"For the patients, [the vertical sleeve gastrectomy] is a lot more affordable...Many of the patients you see do not have insurance coverage for bariatric surgery, but they desperately need it and desperately want it," Treen said.
Bariatric surgery used to cost upwards of $30,000 because it was so invasive. Now, advances in laparoscopic surgery -- in Brasell's case, five holes punched through the abdomen -- enable surgeons like Treen to lower costs and complete the surgery in about 45 minutes.
Brasell will pay $12,000 for this outpatient procedure, but he has to be out of the hospital the same day.
"It's been shown by studies that it pays for itself in about 3-4 years" Treen said. "It's like buying an inexpensive car, but this lasts a lot longer than the car does."
There's one catch: Treen won't perform this operation on patients classified as "super-obese" -- those with a body mass index (BMI) of over 50. His patients usually have a BMI between 40 and 50, which are classified just as "morbidly obese," fat enough to be made ill by their weight.
According to the American Society for Metabolic and Bariatric Surgery, about 15 million adults in America fall into the category of "morbidly obese."
While removing 85 percent of the stomach might be extreme, Dr. Treen said it becomes the only choice left for many patients in what he called the obesity "epidemic."
Such was the case for Holly Matherne, a 38-year-old nurse who recently went to see Treen for the sleeve gastrectomy. She said the surgery was her final hope in battling her weight.
"I've been fighting with weight since I was six years old," the 38-year-old nurse said. "I've been on every diet, I've been to a nutritionist, Weight Watchers, reduced fat, reduced calorie, you name it, I've done it. I may lose weight here and there but then it winds up creeping back on. "
Matherne said she is about 200 pounds overweight, and while she doesn't have the same health complications that Brasell suffers from, she said she wants to be able to keep up with her family.
"I want to take them to Disney and go on rides with them," she said. "I've never been able to do that. I just want to have more energy and keep up with people my age."
In her current physical state, Matherne said she can't sit on a plane and hasn't flown in decades. She also fears that her weight will eventually kill her.
"It's been a long time that I've dealt with it and I'm ready to not deal with it anymore," she said.
For the morbidly obese and the super-obese, often losing the weight or having the surgery isn't enough to keep off the extra poundage. Patients also attend counseling and support groups to help curb their emotional attachment to food -- the comfort they get from eating just to eat.
Brasell is no different. "The real part is going to be not eating, got to figure all that out."
And the hard part? "Seeing if I can make it work. I've got to. There's no choice," he said.