and was charged by the Hong Kong authorities three years later with subversion, secession and collusion with foreign forces. A one million Hong Kong dollar bounty was placed on her head.

22:03So what is her reaction to Joshua Wong pleading guilty to these new charges? I expected it, to be very honest with you. It's a very difficult case to fight over. If you look at what was disclosed yesterday in the court, much of what prosecution made of it were things that he had done before the national security law even existed. So it's a very difficult circumstance. that he's facing. And so I understand why he would decide to plead guilty. And what happens next to him? I believe the sentencing will come later, which the judge will pick another date. But he is about to finish his current sentence by next January, next year.

22:50And so according to the judge, they will try to pick a date before that so he can transfer seamlessly. But that just means that he will continue to stay behind bars. What do you know? What does the outside world know of the kind of conditions in which he's held? He's currently held in Stanley prison, which is the maximum security prison in Hong Kong. It's also the same prison that is housing Jimmy Lai, Owen Chow, a lot of the high profile political prisoners. and from my understanding has been exercising regularly, keep himself in shape, physically try to occupy himself by reading a lot, playing guitars and things like that.

23:39As you say, he began this movement, his own participation in the pro-democracy movement when he was a teenager, as did you. I just wonder, do you think he anticipated what that would mean for him and what that would mean for his potential lack of freedom? Yes and no. Throughout his time being an activist, he had always expected that he would spend a lot of time in and out of prison. And that's really what happened in his teenage years. And so I think he largely expected it. But the national security law is very new. The sentencing, the range is much wider than in the past for protest related conduct.

24:31And so now he's facing years, potentially decades or even life behind bars. How do you view it? You say he is someone who inspired you to get into the pro-democracy movement. How do you view his fate? I've known him for more than 10 years now, I would say, since we were a teenager. It's not a lie to say I looked up to him because he was really in the hope for the future of Hong Kong. But that didn't come true as a reality for him. He's now being put behind bars and being separated from family and friends. It's really heartbreaking to put myself into his shoes and think about the current situation he's in.

25:13I wonder if I could ask you about one issue that is being written about at the moment, which is the fact that there are still Western, including British judges, sitting on Hong Kong's highest court, the Court of Final Appeal. There are calls for them to no longer do that because of the state of the legal system in Hong Kong. What would you say to a British judge sitting on the court of final appeal in Hong Kong? I would tell them that you're absolutely complicit in doing the dirty work for Beijing by sitting there and lending your legitimacy to this regime. A lot of people, including legal professionals, to me are still very delusional about the situation in Hong Kong.

26:09And I think deep down they know that what's happening is not right. Anyone who is trained in law, in legal fields, will know that this is egregious law and arbitrary applied on democracy activists and dissidents. Frances, if you are optimistic, or if there's something that does give you cause for optimism, what would it be? We're actually going to see the UN General's Assembly pretty soon. And I just saw that yesterday, the new UK Foreign Secretary has said that he is committed to take up Joshua's case. I think this would be a great opportunity for the UK to bring up his case, to see the UK speak up more for political prisoners in Hong Kong.

26:56And so I just hope that world leaders could finally step up and speak up for Joshua and others that are still suffering and have been standing on the front line of freedom against authoritarianism. Hong Kong pro-democracy activist Frances Hoy now in exile in the United States speaking to me about her friend, fellow campaigner Joshua Wong who today pleaded guilty to charges which could lead to a life in prison. Now from Steve Reich's different trains to Kraftwerk's Trans Europe Express trains have inspired some of the most innovative modern music. Now the composer Matthew Wilcock has gone underground for inspiration transforming the comings and goings on London's tube network into a musical composition with the help of real-time train data on his laptop.

27:47Every time a tube train pulls into a station, it generates a note, and that means the music's rhythm is the rhythm of the tube. Matt sets the scale and the key. Earlier, he brought his laptop into the studio to give me a demonstration and an explanation of how he began his transport-related musical journey, not on the rails, but on the roads.

28:19I was out walking late one night and I live in Walthamstow so it's pretty close to the internal ring road and I hate the sound of the motorway and I hate the sound of the ring road like depressing connotations I guess but I was walking there and I had my noise cancelling headphones on and I wasn't listening to anything for some reason I don't know why I was in a weird space and I got to the road and I could just feel the cars coming underneath me and I stopped for a bit and was watching and then someone started laying cones out in one of the lanes and the pattern and the rhythm of the cars changed and it made it almost like a polyrhythm something strange happened and I was like oh that's kind of interesting what will that feel like musically so I took some test footage went home and made the first what I call a motorway cycle whereas I put this pink line over the footage and as soon as a car passes the line it creates a note and then within that system accurate rules so one of the most popular ones which is this one