Last week was the moment we'd all been waiting for. Today is the six-week assessment to check up on progress. We're six weeks into a world-first medical trial to treat obesity. And if it works, these New Zealand scientists will lead the way in international obesity research. This could be transformative treatment. This could change the lives of an enormous number of overweight and obese people around the world. There's one big catch. To take the treatment, the girls had to ingest encapsulated poo ` more specifically, fit people's poo. So over 6-months, these girls are taking one for science. And it could change the nature of obesity as we know it. Will the bugs from a thin person be able to make an obese person thin? That is the $64-million question. Coming up ` three months in, things are looking up. But, in the balance, you have lost weight. And with the eyes of the world watching,... Nervous as hell. Nervous as hell. ...it all comes down to the 6-month weigh-in. Today's the day. Captions by James Brown www.able.co.nz Captions were made with the support of NZ On Air. Copyright Able 2018 Six weeks ago, Saskia, Ashlee, Maddie and Alofa swallowed 30 capsules filled with human faeces. They're just four out of a group of 11 teens that make up the first wave of this groundbreaking study. But the results at the six-week mark aren't what everyone had hoped for. So, essentially, your body mass is very, very similar to last time. And your percentage body fat is very slightly greater than it was last time. Oh, I'm gutted. You can see that I've cried. Last time when we scanned you, your weight was actually a tiny bit less. Yeah. 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 bit more. Unfortunately, you have gained a little bit of weight since we saw you last. So it's a little bit disappointing. I'm sure it's a bit disappointing for you. But there might be a silver lining to Alofa's weight gain. I mean, before the treatment, like, gaining weight was really easy. So I'd actually gain more weight than what I did today ` and that was per week. But now it's, like, 2kg over a period of six weeks, so... There's a glimmer of hope in Saskia's six-week results too. Her body weight hasn't changed, but her body composition is slightly different. 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. Generally, though, the six-week results are disappointing for all involved. And everyone is eager to see if things might improve at the three-month 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. TEARFULLY: Especially having people coming up to me, telling me I have, when I look at my results,... (EXHALES) and I haven't. I'm all right. (SNIFFLES) Ashlee's not the only one trying to cheer herself up after the first round of results. It's the beginning of the journey. It is only six weeks of the six months But there are so many other outcome measures that we're looking at too, like diabetes risk, like gut health, like inflammatory markers. Plain weight loss isn't necessarily the only measure of success in the trial. Blood and stool samples were taken, to analyse whether their bacteria has changed, and if it might lead to other health benefits. So, obesity is a ` to use a scientific term ` a state of positive energy balance. OK? Which means that you are eating more than you burn and therefore you put on more fat. Is it necessarily always bad? No. Being obese is bad for many people. But being obese doesn't necessarily mean that you are going to be unhealthy. It's the other nasty diseases that come with it that actually will kill you ` so heart disease, type 2 diabetes, certain types of cancer. And that's bad. My grandfather has diabetes, so I've been told that it's always more common for it to happen to me. And, I mean, I've always been on the edge of getting type 2 diabetes. Every time I went to the doctors, they'd say, 'You need to do something.' So a disappointing first start. But for these girls, the stakes go way beyond just losing a bit of weight. Reducing the risk of disease would be an even bigger reward in its own right. So, Sunday's our family day ` church in the morning, Sunday lunch and then resting. Sunday lunch at Alofa's is a big deal. It's a chance for the entire family to spend quality time together. There's chop suey, corned beef, curry, chicken, salad, chips and... taro. It's a traditional Samoan menu, and it's hard to resist. (CHUCKLES) It's crazy important. Like, you would not believe how many times we've been growled off about not sitting down and eating together. (LAUGHS) It's a common family scene. But this everyday ritual of eating food is at the heart of the experiment. When we eat food, the small intestine digests and absorbs nutrients. The fibre that is left moves down to the colon. Our gut microbes break it down into products we use as energy. Without these bacteria doing their thing, we wouldn't be able to harvest energy from fibre. So gut bacteria are a fundamental part of how we are able to extract energy from food. But not all gut bacteria are created equal. Refined carbohydrates and fatty foods allow bad bacteria to thrive, which means chop suey and corned beef won't do Alofa's colon any favours. My Sunday lunch is always my cheat meal, because I know that, when it comes to it, I don't think I could actually cut off. And Papa hates it when you're not at the table, so it works both ways. The Gut Bugs team are really worried that bad food the girls are eating might kill off their new bacteria. But some research suggests the only thing that really matters is feeding the good bacteria enough of what they really need ` and that's fibre. We spend a long time talking about fat and we spend a lot of time talking about carbohydrates. We don't spend a lot of time talking about fibre, because fibre is no fun. But at the end of the day, it may be the most important nutrient that nobody's talking enough about. You might remember Jeff Leach, who has spent years studying the Hadza, a hunter-gatherer tribe in East Africa with fantastic gut diversity. Their lifestyle is almost identical to how humans would have lived in our evolutionary past. After spending time living alongside the Hadza, Jeff Leach realised they were eating a buttload of fibre. We see that they're eating anywhere from 30g, 40g, 50g, 100g, maybe 150g of dietary fibre a day. We have no reason to believe that that hasn't been going on for a very long time. Fibre is essential to maintain a diverse microbiome. In the Western world, the recommended daily fibre intake is 25g to 30g ` just a fraction of your average Hadza. I've had pretty dramatic changes. I think in some cases I improved my diversity by just being in the environment, becoming a hunter-gatherer, living in grass huts, consuming` drinking their water and so forth, as much as 40% to 50%. But I'm there for weeks on end. When I come back to the States, it drops right off. The next obvious step was to give himself a faecal transplant from one of the Hadza males who had a clean bill of health. So Jeff asked a healthy Hadza tribesman to poo into a bowl. Jeff put the poo into solution, and, using a turkey baster, he inserted it. And then, laying on his back, he pedalled his legs for an hour. Seriously ` this actually happened. At this moment, I probably have the most diverse microbiome of any Westerner in the world. But the experiment is still ongoing. So Jeff clearly had a lot of success keeping his new gut bugs alive. But the girls were told not to change their diet. And nobody knows if that might kill off their new bacteria. So what could they be eating to keep their new bugs happily munching away? Well, as luck would have it, Jeff Leach regularly cooks up big feeds for his own gut bugs. Tonight what we're cooking is, we have leeks on the fire, and then we have onions. Now, what's nice about these is they store the carbohydrate fructan. Now, fructan is a prebiotic. So, prebiotics, if you remember, selectively stimulate the growth of healthy bacteria. So what we're having tonight is prebiotic leeks, onion, garlic, and then we're going to chase that with some sausages. If you actually eat enough of this, you'll enjoy a fairly large bowel movement the next day, which may or may not be preferred, but if you're talking about your microbes, it's a sign of good health. And as Thilini can attest, the trial's super donors all fit Jeff's definition of good health. So, wow, this is a great sample. It looks like a healthy sample, because I can see some of the undigested cereals, and it has the right consistency. It's not watery and it's not very solid. I see some undigested carrots, so I assume he has eaten some carrots for his dinner or maybe for breakfast. (LAUGHS) But you don't need to be a poo connoisseur like Thilini to gauge your gut health. Believe it or not, there's a scale for evaluating your poo and assigning it marks ` the Bristol stool chart. Stools are rated from rock-hard and lumpy to chocolate pudding. Each consistency has its own number. Number one are your rabbit droppings ` hard little nuggets. Number two is longer, full of hard lumps and difficult to get out, like you're pooping a pine cone. These two mean you're probably not drinking enough water or eating enough fibre. Numbers three and four are sausage shaped with soft lumps or smooth and polished. They're a sign your gut is living up to its potential. Numbers five and six are a bit of a mess and mean you're not getting all the nutrients you should. If you have number seven, you've got diarrhoea. Your stool moved too quickly through your bowels and never had a chance at forming a healthy poo. Whatever the shape, 80% of it is bacteria. (MOODY WESTERN MUSIC) The Bristol stool chart is great. But for those don't want to carry around a pocket guide to poo, Jeff knows a foolproof way to tell you're getting enough fibre. If you don't have five to 10 farts a day, and one of those is a head-turner,... (LAUGHTER) ...you're not eating enough fibre. You need to ratchet that up a little bit. When you go to the bathroom, there's two things that you're looking for ` you're looking for floaters and you're looking for patties, OK? If you're delivering the... the classical swirl, that's way too much protein in your diet, OK? You need to add more plants. So if you can get patty, get your five or 10 flatulates a day and a whopper in there, you can probably skip the doctor that year. Right, 130.2. So the long and the short of it is that the girl's bacteria might have a fighting chance if they're getting enough fibre. And we'll soon find out if that's the case, because in four short weeks their three-month check-in is coming up. (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. There's only two weeks left until the three-month assessment, and it's Maddie's 19th birthday. But everyone's curious about how the trial is going. Bubbles or the other one? They're both bubbles. The girls have never actually met, so Maddie has no idea how her own experience compares to the others. PHIL: You don't know how other people are? No. I see them in passing, and we kind of go, 'Hi. Yeah, we're on the same trial.' And that's it. Just walk past and go, 'Hey, chubby.' (CHUCKLES) Phil! Jeez. What'd he say. Are they physically looking any different, to you, to what they used to? I don't know. That's the thing ` I truly don't know who any of them are. I just don't believe there is any quick win on anything ` there's no easy, simple solution. So essentially it comes down to what we put in our mouths and what we do around exercise and things like that. So it's all great, and I'm really supportive if this helps, and helps... you know, being somebody of a larger size, myself. I was really excited, because I thought if it gives her an opportunity to, you know, kind of... drop the weight off and stuff like that, and make her a bit fitter and everything, I... I was really pleased. I really went for it. It would be nice if there was a magic pill. Maddie had a tough choice to make prior to joining the trial. My mum was a bit concerned on the fact that I stopped taking an antidepressant called Citalopram prior to the trial. And she goes, 'What's more important, your mental health or this trial?' And I went, 'Well, at this point, I'm not sure, 'cos my mental health seems fine, and I want to give the trial a go.' Well as the most important person in the room, I suppose I should take the head of the table. Oh my goodness. How many people are you feeding? Maddie's not alone. Obese people tend to have higher rates of depression. But which one causes the other isn't understood. The gut microbiome affects our behaviour and our mood, so that there's this axis of gut microbiome and brain and that suggests that there is indeed a link. And there are a number of studies ` many of them come from animals, from mice and rats ` that show that the gut microbiome can influence levels of anxiety. It can influence depressive symptoms. I've always, always wanted to lose weight, and I've tried my whole life. And I was just like, well, my mental health will improve if I lose weight. And I know it will, because I've had the whole low self-confidence my whole life. And I was like, 'Well, it's worth a shot. 'And if it doesn't work, I can always go back on the antidepressant.' You know the pill won't cure eating half of that, eh? (LAUGHS) Scientists are only just beginning to appreciate this connection between the gut and mental health. WAYNE: There are differences in the gut microbiome with people with schizophrenia, with people with Parkinson's, with those who have Alzheimer's and cognitive decline as they age. And of course the question you might ask is, 'Could you see the same or a bigger effect with a gut microbiome transfer?' And the answer is quite possibly yes. Sorry. I don't like glazed cherries. But you're not eating half a cake. Try me. (LAUGHTER) And so the trial has the potential to change not just Maddie's physical health but her mental health too. I didn't know that gut bacteria could affect that. It seems such an odd concept, if you know ` just that something so far away from your brain can affect it. At the start of the trial, the girls completed a wellness survey which will allow the Gut Bugs team to monitor their mental health for signs of change. We can compare the two groups ` those who get the placebo and those who are treated, and we can also look at before and after ` before being treated and after treated. And clearly that will be interesting, because while we are looking to see whether there's a change in body fatness, it is quite possible that some of the biggest effects we see are not in body fatness. They could be in risk of diabetes, blood lipids, in mood and behaviour. A major hurdle for the trial is that no one really knows what changes to expect over time in someone's gut bacteria. 50 years ago, nobody knew they should be sniffing around poo. It is a real black hole in our scientific knowledge and a big unknown for the trial. But the Liggins is filling that hole, and its all thanks to the art world. 'This side up at all times,' it says. 'Contents toilet wipings and toilet wipings.' Billy Apple was one of the original pop artists in the 1960s. These are the boxes that were used at Adam Art Gallery. And they contain my wipings. In 1970 Billy exhibited an artwork called Excretory Wipings in London. And, as you might expect, he saved and catalogued every wiping his body produced. Billy supplied us with a series of samples of faecal material. It's really quite amazing. It's not the type of resource that you have um, well, really anywhere else that we know of. And so just like the girls, Billy supplied Justin with a 21st-century poo sample. This from the new tissue. This is the new tissue, yes. We get a sample of all of the DNA that's present in the faecal material. That represents, then, all of the organisms that are present in Billy's gut. Yeah, so, it's an awesome record. It's quite unique I learned a lot about myself at the time ` I seemed to. Well, we'll tell you more about yourself when we've done this. Mine was on the surface compared to what you're gonna tell me. (CHUCKLES) Yeah, we're gonna dig deep. We'll tell you about what's on the inside, mate. Right. All right, cool. And that information is critical for the team to get a better understanding of how likely the girls are to keep their new donor bacteria. All right, cool. One week later, and Billy's sequencing is ready. All right, Billy. So, we finished sequencing your biome. Basically, there what seems to have happened is there is a loss of diversity, that some of the species in the actual bacteria themselves, you had them, uh, 30` you know, 46 years ago,... and now you don't. So, with Billy, what we found is that 55% of the microbes that he had present in his gut ` or in his faeces, at least ` when he was in his 30s were still present there now. And so that tells us that they're conserved, that it doesn't really matter that his diet's changed, that his lifestyle has changed, that he's moved hemispheres and cities. These organisms are still present. And that's really interesting, because it's like, why are they still present? What we do know is that the microbiome responds to your diet, to antibiotics, environment. You know, it changes. So there's a component which seems to be the same, and there's a component that seems to respond to what's going on in your life at the time when you're looking at it. All we know from what we have got in your samples is basically that there's a change in the diversity. It's reduced. Others seem to be stable, they seem to be there all the time ` the core, if you like. And those ones, we think that's really interesting too. So on one hand, the samples suggest that it's not unusual to lose bacteria over time. But they also suggest that if the new bacteria can survive in the girls' guts, they might just become partners for life. And that's great news, because three months have passed and the girls are finally headed in for their mid-trial check-up. And both the girls and the researchers are anxious about the results. I do have the opportunities to do everything to try and lose weight. But I'm hoping that... I can... alter my life. Switch to Vodafone and get Vodafone TV Intro and three months' free unlimited broadband. That's over $640 of value. It's gone past your fingers, so you can move your arms now. The girls have all been busy with exams and work and the rigours of teenage life. And today they're back at the Liggins Institute for a three-month check-up. The last weigh-in didn't go as expected, and the girls are all hoping for better news this time. But there's a catch. The scientists have only given the treatment to half the teens in the overall study. The other half have received saline pills known as placebos. So some of the girls are bound to be on the placebos, and they likely won't see any changes at all. But nobody knows who's received what. So, the first time we scanned you was in August. And at that point, you were 55% body fat. Mm-hm. When we saw you the next time, you'd gone up a bit ` 56.9%. So you were about 1.5% up. That's actually come back down again. OK. And as part of that, you've actually got about a kilo less fat than you had last time we scanned you. And your lean tissue has gone up a little bit too. OK. So that's really positive. Cool. It went pretty well. My percentage body weight has dropped a little bit. Lean tissue has increased, which is a really good sign. So overall, really positive, I think. Shows that some things are happening. It's hard to interpret a single result like that for the whole study. It could be positive for us, because what we know about people who are overweight or obese, is that we do expect their body fat to slowly increase over time. And so to actually have things level out and become static could actually be a positive result. And we're not gonna know until we get to compare the people who took the treatment with the people who didn't. So that's a big positive for Maddie. We're off to a good start. But what about the others? Overall, since starting the study, Ashlee, you have had a reduction in your weight. The weight that the machine estimates for you has gone down by about two kilos. I think, actually, your weight on the scales has gone even more than that, which is the better measure of weight itself. From the point of view of your body composition, it's, um... you've had an increase in the amount of fat, and a little bit of a reduction in your lean tissue. So overall, that's not quite so positive. But in the balance, you have also lost weight. I'm quite happy. I'm happy considering that something's finally happening. It just I'm very impatient of a person. I have a busy life, so I want things to happen consistently and right now. But it shows that time will... will help. I've lost 2kg or 3kg, since I first started, um, which is good. but I've also lost muscle, which is also not so good, because muscle helps us to lose weight and increase our metabolism. Because I've actually gained fat as well, even though I've been losing weight. So good and bad. Good and bad indeed. Ashlee's lost weight, but probably not in the way she'd like. Still, it's an improvement on her six-week assessment. Can Alofa do the same? As you already told me, you know that your weight's increased over the course of study. While your weight has gone up, your percentage fat has gone up as well. Alofa's continued to gain weight, and she's actually gained a lot of weight since the start of the study ` she's gained about 8 kilos. When we did her DXA scan, that showed that most of the weight that she's increased is in body fat as well. So that's not a favourable change for her. She knows that's, I guess, obvious, but it's also quite disappointing for us and for her. It's a wake-up call for Alofa. She's worried her lifestyle might be counteracting the treatment. She knows what her problems are, but she's not always able to change them. Eating at the wrong times. What I'm eating, how much I'm eating. Yeah, they all go hand in hand. The last couple of weeks have been really bad for exams, and that's my excuse. But I'm hoping that now that it's over and I've got, like, four months free, I can alter my life. Stand against the board. I do have the opportunities to do everything to try and lose weight. It's... getting into a routine and doing it day in day out. Alofa isn't the only one struggling with routines. Saskia has left school and now has three jobs, so her routine of exercise has completely changed. It's a catch-22, because nobody knows how this instability will impact the trial. My, like, days are longer and kind of different compared to getting up at 5.30 in the morning and finishing school then at` coming home again at 5. It's like, now I'm doing late nights. Since we started the study, her weight has increased a little bit each time we've seen her. What we've seen in the last six weeks, coming up to today, is that she's had basically a change back to how she was at the start of the study. So now she's got about the same percentage body fat as she had before. It could just simply mean I got the placebo and didn't end up with the treatment. So it means that I didn't even have a chance to try it out, which is fine. Because, I mean, if it does work we still have an opportunity to be a part of it. And, I mean, exercise is obviously key, which I do try to keep up. It's just hard at the moment, with changing timetables and things like that. So a mixed bag of results for the girls, and the recurring theme is lifestyle. It's not clear yet if the faecal microbiome transfer has worked for any of them. Could it just take longer to kick in? They'll find out in three months' time. Until then, there's a glimmer of hope. The tests Thilini took at the six-week assessment will be coming in any day, and the team will finally get their long, hard look at their biggest unknown ` have the bugs survived? This first round of treatments is just the first wave of a larger study of teens. Our four girls give us a sneak peek at what the larger study might hold. Up until now, the Liggins team has been busy taking donations and preparing other pills. And with the sequencing results and the final weigh-in coming up, Wayne and Justin have a bit of time to step back and look at the big picture. If the trial is a success, it opens a whole new world of treatments that could benefit people all around the world. But that requires more than just poor old Thilini making each capsule by hand. If we dare to dream and think, if this works for obesity, how effective would it be for the treatment of diabetes, or those at risk of diabetes, or those with heart disease or hypertension, or those with mood disorders or bowel disorders or inflammatory bowel disease? I mean, there's just a whole raft of things. If it turns out that this treatment is effective for obesity or diabetes, that could potentially change the lives of millions of people. So how do we go about scaling? We can't rely on donors. That's incredibly labour intensive. It's almost a labour of love. The organisms can be isolated, you can check which ones they are. You use genomics to do that as well. There's a whole raft of methods to do that. If we think of clostridium dificile infection, that awful form of diarrhoea, they've tended to take a stool from a donor, blend it and then put tubes down or up and give it that way. So previous treatments to change gut bacteria with a tube have been, for lack of a better expression, a real pain in the arse. The Gut Bugs trial could be a game changer, because it would mean changing gut bacteria with a simple pill. When you can identify the organisms that cause the change, you can culture them and use them individually. We've moved beyond you just take a stool, blend it and pop a tube down and that's the treatment, in that we've refined it by isolating the bacteria, putting them in a capsule, putting them in a second capsule, they can swallow them. Yeah. Culture them in vats, and then you could package it up and sell it in supermarkets, just like you do with other probiotics. And that will get to a mass market. If the team can identify specific bacteria in the stool that improve the girls' health, then they could culture them, making poo donations completely obsolete. Yeah, conceptually, if you want to get it out to people, then that's what you've got to do. Cos you're never gonna do it with faecal material in capsules like this. It's just not gonna work. It sounds crazy, but it's the exact same principle at play in any type of probiotic. I mean, the way that we use the term 'probiotics', people think that's the stuff in yogurt at the supermarket. We're actually talking about something a lot more sophisticated. It is a new treatment paradigm which is gonna require a whole lot of work. It's moving away from standard drugs, standard lifestyle interventions. That's what's exciting. Nah, but it has to be in combination with lifestyle interventions. Of course, yeah. True. Absolutely. So the Gut Bugs team could revolutionise the way we treat not just obesity but all sorts of diseases. But first they have to prove that the microbiome can be shared through a capsule, and nobody knows if they've been able to do that. You know, if a drug popped up on the scene and it treated five different things, that would be nothing short of miraculous. But if this was effective, that could be the case. Before that can happen, the team need to know for certain that a capsule-delivered poo transfer will change the recipient's microbiome. And with just one week until she has to present the results, Thilini is trying to make sense of some extremely complex information. Yeah, so this is the final file from the sequencing machine. And on this monitor you can see someone's microbiome. So this has all the information about microorganisms in that particular sample. So I can use this file as an import to a different programme called Chime. And then from that programme, I can get the number of species and the names of the species of microorganisms in that sample. WAYNE: Thilini has been waiting for the DNA analyses of the bacteria, of all of these bacteria. And it's millions of bits of information, millions of bits of information that have to be analysed. What's happening today is that we are at a really interesting stage where Justin and I will get to see some of the early data. The first question is, does it actually change the bacteria in those who have been treated? So that's the question that we're really going to address today. We believe that the treatment ` gut microbiome transfer ` will change the gut bacteria of the recipients. If it hasn't, that is going to be something we're gonna need to think hard about and address. Maybe there are people out there who can be completely detached. It's an up and down. It's a roller coaster ride. It is for me. Nervous as hell. Nervous as hell. Almost half a year has now passed since the girls first took their faecal transplants. The final check-in is coming up. And researchers are starting to worry there's not much to show for the past five months. The Liggins team is hoping they can improve the girls' gut diversity. Higher diversity could mean greater resistance to disease, better metabolism and maybe even weight loss. So, what did you find, Thilini? Today is the very first chance to see what is actually going on inside the girls' guts and if this revolutionary treatment has worked. The orange-coloured ones are baselines. OK. And the blue ones are six weeks. Blue ones are six weeks, treated saline subjects. Right, so these are the placebo. So they've not moved very much at all, which is cool. So bring the FMTs up. The teens who got the placebos have had no change in their gut bacteria. No surprise there. Next up are the teens who got the treatment ` a faecal microbiome transfer, or FMT for short. What the team has been waiting for five long months to discover is, did the FMT lead to any shifts resulting in greater diversity? And so then 05 at six weeks. Are we ready? Mm-hm. Well, that's shifted. Yes. It is shifted. There ain't no two ways about that. No, that's definitely a big shift. That's a big shift. So that's shifted. Mm. Next one? RF07. OK, 07. Here we go. Baseline. OK. Well, that was a massive shift. That's a big shift. And here's the other one. Ready? Watching. Orange. Yeah, that's a big shift. That's a big shift again. So those have moved a lot, right? Four have shifted a lot, of the five. They all pair up much more tightly than anything in the treatment group. Except for that one pair. But the one pair is still further apart than any of these. Yeah, it was still further apart. That suggests to me ` we don't have significance, we don't have the numbers ` they are different. The trend is different. They've shifted with treatment. So it looks like Thilini's poo pills have worked. Those who took the treatment have seen a big change in the diversity of bacteria living in their gut. The shift has gone dramatically towards donors, and towards one donor in particular, right? Like, it reinforces that the microbiome... is manipulable. You can change it if you want to. You know? There's a change. Th-There's a change with FMT. And what we were seeking was a change, right, Justin? Yeah, what we wanted to see was a change. OK. So we know the poo pills have changed the gut bacteria. But after six months, what's the final result it's had for the girl's weight and overall health? And with differing results, which girls were on the treatment and which took the placebo? Nobody knows who took what, but everyone is dying find out if anything has changed. Thanks for coming in. No worries. Thank you for having me. All right, so, the first big question that you have is were you treated or were you placebo? (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. (GENTLE MUSIC) Today is results day for the girls and the Gut Bugs team. They'll finally find out if their microbiome has changed and what it means for their journey towards healthy living in the future. We still don't know which of our girls took a placebo. But everyone is dying to find out if the faecal transplant worked. Good morning, Saskia. Justin and Wayne. Nice to meet you. How are you? We don't know you well, but we sort of know all about you, and lots of you well. (CHUCKLES) Right. So, you were treated. Yeah. OK? So you were on the FMT. Yeah. I mean, it was cool finding out about it. It was sort of something that I thought about at the start, that I kind of had a inkling that I might be on, but then, as treatment went on, I was sort of like,... 'Meh.' So with respect to your microbiome, you started out and you had roughly about 60 different bacteria that we could identify. And over the course of the treatment, your number of bacteria in your gut increased to about... I think it's about 90-odd. That's pretty cool. Your microbiome is more like the donor's now, and it's stayed that way for six months. So you've got the donor potential. We think that is a better place to be. You haven't just moved to a place, we think you've moved to a better` you know, your gut bugs have moved to a better place. We tested your lean fat mass, we tested your BMI, we tested your insulin levels and sensitivity, for the insulin resistance. What we saw was that over that first six-week period, the people who had the treatment like you showed a drop, a general drop in their insulin resistance. So you've gone from being resistant to more sensitive ` in other words, away from the diabetes risk, if you like. Saskia's weight didn't change substantially, but she's improved her microbiome. This could mean a lower risk of chronic diseases, better mental health, and an improved relationship with food. Ashlee's up next. Nice to meet you guys. So, you were treated, OK? So, you had the actual FMT. Oh, OK. It was a surprise, because I do remember mentioning that I thought I had the placebo. Over the course of the time that we looked at you, your microbes changed. I think it was 60-odd through to 100-odd bacteria ` Wow. ...different bacteria that we can identify. So you gained a lot of new bacteria as a result of this treatment. You became more sensitive to insulin, so that's a bit more protective against diabetes. I think it's very cool that my gut bacteria changed. It reduces diabetes, the insulin levels. Obviously, it's a positive in the fact that I will be less prone to disease. But I'm going to have to try to preserve what I now have. That's good news for Ashlee. But now Alofa will discover if she was on the treatment or a placebo. Alofa,... so, you weren't placebo; you were treated. Aw, you're kidding me. I was shocked, I guess, um, that I got the treatment. Um, yeah, I mean, I've said it a million times, but I was so dead set on the placebo. Over the course of the study, your microbiome shifted, OK? You started out, and you had about 65 bacteria that we could identify. Over the course of the experiment, that increased to 88, OK? And it just consistently went up. So you got new organisms over the course of this experiment. And so, six months later, the microbiome that you have is different to what it was before. The issue is, has the rate of changing weight changed? In other words, have those who were treated gone from rapidly gaining weight to slowing down? Perhaps not losing weight. And whilst we'd always hoped for weight loss and great weight loss, if you think about driving a car down the motorway and you're doing 100km/h, generally, to be able to go backwards, you have to slow down, you have to stop and then start reversing. It's very hard to be driving 100km/h, just stick your gear lever into reverse and suddenly go from 100km/h forwards to backwards. So there is this sort of transition, if you like, in terms of the stages that need to happen. I am really interested to see, I guess, how my microbiomes help me from now on. The changes to Alofa's gut health have given her the chance to create a new, healthier lifestyle. Maddie is hoping for the same. But so far we've had three girls on the treatment, and no placebos. Hi. Hi, Maddie. Wayne Cutfield. How are you? Nice to meet you. I'm Justin O'Sullivan. How are you? Nice to meet you. Have a seat. So,... you were actually on the placebo. Yeah, I figured as much. I figured that out very quickly. I was like, 'I am on the placebo'. I'm not really surprised, shocked, upset. I'm just sort of like, 'OK.' I mean, in some ways it was good, because it gave me that push to go do something. Because I've changed my diet and started exercising and stuff, I've lost nearly 10 kilos. So in that way, the trial has really helped me. So Maddie's been on a placebo this whole time. But if the final study shows health benefits, she'll also be offered the poo pills. We think of you as a pioneer. We kind of think we're pioneers, but you, the participants, are the real pioneers, because you've taken on something that is kinda new and novel. There are other conditions that it could be useful for ` things like inflammatory bowel conditions, diabetes. So without you, it just wouldn't have been possible. So we owe you a huge debt of gratitude. So, what we noticed over the course of the trial was that with the people that were on the FMT, that actually got the treatment, that generally in that group there was a reduction in their insulin resistance. We also noticed there wasn't much of a change in weight. And so, unfortunately, it looks like, you know, with the numbers we have at the moment, we can't really say that this is an effective treatment for weight. Yeah. 'I can change my weight with diet and exercise.' But I thought that it helps with insulin resistance is absolutely fantastic, because diabetes is a really big problem. And the fact that it can help with all sorts of these other diseases, it's huge. It's revolutionary, in terms of, like, medical science. So that's it, then. There's no free ride to Skinny Town. But the trial has provided something far more valuable ` the first glimmer at a way to save people's lives by successfully manipulating their gut bacteria. Six long months of uncertainty has taken its toll on the girls. And now, with the trial over, a publicity shoot for this series gives them a chance to meet and let their hair down. Voila! I feel like the Princess Bride or something. Hi, I'm Ashlee. (LAUGHS) Saskia. It's so weird meeting you. I know. You've had the same experience as I have. Yeah. (LAUGHTER) (UPBEAT MUSIC) (ALL LAUGH) ALOFA: The trial made me... less ignorant, I guess, of my food, because I know that I can do all the exercise; it's the food that really got to me ` that the trial really helped bring that out. I went out for dinner with some friends, and we went to town after that, and I was like, 'How many calories is this one little shot?' My mental health is what impacted my whole journey. Cos if you're feeling down, you don't wanna exercise, you don't wanna eat well. You're thinking, 'Nah, I'm gonna stay in bed and watch TV.' It makes you more aware of what you're putting into your mouth, and what you're doing influences it. Like, definitely, it is an environmental thing. Like, the pills and treatment can only do so much. A lot of it comes down to ourselves. While the trial may be over for the girls, for the scientists it's just the beginning. Is there gonna be a one-size-fits-all cure for obesity? And I think the answer is no. You could say we could change the environment so that everyone eats less and everyone moves more, but that's impossible. Each person is gonna have to be treated as an individual when it comes to curing obesity. So there's not gonna be one cure for obesity. There are going to be many different cures for obesity. If we can improve metabolism, then we can make people who carry more weight healthier, even if their weight doesn't change. And that's really important. If being heavier no longer affected your health, then it would not be such a problem. We would like to look over a longer period of time to see how long it could be sustained. Clearly, with this first study, we're looking at obesity ` huge, major problem. But there are other places to look, and that includes type 2 diabetes ` huge problem. Does it improve your well-being? Does it improve bowel habit? Does it reduce the risk of bowel disease and bowel condition? These are all things that could be looked at. The trial is over for the girls, but their journey isn't. Three of the girls have changed themselves from the inside out with new microbiomes. And Maddie now might just do the same. I'm honestly at the point where I don't care if it helps me lose weight or not, because if it can help people who have lifelong diseases, that's way cooler. I just need to be a bit more selfless and remember there is more important things in the world. So... I hope that it can help people. All four have gone through a life-changing experience and now have the knowledge to keep their health moving in a positive direction.