INSATIABLE (continued)

 Finally, Veronica’s therapist suggested she spend a month at a behavior-modification clinic in Durham, North Carolina. Unlike the eating-disorders rehabs, where Veronica felt like a second-class citizen (because she was fat instead of fashionably emaciated), everyone in Durham was looking to lose, and she felt at home. She ended up staying more than a year - at an expense to her parents of well over $50,000. They had her car driven down for her, paid for friends to fly to visit, and went down themselves to participate in family therapy. "People would come and go, but I was still there," she says. "I even had a Christmas tree." (She doesn’t want to name the clinic for fear of hurting the staff’s feelings, since, ultimately, her treatment there wasn’t successful.) She spent her days exercising, attending group and individual therapy, and taking part in workshops on subjects like nutrition and anger management. In the controlled environment, where every bite of food was planned a week in advance and every calorie counted, Veronica shed more than 100 pounds. But once she went home, she gained back all the weight in two months. Anita recalls sitting at the kitchen table at the time watching Veronica chat with her brother on the patio. She could see from Veronica’s manner that she was self-conscious about regaining the weight. "My heart was just breaking because I knew she was embarrassed in front of her own brother," Anita says. "I just wanted to put my head down and sob, just sob for her." Part of the problem was that she was returning to the same environment, with the same lack of purpose (besides losing weight), the same fast-food restaurants beckoning outside, and the same family and friends. Peter compares Veronica’s problem to alcoholism, "but a person with an eating disorder needs food to survive." Veronica’s homecoming was something like an alcoholic’s leaving rehab only to hang out in his favorite bar with his drinking buddies all day. "I should have gone back to work right away, but I felt like I wanted to focus on losing the rest of the weight," she says. "That was my biggest mistake." In retrospect, she also doesn’t think the clinic’s strict three-meals-a-day program was right for her, since she’s a grazer with, she says, an "oral fixation." Indeed, such rigid diets can trigger binges in compulsive overeaters, says Ruth Quillian-Wolever, a psychologist at the Diet & Fitness Center at the Duke Center for Living (Continued on p ???) in Durham (not, by the way, the program Veronica went to).

But once the weight came back on, Veronica began to realize that tinkering with her diet and exercise routine was not the answer, anyway. She needed to change everything from the inside out. She sat her parents down in her living room one afternoon and told them they had to look into stomach surgery for her or she was afraid she would die from her obesity, or throw herself off her terrace. Anita and Joe were reluctant, but by now Veronica’s desperation had become contagious. "You are helpless, as an outsider, you are helpless against the disease that she had," Peter says. "It was a crazy, crazy, vicious circle; if you’d sit there and think about her condition too long it would ruin your day, you know? You’d stay up at night thinking about what a prisoner she felt in her own body." Her parents agreed to accompany Veronica to an informational session with a surgeon.

The introductory meetings at the office of Rafael Capella, MD, the Ramsey, New Jersey, surgeon Veronica chose, are like religious revivals. Twenty to thirty people, including potential patients and their relatives and friends, meet in a nondescript conference room with Botero prints on the walls outside. When Capella, a lithe, energetic man with a slight Italian accent, strides in, the room settles down immediately: Here is their savior. Capella begins with his experience, which is prodigious - he has done more than 3,000 bariatric surgeries - and uses a slide show to catalog the insults and dangers of obesity: sleep apnea, heart disease, diabetes, incontinence, uterine and breast cancer, arthritis, gallstones, infertility, poor quality of life, job discrimination. "It’s a killer," he says, as a few people call out in agreement, and the whole room nods. "People don’t appreciate how awful this is." Can I get a witness?

And then the doctor shows them salvation. He explains the surgery with a diagram and presents a chart detailing its results: If you weigh 200 to 250 pounds, you can expect to lose 88 pounds. If you’re 300 to 400, the average is 137 pounds; 400 to 500, 218 pounds; and so on. As he reads out the numbers, you can watch people do the math in their heads: 300 minus 137 equals. . . . Finally, he shows the before-and-after slides: A woman whose features were once obscured by fat who won a beauty pageant after surgery. A man who complained his stomach was too big to get close to his wife later stands inside his old pants, clutching her to him. A woman formerly glassy-eyed with depression, stains all over her shirt, now beams into the camera. Then a man and a woman who had the surgery testify. "I swear on a stack of Bibles that he is not paying me to say this," the man says. By now the room is excited; people are murmuring. An extremely obese woman ducks her head and breaks into a shy smile. Capella finishes with the nitty-gritty: price, insurance, laparoscopic versus traditional surgery, complications, recovery time, side effects, vitamin supplements. When the meeting breaks up, patients line up so fast to make appointments for evaluations, they knock over the fake calla-lily arrangement in the foyer.

The Roselles brought their internist with them to one of these meetings. After seeing the presentation and talking to Capella, the he said to Veronica, "I’m not going to let you not get this surgery." And so in March of 1999, weighing in at her heaviest ever, 359 pounds, Veronica underwent a combination vertical-banded gastroplasty and gastric bypass - the version of the surgery Capella favors, which involves not only stapling part of the stomach shut and circumventing three feet of the intestines (to reduce caloric absorption) but also inserting a band to constrict the point at which the stomach empties into the intestines, making patients feel fuller longer.

Her family and friends thought she was crazy - even those who eventually got the surgery themselves. And as Veronica recovered, she began to think they were right. She was in tremendous pain - she’d had traditional surgery, so her whole stomach, from under her breastbone to her navel, had been cut open - and she could barely eat at all, a few baby spoons of yogurt at a time. Veronica would sit on her patio, breathing in the smell of Chinese food from King Chef across the street. She didn’t know what to do with herself if she couldn’t eat.

"The surgery can be very disruptive," says Joseph Capella, MD, Rafael’s son, who is a plastic surgeon and works with his father, performing both bariatric surgeries and cosmetic procedures. While the changes can be positive - improved health, a better sex or love life, new career opportunities - that much change at once can seriously threaten the equilibrium of the patient and her loved ones. Couples often get divorced, he tells me, because the compact of the marriage was based on who the patient was when he or she was obese. One way to bring the family in sync is to do what the Roselles did and reduce together: Joe says he and his father often operate on one family member after another.

Gradually, as Veronica learned how to cope with her emotions and the pounds melted off, she became increasingly delighted with the results, even gleeful. "I would look at it in decades," she says. "I went into the 340s, and the 330s, and the 320s; when I hit 300 and 299, I was just, like, ‘I’m a rock star.’ At 250, I was like a huge rock star. And then when I got under 200, forget it, I just couldn’t have been happier." As soon as Veronica told her childhood friend Cathy Musselman about the surgery, she told her husband she planned to follow suit, if her insurance would cover it. She decided to use a different surgeon and have the laparoscopic operation - which requires smaller incisions than Veronica’s procedure but takes four to six hours longer. That version also appealed to cousins Dina and Denise, and by June of 2000, they’d both had the surgery, using Cathy’s doctor. In July of the same year, Veronica’s mother, Anita, went under Rafael Capella’s knife. Then Cathy had the operation, as did Aunt Marie and a family friend. Finally, in 2001, the caterer, Uncle Tony, and another family friend joined the ladies.

The Roselles and their circle have been unusually successful with the operations. They haven’t suffered any major complications - like infection, leaks in their staple line, or gallstones - and have lost more than the average amount of weight. Their impressive record may have something to do with the support they give one an other. Since the bariatrically altered are often the majority at family gatherings, they’ve actually changed the environment (to go back to the alcoholism model: All the barflies have dried out). They can’t eat like they did, so they’ve developed new pastimes, such as going for walks together or out on their boat.

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