An 11-year-old boy from Indonesia became the youngest person ever to undergo invasive gastric bypass surgery recently, after they boy’s parents became worried that their massive son — six times the size of his peers — would meet an untimely early death due to his astounding size.

The 420-pound youngster had trouble walking for more than five minutes — not a symptom conducive to a long, prosperous life.

Indonesia, a rapidly developing chain of islands that has a population over over 250 million, is a nation caught between the First and Third worlds, boasting 24 billionaires, but also untold millions trapped in poverty. It’s South East Asia’s largest economy, but also a country facing increased threats from radicalized Islamic extremists in areas where the government has little to no control.

Perhaps no better microcosm of their unique situation exists than this infamous video of the baby who smokes 40 cigarettes a day.