INSATIABLE (continued)

The only negative side effect any of the ten have experienced is some nausea and vomiting when they’ve overeaten or eaten the wrong thing. Veronica has had the common "dumping syndrome" - nausea and diarrhea usually caused by eating too much sugar or fat too quickly. But Anita’s rheumatoid arthritis has virtually disappeared, and her pre-diabetic condition has also resolved, as has Marie’s.

The women need to be careful when they eat rice and pasta, because it expands in their stomachs - but that’s all right, because what they crave these days is salad. In fact, though they cannot physically go on binges anymore, the weird thing is that no one even wants to. "I have no desire for chocolate at all, and I used to eat ice cream at least once a day - at least," Anita says, a tinge of wonder in her voice. It could be a sort of Pavlovian response to having gotten sick when they’ve eaten the wrong things. It could be that the angst that fed their overeating has dissipated now that they’re thin. As Denise, who is petite and wearing a pair of siz- 4 shorts the day I meet her, puts it: "Nothing tastes as good as thin feels." It could even be that the surgery somehow changed their brain chemistry. James O. Hill, PhD, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center in Denver, says that a study comparing those who’ve lost weight with the operation to those who did so through diet and exercise shows that the surgery group can eat more fat and exercise less without gaining weight, suggesting the operation may accelerate patients’ metabolism. Other research is under way to see if it alters dopamine receptors in the brain. Of course, the Roselle family’s new disinterest in food could simply be the result of crude mechanics: Their tiny stomachs allow them to feel "Thanksgiving full" - as Denise and Veronica describe it - without bingeing.

As it becomes clearer that the risks of surgery (which has a death rate of about 1 percent) are lower than the risks of obesity (which increases the risk of death by up to 100 percent and causes 300,000 premature mortalities a year), a few doctors are advocating offering the operation to more people. The current recommendations of the National Institutes of Health are that only those with a BMI of 40 or more (at least 233 pounds for a five-foot-four woman), or with a BMI of 35 with serious co-morbidities such as diabetes or heart disease, undergo the surgery (the Roselles and their friends had BMIs over 40; Veronica’s was 56.2). At a recent American Medical Association meeting, George Bray, MD, professor of medicine at Louisiana State University Medical Center and one of the top experts in obesity, suggested the requirements be lowered to a BMI of 33 (193 pounds for a five-foot-four woman). This would make as many as 15 million Americans candidates for a surgery that is now done on around 50,000 people a year.

But others remain circumspect. Susan Roberts, professor of nutrition at Tufts University, points out that we don’t have any data on the surgery’s long-term impact (for example, its effect on pregnancies or osteoporosis rates), and that it’s a drastic step requiring a highly motivated individual who will comply with follow-up care. Steven B. Heymsfield, deputy director of the obesity research center at St. Luke’s-Roosevelt Hospital Center in New York, says that while he theoretically favors the surgery for patients who meet the current criteria, if every one of them ran out to get it today, there wouldn’t be enough qualified surgeons to meet the demand: "You don’t want to create surgery mills. That could hurt everybody because there will be more deaths, and this will discredit the surgery." Heymsfield and Roberts are both more interested in finding a nonsurgical option (after all, they are research scientists who work in the more delicate realm of metabolism and hormones, rather than the stitches-and-scalpels world of surgery). But, Bray says, medications and the like are probably at least a decade away. And if there’s a cure for obesity available now that makes people not only healthier but happier, can we really justify the wait?

More than any of her family and friends, Veronica admits she still has a tendency to overeat when she’s stressed or simply lets down her guard. One night we went out to dinner with a friend of hers, and Veronica ordered a healthy but large meal - a Caesar salad, sea bass, a dirty martini with lots of olives. She was telling me a story and didn’t seem to be paying attention as she ate a couple pieces of bread before the entrée even arrived. Not yet having any sense of how much she could eat, I felt a little anxious and thought I detected concern on her friend’s face, too. When the fish finally came, I watched in semi-amazement as her friend wolfed down half of Veronica’s meal while she finished her story, falling on her sword for her. And Veronica still had to excuse herself from the table later because she
felt sick.

She has become nearly as obsessive about her body as she once was about snack foods. She has a special section in her Filofax where she records her weight each week. If it goes up by even a few pounds, she’ll start a food diary to be extra-conscious of what goes in her mouth. She has had cosmetic procedures to remove excess skin that did not snap back after she lost her weight (including a brachioplasty, or arm tuck, two breast reconstructions, and a full body lift in which thirteen pounds of skin were removed from her midsection, leaving a scar wrapping around her waist like a belt). Early last summer she passed the exam to become a certified physical trainer, in hopes of helping others who are heavy. "If I can help one person, then maybe I was put through this s--t, this grief, for a reason," she says.

Now she works at a small health club called the Fitness Company. Just after she started the job, I had lunch at Anita’s house with Veronica, Marie, Denise, Tiffany, and Cathy. Veronica told us a story about how, a few days earlier, another instructor had introduced her to a class as a new staff member. "I had on my, you know, Lycra workout pants, and even though I have scars on my arms [from the brachioplasty], I was wearing a sleeveless shirt," Veronica said. "[The instructor] goes, ‘Okay, ladies, good morning, but before we start I wanna introduce you to Veronica. Veronica, where are you?’" Veronica pantomimed waving hello to the class for us. "And [the teacher] says, ‘Veronica is one of our new personal trainers here at the Fitness Company, and boy, has she overcome a huge obstacle.’ And she goes, ‘Veronica has lost over 200 pounds, and look at her body.’ Well, the women put down their weights and started clapping. And I cried," Veronica said, starting to cry all over again. "I can’t explain to you how surreal it was. I just cried that all these women put down their weights to look at my body in a positive way, in admiration, in admiration."

By this time, the rest of the table was tearing up. Anita reached over and patted Veronica’s arm. "Absolutely, you work hard, Veronica."

"And I do. I work really hard, and it was just like - I just said, ‘Thank you, God,’" Veronica said, her voice becoming unusually small and quiet. "I didn’t know what else to say."

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