We eat more,... I love the taste coming` like, coming down my throat. ...care less,... This tastes so good. ...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. We've 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 telling me that I'm gonna die by the time I'm 50. FLATLINING TONE Copyright Able 2016 SUBDUED MUSIC Josephine is 35 and has lived at home in Otara with her mother most of her life. Open your eyes. She's been overweight since she was a child, and now, at 166 kilos, she's twice a healthy body weight for her tiny 5'2" frame. Puss puss, breakfast time. Takeaways form her staple diet. (GROANS) It's a nice day, eh, Mum? First up, breakfast. I always prepare the bread first, and` (EXHALES) in sections. CURIOUS MUSIC Yeah. My favourites are the edges ` this part here. Measure it. Mmm. KNIFE SCRAPES ON PLATE Never get tired of bread. There we go. I always make one section at a time and put it together and admire the` admire the artwork, if I can call it that. No, Charlie. I'm sorry, but you can't have this, darling. OK. Here we go. BAG RIPS Uh` Mmm. WOMAN: Tell me about the joy of KFC. > I love the taste coming` like, coming down my throat. This is what I'll eat, and I'll be happy at the same time eating it. So, what is the sandwich made up of? > Oh, it's gonna be made out of chicken, chips and a little bit of gravy ` just give it that nice, um, moist for the chips and the chicken together. And I'm on cloud nine. (CHUCKLES) That always goes down the bottom. CURIOUS MUSIC The best part's the skin. That's where the taste is and, of course, that's where the fat is. (CHUCKLES) But I always make sure I eat all my skin on the sandwich. To top that up,... pa-da! And just pour it over. CURIOUS MUSIC I have these two sandwiches and another big chips beside it. Boom. Breakfast. MELANCHOLY MUSIC A homebody, Josephine has spent most of her life indoors. Her day revolves around food. She started eating for comfort after a childhood trauma, and ashamed of her size, she stopped going outside. Struck with agoraphobia, she is only now taking baby steps towards recovery. Most of the time when I go out I feel so uncomfortable, because I can't really do much what people say or... the way they` how they look at me. I just can't control that, so I come home and I'm upset and I start eating, and that swallows every sadness away. So sandwiches helped, because they're affordable to make and... they're yummy. (CHUCKLES) MELANCHOLY MUSIC MUSIC CONTINUES < As you're eating it, how are you feeling now? You look happy. Safe. (CHUCKLES) Because the food made me happy, I just saw it as my other friend. It still is. (LAUGHS) < Is there a danger that, if that's what makes you happiest, you could just, sort of, eat all day? If I eat all day, I'll die. (CHUCKLES) Um,... (EXHALES) < Are you worried about your health? Yeah. Um,... I've got type` type II diabetes. I'm sleeping with an apnoea machine. Um,... my heart ` the` both side of it's leaking, so it's not beating as it's supposed to. Josephine is going to need to overcome more than the challenges of dieting and exercise. To be a successful candidate for weight loss surgery, she will have to find the strength to overcome her fears. Surgery could help give her the future she can't give herself. The Manukau SuperClinic sees patients like Josephine every day. With thousands of referrals asking for weight loss surgery, the clinic has to choose patients who are most in need and most likely to succeed. Surgeon Richard Babor chooses who makes it to his operating table. Hi, I'm Richard Babor. I'm one of the surgeons here. How do you do? Oh, kia orana. Hello. You wanna have a weight loss operation? JOSEPHINE AND HER MOTHER: Yes. Wh-Why do you wanna do that? Because I can't find any other way to lose weight. < Yeah. I've tried everything from Jenny Craig, Weight Watchers, the lemon diet, to the gyms. I lose weight, but it comes back on again. < The lemon diet? The lemon drink. What's that? How does that diet work? You just drink the lemon drink three times a day for a week` > Really? ...and it cleans, so I to` was told. > Sounds tough to me. It was. (CHUCKLES) Well, you've got type II diabetes, and you're on the CPAP. How long have you had diabetes for? I think since last year. Last year. So, can I just go` we're just gonna have a look at your tummy. Get you to come and` OK. ...lie down for me. OK. Uh, at the moment I can't even feel your ribs because you've got so much fat just here, and so I need you to lose some weight for me ` you know, 10 kilos to 20 kilos. Can I get you to hop down? So, I'd like you to start losing weight. And in your case it might take a little bit longer before we get you to the point where it's safe and possible to do weight loss surgery on you, but that's OK, we'll try and help` try and help to get you there. Because it's bad for you to have, at your a` you're very young to have diabetes and breathing problems and all those kinds of things, and I think it's important for you to take advantage of this opportunity. OK, Josephine. Sign here. HOPEFUL MUSIC Thank you. Good. All right. Nice to meet you both. INDISTINCT CONVERSATION I know my life will s-start to begin because of today. And Mum's happy about it, and I've got her support. (LAUGHS) I waited for this for so long, um, and that is` Hilda starts to go away. (LAUGHS) Hilda. (CHUCKLES) The pain will go as each weight disappears. 2 INTRIGUING MUSIC Obesity is a New Zealand public health time bomb already costing $1 billion a year. The weight loss team at Manukau SuperClinic are trying to defuse the desperation by offering a select few bariatric surgery. For those that are morbidly obese, surgery is a lifeline. Patients who are, kind of, locked in this body that they can't seem to escape in any other way, despite all the things they try ` diet, exercise ` it kind of gives them a way to be... healthy and not obese again. And, so, what drew me to it when I first started, kind of, training as a surgeon, was that the clinics where pa` where post-operative patients from weight loss surgery seemed to be such a happy place; the people were satisfied. HOPEFUL MUSIC Truck driver Nat is hoping for the best. Moments away from surgery, he's about to have 90% of his stomach removed permanently. If the surgery is successful, he can look forward to losing up to 50 kilos. < WOMAN: This is it, Nat. How are you feeling? Yeah. Butterflies,... but ready. It's been a long road for Nat, a night shift worker. He rediscovered exercise... and his toes. He swapped steak... for shakes. And right now, he's not feeling too steady. POIGNANT MUSIC < Might just get you to come up a little bit more ` don't want you to slide down on those pedals. < That's it. Yeah, OK. That's fine. MACHINE BEEPS POIGNANT MUSIC NAT: In my wildest dreams, just imagining losing 50 kilos and being able to have no limits ` being able to run around again ` I'd feel full of energy, just lighter on my feet. Skydiving's a big one. Um, had that as a dream as a kid. Just having that sense of freedom ` yeah, it'll` it'll feel great. And just being able to soar down as, you know` be free like the birds do. Wind blowing past your body and all that sort of stuff, you know ` it'd feel great. INDISTINCT CONVERSATIONS, MACHINE BEEPS Nat has a long way to go. First of all, he has to get through surgery, and an operation like this always carries risk. He's a difficult shape. He's got a high BMI and, like most males, he's an apple, you know? And so that can make things technically difficult because he'll have a lot of visceral fat. MACHINE BEEPS OK. Everyone happy? All right. So, K, gas on. Top lights off, thanks. OK. TENSE MUSIC Tissue here ` it's got quite a lot of fat in it. What's that? Oh, got quite a big left load, hasn't he? Show me the bottom edge of the liver. This is the hardest part of the operation. Using keyhole surgery, Richard has to part a sea of fat and organs to locate the stomach and cut it out using a stapling device. The fat here's thicker. There's no windows, you know, of, sort of, tissue here. So that doesn't fill me with joy. (EXHALES) MACHINE BEEPS TENSE MUSIC OK. There we go. So, yeah, we've managed to find the stomach. In most people, kind of, regardless of their size, their stomach will hold about 1.5 litres of food and fluid. When we're finished with it, the stomach will be, yeah, like my thumb. To some extent, it's gonna be hard for Nathaniel to have a healthy diet. Not always the patient's fault; sometimes it's the fault of the environment. Shift workers ` you know, those` the guys go in the smoko room or whatever, in a container, and they all have sausage rolls and mince pies and cigarettes. You know? And that's the environment that he's gonna go back to. We know that carbohydrates are very very addictive, aren't they? As soon as you eat some carbs, you get this very strong signals in the reward centres of your brain ` like heroin, you know, or sex ` and it's almost impossible to resist that. INTRIGUING MUSIC Nat is taken straight into Recovery, where he'll be under constant supervision for three days. He'll have to learn how to eat and drink again. Like a baby, he'll have to wean himself slowly on to solid food. He'll go through a period where he doesn't like it very much, you know. Everybody does. He'll struggle. It's a big adjustment to make for a guy like Nathaniel. MACHINE BEEPS JAUNTY MUSIC Lolly lover Maria has made great strides. Her caravan home has been purged of its secret sweetie stash, and with the help of her son, Vincent, Maria has lost 5 kilos in three weeks. JAUNTY MUSIC KETTLE BOILS BIRDS TWEET She hasn't been secret eating. It's more along the lines that she's been` (STAMMERS) I have driven past the bakery` Yes, you have. ...and I know it's there. < Yeah. And I'm moving... (CHUCKLES) < Moving beyond the bakery? I don't stop! (CHUCKLES) Yeah. But see, see, those little changes will change your whole attitude in terms of food and how you're going to eat the food. The sweets are in the bin and the veggies are in, but this could be the one time that Maria doesn't polish her plate. Can you take out those things in the middle, please? The stalks? Yes. I don't want to eat any stalks. < Oh, do you wanna cook? No. Do you wanna hop up and cook` and try and cook? IRRITABLY: I'm helping you. How much an onion? Half an onion? Don't want much onion. You want garlic in it as well? No. Why not? Just thought it was pretty in the cupboard, that's all. > Oh, you don't want to ruin it. I hope you washed your hands. I did ` of course I did. Yes. LAUGHS: I know it tastes` this probably isn't done really` Don't you put too much pepper in. GIGGLES: But you asked me to put in` No, just a little bit, Vincent. Give you extra cucumber. Here you go. No, not pepper. Cover it in cucumbers. There we go. That looks about adequate. < # Din, da-din-din, da. # Oh, excuse me. < (LAUGHS) OK, here you go, madam. There you go. That's all yours. Oh, wait` Yeah, that one's yours. Thank you. It's my` More cucumber. ...my entree. (CHUCKLES) No, this is your dessert and your dinner and your supper and your` Put some salt on it? ...breakfast the next morning. I've got plenty of mine, thank you. < WOMAN: Do you think you could live on this sort of food for the rest of your life? No. < (GIGGLES) CHUCKLES: No. No. < So, what are you gonna do? I'm going to walk down to the dairy. < What are you getting from the dairy? Ice cream. (CHUCKLES) Chocolate ice cream. Maybe some lollies. (CHUCKLES) And a drink. Hello. DOOR SENSOR BEEPS INDISTINCT CONVERSATION Sense prevails, and Maria comes out empty-handed. DRIVER WOLF WHISTLES (SIGHS) It's changing your whole... mindset, and not just your personality but... saying no, and when people say, 'Sure, you want some chocolate? Ha` Sure, have some, come on,' and push, push, push, saying, 'No, no, no.' JAUNTY MUSIC Maria's newfound sense of resolve has led her to the leisure centre. What are you cooking me? I dunno. What do you want? No, not from your frozen foods. (CHUCKLES) Yeah. I'll defrost them. No, fresh. No? Fresh. No! Still got wheatmeal and pasta. No! No? No. What do you want, then? Smoked salmon. (CHUCKLES) < Smoked salmon has protein in it? Yes. < Does it? Yes. < Oh, OK. That could work for us. Yes. I'm learning these things lately. Yeah. It's good. For now, a bit of soul searching is keeping Maria on the straight and narrow. < Do you want to be skinny? Yes, yes. < Tell me about that. What do you think that would be like? It's` To me, it's worth more than money. (CHUCKLES) In the dream, you can just put jeans on and it's` it's comfortable and you can just get dressed quickly and... (SIGHS) life is... life just seems much` so much more. CLUNK! SPLASH! HOPEFUL MUSIC On the other side of surgery, Nat's waking up to rapid weight loss ` 10 kilos in three days. Gotta clean my hands before I come in there, eh? Best mate Mili has shown up with a gift ` Hungry, brother? Hungry? (LAUGHS) ...Nat's first solid meal. < That's gonna be normal` Yeah, I know. < ...for now. Actually, it might actually a bit much for now, to start off with. Looks like baby food. HOPEFUL MUSIC Nat leaves hospital a little lighter on his feet, but will he be able to navigate a future of tiny portions and the alien world of fruit and vegetables? He'll never be able to eat normally again. (LAUGHS) Oh gee, you're on fire! Next time on The Big Ward ` Josephine ventures outside. I've got that goal. Got that goal. But will it be enough to qualify for surgery? (WHIMPERS) He's given you a very big, tall order, hasn't he? Yeah. While Maria struggles with old habits. The smell of it. Smell? That's all I want is to smell it. Mmm! (LAUGHS) Deep-fried. Captions by Tariqa Satherley. Edited by June Yeow. www.able.co.nz Captions were made with the support of NZ On Air. Copyright Able 2016