This is Maddie, Alofa, Saskia and Ashlee. These four teenage girls are the first in the world to trial a revolutionary new obesity treatment. If this actually works, this is crazy. A free ride to Skinny Town. (LAUGHS) And these are the pioneering New Zealand scientists that created it. Imagine just for a minute that... that you can treat obesity with... with a pill. Their theory is bacteria from fit people's poo could help obese people lose weight. We're in virgin territory here. This hasn't been done before. The team are treating 80 obese teens. Over the next six months, we're following four of them to see the results first-hand. I've been overweight my whole life, and I'm willing to try anything. If it works, it would end global obesity as we know it. Last time ` the girls got into the thick of it, with their first dose of poo pills. Easier than I thought, to be honest. I thought they were gonna be bigger. And coming up ` the pills take effect. It's possible that their gut microbiome is actually influencing their appetite. And their first chance to see results is at the six-week weigh-in. It's just a waiting game. You just have to wait and see. Captions were made with the support of NZ On Air. Copyright Able 2018. That's the treatment for today. After months of planning this million-dollar study, day one of the six month trial is done and dusted. Done. Awesome. Our girls just swallowed 16 poo pills, and tomorrow they'll return for the final dose, as long as nothing unusual happens. 'The issue is if they break down a little too quickly on the way,' could that result in some sort of funny aftertaste ` farty burps, basically. And that would be horrible, and that would just put people off coming in. You know, really it would. I mean, it would put me off coming back. So, today's day two of the treatment. I'll be taking the next 12 pills. Last night I ate KFC. (LAUGHS) But it's all right ` I had the coleslaw. We're just coming through this door. Obviously, you took the first lot of the treatment yesterday. How was that for you? It was good. It wasn't that bad. Yeah. How did you feel yesterday? Did they make you have tummy pain or diarrhoea or vomiting or...? No. No burps or...? No, I don't burp, so... Had any side effects from them? No, not at all. No sore tummy, bloating, diarrhoea, vomiting? None of that, no. You didn't fall over in the park? No. (CHUCKLES) Fantastic. Before taking the treatment, the girls all took a strong laxative called Glycoprep to give their gut a blank slate. What happened afterwards? The Glycoprep came into play. Oh really? Yeah. I felt it yesterday, rather than Monday night. That's surprising. So exactly what happened yesterday? I was sitting in my lecture, and then I just felt the urge to go to the toilet. Yeah. And my tummy starting rumbling, and then... Alofa isn't the only one with these symptoms. Just lots of loose stools still. How many do you think you've had since yesterday? Probably two or three. OK. Just a guess. So not a huge number. No. But obviously more than usual. Yeah. And, like, watery or...? Yeah, very. So the farty burps are thankfully a no-show, but these bouts of diarrhoea are unexpected. One of the things you would worry about is, could we have just given her an infection that causes diarrhoea? I think that's really unlikely, because the infections that do that, they take longer to start, actually. They often take a day or two at brewing before you get sick, and then they often last a bit longer, make her feel more sick, might make her vomit as well. So that none of those things happened makes me think that it probably was just the bowel prep. It's not enough to halt treatment, but there's a lingering question ` have Alofa and Ashlee just flushed all the good new bacteria right down the toilet? It might have. I doubt that it would have knocked out all of them. But Justin thinks this glass is actually half-full. Yeah, you could even argue that you know, bacteria taking hold, starting to grow could cause something like this. Because we don't know. And lots of us who have travelled overseas and eaten some foreign food, and we often get a little bit of diarrhoea after doing that even though we're not sick, because we're getting some of the local people's bacteria from that region. And, of course, they're fine having those bacteria in their guts, but when we swap them over, we get a little bit of diarrhoea. So it might be a sign that we're actually making a difference and it's part of the treatment. The girls are due back in six weeks for an assessment, but nobody knows if the new bacteria will survive that long. What we wanna do is get a sample from you two weeks, four weeks and six weeks after having this, so we can see that the bacteria in your bowel have changed. Mm-hm. So Wayne, Justin and Ben have got a plan. What you're gonna do is two weeks' time ` we'll get you to go to the toilet, take this with you, do a poo, and then get a little bit of toilet paper, fold it into a rectangle, wipe so you get some poo on it ` it doesn't have to be tons, just a little bit. Basically, their first wipe after they go to the bathroom, they're going to return that to us, sort of, in a little sandwich between some tissue paper, which will suck water out of it, and silica pads, which basically suck any water out of the atmosphere, and then they can send that to us, return that to us pretty quickly, and then we can extract from the toilet tissue pretty much within 24 hours. So, just to be clear ` what they're asking the girls to do is take their used toilet paper, put it in a courier bag and pop it in the post. So, they're coming back in biological sample bags ` yeah, it'll be perfectly safe, yeah. Yeah. Other than that slightly unsavoury task, the girls don't have to make any changes to their lives at all. With the diet from here on out, do I need to, like, change it or just keep it relatively the same? Relatively the same. We're not prescribing the diet and saying you must eat` Yeah. ...these things as part of the study. Basically, we'd like you to be eating a generally healthy diet and keeping the diet about the same throughout the study, but we're not gonna very specifically tell you what to do. OK. If the girls do lose weight, the team wants to know it's because of the new bacteria and not a sudden change in diet or exercise. And in just six weeks, we'll get the first look at how the bacteria is affecting them. I think the hardest part is just gonna be the waiting. Just have to be patient, cos I can't rush it. It's just a waiting game. You just have to wait and see. I'm just gonna go off to school, cos I've already missed a morning, so I've gotta go finish the rest of the day. Good afternoon to you. ALL: Afternoon, staff! Have a seat. At 17, Saskia is the youngest of the four. She's finishing off her last year at Vanguard Military School. I've always been a bigger girl. And it's what it is, and it's fine. And this is something that could change that potentially ` it could have good effects. Even though we have the same number of chromosomes, our genes ` remember, gene is a section of DNA. I'm interested in my science and my biology and things like that, so then when they were talking about the change from the bacteria and things like that, that all interests me. And then just the fact that it could benefit me personally made it more interesting. and then yeah, it just kind of all sounded quite cool. Stand at ease! ALL: Forward! Left, right, two. Left, right, one, two, three! From Tuesday through to Friday, we have PT in the afternoons ` anything from running with logs, running with tyres, so it's very physically draining, but its good. Yeah. One, two, three, zero! ALL: One, two, three, zero! Feeling attractive is defiantly important at my age, and definitely, the boys at school, that help me get through it and made me see the more positive side of it. They talk a lot about embracing the curves, which is virtually what it is. I can't explain what they do ` they just do little things, and it makes you feel a little bit better about yourself. Eyes front! ALL: One! Have a good evening, ladies and gentlemen. Do something nice for your parents ` maybe cook them dinner tonight. So discipline is a big part of Saskia's life with exercise, but not when it comes to food. So, I know that although my physical is real high, my eating habit's also high, so it's not great. It's not like one cheat day a week; it's every day's a cheat day. But the problem is when I'm, like, travelling to school and things like that, you get bored. Boredom is my weakness when it comes to eating. We just did PT; now we want some ice cream. But Saskia's parents think there's more to it. 'I'm aware of eating decisions...' that are not shared in a family environment; that she is eating, um, in her bedroom on her own, which I think at a level is quite sad; and that she finds that necessary, and it's behaviour that she's just got herself into. Sushi's healthy when it's, like, covered in sauce (!) I know. I mean... (CHUCKLES) Chicken ` that's protein. Travelling a long way home isn't always the best for me, when I've got, like, transitions in, say, the centre of town and things like that Oh, look ` you're walking past McDonald's; oh, look ` you're walking past the dairy. Oh, you can just go in there. You'll be right. But then it's not always best. But it's hard to ignore sometimes. We look at fat people or overweight people and you assume certain things which are not always positive. Look, she's a lovely girl, she presents well, she's enthusiastic, she's got a lot to give, and then when she's with her peers, she likes to be the funny girl. And that funny girl is covering up a little bit of a sad girl under there that's struggling with other issues. She needs to own and stop some of this overeating. Yeah. Enough's enough. There may be more to it than energy in, energy out, though. The whole point of this trial is to find out whether our gut bacteria has a role to play in our weight. Most people perceive obesity to be a simple problem ` you know, it's an eat less, move more, physics, thermodynamics problem. And I think that's true to an extent, that is certainly what causes obesity ` you eat too much and you don't move enough. Would you like everything? (INDISTINCT CONVERSATIONS) What we were now beginning to realise is that the question to ask is not a physics one, but the question to ask is why some people behave differently in the environment that we are in ` why do some people eat more than others? Often people who are overweight or obese eat a lot, and it's possible that their gut microbiome is actually influencing their appetite ` it's sending signals into their bodies through their bloodstreams to their brain, that stimulates appetite as well. Saskia admits that she overeats, but maybe it's not a lack of willpower. What if her gut bacteria has been causing her to crave chips over chickpeas? And is that all set to change with her new gut bugs? (LAUGHS) You little beauty! Something light. Like... Okarito. Okarito. Goes well with Alexandra. Oh, look. Whoa, pink. Or... Hot Water Beach. Very relaxing. Pinky, blue. It's not very kitchen-y. But it is pretty... nursery. Hmm. Nursery? Or we could go Rangitikei River. (GASPS) Oh! (LAUGHS) You little beauty! So, the nursery. All the girls are hoping the poo pills will work for them, but there's a catch ` not everyone is getting the treatment; half the capsules are placebos. Half of our subjects will receive the treatment, and half will be randomised to receive the placebo. If the treatment works, then at the end of the trial, those who are in the placebo group, getting effectively the empty capsules, they will be given the treatment. Because the groups are randomised, none of the girls will know which pill they are taking. So, randomisation is really important for this, because if people know what they're taking, then they expect a result. You know, as far as they're concerned, they could be having salt solution or the capsules ` It doesn't force them to expect anything. It doesn't force them to think, 'Hey, look, I've been given this pill, it's supposed to be making me thin, 'so I'm gonna be much more careful about what I eat, and I'm gonna try and exercise more, right?' It's just, like, well, I could have that or I could have this. No one in the research team knows either ` it's a practice called double-blinding. It does exactly the same thing. You know, it means that if we see changes, we don't know whether it's someone that was in the placebo group or the treatment group, and because of that, we're not unconsciously biasing the way we're interpreting things. It's a critical part of all clinical trials. Two sets of capsules, both double encapsulated, both frozen to minus-80 degrees ` only one person can spot the difference. Yes, I can, by looking at the colour. So, I'll show you two. So you can see the saline capsules and the faecal capsules together, but you won't see it unless you are given both side by side. So who got what? We don't know either. All four girls could be on the treatment or they might be on saline ` it's probably a mix. But we won't find out for sure until six months. Until then, the earliest indication would be if some of them start to lose weight and some of them don't. There's one more of our girls on trial you haven't met properly, and she's eagerly awaiting the six-week weigh-in. My name is Alofa So'olefai. I am Samoan. I'm 18. I study at Auckland University ` ancient history and mathematics. I'm the eldest of five children. The youngest is 2. I have three brothers, one sister. So, today is White Sunday, which means the kids run the service for church. The past week's been hectic. I mean, practices at, like, 5-9 in the afternoons, yeah. All the songs ` trying to get the kids to learn the songs, learning all the actions. For Alofa, the trial was too good an opportunity to pass up. And as you can see, I'm overweight, but I've been trying, I don't know, fitness programmes ` Zumba, CrossFit and everything like that. I mean, it does work, but, like, I can't seem to keep it off. She's optimistic the treatment will help her shed the kilos for good. I get self-conscious about my weight. Um, it doesn't bother me,... but it does irritate me that there are times when I can't find clothes. So I'd have to do, like, online shopping, and plus-size clothing is a bit more expensive than normal clothing. Alofa is keen to take part in the study, but she has reservations about how much detail she shares. So, I didn't tell my mum until last week. (CHUCKLES) I didn't tell her I was doing it until the day I had to go in. I don't really do things on my own ` everything that I do, I have to go through my mum. And I just... I don't know ` for me, I just felt this was a bit personal. And I was like, mm, do I really need Mum? Yeah, yeah. # Tell the world of the treasures you've found. # I'm feeling very hopeful. I mean if it does work, then I am shopping. I am going shopping. I mean, there are clothes out there that I have looked at, and I'm, just, like, 'Oh, my gosh, Mum. What if I fit this?' If I do, then I'm just, like, oh, that's crazy. Like, I can actually go shopping. I could steal my auntie's clothes. I mean, I love her style. She's a flight attendant, and so she's got some crazy clothes, and I'm just, like, 'Ooh, I'm stealing this one day.' And she goes, 'No you're not. You're gonna rip it.' And I was, like, 'You wait. You wait. You wait.' (LAUGHS) Being able to fit into borrowed dresses is just one of the potential changes from the trial. The gut bugs team will be looking out for other changes at the microscopic level, but their plan to analyse regular postings of poo has hit a big problem. We have tried to set up this toilet-tissue experiment. Mm-hm. And so, being the good scientist that Thilini is, she decided that we should do a trial. And so we did that on Monday, and so far, the tissue hasn't arrived back here. And seeing as I put it in the postbox just down the road here, which is only, like, a hundred meters away, I didn't expect` What did you put it inside of? I didn't expect it to take four days to come back here. No, so, it's only the tissue ` it's only the wipe. And it was packaged as per protocol, but that means that unfortunately, I don't expect that New Zealand Post have taken that long to deliver it, so it's probably sitting somewhere within the university, being sorted before it gets here, which basically brings us to the point that that system's not gonna work. 'So, we were gonna do poo in the post, right. But unfortunately, we can't send it in the post.' You know, there's not a lot of material there, so it's not really a hazardous, but it does actually classify as hazardous, and so unfortunately, you know, we can't send the stuff that way, and we can't sample it. I don't think it would actually be a hazard, because it's not like you're sending tubs of faecal material or anything like that, but we decided we'd stop that. So the toilet-paper programme is scrapped. Jokes aside, it's a real blow for the trial. The team is flying blind in the meantime, and so now they've got to wait four weeks until they see whether there's been any change at all. A month has now passed since the girls took a heaping dose of fit people's poo, and their first assessment is on everyone's mind. We've had our first batch through, and we've got other batches going through now, and they've been treated, and we're just currently now waiting to look at the sequencing results from our first batch. Scientists are eager to see if the gut bugs are thriving, but what we really want to know is have the girls noticed anything different yet? Do you think you've seen any, like, changes within yourself ` like, physical or, like, from the trial at all? I mean, personally, I haven't seen any, like, dramatic changes in, like, physical looks, but I think just being on the trial, you generally are more aware of what you eat and things like that, so internally, it might be getting better. I think habits have changed a little bit just because subconsciously or consciously, you do think about the trial, you do think, you're, like, 'Actually, someone's monitoring what I'm doing. Like, someone's actually checking up.' So, lots of people are telling me that I have been losing weight. I look a little bit thinner, a little bit more toned, and then, of course, I'm still unsure if it would be the pills that I took or even if it's just my own progress. Maddie's also noticed something going on. I went out for lunch with my gran and thought I'd put on this dress that I hadn't worn yet because I bought it in the middle of winter, and it was just too big for me and, like, really baggy at the sides, and I was heartbroken, but also really happy, because hopefully, I've lost some weight. Alofa hasn't quite dropped a dress size, but she is exercising a lot to try and help the bugs along. I do quite a fair bit. (CHUCKLES) I mean, there's boxing Tuesdays, and then there's Zumba Wednesdays and Saturdays. Now I can do sort of do half a burpee, and it's been, like, a couple of weeks. So it's really had to start it, but, I mean, you just have to do it. So I know I've done pretty well, but I know that I can do way more. (CHUCKLES) The six-week assessment is approaching fast, and whether their new regime has impacted their kilos or their gut is anyone's guess. Before she can worry too much about results, Thilini still has more poo pills to push out. Our four girls are just the first wave of recipients. Thilini is preparing hundreds more capsules and still needs regular donations. (GIGGLES) This is too small, so I'm not going to process this. At least I should have 50g,... 50g or so. It's a shame for good poo to go to waste, but what actually makes good poo good? (DRUM MUSIC) The trial is heavily dependent on super-donors, like Sarah. When the gut-bugs team assessed her health, they also analysed the gut bacteria in her poo. So, Sarah has quite a diverse bacteria, so she had about 112 different species that we could identify. The team's best theory is that diversity is the secret to good gut health, and Sarah's gut is a regular microscopic zoo of species. Diversity protects us from an abundance of less ideal bacteria,... who do things to us that we don't want them to do. In other words, they scavenge more calories to give us back, they release these inflammatory products into our bodies and our bloodstreams, which aren't helpful to our health ` diversity helps with that. It also gives us a greater resilience to what we're exposed to. There's an easy analogy that explains why diversity makes us more resilient. If you think of a rainforest, it has huge diversity of plants and flora, and it has greater capacity to cope with all of the environmental changes that can occur, versus having a single forest that one day could get afflicted by a pine-tree disease, and then it could wipe out or destroy a large chunk of the pine forests. That's one of the benefits of diversity. So if Sarah is our rainforest, that makes our girls the pine trees. The recipients that we had, they had roughly half the identifiable species that we saw in Sarah, so about 60-odd. They have markedly less diversity in their gut bacteria than our donors, and with treatment, we could improve the diversity and improve the distribution of bacteria, so they look more like the donors, because that's the whole purpose of the intervention. That's why we use those donors. So the girls are getting all of Sarah's 112 species of bacteria, plus those from every other super-donor as well. If we use one donor, then that's just one set of bacteria, right? So by taking four donors, we were actually able to take bacteria from four individual people and mix it together, and so we get quite a lot of diversity, because even though you have the same bacterial species, some of the strains are different. And so we get a really diverse mix of bacteria, and that's what we are hoping ` that these people, you know, is gonna shift the baseline of our individuals. The first sign of the trial's success will be if our teens improve the diversity of bacteria living in their gut. There's a reason we think good diversity leads to good health. For the last few decades, scientists have been studying an ancient hunter-gather tribe in Tanzania called the Hadza. and for the last 10 years, Jeff Leach has been studying their gut bacteria. Hadza have one of the highest diversity of gut microbiomes of any documented population in the world. There's very little obesity. You do see it in some villages, where they have access to corn and things like that. They're not that much more active than your average Westerner, so it's not because they're running all day. Packing our girls off to live with the Hadza to improve their gut diversity is probably not the solution, but the trial gives us an alternative. Sarah with her 112 species of gut bacteria can be our substitute Hadza. She may not have as many varieties of bacteria as the Hadza, but somehow she's ended up with a more diverse community than most. and with just two weeks to go until the very first weigh-in, the success of the trial depends on understanding why. So, why do our four girls have such different gut bacteria to Sarah? Where does our microbiome come from in the first place? To understand that, we really have to start here. Meet Hannah. Hannah is about to give birth, and the birthing process is where our first microbes comes from. A traditional birth's a miracle, but it's a pretty messy miracle. You're immediately going to be exposed to microbes in the birth canal, and then during that process of passing through the birth canal, you are going to be coated very thoroughly in a thick layer of microbes. Additionally, it's very frequent that you'll be exposed to the mother's faecal material during birth. And we're just starting to understand the contribution of that in providing you with your first microbes is just starting up. That's it. Here he comes. That's it. Here he comes. It's probably not what most new parents have in mind for baby's first meal, but as far as beginnings go, this baby's microbiome has been given the best possible kick-start. Studies show that babies born vaginally have more diverse gut bacteria than babies born by C-section. Being born pre-term, being born by C-section, they both have increased risks of becoming obese when you're later on in life. And that's exactly how Maddie came into this world. That's a baby that will fit in the palm of your hand, you know. That is a very underdone baby. Maddie was born three months premature. She was delivered by emergency C-section at 27 weeks and weighed just 2.3 pounds. She spent the first two months of her life in an incubator. So did Maddie's C-section cause her weight gain as an adult? There's no way to know for sure. But there are a couple of factors at play. 'Premature babies have relatively underdeveloped guts.' They are much more stressed, they have more infections, they are often exposed to steroids and antibiotics, and these are all things that affect gut and, of course, the gut microbiome. Maddie's microbiome was already compromised by her emergency delivery, but there was another blow in store. Did I get sick a lot, like, other than being premature? They had a scare at one stage, but they just dosed you up with antibiotics, and you came through. That was a frightening couple of days. The antibiotics that Maddie needed to save her life had an unintended effect. Antibiotic treatment changes your bacteria, right? I mean, you're basically napalming what's in your stomachs and in your system. And new research is suggesting this difference in gut bacteria can last through childhood. We're currently analysing data for a study showing that children born prematurely have a different microbiome in mid-childhood, so when they're 7, 8, 9 years of age, the microbiomes between term children and prem children are different. And as premature children grow, they are more likely to be at risk of diabetes and other inflammatory diseases. What they have is different levels of this protein called calprotectin, and calprotectin is a marker of inflammation and gut inflammation and gut-wall integrity, and so that indicates to us that these pre-term children, the ones who were born preterm, have leaky guts. A leaky gut allows compounds to pass into the bloodstream that can cause obesity and chronic diseases. Very precious, this book. But Maddie's parents did her a big favour. Despite her setbacks, Maddie's microbiome got a big leg-up with early syringes of breast milk. Was that a burp or was that a snort? Breast milk is always considered the golden standard. It's often discussed as a golden standard for fats and proteins and vitamins and other kinds of things for children. But the human milk oligosaccharides, there's a reason that's in breast milk, and so that's food for bacteria in the baby's gut. So if you remove breast milk, you're also removing the bacteria, cos breast milk contains bacteria as well. So if you pull breast milk, you're pulling an evolutionary heirloom, if you will, that's always been there. There's a window of opportunity of just 1000 days before a child's biome stabilises. Those first three years are essential for maximising the diversity of good bacteria. A lot of people let their fear of germs and bacteria go too far and wage a war against every germ in their household, so there's a lot of evidence, both in humans and in animal studies, that keeping things too clean and eliminating exposure to the good bacteria is a problem for the developing immune system. And this is where our trial comes back into play. by the time a child hits three years, the gut bacteria remain fairly constant over a lifetime. Changing that microbiome isn't impossible, but it's not easy either. It's very hard to change microbiome more than a little bit and certainly hard to change it in a lasting way through things like going on an extreme diet for a day. On the other hand, what you eat over a period of six months to a year has a very large impact. It always comes back to what you eat. If you want to improve your gut bacteria, you need to eat things to make them thrive ` unless, of course, someone invents a magic little pill. What do you feel like? OK, I really just want doughnuts and dumplings. Ew. Maybe I'll get some pork shumai. Six weeks have flown by, and tomorrow we get the first clues to whether the faecal treatment is effective. If the poo pills work, they'll instantly give the girls a whole batch of new bacteria. But anyone can change their gut bacteria at home with the food they eat, though it goes both ways. One extra-large, please. Extra-large. Your gut is full of this huge range of different bacteria, and they're specialised in consuming different parts of food. So, for example, if you're eating really high-fat food rather than food that has more fibre in it, then that will actually sway which bacteria are present in the gut. And those bacteria, we now know, are really important for the way metabolism works. Can I get cheese, please? Cheese? Yeah. Thank you. Cool. Thank you so much. Thank you. Argh, hot! It's a vicious cycle ` fast food feeds the bad bacteria and starves out the good. And once the bad bacteria take hold, they push us toward making bad food choices. Hi. Can I get two boxes of the Oreo, please? The gut microbiome can affect not just how many calories we absorb; in other words, an unhealthy microbiome might mean that there's an additional 150, 200 calories a day that we absorb that wouldn't have, but it may also influence things like appetite. And once your gut is full of bad bacteria, the chances of losing weight are slim. These are so good. Thursday nights are takeaway nights for Alofa and her family, but then, so are most other nights. Because Mum works Monday to Friday, there are times when we don't really make dinner, um, so sometimes it's just... no, not even sometimes ` all the time, it's just takeaways, um, fish and chips. For us, it's just cheaper. It's not the healthiest, but it's something that will feed everyone. We always tend to go for the specials, and healthy options are never on special. And that's an issue for a lot of families ` calories are cheap and nutrition is expensive. So, how do our super-donors manage what they eat? This is just a bit of, uh,... whatever's in the fridge veggie-wise gets cut up and goes into the pan. We already know that Sarah has a far more diverse range of bacteria than most, so what does she eat? My approach to food would be to just try and keep it varied, try and keep it straight out of the ground or off the tree as possible. So I try and spend most of my time in the supermarket in the fresh produce area. So junk food makes bad bacteria thrive, and we also know fruit and veg creates a diversity of bacteria. Sarah has twice as many bacteria as the girls, so her diet comes as no surprise, but it still doesn't tell us whether any of this will actually work. Will the bugs from the thin person be able to make an obese person thin? That is the $64 million question. And at last, it's the day of reckoning. It's been six weeks since the girls took the poo pills. Today's the day they'll get their very first look at how it's going. I think I've lost a bit of weight, but then again who knows? It could just be all in my head. There's hints that you could have the treatment, but then there's also reasons why you could also just have the placebo. I didn't see any progress for me, but maybe something inside is happening ` I don't know. I'm hoping I would have lost a little bit of body fat, hopefully. I'm hoping I won't be too disappointed if I don't, cos I'm not sure if I have. People have told me that I look like I have, but I haven't seen anything yet. Step on the scale. I haven't been the best with my decisions, but it's better than before ` just the things I eat, what I do for exercise, how often I exercise. And, like, cut-off time for eating. (CHUCKLES) If nothing else, the girls are definitely more aware of their bodies than ever before. I'm feeling quite good in myself, really. I think I've had a confidence boost with it all. I'm just feeling happier in myself, which is really nice. So it's been a change, but it's a nice change. I've sort of been monitoring what I eat maybe a little bit more, just because you have that, like, subconscious feeling that you could be on the treatment, so you, like, wanna kind of help that a little bit. Hi, Alofa. Come in. Cool. So, um, we're gonna do the DXA now, Alofa. Um... The scales don't tell the whole story ` the DXA scan will reveal if the girls have lost any body fat. Do you think your diet's been different in the last six weeks to before? And the much anticipated results are coming up. Something light. Like... Okarito. Okarito. Goes well with Alexandra. Oh, look. Whoa, pink. Or... Hot Water Beach. Very relaxing. Pinky, blue. It's not very kitchen-y. But it is pretty... nursery. Hmm. Nursery? Or we could go Rangitikei River. (GASPS) Oh! (LAUGHS) You little beauty! So, the nursery. Switch to Vodafone and get Vodafone TV Intro and three months' free unlimited broadband. That's over $640 of value. Do you think your diet's been different in the last six weeks to before? I don't know. My auntie's here from Australia, and she's, like, addicted to veggies ` kinda just have veggies every day. Is that different to before? Yeah. Definitely. What were meals like before she was visiting? Um, veggies would be on Sundays, Sundays or Saturdays, cos it's the only time everyone can actually go to the shops. Yeah. During the week, everyone finishes around 5, and that's the time the veggie store closes, so takeaways. So it would be takeaways most days of the week? Yeah. Wow. And now how many times a week is it takeaways? Four. Four to five. Yeah. So it's less, but still quite a bit. Yeah, definitely. After six weeks, the team is finally getting their first glimpse at whether the poo pills have tipped the scales at all. You've seen one of these reports before? Yeah. So, your overall percentage body fat is just over 50%. Um, you weigh about 126 kilos, and that's what you'd expect with the percentage about half fat, half lean tissue. The DXA will reveal not just whether the girls lost weight, but whether their body fat percentage has decreased. Unfortunately, you have gained a little bit of weight since we saw you last, um, and a part of that is lean tissue, so you have gained some muscle since we saw you ` about 500g of muscle ` but you've gained a bit of fat as well, so overall, your percentage body fat has gone up a little bit. It's a little bit disappointing ` I'm sure it's a bit disappointing for you. Alofa has gained a bit of weight, but, of course, we still don't know who is on the placebo. Ashlee is in next. So, the DXA says that your weight is around 93 kilos. Mm-hm. Um, 44 kilos of that is fat, 46 kilos is lean tissue, so that you're about 49% fat. Mm-hm. Your percentage body fat is very slighter greater than it was last time. Mm-hm. So Ashlee's weight is about the same, and her body fat percentage has actually increased slightly. That doesn't mean that you haven't had any benefits, of course. Yeah. So, in terms of body composition, that might improve over a longer period of time, and it's totally possible that you could have had an improvement in metabolism that we can't tell just by doing measurements and scans, so it's really important we do that. They've told me to stay positive about it, because there could be improvement, and we'll see in three months' time. So despite her hopes, Ashlee has actually gained a bit of fat. I know that you're putting some effort into your lifestyle. Yeah. Don't stop doing that. It's still really, really important. Mm-hm. Cool. Is there anything you wanted to ask me about that, Ashlee? Nope. Fair enough. Straight up. So, we can just go through the results, Maddie. So your total weight about 115 kilos. Mm-hm. 48 kilos of that is lean tissue, so mainly muscle. Mm-hm. And 63 kilos is fat, which means that overall, that's 55%. Last time when we scanned you, your weight was actually a tiny bit less ` it was about 114 kilos. And actually, your percentage of body fat was a tiny bit less as well. It's a pretty small change ` unfortunately, it's not in the direction that you're hoping for. It was a little bit of a sinking moment, but it just sort of made me realise that well, maybe I just need to focus on it a little more. It's just hard, because I have improved my lifestyle, and to not see results, it sucks. But, I mean, I'm just gonna work harder. I'm not gonna be discouraged, like I am right now. I'm gonna be positive. It could mean that one ` I'm on the placebo; or two ` the effects just haven't started yet. So it could be doing something to my metabolism in my blood, which they'll see in the tests, and that it's just a bit more slow going than an immediate reaction, so time will tell. I guess there's a couple of things that we don't know, and we don't know what would have happened if we hadn't done the treatment ` would you have gained a bit more fat than this, than you have ` but it is a bit disappointing. We were really hoping that we would see a bit more benefit than that. Despite the fact Alofa's weight is headed in the wrong direction, she's actually pretty chuffed about it. I'm kinda happy. Before, I would gain a lot of weight per week; this is over a period of six weeks, so I'm happy. And, like, a certain percent of that was muscle, so I'm not completely disappointed. OK. Can you just make a fist for me? OK. Cool. A first step to losing weight could be a slowing of weight gain, and this could be a big deal for Alofa. I'm not worried about gaining 2kg in a week now. Like, I know that I'm doing something right if I'm only gaining 2 K's in six weeks. I mean, that's a month and a half. It's past your shoulders now, so you can turn your head as well. I guess there was a couple of positives, I think, out of it. So, I mean, they can see small changes, but it might take a longer time to actually see any actual significant changes. You can stand up when you're ready. Her weight is basically what it was six weeks ago, so her weight hasn't changed. So compared with how she was before, she now has more muscle than she had and she's also lost some fat, and it's likely that her metabolism has improved because of it. It's still early days for the study, and none of the girls know whether or not they're on a placebo. But without a doubt, everyone was hoping for far more dramatic changes at the six-week mark. I think it's just hard for me to process because I have been on a weight-loss journey before, and it wasn't as hard as it is now. (SNIFFLES) Especially having people coming up to me, um,... telling me I have, when I look at my results,... and I haven't. I'm all right. (SNIFFLES) There's still one key result that we don't have yet. And as expected, this part of the trial also requires Thilini's golden touch. The girls have all left her a sample, and only that will tell us if their gut bacteria has changed. This is the first trial that we do in humans. Everyone is very excited, because they want to see whether there is any change in these microbes. We collected stool samples from these recipients, so now we want to see which microbes are present in these six-week stool samples. The team's plan to post dirty tissue went down the toilet, so this is their first opportunity to see if any of the bacteria has survived. What we want to see next is that whether we can see any positive change in their microbiome. If it doesn't work, that is also a discovery, so we know that it is not working, but that's not our hope ` we wanna see the change. More diverse microbes would equal health benefits that go beyond shedding a few kilos. What now? I'm gonna do the same thing ` I'm just going to keep at it, I'm gonna keep going to the gym, I'm gonna stick with my diet, keep it the same, maybe eat out a little less. But yeah, we'll see. (SNIFFLES) It's not gonna hold me back. I'm still gonna keep going. Is it working, then? I don't know yet. But we wouldn't do this type of study if we didn't think it would make a difference. Next time ` three months in, the girls get their first good news. On the balance, you have lost weight. I'm quite happy, considering that something's finally happening. The research team digests their initial results. This could be transformative treatment. This could change the world. Cos I mean, this should actually be a damn sight simpler than this. This is slow torture. This is slow torture. Losing weight is just half the battle. Because I've had the whole low self-confidence my whole life, my mental health will improve if I lose weight, and I know it will. And everything comes down to the six-month weigh-in. Today's the day. Nervous as hell. Nervous as hell.