New Zealand ` clean,... green,... ...and fat. In the last year, nearly 70,000 extra New Zealanders became obese. Now most of us are fat. You are... morbidly obese. Do you know what the word 'morbid' means? It means 'deathly'. Premature death. 65% of adults are dangerously overweight and South Auckland is the ground zero of our obesity explosion. The Manukau SuperClinic is on the front lines of this epidemic, treating over 1200 patients with controversial weight-loss surgery. We remove about 80% to 90% of the volume of the stomach. Not much room for food. We've now spent two years with the most at-risk patients and the specialist doctors and nurses dedicated to helping them through the highs and the lows of their weight-loss journey. I'm anxious and scared. That's what I feel. I did this because eating was my safe place. It's where I went. INTERVIEWER: Why are you doing it? For myself. I wanna do it for myself. I can't wait to tell people,... 'Stick it up your arse,' really. (LAUGHS) (HEART MONITOR BEEPS, FLATLINES) Copyright Able 2018 That pink top in the window. At 18 years old, Lauren is a typical Kiwi teenager. Would you wear that? Yeah. Oh my God. She loves shopping. I think it's really cool. I wouldn't wear it. Look at that one there. With a peak weight of 167 kilos, she's also morbidly obese. Would you wear anything that tight, Lauren? (LAUGHS) No, definitely not. And I don't like things tucked in, either. No trip to the mall is complete without a visit to the food hall. I'm getting a nachos. What are you gonna have? Last time I had... ...the quesadillas? Quesadilla, yeah. That was real messy. Nachos are the Wednesday deal, and that's what I'm getting. Lauren's the youngest weight-loss hopeful currently on the clinic books. Only just an adult, she's now old enough to qualify for surgery. I'm changing cos I have to. Yup. Like, I have to make a change, otherwise it could just get worse. I know I've always needed to. But it's not like I eat wrong foods. It's just the amount. INTERVIEWER: What are you now? In size? Yeah. 26. Yeah. So, you wanna get from a 26 to a` ...14. Yup. (WHIMSICAL MUSIC) Lauren is a passionate foodie who recently finished high school. She lives at home and is in charge of shopping and cooking for her entire family. Always been a toss up between being a primary teacher and a chef. That was always what I wanted to be, so, yeah. Yeah, I like cooking, and like, choosing what we're gonna have so I know. I like knowing what's gonna happen instead of having to come home, or be out and then go, 'Oh, what are we having for dinner?' Yeah, cos it's written up on the whiteboard on the seven-day week, they kind of know what we're having. So they can read it and know what we're having, yeah. She can choose what she cooks and eats. My favourite's lasagne, or bacon and chicken fettuccine. So it's the pasta-y, Italian dishes. They're my favourite. Lauren has been overweight since she was four years old. And now, at 18, her weight is causing strain on her whole body. Her doctor recommended weight-loss surgery, and it could change her adult life. (LAUGHS) INTERVIEWER: Why do you want weight-loss surgery? For` For me to be healthy, confident. I just wanna be able to go out and be able to... kind of be accepted into the community, rather than looked at and, like, shamed upon. I want to lose over half of my body weight. So that would be about 80kg. I would ultimately like to lose over the next couple of years. (WHIMSICAL MUSIC) Lauren's challenge will be balancing her desired weight loss with her lifestyle. For Lauren, food is about more than just eating, one that brings her the greatest joy. Today, she's making a cake for her sister's 17th birthday. INTERVIEWER: How many cakes have you done? Uh, a few. I used to make them for my friends as well. And then I do Mum's, Dad's, my brother's and my sister's. I made mine one year because I wanted it a certain way. (CHUCKLES) Do you like making cakes and decorating them more than you like eating them? Or do you like eating them more than you like... I like eating them as well, but I think decorating's more fun. Chocolate cake's all right, but if it was carrot cake then I would definitely eat some. Lauren's crossing a threshold from child to adult. It's a difficult age group for weight-loss surgery. Surgeon Richard Babor is concerned that teenagers aren't mature enough to handle the hurdles of making the list. They're not totally autonomous in their decision making. Often they're not responsible for their own food, you know, they're not doing the shopping, cooking, etcetera. Their ability to cope with the massive psychological and physiological changes after weight-loss surgery is a little bit less than an adult who's, you know, mature and got more coping mechanisms. It's fraught with difficulty, operating on kids and/or adolescents. Two weeks later, and Lauren and her mother, Sharon, are meeting Richard for the first time. How well does an 18-year-old understand... They'll have to convince him that Lauren is mature enough for surgery. Lauren,... you want to have a weight-loss operation. Tell me why, please. For health and just be able to be more comfortable around... be in different situations positively. How long have you been overweight? I've always been larger than most people, yeah. Do you eat a lot of sweets? Occasionally, but not often. Like, I prefer savoury foods over sweets. It's the carbs and stuff. Yeah. What do you think of your family's diet? It's pretty hard to criticise your mum's` Mum's cooking's terrible. I cook. She cooks. Oh, you cook. Does all the cooking. Yup. You're only 18, and you're cooking for the whole family. Yeah. I always have for a long time. Good on you. You know, you're very articulate for an 18-year-old. You know, like, you kind of speak up for yourself, which is reassuring, eh? I like being around people and talking to people and stuff, so I always have been. Yeah. So this surgery ` you realise that there are big implications of it for you, that you can only be able to eat very small amounts. Yup. Yeah. And you realise that you're gonna struggle with it, and there'll be times that you're gonna hate it? Have you been able to go on a diet and lose weight? Last` Oh, not last year, the year before, I was doing a fitness boot camp thing,... Yeah. ...and, like, eating a little bit better and everything. Playing netball... and I lost quite a big of weight and stuff. How much did you lose? So, I got down to, like, 150 at one point. The kind of deal is that we're gonna set you a goal. I've set you a goal today of 10 kilos. And then come back and see Cecilia in about eight weeks' time. And if you're making good progress towards that goal in eight weeks' time, she'll start looking for a date for surgery for you. (LAUGHS) OK. Really, really nice to meet you both. I think that's really great. She's very mature, isn't she? She's kind of a little bit special in that respect. You know, like, she kind of comes across as very adult. She's very independent and smart and motivated and seems to have a good grasp... but I think, yeah, she'll even... You know, 18 is 18. She'll still struggle. Mum, Sharon, knows her daughter well and isn't leaving anything to chance. I'm ready to take on the challenge with her, and, um,... yeah. Let's see some results in four weeks' time. I'm really keen for that to happen. * Weight-loss surgery hopeful Lisa has a deep relationship with food. There is nothing better. Some people, it's alcohol. Some people, it's drugs. For me, it's food. Lisa suffers from depression. Then the negative thoughts started coming back again. Feelings can get really, really strong and you get overwhelmed and anxious. It controls her body and her mind. Getting out of bed and you weigh a ton. Everything weighs so much more. And so heavier... your whole body's heavy; your brain is heavy. The prescription ` more exercise. I'm so unfit. It's not comfortable. (PANTS) INTERVIEWER: So, we've only been going about 10 minutes. Yeah, I know. (CHUCKLES) It's sad. It's very sad how unfit I am. But Lisa got the good news she was after when she made the weight-loss surgery list. We should just get on with things, and we'll try and get Cecilia to get you a date as soon as possible. And husband, Chris, went from enabler to bad cop. So you can take me out to lunch to celebrate now, eh? (BOTH LAUGH) Yeah. You only get salad for lunch. Mm. A week later, and Lisa is already testing Chris' resolve. Can you get me some chip and dip? No. Yeah, yeah. You know you want some too. I don't` I don't like chip and dip. OK, um... what about chocolate? No. You go and get it. Sour Squirms. But you've already had some before. No, I didn't. Yes, you did. You can't prove it. No, I didn't. OK ` rubbish bin. I haven't! That's not Sour Squirms. That's Spearmint Leaves. See, he lied. (CHUCKLES) You are so gonna pay for this. The hearts. This is what started it off. Lisa snuck into the` my early Christmas present. I haven't touched any of this stuff for 11 weeks, and... yesterday I... fell off the wagon. I wish I could agree with you on that one. (SIGHS) We're being honest here. Honesty is gonna get you through. And what did we have for dinner last night? I didn't eat it all. So it's still in the fridge? Yeah. I didn't eat it... all. Shall I get it out? (SIGHS) I wanna say some nasty words to you right now. This is one of your favourite, go-to meals. Because I can't have fish and chips. INTERVIEWER: What is that? It's sweet and sour pork. That little exchange inside gave me just a slight insight into how supporting someone can be hard. The guilt ` it's a lot of... yeah, a lot of guilt. 'Do you love me?' And you want` You want your partner to be happy, but it's not a happy time. It's very hard, but... you've got to keep the goal in your head just as much as the other person. If anything, more, because it's very easy to slip. Sorry. (SUSPENSEFUL MUSIC) A fortnight later and Lisa's trying to remain upbeat as she heads to her weigh-in. I feel quite positive. The worst thing that could happen is that I stand on the scales and I haven't lost a thing. And then I have to go back to the drawing board of what I'm doing wrong. That would be awful. But last week I lost quite a bit on it, so... I'm picking that it will be successful. Sister-in-law Karen has met her at the clinic for support. Here goes. (INHALES) I've put on 600g. Shit. (SNIFFLES) I'm just going through my mind what I've done wrong. Damn. (CHUCKLES) I wasn't expecting that. No. I wasn't. You've been really dedicated, haven't you, this week? Yeah, yeah, I have. But don't let it knock you back. No, it won't. You're doing really well. INTERVIEWER: Is it tempting just to eat? No. No. That's amazing. Uh-uh. No, I don't feel that at all, which is bizarre, because normally I would. But no, I'm now focusing on what do I have to do and what do I have to take out of the diet. And, obviously, I have to exercise. Duh. Lisa's not only going to have to throw out the rubbish from her diet if she's to keep the weight off. With only a few weeks until her official weigh-in, she's going to have to get moving. A bargain found at a garage sale gives her the opportunity to walk the road less travelled. Just got to figure out how to use it. (TREADMILL BEEPS) That's encouraging. Whoa. (CHUCKLES) Here we go. When was the last time you did any serious exercise? A year,... maybe. Yeah, probably around a year. That's really bad. How's it feeling? Bit harder. (PANTS) I'm just so unfit. (GROANS, PANTS) Sorry. (WHEEZES) Oh shit. (SIGHS) Oh God. (SIGHS) Glad you did it? Yeah. I mean, it doesn't look like much, does it? But it feels like a lot. Well, they say it takes six days to make a habit, so six days it is. How will you make it a habit? Force myself to do it every day. * For 69-year-old William, everything has led to this moment ` surgery day. With best mate Elizabeth at work, William must face this on his own. He's been a hardcore diet disciple, proving that age is no barrier to weight loss or surgery. Six months in, he's dropped 47 kilos. But with minutes until knife to skin, the retired butcher is surprisingly queasy about surgery. I just feel, yeah, you know, like it's all happening now. (CHUCKLES) And, uh, yeah. (REFLECTIVE MUSIC) I just feeling... yeah, like... I don't know. I don't know. I know I just feel a little bit nervous. WOMAN: William! Yup. (REFLECTIVE MUSIC CONTINUES) Surgeon Richard Babor is impressed with William's effort. He's lost such an incredible amount of weight pre-operatively that it's, um, much better than... often what we see here. He's done amazingly well. It's an extraordinary... effort. And I think because of his age, it's the only thing he can really do to bring his risk down, is lose weight pre-operatively. All good to go, eh? Mm-hm. Local, knife... Gas on. Top lights off. OK, cool. INTERVIEWER: Isn't 70 a bit old for drastic weight-loss surgery? So, you know, if people, kind of, reach a stage in their lives where they really wanna do something about their health and they're morbidly obese, then really, this kind of surgical intervention is currently the only thing that we have that actually works for them. Or else we just decide, 'Oh well, that's the new human condition.' 'That's what we are.' William said he struggled giving up carbs. I mean, we know that the same reward centres that are activated by drugs like heroin and cocaine and nicotine and sex in the brain are activated by carbohydrates. And so, yes, that same sort of pattern of brain activity that we see with very highly addictive things, you see the same centres light up when people eat carbohydrates. There's lots of animal experiments that show that rats would rather eat carbs than take cocaine, you know. We're almost there. That was big, eh? Surgery's a success, but William's not out of the woods. So, having got him through the operation is one part, but the risk of him having complications happens over the next few days. Over the next week in particular. And those risks are things like heart attack and stroke and pneumonia in the first few days, and a leak. And a leak is the one that scares us the most, because that would make him really sick. Captions by Amelia Rushbrook Edited by Antony Vlug.