Obesity: 'My body has become my prison'
"I have built a prison for myself and it's stopping me from doing everything."
Suzanne is a woman who is trapped. The 35-year-old from Wrexham is so embarrassed to be morbidly obese - she is a dress size 32, 5'1'' tall and weighs 34 stone (215kg) - that she rarely leaves her home.
But, she was so desperate to try to lose weight that she made a 10-hour return journey to one of Wales' only doctor-led weight management clinics in Blaenau Gwent.
She said she was forced to make the journey south as there was no help for her in north Wales.
It is something that needs to change urgently, according to Wales' leading expert on obesity, Prof Nadim Haboubi, a bariatric physician at Nevill Hall Hospital in Abergavenny.
He said: "There's no real services for obesity in north Wales. There's good efforts being made by certain GPs and consultants who are trying hard but there's no real commitment to actually establish decent services in north Wales."
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South Wales has two specialist NHS obesity clinics led by doctors, while bariatric surgery is performed at Swansea's Morriston Hospital for those most in need from south, mid and west Wales.
The doctor-led clinics in Blaenau Gwent and Cardiff provide access to a range of specialist services, including dieticians, cognitive behaviour therapy (CBT) therapists, clinical psychologists, exercise trainers and consultants.
But in north Wales, patients are sent to Salford Royal for surgery and there are no doctor-led clinics.
- Obesity in Wales is worse than any other UK nation - 59% of adults are overweight, with 23% classed as obese, according to the National Survey for Wales 2016-17
- Among reception-age children, 26% were found to be overweight or obese during the latest annual Child Measurement Programme in schools, compared to 22% in England
- Some 11% of reception-age children were obese in Wales, while over the border the average dropped to 9%
Betsi Cadwaladr health board said it is to start a "multi-disciplinary service" in north Wales to support people with severe obesity.
Prof Haboubi, chairman of the Welsh Obesity Society and professor in clinical nutrition and obesity for the University of South Wales, said a doctor-led service was needed.
He said clinics - like the one he leads in Blaenau Gwent - were "essential" in a society where obesity was increasing as they gave people the tailored help they needed to successfully lose weight.
For Suzanne - who is too embarrassed to be identified - the postcode lottery for tackling obesity in Wales is adding to her frustration.
"I need help. My GP has tried to cobble together help with a dietician but it's not geared up for people of my size," she said.
"For example, I'm too heavy for the scales at the doctor's surgery and I worry I will break the equipment in the gym.
"So when I heard about the clinic in Blaenau Gwent, I realised I had to go.
"Luckily, my friend took me to south Wales by car as going on the bus leaves me very embarrassed and anxious, as well as uncomfortable.
"Travelling for me is a big deal but I felt I had no choice.
"I'm fully aware this situation is of my own making and I feel guilty taking up medical resources but I desperately need help."
She said she has been spurred on by wanting to make a better life for herself.
"I decided to go to university when I was 30 to do a bioscience degree and my dream is to become a science teacher in a secondary school," she said.
"But I'm trapped in my own body. Mentally I'm ready to do it as I know I would love it and be brilliant at it.
"But physically I can't stand up in a classroom for an hour and I can't walk very far.
"I do go to work in a taxi office but a taxi has to pick me up and drop me home every day.
"Apart from that, I rarely leave the house as I don't want to put myself in a situation where people make fun of me.
"I live in such a beautiful part of the country and would love to go for a walk but just going upstairs is a struggle for me.
"I would love to buy a top that doesn't cost me £50. I would love to sleep without the machine I have for sleep apnoea.
"I have built a prison for myself and it's stopping me from doing everything.
"It's like I'm two different people - who I really am and then what my body looks like.
"I just want to be me and be productive and do the best with my life. I think it would be hard to begrudge anybody that."
She said she was hoping to qualify for bariatric surgery in Salford but had not yet heard whether her referral had been successful.
Adrian Thomas, Betsi Cadwaladr health board's executive director of therapies and health sciences, said recruitment had started for a new multidisciplinary service for people with severe obesity in north Wales.
"This exciting development will enable us to meet the NICE [The National Institute for Health and Care Excellence] guidelines and provide the most appropriate support to people," he said.
"We also anticipate the multidisciplinary team's interventions will lead to a reduction in the number of people requiring bariatric surgery.
"Bariatric surgery for people in north Wales is currently performed at the Salford Royal as we do not have the critical numbers to enable surgeons to meet national guidelines.
"We work closely with colleagues in Salford to ensure that our patients are well supported throughout their episode of care and Salford have a pathway in place including a 'one stop shop' clinic with all of the relevant specialists required to deliver the service."
A Welsh Government spokesman said: "We are committed to producing a national strategy on preventing and reducing obesity.
"There is already in place an All Wales Obesity Pathway to manage and treat obesity in Wales.
"Health boards, working with partners, are responsible for delivering the pathway in their areas."