The mound of pill bottles lying on Bob Brasell's chest kept growing.
"This is for Lipari for diabetes," he said, plunking yet another pill bottle onto his hospital gown, "one of these every morning. This is Metformin, take two of these for diabetes every night...that's for cholesterol, I think."
Those are just some of the 15 or so pills Brasell takes every day to battle the deadly health conditions associated with his obesity.
At 320 pounds, Brasell is joining the growing ranks of thousands of Americans fighting against obesity, not through diet or exercise, but through an emerging and extreme surgery called vertical sleeve gastrectomy.
It's a radical, yet remarkably simple surgery in which 85 percent of the patient's stomach is removed in a procedure that lasts less than an hour. An increasing number of Americans whose insurance won't cover the surgery are paying in cash or credit, and having the procedure done on an outpatient basis.
Brasell is one of them. In a hospital gown at West Jefferson Medical Center in Marrero, Louisiana, he lay bundled on a bed too narrow for his girth. He has to keep his arms on his stomach to keep them from dropping off the sides.
Before going into surgery, Brasell's heavy-lidded blue eyes were bloodshot. He complained of thirst and craved food -- patients are required to fast before surgery.
But in less than three hours he is wheeled into an operating room and lifted onto a specifically made bed certified up to hold 500 pounds, but is capable of bearing 1,500 pounds.
Brasell's surgeon, Dr. David Treen, preached the benefits of the sleeve gastrectomy.
"It's not unusual for us to see a patient lose 100 pounds in six months with this," Treen said.
Treen said the weight loss happens because the bulk of the stomach is removed permanently -- gently eased out of a dime-sized hole in the abdomen. Perhaps as important, the part of the stomach that's taken out is also the area associated with the production of the hormone ghrelin.
"Ghrelin is a powerful appetite stimulant, and when you remove this part of the stomach, most of our patients tell us after surgery, they're not hungry. Ever," Treen said.
ABC News was given rare access as Brasell went through surgery, which began with a series of holes cut into his abdomen. The abdomen was inflated and Treen cut away lumps of fat from Brasell's stomach. Then, using a device that cuts and staples simultaneously, Treen cut off about 85 percent of Brasell's stomach. Minutes later he methodically twirled the chunk of the stomach out from a dime-sized hole in his abdomen.
So what was Brasell's new stomach size? "It has the capacity of a plastic Easter egg," Treen said.
The surgery is surprisingly clean, with very little blood loss, and overall reduces the volume of food the patient's stomach can hold before he feels full.
"He will probably lose 100 pounds in the first six months," Treen told ABC News during the surgery. "Weight loss will slow down after the first six months, but by that time, that big bag of medicines will be a very small bag of medicines."
The surgery can have its complications, such as leakage or fluid escaping from the stomach. Few people have undergone the procedure so long-term effects are still relatively unknown.
Nonetheless, Treen said he supports this bariatric procedure, in part, because of the price.