Oct. 25, 2010 -- 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.
Extreme Surgery Removes Large Chunk of the Stomach
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.
"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.