Doctors decided to perform the surgery, called a Roux-en-Y gastric bypass, on Max despite his young age because his case was so extreme. Obesity doctors measure health by a mathematical formula called Body Mass Index. A person of ideal weight has a BMI of 20 to 25. A person moves into the obesity danger zone with a BMI of 40. Max had a BMI of 90.

[Maria] is grateful, but the process hasn't been easy for her. She cared for Max and his two sisters and a brother for nearly nine years as a single mother. She was often overwhelmed with caring for her obese son, unable to work at an outside job because he required so much attention. She spent her time driving Max to an endless round of doctors' appointments, following him around nearly 24 hours a day to make sure he wouldn't fall and hurt himself, and dealing with Max's foul moods over his condition.

Max remained thin until sometime between his third and fourth birthdays. Then, he began gaining weight rapidly. Maria did not keep records at the time, but she believes Max weighed close to 200 pounds when he entered first grade.