July 31, 2011

Happy Diminishing Returns

After weight loss, family rediscovers small joys

By Michael Vitez, Inquirer Staff Writer

Matt Sullivan never sat in a booth at a restaurant, ever. When you weigh 390 pounds, a booth is a tight, humiliating squeeze.

But now he loves booths. Now he weighs 185. "You've got a table open? No, thanks," he'll tell the hostess. "I want a booth. I'll wait."

Oh, and how about this: He had to learn how to run again. When he went out on a tennis court with his new body, "my muscles just forgot how." He watched his 12-year-old son and imitated him.

Matt, 53, was the guinea pig. He is one of 12 Sullivan children, most of whom grew up in Warminster or Willow Grove. As kids, the siblings were divided into Fat Sullivans and Skinny Sullivans, though most were Fat Sullivans. "We were a large family of large people," Matt said.

When Matt told Dion, 44, the baby, just 364 pounds, that he was having weight-loss surgery, Dion said: "You're insane. No way I'm going to think about doing this to my body. You talk to me in a year, and I'll see if you think this is still a good idea."

A year later, Matt called. Dion had the surgery April 21 and is already down 80, a new man.

"When he [Matt] didn't die," said Greg Sullivan, 45, another brother, 357 pounds, "I figured, all right, I'll look into it."

Greg had surgery in early March. He has dropped 115 so far.

Five Sullivan siblings now have had weight-loss surgery at Abington Memorial Hospital and eight relatives in all, including one spouse, a daughter, and her husband.

The first four had surgery more than a year ago and have lost 640 total pounds. The next two, Greg and Dion, have shed 195 more so far, making 835.

The seventh relative, Dion's wife, Amy, had the surgery two weeks ago, and the fifth sibling, Francine Stafford, 50, at 270 pounds, just had it Monday.

"I didn't want to be left behind," Francine said.

Liquid Diets

Nadine Sullivan, 58, went third. She said she had been a camel: Were famine to strike, she would have been the last person alive, because her body held on to every calorie. Five times she dieted and lost 100 pounds, basically through starvation and liquid diets, but the moment she stopped dieting, or just looked at food, the weight came back, and then some, so she'd end up fatter than she had started.

She's down from 330 to 158. Type 2 diabetes, gone. Hypertension, gone. High cholesterol, gone. "I'm starting to feel like being fat was a dream," she said.

She was the sister who had tried her best to prove that the surgery, biliopancreatic diversion with duodenal switch, the rarest and most complicated bariatric surgery, was a terrible idea. A newly minted Ph.D. in sociology, she spent two days trolling academic websites, but came up only with reasons to do it. "Everything was like, 'This will save your life.' "

Seven of the ever-diminishing Sullivans sat in the living room of Greg's home in Bala Cynwyd the other day. They were there to give emotional support to Francine, who was to have her surgery the next morning. They talked about all the diets they had tried, over and over and over, and all the abuse and criticism they had taken from all the know-it-alls who passed judgment on them for being lazy or lacking willpower or living like gluttons. And now they are so happy, reborn.

"I was on 11 different prescription medicines," said Matt. "Now I'm on one."

All believe they have added years to their lives, gaining energy, stamina, and confidence. Small joys have been rediscovered.

"I love drying my clothes in the dryer," said Greg.

"Instead of having to hang them so they won't shrink," said Nadine.

"Maneuvering in public restroom stalls," said Dion. "Being in a public restroom without smacking your head into the wall."

"There are only two stores I could shop in," said Amy, still on a post-op liquid diet. "I'm so looking forward to shopping in any store I want."

"You know what I'm waiting for?" asked Francine. "I'm waiting to tie my sneakers the skinny way instead of the fat way."

Everyone in the room understood: no more putting your foot up on a chair, or tying the laces on the inside of the foot because that's as far as you could reach.

"New positions in sex," said Nadine.

Good at Storage

The body is designed to store fat, to bank energy. Two people can eat a hamburger, and one will keep more fat and calories from it than the other. The fattest people, like the Sullivans, are just really good at storage.

Does being "a camel," as Nadine would say, run in families? The Sullivans believe it does. Many experts agree.

"Just looking at this family, there is a quite significant suspicion that we are dealing with genetics, too," said Gintaras Antanavicius, the surgeon who operated on seven of the eight.

All eight had a procedure used for the heaviest people or those with complications such as diabetes. Only 2 percent of the 200,000 bariatric operations performed annually in America are biliopancreatic diversion with duodenal switch, said Robin Blackstone, president of the American Society for Metabolic and Bariatric Surgery.

Abington says 40 percent of its bariatric operations are this type. With other forms of gastric bypass, Abington doctors say, super-obese patients won't lose enough weight. The operation cuts out 85 percent of the stomach and reroutes the small intestines, keeping the food and digestive fluids separate until the last 100 centimeters, so the body doesn't have time to absorb too many calories.

By removing most of the stomach, the surgery also reduces the production of the hormone that makes you feel hungry.

The great risk of duodenal surgery is that the body will go too far, become malnourished. All the Sullivan family members take from 17 to 30 vitamin supplements a day.

But they say they don't mind. They were taking so many medicines to address their obesity-induced infirmities that the quantity of vitamins is an acceptable trade. Matt said he had been eating a diet targeted to sustain a 185-pound man, and his weight plateaued when he reached that weight.

Lifestyle Change

The Sullivans' form of bariatric surgery requires a lifestyle change. You can't drink for 15 minutes before eating, during your meal, or for one hour after. You can never eat late at night.

You must chew 20 times before swallowing. Eating takes much longer, even small portions, because you quickly feel full and must let each bite settle. In the early months after surgery, they realized how ridiculous this looked, a fat person picking at food, but now they love eating little.

Greg went the other day to a fancy Manayunk restaurant where dinner is a work of art and portions are small - and he still went home with a doggy bag! He was proud.

More downsides: No alcohol. No carbonation. For the first week after surgery, liquids only. Then three weeks of pureed food. Baby food is acceptable. Dion opened a jar of Gerber peas, but was revolted at the idea. "I just couldn't do it," he said.

Surgery is expensive. Some insurers won't cover it.

At Abington, without insurance, the cost for their particular procedure is $52,700 and must be paid in advance.

All of the Sullivans had insurance. Dion, for example, teaches auto-body repair at a vo-tech school in Bradford County. Abington billed $95,797. The insurer paid $20,753. Dion said he had a $2,000 co-pay.

Francine said her husband's plan no longer covered the procedure. She had to get coverage through her own employer. That's partly why she waited.

The bottom line, say the Sullivans, is that if you're not ready to change your life, don't have this surgery. Don't even think about it.

But each of them feels like a new person.

"This feels like the real me," said Nadine, "who I always wanted to be."

"I don't even remember you being that heavy," said her daughter, Sarah Boujais, 31, who has lost 170 pounds since her surgery about 18 months ago. "I don't remember myself as heavy as I was, either."

Sarah walks past a storefront, sees a reflection, and says to herself, "Who the hell is that? Oh, it's me."