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Told in the voices of patients Marcie Mandlebaum, Bobby Konopka, and Annie "East" Itou, Teenage Waistland is a story of betrayal, intervention, a life-altering operation, and how a long-buried truth can prove far more devastating than the layers of fat that protect it.

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1

Cattle Call

Sunday, May 3, 2009

Marcie, 5'4'', 288 lbs

Marcie Mandlebaum here: sixteen years old and sporting the collective girth of the Tenafly High cheerleading squad--this according to their captain, my twitorexic stepsister, Liselle. She's too much of a dimwit to master the intricacies of a tape measure, but there's no denying it. Her guesstimate is in the ballpark.

We're crammed into a crummy conference room in the Midtown Sheraton, waiting for some Park Avenue doctor to pitch his clinical trial for Lap-Band weight loss surgery for teens. By we, I mean me; my mother, Abby; and every fat chick within a fifty-mile radius of New York City who could stand to drop at least one hundred pounds. A couple of fathers and maybe six fat guys are here, but it's more a female thang--sixty or so heifers being herded around, for the most part, by tiny fat-o-phobic, lipo-sucked mothers like mine. This is nothing like SeaWorld, where every baby whale can count on having a bigger mama.

I haven't seen so many fatties together in one place since our nightmarish visit to Graceland in Memphis last summer. We spent four sweltering hours waiting in a stampede of bulging polyester just to get in. "Ground zero for the world's obesity epidemic." "Welcome home, Moosie," Liselle had snickered. But rather than injecting her usual diplomacy to avert a brawl, Abby seized the reins of Liselle's bandwagon and said, "Of course you're not anywhere near the size of these people, darling, but your weight has been moving in the wrong direction and you need to turn it around." But that was more than sixty pounds ago, so now Abby's dragged me here.

Five rows of metal folding chairs have been halfheartedly arranged in front of the stage, as if the bozos setting up for the event weren't certain this particular audience should sit in them--for me and my tubby brethren, there's a fine line between a chair and a catastrophe. I blow past whatever few empty death traps are left and park myself in one of the open spots against the wall. Abby, hot on my trail, wiggles her way into the three centimeters of breathing space beside me by shoving one blubbery mass into another with an apologetic smile. "Standing room only," she whispers into my ear, ignoring their glares. To Abby, who won't eat in a restaurant that doesn't have a waiting list for an open table, crowds--excluding the one at Graceland--provide indisputable evidence that we're in the right place. The thing is, we're not.

Finally, while the groans of stressed metal die down, Dr. Hal Weinstein, the head of the Lap-Band program at Park Avenue Bariatrics, steps to the podium and tests the microphone. This is my signal to pull out my iPod--what don't I already know about this surgery? I've been hearing about it blow by blow for over a year. But Abby whacks my hand and flashes her eyes at me--her behave yourself glare. "Just listen for a change. You might learn something," Abby hisspers--her standard hiss/whisper combo--and I resign myself to a slow and painful death.

Weinstein leans forward, pauses, and then booms into the mike: "The Lap-Band is not the solution to weight loss." My eyes fly open. WTF? Has the seminar been hijacked by some fanatical "fat power" fringe group and the real doctor is lying gutted in some back room? My hopes are dashed as he finishes his thought. "The Lap-Band is merely a tool, albeit an effective one if employed in a comprehensive supervised program that addresses the behavioral, nutritional, physiological, and psychological aspects of obesity.

"But as a long-term weight loss tool, the band is only effective if accompanied by behavioral changes. So while nutritional support and exercise are key aspects of our program, we place special emphasis on addressing the emotional issues underlying teen obesity. That's why participation in weekly group support sessions is mandatory for the first year after the surgery." I groan and shake my head and Abby nudges me with her elbow.

"The requirements for admission into our clinical trial are documented in your?.?.?." And then I can stand it no longer, and tune out completely.

To understand the magnitude of this disaster, you have to understand what a clinical trial is--and why, unless you have a terminal illness and nothing better to do with your time left on earth than get poked like a lab rat, it's best to stay away from them. There's a federal agency called the Food and Drug Administration--or FDA, to the literate few--whose job is to ensure that all food, drugs, and medical devices (like pacemakers, artificial limbs, and Liselle's future breast implants) sold in the United States are safe and effective. To prove "safety and effectiveness" to the FDA, companies experiment on small groups of carefully selected volunteers in tightly controlled settings.

This Lap-Band thingy is one of these so-called medical devices. It's an inflatable silicone band for super fatties that gets surgically installed around the top of their stomachs. When the band is inflated by injecting saline solution through a port implanted in the abdominal muscles, it contracts. And now you get a tiny stomach pouch into which only the smallest amount of food will fit. So when the aforementioned fatties can't plow through their usual amount of chow, lo and behold, they lose weight. It's a short, simple, reversible low-risk operation and you're out of the hospital in less than a day. And the Lap-Band has already been approved by the FDA! Megatons of weight lost, safety and effectiveness totally proven, et cetera.

But of course, there's a catch. The FDA approved the Lap-Band exclusively for adults. So livestock under eighteen can only get their hooves on this miracle of modern medicine in one of two ways: through an FDA-approved clinical trial, like the one Doc here is recruiting for, or, like my best friend, Jen, did, by going to Mexico, where the FDA can't throw its weight around.

For obese American teens who can't get into or afford a Lap-Band clinical trial and have xenophobic parents who won't cross international borders for medical care, there's another surgical option in the United States. It's called gastric bypass, and it's scary stuff--Abby and I looked into it last month. They pretty much slice, dice, and rearrange your entire digestive tract. Something like one to three percent of gastric bypass victims die from it, and a large percentage get seriously screwed by pulmonary embolisms, leakage, infection, malnutrition, and other health issues. But because the FDA hasn't approved the Lap-Band for teens yet, far more of us are undergoing gastric dissection than getting banded. Shaken, Abby had marched me right out of that consultation. Her epiphany: Being fat is, in fact, preferable to being disemboweled.

It's ten p.m. and I'm splayed on my bed, taking a break from ranting.

"Maybe Abby is right and this clinical trial isn't the worst thing," Jen finally pipes up, as if she's had me on call-waiting the whole time and hasn't heard a word. Jen, of all people, should appreciate the epic proportions of this catastrophe; I was at her bedside in Mexico--along with her mom--when she got her Lap-Band done there, the Christmas vacation before last. Besides, we've been inseparable since my first day at Fuller Prep--she flipped off a teacher when he corrected her pronunciation of "antebellum," and even though she was freakishly large, and so sharp and tough that the other kids seemed terrified of her, I knew instantaneously that she was my girl.

"Jen!" I wail. "This clinical trial isn't anything like what you did! For me to even be considered for admission, I have to get a million physical exams--bone density, pulmonary function, blood tests--"

"No kidding, genius," she cuts in. "Everyone gets a battery of tests before surgery, no matter where they go."

"But that's only the beginning! There's a mountain of paperwork--doctors' letters, notarized releases, insurance authorizations or evidence of financial ability to--"

"So what? Abby's going to deal with that stuff, Marce, not you. Your insurance probably won't cover it since it's a clinical trial, but Rich Ronny--"

"Hold your fire, Jen. There's more! Then I'll be interrogated by their 'fat nazi' shrink to make sure I can commit to the Lap-Band 'lifestyle.' Plus, Abby has her own evaluation, where she's got to sell this shrink on her ability to ride my beached-whale butt into submission--as if Gran doesn't barrage my mother with new starvation plans for me every other day. Now what do you think, Ms. In-and-Out-in-Three-Days?"

Jen snorts. "Listen, Ms. Drama Queen. I had the same evaluations. Adults never think teens are equipped to make big decisions, so they just want to be sure everyone involved understands what they're in for. Makes total sense. Can we roll the credits on your daily diatribe now?" "Daily Diatribe" was the name of the hysterically bitter feminist poetry rant series Jen used to post on YouTube.

I snort right back at her. "Nope, saved the best for last. If I even get in after all this crap, they're going to make me join a cult where I'll have to wax poetic about everything related to my eating--from my 'feelings' to my bowel movements--every week for a whole year!"

"Oh my God--you mean a support group like Alcoholics Anonymous? That really does suck," Jen says in her horrified by the sheer inanity voice. Finally, she gets it. "Look, Abby is reasonable. Discuss this with her. Just do it calmly and nicely. She always listens when you're not laying into her."

"I guess I'll give it one last shot. Stay tuned," I sigh, and take off to find Abby.

"Marcie, I get it. I was there," Abby says wearily the instant I calmly embark on my rap about how needlessly annoying and drawn out the clinical-trial admission process is compared with getting the stupid surgery done and over with south of the border. She and Ronny were polishing off a bottle of wine on the porch when I found her, and he politely took off so as not to intrude--probably his euphemism for "listen to Marcie gripe." "Just give me your Mexican surgery spiel so that I can go to sleep," Abby says.

I whip out my iPhone with my right hand and Abby's credit card with my left. I really want to fling them at her, but I keep my grip on both items and wave them in her face instead. With the wine and all, she's slow on the uptake and gives me the quizzical variation of her get to the point already look. "Mom!" I shriek. "I'm demonstrating the elegant simplicity of the Mexico option. You just need to be able to dial the freaking phone number to set up an appointment and place a deposit. That's it! The exact same surgery! Jen was in and out of the clinic in a single day. No hoops, no groups, no one breathing down her neck for all eternity. Plus, it costs ten thousand dollars--that's less than one-third what Park Avenue Bariatrics is charging. We can even upgrade to the all-inclusive Cancún special--the surgery plus five nights at a five-star beachfront resort, a private nurse, and--"

Abby shakes her head, grabs her empty wineglass, and heads inside to the kitchen. "Forget Mexico, Marcie. Money isn't the issue. I want the best for you. You'll be under constant supervision of doctors and nutritionists throughout the entire weight loss process. And the support--"

"Mom! I can't sit in a support group listening to a bunch of fat losers ramble on about their stupid little lives. Get me another psychologist--I promise I'll cooperate this time and not spend the session texting with Jen."

Abby slams her glass on the marble countertop. "So that's what you were doing?" she snaps, and storms out. I resist the urge to take her precious crystal wineglass and smash it on the floor. Instead, I just wait to hear her footsteps on the stairs before grabbing a spoon and hitting the freezer.

God, I hate my mother. Of course she can afford to put me through this ridiculous and expensive clinical trial now that she's married to Rich Ronny Rescott. The more money Abby can spend on my misery, the more she'll enjoy the ride. Just the idea of not getting ripped off sends her running for refuge in the Dolce & Gabbana department at the Short Hills Neiman Marcus. They only make clothes for women size 14 and smaller, and Abby fantasizes about me one day fitting into her beloved D&G the same way competent mothers dream of their girls graduating med school! If Abby had stayed married to my dad, I'd have been banded in Mexico before you could say "burrito grande with extra sour cream." Then again, if my mother hadn't dumped my father and moved me to this soulless suburban hell so she could be with Rich Ronny, I wouldn't need my stomach cordoned off in the first place.

From the Hardcover edition.

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Teenage Waistland

Teenage Waistland

0375860347

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