A matter of life or breadth: Obese siblings take the cure

LOS ANGELES —

Cyrus Tehrani, 34, had grown gargantuan. His girth had destroyed his knees, spiked his blood pressure, sapped his breath and landed him in the hospital for several days with severe leg swelling.

Cyrus' older sister, Sheila Tehrani, 37, was just as big and just as imperiled.

Only a pound separated the siblings: Cyrus weighed 578, Sheila 579.

Late last year, the Tehranis launched a last-ditch attempt to shed the weight that was smothering them. Surgery to slash their food intake would cost $25,000 each. With no health insurer willing to pay, the only recourse was to refinance the house they had inherited from their father.

Sheila researched options on the Internet and made an appointment with one of Los Angeles' most experienced bariatric surgeons, Dr. Carson Liu.

Vast numbers of Americans face a similar predicament. They have outgrown the weightiest medical description, morbid obesity. About 725,000 to 1 million people fit in this "super-obese" category.

But even that term is no longer expansive enough for the Tehranis and a fast-rising number of others. Between 140,000 and 400,000 Americans are believed to weigh more than 400 pounds each.

With a few hundred extra pounds severely straining every bodily organ, they appear to have one last hope: bariatric surgery. But that surgery poses such risks for huge patients that many surgeons refuse them.

"They are at the end of their lives," Liu said. "They are being operated on much too late. These are the patients that have bad congestive heart failure — their hearts can't keep up with their bodies, which are falling apart."

By the time the Tehranis consulted Liu in early April 2005, they could walk only a few yards before becoming winded. Their distended bellies draped to their knees like sandbags. Restaurants with booths, chairs with armrests, airline flights, even clothes from shops catering to big and tall people — all were out of the question.

A pudgy child, Sheila had grown heavy by high school, despite the attempts of her father — an engineer who immigrated from Iran — to police what she ate.

When she was 11, her father sent her to the now-defunct Schick behavioral-modification center in Pasadena, where she received electrical shocks as she took bites of a Hostess apple pie. Like the diets before, it didn't work.

By her late 20s, she no longer could fit behind the wheel of her Toyota pickup. She sold it and gave up driving. She grew more sedentary, rarely leaving her studio apartment in the back of the family house.

Family burdens

Cyrus, who as a husky teenager had biked and lifted weights, wedged himself behind the wheel of his Ford Windstar minivan to commute to Santa Ana, where he makes DVD masters to mass-produce movies and music.

Caring for six children — three of his own with Karen, his wife of seven years, and her three children from a previous marriage — kept him busy.

But his stamina had dwindled. Cyrus could barely get out of bed or bend over to tie his shoes. To ease his aches and lower his blood pressure, he downed prescription and over-the-counter pills by the handful.

The Tehranis certainly overate. They loved heaping portions of calorie-rich Persian foods — breads, rice, cheeses and kebabs. Cyrus often ate super-size fast-food combos for lunch and had a weakness for ice cream.

But they and friends insist that they weren't eating near the quantities one would think necessary to be 400 pounds overweight.

Unfortunately, all it takes to gain a pound a week is a 500-calorie surplus every day. That's two Mrs. Fields cookies or a large order of McDonald's fries. A pound per week totes up to 52 pounds annually. In five years, that's 260 pounds.

Nature and nurture

Surgeon Liu attributes two-thirds of super-obesity to genetics (many members of the Tehrani family are heavy, though not super-obese) and one-third to eating habits and lack of exercise. Yo-yo dieting can make it worse.

"There is something that happens when fat cells starve," Liu said. "It makes people extremely hungry, and they fall off their diets and gain the weight back so fast — and then maybe add an additional 20 pounds."

Above 300 pounds, the weight seems to accrue even faster, Liu says, without "the patient — or anybody — realizing exactly why."

Cyrus' health insurer refused to cover weight-loss surgery. Sheila has no insurance.

By the time they saw Liu, the Tehranis, inspired by the huge weight losses of NBC weather forecaster Al Roker and singer Carnie Wilson, were convinced they needed a gastric bypass procedure.

But Liu told the Tehranis gastric bypass was too risky for them. Super-obese patients are 10 times more likely to die from bariatric surgery than those who are morbidly obese. And he warned that a serious complication necessitating hospitalization for a month could easily cost $300,000, virtually all the equity in their childhood home.

The only procedure he would do for them was the Lap-Band adjustable gastric banding system, in which a synthetic ring is attached to the upper end of the stomach. Liu has performed more than 1,700 gastric bypasses and 350 using Lap-Bands. He said he prefers the latter because it is far less drastic and, unlike the bypass, is adjustable and reversible, though weight loss is slower.

If they still wanted a bypass, Liu assured the Tehranis, he would do it — after they each lost 150 pounds with Lap-Bands.

He instructed the siblings to lose 28 pounds, about 5 percent of their weight, before the surgery to show their determination, shrink their fatty livers and make the surgery easier.

They stuck to two protein shakes and one healthful low-carbohydrate meal a day. In six weeks, Sheila dropped 28 pounds and Cyrus lost 19.

At the hospital, Cyrus and Sheila nervously poked fun at each other. The only children of parents who divorced when they were 3 and 7, they have always been close and see (and tease) each other constantly.

Liu was worried not so much about Cyrus, whose health had improved with the weight loss, but about Sheila. Her liver hadn't shrunk much. So much fat still swathed her overburdened lungs that he worried she might not wake from the anesthesia.

The morning of June 7, their hearts were beating at triple the normal rate. But test results revealed no permanent damage. Liu gave the go-ahead for both.

Sheila was first. Liu inserted an instrument equipped with a tiny camera into her navel. An image of her insides flashed onto monitors above the operating table. He inserted three more tong-like cutting and suturing devices into her abdomen.

It took more than an hour to work through the hardened fat, which looked like yellow gel on the screen. Finally, Liu saw the left lobe of her liver, swollen to the size of a five-pound steak from what is normally the size of an orange. The surgeon assisting him pulled it aside to unveil the stomach.

Liu positioned the inflatable Lap-Band so it cinched her stomach into an asymmetrical hourglass shape, with 98 percent of the stomach below the band.

At 11 a.m., Liu finished the 2 ½-hour procedure. It had taken five times longer than usual.

Cyrus' abdominal wall was softer and his liver much smaller. Liu finished the procedure in just 50 minutes. The Tehranis went home the next day.

The Lap-Band, which narrowed the stomach opening from the size of a silver dollar to a dime, made the siblings feel stuffed.

For the first month, Sheila was depressed. But she dropped 22 pounds by the time they next saw Liu, two weeks after surgery.

At a family cookout soon after, Cyrus and Sheila could eat only about one-third of a chicken breast and some green beans each.

By mid-July, Cyrus began to pull ahead; he had dropped 48 pounds in five weeks, 83 pounds total. Sheila had dropped 28 pounds for a total of 61.

Cyrus began walking more around the neighborhood with his children.

Checking in

Two months after the surgery, both Tehranis had dropped below 500 pounds. Cyrus had lost 97 pounds and Sheila 85 pounds. The whole family rented a recreational vehicle and went camping at Perris Lake, the siblings' first camping trip since they were kids.

At their October appointment, Sheila told Liu she needed "a Lap-Band for my mind," something to choke off the emotional issues and the habits that drove her to eat.

On the eve of the family's Thanksgiving potluck dinner, Sheila made chocolate chip and gingerbread cookies, without sampling any batter, and ate only a few the next day. Cyrus ate turkey and splurged on a dollop of homemade cranberry sauce.

Cyrus has become zealous about going to Bally's gym in Pasadena several nights a week to lift weights and walk on the treadmill.

It has been six months since the surgery. At their most recent appointment, early in December, Cyrus registered the loss of 19 more pounds, while Sheila showed a gain of 1 ½ pounds. All told, Cyrus had lost 146 pounds and Sheila, 101.

Sheila's dilemma

Sheila was disappointed but refused to let Liu tighten the Lap-Band. She already had trouble eating chicken and meat and told him it was painful to down more than half a cup of food at a time.

Liu told her she must start exercising. She vowed to get a treadmill.

She later said she felt "like we're having two completely different experiences. He stands up at support group meetings and he's saying, 'It's all mental.' He's like, 'Don't eat it, don't do it.' I don't know if it's because he's a man and I'm a woman, but I'm much more emotional."

The one thing the siblings — who were down to 432.6 and 477.6 pounds as of Dec. 7 — do agree on is how much the weight loss has changed their lives. "It's amazing how much more energy I have now," Cyrus said. "I've lost a whole person."

Their faces look much healthier. Sheila walked up a steep hill at Eagle Rock Hillside Park on Thanksgiving, with the rest of the clan. She played in the first annual Tehrani kickball game — though her 3-year-old niece served as pinch runner. For the first time in years, she went Christmas shopping, spending a few hours walking around the Glendale Galleria with her best friend.

Cyrus has lost 20 inches from his waist. He no longer needs medications and his blood pressure is nearly normal.

The Tehranis say they don't mind paying $730 more each month for the next 30 years to pay off the $100,000 home-equity loan they took out to pay for their transformation and the surgery they may need in the future to cut off the folds of de-fatted skin.

Said Sheila, "Oh, my God, we are so lucky we had the option ... How do you put a price on your life?"