NZ ` a land of greats. We conquered Everest, split the atom, smashed the first four-minute mile. Now we are set to boast another heavyweight title ` the world's fattest nation. There's more obesity in our population than in the United States, Mexico, which have always been the front runners. Australia's been up the top, but we now have, uh, more obesity in our population than Australia. We eat more,... And instead of passing a rugby ball, I was passing a Big Mac from one hand to another. ...care less,... I love the taste coming` like, coming down my throat till I'm on cloud nine. ...and it's killing us. You are morbidly obese. You know what the word morbid means? It means deathly. South Auckland is the ground zero of our obesity explosion, with 63% of adults dangerously overweight. The Manukau SuperClinic is on the front lines of this epidemic, treating close to a thousand patients with controversial weight loss surgery. MACHINE BEEPS We know that diet and exercise doesn't work. This is the only thing that we currently have that does. We have spent a year following the fortunes of the biggest patients and the specialist nurses, dieticians and surgeons dedicated to helping them lose weight. For these people, weight loss surgery is their last chance. If I continued eating, it would end up killing me. He's just telling me that I'm gonna die by the time I'm 50. SHAKILY: I know that I` I deserve... a life. FLATLINING TONE At Manukau SuperClinic, recent requests for weight loss surgery have more than doubled. Hello, my name's Richard Babor. I'm one of the, um, weight loss surgeons here at Counties Manukau. Everyone in this room is big, sick and have tried and failed every diet in the book. As a last resort, their GPs have referred them for stomach-stapling surgery. We remove about 80% to 90% of the volume of the stomach. So your normal stomach holds about 1.5 litres of food and fluid, and after this operation, you're left with about 150ml to 200ml. Not much room for food. Richard hopes to weed out the ones who don't have what it takes to lose weight pre-surgery. I can't, like, sneak around in the dark at night outside your house to see if you go for a walk and make a note in my diary. Uh, we can't break into your house and look through your fridge to see if there's cheesecake in there and throw it out. We've just gotta measure your weight. And that's part of our selection process. Not everyone signs up. But for the ones who do, weight loss surgery will turn their lives upside down. At 47, Maria's life expectancy is 50. I would go through this way. CHUCKLES: You go straight to the chocolate aisle. Weighing in at 140 kilos, she's been morbidly obese since the birth of her son Vincent ignited her passion for sugar. Where's the Pineapple Lumps? A couple of these. Just a couple. Now they are both sweet enthusiasts who just can't say no. Want a doughnut? Oh, yeah, let's get a doughnut. Yeah. (CHUCKLES) The mud cake. The mud cake. I'll have the icing, you can have the cake. (CHUCKLES) And that chocolate cheesecake filling. < Huh? You're not listening to me ` the chocolate cheesecake filling. I'm excited over food. Oh, this is good. It's got all your calcium in for the day. Chocolate. Obviously you can see the happiness on my` my face. It's like, 'Oh! What should I get?' You know? Hundreds and thousands. I like the ones with the lollies on it. Yeah. It's a good breakfast, a packet of this. The tastes and the flavour of chocolate... Get that all in, Vincent. Morning and afternoon tea. WOMAN: How long would a pack like that last? Oh, a few days. Maybe two. Yeah. I share. I give him one or two, yeah. Does she share? No, not usually. Not a lot of words for it, really, but, um, the greed of wanting to consume it and enjoying it. Food` Food controlled me. I haven't controlled it for, like, 20 years. It's something that I've done to myself. DOG BARKS Close neighbours, mother and son share a backyard,... Eat. ...a pet cat... and caravan homes. So, we live in Papatoetoe. Here's my caravan over here and here's Mum's humble abode. But there's one thing Maria likes to keep to herself. Her sugar addiction is more than just skin-deep. This is the least place someone would think to look. It'd be under here, because no one would think to look under there. And you always check to make sure you haven't forgotten any. CHUCKLES: They should make them a lot bigger; like, real long sizes. But then you'd still need to get, you know` Sometimes it feels like they make the packets smaller, but (SIGHS) yeah. Can really get lots tucked in through here. CURIOUS MUSIC You'd have it in another bag. You don't really want to share them. If you do, you can let, you know` If you had someone visiting, you could let them have one, but make out you only had one and later on, finish them off. You always put it behind things, tucked at the back. RUSTLING So, um... RATTLING And you know how many there is. Oops. OK. And then underneath, you can have some more` more of these. It's a bad habit, but bad habits are the most enjoyable. (CHUCKLES LIGHTLY) Is it worth dying for? Sometimes it has felt like that, yes,... um, to be honest. Mm, you know, when there's not that much enjoyable things in your life at times, (SIGHS) this` it brings happiness. As I've got older, I've realised how strong it is. Um,... I try to look at it now as if this will be the death of me. Um,... if I continued eating it, it would end up killing me. REFLECTIVE MUSIC Maria wants a second chance at life. And weight loss surgeon Dr Richard Babor has spent his career helping people just like her. Weight loss surgery is where I kind of get a little bit of (CHUCKLES) emotional nourishment as a surgeon, because it often has happy outcomes. Hello. Nice to meet you. So you're Maria. Yes. So you want to have a weight loss operation? Yes, please. Why? Um, so I can feel healthier and not sleep as much and be able to move around better. Have a better quality of life. I know I'm an emotional eater, and I do tend to hide and eat. Do you? > Um, yes. Secret eater? > Yes, yes. Mm. Can I examine you? I want to have a look at your tummy and see what sort of shape you are. It's not a pretty sight. (CHUCKLES) It's really a bit` OK. I'll get you to just lie flat on your back. You don't need to` Yeah, that's good. Can you lose some weight for me before surgery? Uh, yes. Yeah. Can you lose 10 kilos? Oh yes. Good. All right, you can hop down. It's just not eating sweet stuff. You must not eat any sweets. If you eat sweets after the surgery, then you'll` you will regain weight in the long-term. So if you lose some weight for me preoperatively and you're willing to, kinda, give up eating, then, you know, we'll do it, if you want to. I'd love to have that done. Maria's made it over the first hurdle. But can Maria change everything about the way she lives? REFLECTIVE PIANO MUSIC Otara, the capital of South Auckland's obesity explosion. Got some sirloin steak we're gonna have for some lunch. Truck driver Nat has waited two years for weight loss surgery. He's supposed to be on a low-calorie diet, but has struggled with portion control all his life. WOMAN: What were you eating? Anything. Anything that was chucked in front of me. Just salt up our pan so it doesn't stick. My old man taught me how to cook, and one thing he always taught me how to cook well was a steak. You put it on the grill and, um, you leave it alone; you don't play with it; um, flip it once. At 29 years old, Nat's BMI is 60. He is officially super, super obese. He's hoping that surgery will force him to do the impossible ` control his eating. FOOD SQUELCHES MUFFLED: It's a good sandwich. (CHUCKLES) BIRDS CHIRP Well, as you can see, uh, welcome to my little man cave. I'm a bit of a Transformer nut. I think I've got about 13 Optimus Primes now. (CHUCKLES) But is there something there as well? I mean, you're hoping to transform yourself, aren't you? Yeah, yeah. Um, not into a truck. (LAUGHS) But yeah, um, with this` with this surgery, I'm hoping that, you know, I'll go f` Yeah, it's like that second chance sort of thing, you know? Nat wants to get back to the days when he was a NZ wrestling champion. His dream of going professional was cut short after he broke his neck and gained 100 kilos. Yeah, I got that urge to jump back in the ring. I` I'm not gonna lie. My escape was sport. When I couldn't play sport, food became that` that comfort. You know, instead of passing a rugby ball, I was passing a Big Mac from one hand to another. When I was at my` at my biggest weight, which was 177, one of my veins burst in my leg. And I` And I just noticed all this blood bloody squirtin' out of my leg, and... that was` that was probably the single part where I said, 'Nah, something's gotta be done here.' Come on, this way. DOGS PANT, WHINE Nat decided that surgery was his only option. Having lost his 15-kilo target, he has to keep it off while waiting for the hospital to call with a date. TELEPHONE RINGS If he regains the weight, he'll be struck off the list. WOMAN: So, we have a date for surgery. OK. Surgery date is going to be the 23rd of February. 23rd of February. Nat will now have to go on an even stricter liquid diet. OK. So basically tonight's my last supper, sort of thing. Pretty much. Yep. Ah, yep. And then it's all go tomorrow. OK. Cool. DISCONNECT TONE Uh, well, yeah. It'd have to do something with steak. REFLECTIVE MUSIC INDISTINCT CONVERSATION Three weeks later, and Nat's struggling with the sudden drop in food quantity. Afraid of falling off the wagon, he's invited his best mate over. Milly had surgery a year ago and has lost 70 kilos. I was gonna suggest that we go to` to the Subway, go down there and have a feed. Then I thought, 'Hang on, I can't have bread.' This is the area where you're gonna find it hardest, in the kitchen. You know, you walk in and you go, 'Oh, I feel like that. Oh, I feel like this,' because you're so used to having that beforehand. No regrets. Don't get me wrong, I'm not regretting it. It's just bloody something to get used to now. Food's gonna be one of his biggest challenges because of the type of work that he does. Cos he would've been so used to going to the bakery or going to the local takeaway bar getting something quick and easy. So no, there's no more` no more mince pies, no more full on burgers, McDonald's. Um, he's gonna have to actually get up and make his lunch. (LAUGHS) Nat lives an upside-down life. Night-time brings the start of his 80-hour working week. Midnight. (LAUGHS) Early in the morning, too early for this. (LAUGHS) You know, for the past, what, seven years, I think, I've been doing the night shift. Shift workers gain 4.5 kilos more a year than the rest of us. Limited food choices on the road make it easier to put on weight and harder to lose it. Like, food, anyone would just grab something that's there, and normally it's a five-minute road trip down to McDonald's or something like that. On the other side. You have to make a healthy choice and... BIRDS CHIRP After a 14-hour shift,... it's bedtime. MOTORIST BEEPS HORN > REFLECTIVE MUSIC Nat suffers from sleep apnoea, a condition that causes him to fall asleep without warning. If he wants to keep his driver's licence and his job, weight loss surgery is his only hope of a cure. OXYGEN HISSES BIRDS CHIRP NZ's obesity problem starts here in South Auckland. Sugar addict Maria is on the wagon. It's time to purge the caravan of its deadly booty. Mm. Say goodbye to my friends. You can't` You can't even smell them. Just have a little nibble on each corner before they go in there. Come on. Now you have to give it up and not buy it again. That's right. Yes. Mm. You needed a healthy lifestyle. Yes, have a banana instead. Good riddance, eh? There you go. Oh, thank you. Chuck it in the big bin. Chuck it in the` BOTH LAUGH Thank you! That's mine! She'll have to change herself. As a person, she's gonna have to change... her` essentially her life, because she had such a reliance on food. She had such a reliance on it revolving, uh, around her, you know? It` It was everything, you know? And then now it's, like` it's fully cut off. SPLASHING Vincent drags Maria to the pool in a bid to lose the target 10 kilos. But Maria is having a hard time adjusting to the new regime. You're treated differently when you're overweight. You get those looks as if, you know, something's the matter with you. It can look like I'm pregnant. (SNORTS, SNORES) VINCENT: Mum! Vincent is determined his mother will change. Oh, can't do this! I'm pulling you up. Stop it! Be a good boy! Don't laugh at me. BOTH LAUGH Stop it. I feel like a` a` like a drill master, like a personal trainer sometimes. SPLASH! Helping her on her way. CURIOUS MUSIC REFLECTIVE MUSIC SIREN WAILS It's surgery day, and Nat's come straight off the graveyard shift. He doesn't know if he's maintained his target weight loss of 15 kilos. He'll be sent home if his weight is up. That's two years hard dieting, all for nothing. Patients need to lose weight before surgery because often their liver is large and full of fat, and the stomach lives behind the liver, so we need to lift this part out of the way. WOMAN: So is that the whole, um, point of the weight loss before surgery? Part of it. It's partly` mainly to do with that safety, but it's also to just make sure that patients are able to lose a little bit of weight and change their behaviour a little bit before surgery. INDISTINCT CONVERSATION (LAUGHS) Best mate Milly has shown up so Nat doesn't have to face surgery alone. All good? All good. (GROANS) So, how you feeling? Nervous. (CHUCKLES) Why are you nervous? I don't know. This is the easy part; coming to the surgery is the easy part. You've` You've gone through the hardest part of it. It's gonna hurt a little bit, but, mate, you just gotta harden up. BOTH LAUGH Come into this room. WOMAN: OK, let's weigh you in. At his heaviest, Nat weighed 177 kilos. Shed as much weight as I can. (CHUCKLES) Is he too big for weight loss surgery? What have we got, Nathaniel? Um... > 154.3. (LAUGHS) He's lost more than 20 kilos, but ultimately the decision to operate comes down to one man, surgeon Dr Richard Babor. So you're all set to go, are you? All right. Pretty much. You've lost a bit of weight. Yeah, 176 I was at. < So you` Over 20 kilos? Yeah. You look a pretty intimidating sort of a shape for a surgeon, to be honest, when I've` when I've seen you with your gown on. But you can hop` hop down. (GRUNTS) I mean, you're pretty big. There is a bit of a risk occasionally that we can't actually do a surgery in a` in a bigger person like yourself. When we get in, the liver's too big, I can't get it safely out of the way or can't get to the stomach for some reason. REFLECTIVE MUSIC So, how you feeling? Nervous? Little bit. Butterflies. Guess not a good thing to have when you're having surgery on your stomach. (CHUCKLES) Have butterflies in the stomach. Here's a good reminder of where you're at. What you had to go through. He's very big. He's got a apple shape like a lot of bigger men, and, uh, technically much more difficult to do and they have a higher rate of complications. He'll take longer than usual and, uh` and it'd be probably a little bit trickier. REFLECTIVE TONE Coming up next time in The Big Ward, we meet Josephine,... Boom. Breakfast. ...Maria eats her greens,... WOMAN: Do you think you could live on this sort of food for the rest of your life? No. VINCENT LAUGHS ...and Richard gets a large surprise. That doesn't fill me with joy. (EXHALES SHARPLY) Captions by Jake Ebdale. Edited by June Yeow. www.able.co.nz Captions were made possible with funding from NZ On Air.