“I don’t know what to say. I’ve always been—”
“What’s your name, girl?” Phat Girl heckles. Coco flushes.
“Oh, sorry. Coco Martinez, Flushing, New York. And I’m fourteen—closer to fifteen, actually. Um, I’ve always been heavy, and I can’t really remember a time when I wasn’t trying to diet. When I’m full, I have all the discipline and determination in the world, but no matter what diet I try, it falls apart the minute hunger hits.”
Bitsy nods vigorously and glides over to the whiteboard on the wall just beyond the circle. “Let’s talk about hunger.” She draws a pathetic-looking stomach with a black marker. Then she takes a green marker and makes some X’s around the very top of the stomach.
“The green X’s—those are your stomach’s largest concentration of nerve endings. They’re the ones that send the message from your stomach to your brain that you’re full and no longer need food. But what does it take to get us there? Around the room, starting with Bobby.”
“Two pizzas and a six-pack of Red Bull,” Jersey Boy—Bobby—says, doing nothing to change my opinion of the average jock IQ.
“The left three panels of the menu at Taco Bell,” drawls a red-haired girl with a startling Southern accent.
“You go, girl!” says Phat Girl, waving her fist. A free-for-all breaks out.
“Two pints of Ben and Jerry’s, any flavor!”
“Half a tray of my mother’s lasagna!”
“Three triple Whoppers with bacon and cheese!”
“An entire dim sum cart.”
“Hey—speaking of which,” Char howls above the dither. “We know a great Asian fusion place called Chow Fun House just around the corner! Anyone in for a bite after group tonight?” The place goes wild. A heaping plate of sweet-and-sour chicken would be nice about now.
Bitsy reddens and raps her marker on the whiteboard.
“Char, I’d like to have a word with you after session. Everyone else—the time to start thinking about your food choices is now, before the surgery. The Lap-Band is not a magic wand and it’s not a cure for obesity. It’s a weight loss tool that must be used correctly to be effective. These presurgery weeks are not a go-ahead to binge—they’re for developing the proper eating habits that are critical for your success with the band. If you can’t commit to them now—today—you shouldn’t go further.” Bitsy breathes deeply and looks around the room. “So, there’s room for thousands of calories before you get filled to the green X’s. Now, check this out.” Bitsy encircles the top of the stomach with a heavy red band, leaving about an inch between that and her green X’s. “What if you only had to fill up to here before you set off the ‘I’m full’ signals to the brain?”
“That looks like about three pieces of pepperoni,” Bobby says. I can’t tell whether his terror is real or just for comic effect.
“How much space are we talking?” Coco asks, looking a little panic-stricken herself.
“About two ounces. At first, anyway,” Bitsy says. “That’s four tablespoons of food. And not heaping tablespoons either. Enough to fill an espresso cup.”
The room goes silent and I’m wondering whether anyone’s really going to that Asian place after group, and if I’ll have time to join them before Carlo, Ronny’s driver, picks me up.
Char is the only one who seems unconcerned about bird rations.
“Just think, guys! We’ll so be able to get that all’s right with the world feeling, as East here would say, in just a couple of bites.” She’s like Sumo Girl’s voice box. East reddens and slinks in her chair.
But Bobby is right there with Char. “Yeah—like getting an excellent buzz on one shot—” Bobby turns red and coughs a couple of times. “Yeah—I get what you mean.”
Bitsy narrows her eyes a bit, but nonetheless she seems relieved that the conversation is on track.
“Char is right, everyone. That’s the most important thing the Lap-Band will do for you. It will prevent you from eating more than a few ounces of solid food, and signal your brain that your stomach is full. Emotional hunger, or ‘head hunger,’ as we call it—that’s something different that we’ll get to.”
Bitsy puts down the markers and returns to her seat. She crosses her legs and leans in yet again.
“Here are some pitfalls: if you eat too much or too fast, your food will come back up. It won’t be like vomiting—it’s something called a ‘productive burp.’ Also, there are certain foods your Lap-Band won’t like. For some people, it’s fried foods or spicy foods; for others, red meat like steak, for example—requires about twenty chews if it is to stay down.” Bitsy clears her throat and stands up again. “Remember to update your food diaries every time you put something in your mouth—not only what you’re eating and when but also the events and thoughts that trigger your eating. Pay attention to how your moods play into your food choices, folks.”
Food choices my butt, I want to bellow. I don’t get any choices about my life, not even about food. If I did, they’d stop feeding me this crap and send me straight into anesthesia.
10
Lord of the Fries
Friday, July 3, 2009
Marcie (+2 lbs)
WTF? It took weeks for the stranded kids in Lord of the Flies to go from civilized schoolboys to bloodthirsty savages. Jen’s only like six minutes late, and these Lord of the Fries lardies are already showing signs of wanting to run me off a cliff. If Lucia could liven up her “relationship with food” monologue everyone wouldn’t keep checking their watches and glancing at me as if I’m getting telepathic updates about Jen’s whereabouts and holding out on them. But Lucia is taking us through Twinkie by Twinkie, and with Bitsy all rabid about this group being our “haven,” I’m not allowed to interrupt for permission to take out my phone and find out what’s keeping Jen.
“Marcie?” Bitsy finally says when Lucia finishes her pathos-ridden “they called me fat in the lunchroom” story. “You’re certain Jennifer is coming? We’re only in session today to hear Jennifer share her Lap-Band experience with the group, and this has undoubtedly disrupted holiday weekend—”
“Of course she’s coming,” I say. Bitsy botched the scheduling, not me, but I manage not to mention this. “If you would just let me check my phone, I could find out if her train—”
“I’m so sorry I’m late,” Jen says as she bursts through the door in all her size 2 glory. I just saw her a month and a half ago, and she’s constantly sending me photos. Nevertheless, I don’t quite recognize her. Even Bitsy looks like a cow in comparison. And there’s something different about her—
Ohmigodohmigodohmigod—she got the breast implants after all!
The room goes so silent, you could hear a marshmallow drop. They’re all stunned by how gorgeous she is. She looks like she had a lip job too—she’s the spitting image of Angelina Jolie, only shorter and with black hair.
Bitsy rises and steps out of the circle to greet her. “I’m so sorry I’m late,” Jen repeats, shaking Bitsy’s hand. “A friend drove me down from Boston, and the holiday traffic was worse than we expected.” I’m about to bark, “What’s with the friend”—Jen’s supposed to spend the weekend in Alpine with me—when Bitsy guides Jen to the edge of the circle.
“Group, please say hello to Jennifer. Jennifer, your pictures have caused quite a stir, and we’re all eager to hear about your experience with the Lap-Band. Why don’t you take the open seat next to Marcie so that we can begin?” Jen’s greeting everyone as they fall over themselves and each other to get introduced. “OMG, you’re so tiny!” “OMG, you’re amazing!” and other sycophantic babbling winds down when Jen places her tiny tush on the seat next to mine. She elbows me with a grin and I elbow her back. Bitsy clears her throat.
“Jennifer, sitting before you is a group of teens who will shortly embark on the same journey you’ve taken. What are the most important things they should know before they begin—experiences, for example, that you didn’t expect?” She gestures to Jen that the floor is
hers.
Jen surveys the circle with a smile and then folds her hands in her lap and leans forward—a motion, I realize, that is only for people who don’t have seventy pounds of flab to balance on their laps.
“I see this more as a process than a journey,” Jen begins, taking a beautiful whack at Bitsy’s irritating “journey” metaphor, “and it’s not as easy as you’ve probably been led to believe.”
Bitsy clears her throat again and nods a little stiffly. “Excellent, Jennifer,” she says. “Here at Park Avenue Bariatrics, that’s the very point we try to get across—the Lap-Band isn’t a fix, it’s only a tool, and there’s a lot of hard work and self-discipline involved. The band will solve the hunger aspect of your eating, but not the underlying reasons that you’re self-medicating with food.”
Jen smiles primly. “The ‘solve the hunger’ aspect is actually what I’m referring to.” She pauses to enjoy the ensuing commotion.
“What the—” Phat Girl starts, but Bitsy raises her hand to shut Michelle down and gives the hold off signal to Geek Olive—neckless unibrow boy with the pimiento-red hair—who’s raising his index finger in lieu of his arm. Talk about the sedentary lifestyle of today’s teens.
“Please elaborate, Jennifer,” Bitsy says, narrowing her eyes.
Jen grins like she doesn’t mind the cool air. “If you go into the surgery thinking your eating will be restricted from day one, you’ll be very disappointed. I know I was. But the fact of the matter is, until your band has been tightened enough to keep food from flowing straight through your pouch into your stomach, you’re pretty much on your own with the diet—the band isn’t going to help you feel full. It took over three months for me to get the band tight enough for meaningful restriction, and during that time, I actually gained two pounds—the pizzas and burgers still went down, they just took a little longer.” Jen glances at me and suppresses a smile as all hell starts to break loose.
Bitsy raises her hands as if trying to fend off the questions being pelted at her. “People, please. Simmer down so that I can address Jennifer’s particular experience.”
“If you go online and read the Lap-Band message boards, you’ll find that my experience was hardly rare or unique,” Jen retorts loudly. As the murmuring rises in intensity, I lean over to whisper, “Jennifer raised an excellent point,” and smell it—liquor—on her breath. WTF? Bitsy claps her hands for silence and I silently pull away.
“Everyone, Jennifer raised an excellent point. The first six weeks after surgery, your stomach will be healing. After that, you’ll be scheduled for your first fill, and you’ll be eligible for subsequent fills every three weeks thereafter. Some people can reach their ‘sweet spot’—the level of band restriction that optimizes their weight loss—in their first fill, but it can take three, or even—”
“Whaaat?” Michelle bellows. “My stomach isn’t going to be closed for business right after the surgery?”
“Hold on, Michelle. For many people, the band in itself and the initial swelling from the surgery provide some restriction before the first adjustment, or fill. Jennifer, you say you gained two pounds in the weeks after your sur—”
“Months,” corrects Jen.
“But weren’t you provided with any sort of eating plan following your surgery?” Bitsy says in a so you didn’t stick to your diet, did you? voice.
“Of course,” Jen says with icy politeness. “But if I had been able to stick to a diet, I wouldn’t have needed surgery in the first place, would I?” A couple of kids giggle.
“Well, Jennifer, that’s one of the reasons our teen patients attend group sessions—to become conscious of and responsible for their eating behaviors. So that they are able to stick to a diet,” Bitsy volleys back. Faces turn back and forth watching the two skinny chicks go at each other.
“If group sessions are so effective, why not just slap a Weight Watchers sign on the door, and dump the surgeons altogether?” Jen returns sharply.
Bitsy lets out a sigh. “Jennifer, we’re getting off track here. Let me just say that in our approach to weight loss, the Lap-Band is a tool used to address the physical hunger that accompanies dieting while we help our patients develop a healthier relationship with food. Can you describe the changes in your eating behaviors over the past eighteen months?”
“Of course,” Jen says. “You’re absolutely right about the Lap-Band limiting physical hunger, and it did finally work for me. I’ve learned to eat very slowly, take small bites, and chew my food thoroughly. And I never consume liquids while I’m eating—they’ll come right back up if there’s enough solid food already in the pouch, or they’ll empty the pouch by washing the food down, and I’ll end up eating more than I should.”
“But what about your specific food choices?” Bitsy asks. “How have they changed?”
Jen pauses for a moment. “I go for softer foods now—lean ground turkey over steak, for example. And boiled chicken instead of barbecue or roasted. And if I find myself ravenous, I go for the foods that I know will fill me up quickly. One hundred-calorie ounce of cheese will eliminate my hunger in minutes, and keep me satisfied for several hours. Of course, I’ve completely eliminated all processed sugars—the band is useless in the face of junk food. Also, I stay away from starches, especially bread and pasta. Not only are they fattening, they can gum up the band and get stuck.” Jen shrugs. “Did I miss anything?”
“What about your relationship with food?” Char bursts in, elongating the word relationship the way Bitsy does. Before Bitsy can jump on her for interrupting, Michelle chimes in.
“Yeah—how’s that relationship working for you?”
Jen laughs and waves her tiny arm like she’s casting something aside. “Oh, that relationship is long over. It’s not gratifying anymore. I just eat because I need to—for energy and nutrition.”
Bitsy nods. “So, would you agree that you now have a healthy relationship with food?”
“Of course. That’s what I just said. Unless healthy and ungratifying are only synonymous in my thesaurus?” Jen and I look at each other and bust out laughing. Bitsy’s smile tightens and I elbow Jen to stop.
“Jennifer,” Bitsy says, “I have one more question before I turn the Q and A over to the group. The dramatic change in your eating must have been difficult to cope with in social situations, especially among your peers—most teens who get weight loss surgery prefer not to let others know about it. Can you describe what that was like—were you self-conscious, and how did others react?”
Jen leans forward. “Dr. Glass, I’m not sure you’ve ever been told this, but I’m guessing you have never struggled with your weight. Because there are some unspoken rules among those of us who have fought the good fight—a sort of universal code embedded in the fat cell itself. Most fat people eat the same or less in social settings that involve nonfat people. Never more. By a show of hands, who’s with me on this?” Bitsy shakes her head as the eleven of us raise our hands and wave them at her.
“Okay, put ’em down.” Jen says. “One exception to the rule: your BFF isn’t a porker, but she loves you just as you are, even when you’re chowing big-time.” Jen elbows me and continues. “Any other exceptions to the rule?” Hands start flying again and Jen points to Char.
“You’re with your porker chub-buddy, say, and you’re seated in the back of a restaurant—not the school cafeteria. As long as no one is within eyeshot of your table, you can eat normally. Or—more accurately—abnormally.” Char takes a mini bow and we all applaud.
“Anything else?” Jen asks.
“My dad and my brother aren’t big eaters, and I don’t mind pigging out in front of them,” drawls Jamie, this Southern girl.
“Okay, good. Family. Raise your hand next time. Anything else?” Coco, who’s sitting on my left, flaps her jelly arm right in my face so Jen can see it. I brush it away.
“Okay, Coco,” I say. “This’d better be good since you nearly gave me a bloody nose.” Jen nods and Coco gives me the
thumbs-up.
“For medical or medicinal purposes!” she shouts triumphantly—like she’s a contestant on Family Feud and she’s sure she’s got the number-one answer. There’s not a face in the room without WTF? written all over it, but Jen keeps it gracious.
“Interesting. Elaborate,” she says.
Coco shakes her head like we’re dense. “You know, if you’re sick. Like when I had my tonsils taken out. I was in a hospital room with three regular-sized kids, but I was able to keep asking the nurse for more ice cream because my throat hurt so much.” Naturally, everyone is dumbfounded, but this moron is looking right over me for confirmation from Jen, so it’s taking every strand of decency in my DNA to keep from laughing, and the silence is killing me. Please! Somebody say something.…
“That’s ridiculous,” Tia, our Planet Pierce Observer, finally sneers—and Coco’s hopeful smile evaporates.
“No, Coco—that’s so totally valid,” Char interjects. “C’mon, everybody. I bet there’s not a person here who’s never taken advantage of a sore throat to get extra cough drops. Or complained that a vaccination shot in the doctor’s office hurt more than it did to get another lollipop or two.”
“Once, when the urchin next door pummeled me especially badly, his mother baked me a chocolate cake?” Geek Olive offers meekly.
“And Char—remember when I was so upset you couldn’t hang out for almost a week after your appendectomy that you bought me a huge bag of M&M’S?” East adds. Coco smiles gratefully at her.
Bitsy, who has quietly observed this interchange, claps loudly to get our attention. “Okay, gang. We’ve veered off into comfort eating—another topic for another day. We’re talking about Jennifer’s experience with food restriction. Jennifer, going back to your ‘rule,’ it’s not as if you can eat even the same as thin people in a social situation. Fact is, you’re not able to consume much at all, so even eating less than small eaters in a social setting creates a problem, which I was hoping you would honestly address for the group. In other words, if you’re able to consume only a few bites of solid food at a meal, how can this not have caused issues in your social eating?”
Teenage Waistland Page 8
