Weight loss surgery comes with a lot of stigma and a high price tag But bariatric surgery can also transform lives, and, despite the hurdles, more Māori are going to great lengths to access surgery.
For Whakatane local Mawera Karetai, the choice to have gastric sleeve surgery was simple.
"If I didn't do it I'd probably be dead by now," Karetai said.
Karetai is just 5.1 feet tall. A year ago she weighed 140kg, after surgery, she is 70kg lighter.
"I've lost a whole person," she said.
Mum of three Eva Ngāmotu spends her days making other women feel gorgeous in her Taupō beauty business.
But she struggles to feel that way about herself after battling with her weight for the past five years and what she sees as the unrealistic expectations of social media.
After suffering from bulimia in her early twenties, Ngāmotu wanted a healthier way to get into shape.
"I have to live in this body and I want to be comfortable. And I only have one life," she said.
To start her new life all it took was a click on a website. Ngāmotu is one of hundreds of Kiwis including many Māori who are travelling overseas for bariatric surgery.
She chose to travel to Turkey - part of a growing trend of New Zealanders embarking on medical tourism.
For many, it's a financial choice. Ngāmotu's gastric sleeve operation at Reyab Hospital in Istanbul cost her $5000. With flights, she's expecting to spend around $8000.
When she comes home she will leave 80 percent of her stomach behind in Istanbul.
Karetai had her operation in Aotearoa after a battle with her Kiwisaver provider to get the funds to have it.
"This is not a medical professional... saying no. This is an accountant making a decision about my life and my level of unwellness and my likelihood of death," Karetai said.
She eventually got the money on financial hardship grounds.
"So, $27,000 it cost to save my life. And it has saved my life. So it was worth it," Karetai said.
Dr Michael Booth started the first public health surgery here in Aotearoa 20 years ago.
He has concerns for patients who fill in a form online at home in New Zealand and then go overseas for major abdominal surgery.
"We don't know what the results [are] of patients who access surgery overseas," Dr Booth said.
He said the small incisions left by laparoscopic surgery could lead those patients to believe they've had a minor procedure.
"One must never be fooled that just because they've got small skin incisions, that they haven't had a major operation," Dr Booth said.
Dr Booth defends the cost of surgery in New Zealand.
"You're looking at laparoscopic ports, anaesthetic time, theatre time, then there's the surgeons' fees, dieticians, psychologist and then there's post-operative ward care," he said.
"When you take it into context with, say, a knee replacement, which might be $35,000, to my mind it looks like good value."
Karetai has no regrets about her gastric sleeve surgery.
"I was on a lot of medication for diabetes, for my heart, for my fatty liver, for my inflammation from my arthritis. I was not feeling overly optimistic about the future.," she said.
"If I didn't do it I'd probably be dead by now. My life has transformed completely in every conceivable way."
But Karetai said she was forced to go private because of hurdles she faced when trying to access the surgery through the public health system.
She said the public system makes it really difficult because patients are expected to attend a number of appointments during a programme of preparation and assessment.
"I just realised straight away, as soon as I couldn't make the appointments, that they were never going to sign it off," Karetai said.
Dr Booth agrees it's hard for many patients to get time off work to attend the necessary pre-operation appointments.
"We're seeing more Māori and Pacific Islander patients coming through public and private, which is good. The problem in public [health] is accessibility," he said.
Dr Benjamin Wheeler is currently the only full-time Māori bariatric surgeon in Aotearoa. He's seen the difficulties some patients face to get surgery.
"You know, if you've got a white collar job and you've got control of your life. Great. You just tell the boss you're going... But if you're blue-collar. If you don't have that kind of freedom, then it becomes really difficult," Dr Wheeler said.
Dr Wheeler has found the rules around who can access their Kiwisaver for weight loss surgery unclear.
"I don't like variability because as soon as the same people are getting different treatment in different places, that opens the door to bias. That's the slippery slope towards racism," Dr Wheeler said.
"Superannuation is no good to you if you're not going to make it to retirement age."
He said doing bariatric surgery earlier has a much bigger payoff later on, citing the example of operating on someone newly diagnosed with diabetes rather than waiting until their kidneys are failing.
"It can cure their diabetes, and that will save the health care system a whole lot of money that will save that person a whole lot of heartache," Dr Wheeler said.
Karetai's life has been transformed from someone who was frequently in hospital for costly treatment for her heart and fatty liver, to someone who cycles everywhere.
"I love my bike," she said.
She has also noticed a difference in the way people treat her.
"I would always note the looks that people would give me, the judgments, the sniggering, the comments behind hands," Karetai said.
"I don't get those looks anymore. And I just, I feel really sad, actually. I feel sad for the old me."
Eight days after her surgery in Istanbul, Ngāmotu sent The Hui a video update. She's lost 7kg in eight days and wishes she'd had the surgery earlier.
"It may seem like a selfish move but I only have one life."
Made with support from New Zealand On Air and Te Māngai Pāho.
