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On a Scale of Life or Death

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It started with a terrible dream: Cyrus Tehrani had died. At the funeral, his wife and six children wept over his outsized coffin.

That nightmare jolted Joe Guarderas awake. He knew that if his best friend Cyrus, 34, didn't take drastic action, the dream would become reality.

Cyrus 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.

Guarderas hatched a plan. "If you knew Cyrus was going to die," Guarderas recalled asking the healthier Sheila, "would you give anything to get him back?"

"In a heartbeat," Sheila replied.

"Would you give up the house?"

"Of course," Sheila replied.

Well, said Guarderas, "that's what you may have to do."


That conversation late in 2004 launched the Tehranis' last-ditch attempt to shed the weight that was slowly smothering them. Surgery to slash their food intake would cost at least $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 still lives in a studio apartment behind the house.

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

Liu wondered if it was too late. Had the siblings become so huge that the surgery was too risky?

Vast numbers of Americans face a similar predicament. They have outgrown the weightiest medical description: morbid obesity. About 725,000 to a 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. Liu dubs them the "super-duper" obese.

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 grave risks for huge patients that many surgeons refuse to operate on 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 arms puffed out like basketballs. 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. (Cyrus jokes that labels on his clothes couldn't accommodate all the Xs: he wore 7X shirts over 78-inch-waist pants.)

Stares were as painful as stairs for Sheila.

A pudgy child, she had grown quite heavy by high school, despite the attempts of her father — an engineer who immigrated to the United States 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 tiny 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 truck. She sold it and gave up driving.

She grew more sedentary, rarely leaving her studio apartment in the back of the family house. Instead, she earned money baby-sitting the children whom relatives would take to her home.

Grocery shopping required exercising only her index finger — to dial Vons for delivery.

Cyrus, who as a husky teenager had biked and lifted weights, wedged himself behind the wheel of his Ford Windstar minivan ("thank God for tilt steering," he says) to commute to Santa Ana, where he still makes DVD masters used to mass-produce movies and music.

The Vietnamese immigrant owners and workers there affectionately rub his belly and call him their Buddha. He calls the men there — and everywhere else — Slim. Other potential employers snubbed him because of his size, he says.

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. By the time Joe Guarderas talked to Cyrus' sister, he 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.

When he was in the hospital last spring with his leg problems, a cardiologist told him he'd be lucky to live 10 years.

But until Sheila convinced him of the serious health risk after Guarderas' dream, Cyrus preferred to look at the "funny" side of being fat. He reveled in his young son's riposte to an unkind remark by his kindergarten friend: "Wow, Gavin, your dad is really fat."

"My daddy's not fat," Gavin shot back. "My daddy's full of love."


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 Ben & Jerry's Chunky Monkey and Chubby Hubby ice cream, at about 600 calories per cup.

"If I knew I'd buy as much Ben & Jerry's as I have, I'd have bought stock," said Cyrus, who really packed on the pounds after quitting smoking in his 20s.

The siblings also ate to soothe bouts of depression after the deaths of their parents and a half-sister.

But the siblings and friends insist that they weren't eating near the Costco-size quantities one would think necessary to be 400 pounds overweight. "It's not like we were pulling up to a food trough," Cyrus says.

Sheila said she did none of the things she heard others report at Overeaters Anonymous meetings. "I thought these people were sick, because they were eating out of the trash and were closet eaters," she said.

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 52 pounds annually. In five years, that's 260 pounds.

The bigger the Tehranis got, the less they restrained themselves. At their size, what did one extra Krispy Kreme doughnut matter?

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."


Few doctors have a scale that goes beyond 350 pounds. So Cyrus was shocked in April when he stood on Liu's and it registered 150 pounds more than his last weigh-in four years earlier.

"I knew I had gotten fatter, but I never thought I would break that 500-pound mark," Cyrus said. "And when I saw 578, I got sick to my stomach."

Standing 5 feet 11, Cyrus had a weight-to-height ratio, or body mass index, of 81, more than triple the maximum 25 considered healthy for most adults. At 5 feet 2, Sheila had a body mass index of 106.

Cyrus' health insurer refused to cover weight-loss surgery. Insurance companies typically want documentation that patients have tried dieting. The insurers blanch at the procedure's mortality rates, and also fear that too many of the 20 million obese patients nationwide will sign up for their plans if they offer the surgery too readily, Liu said.

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% of their weight, before the surgery to show their determination, shrink their fatty livers and make the surgery easier.

The Tehranis delayed the start of their diets for a week until after Sheila's birthday party. After that, 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.


But Liu said he was worried that swelling in Cyrus' legs might indicate the right side of his heart was failing. He was concerned that Sheila's fast pulse might mean her heart was starting to give out.

Liu said he needed to conduct tests for congestive heart failure. The overnight stay in the intensive-care unit at Olympia Medical Center, near Beverly Hills, cost the siblings $5,000 each.

On the last day of solid food before the operation, the Tehranis pigged out one last time. Cyrus downed a Tommy's triple cheeseburger topped off by Chubby Hubby.

Sheila had higher standards. "I'm not investing my last meal on Tommy's," she recalled telling Cyrus. She opted for rice and kebabs from Shiraz restaurant in Glendale.

Liu dubbed such binges "last meal syndrome."

Sheila barely slept the night before she and her bother entered the hospital. Cyrus' children clung to him as he prepared to leave.

"Any questions?" Cyrus recalled asking the kids.

"When you come home, will you be skinny?" 5-year-old Jillian piped up.

He reassured them it wouldn't be long before he could ride the rides at Disneyland with them — something he's been too big to do since age 21.

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.

"I told [wife] Karen I have atrophy of the jaw because I'm not chewing nearly as much," Cyrus told Sheila.

"But you're still talking," Sheila shot back.

A nurse asked Cyrus if he had any valuables with him. He looked at Karen.

"Just her," he said.

"Do you have an advance directive?" the nurse asked.

"She knows what I want," Cyrus said.

As they were wheeled separately into their intensive care unit rooms, the Tehranis realized they wouldn't see each other for a while.

"Bye, Fat," Cyrus said to his sister.

When Liu looked askance, Cyrus explained that "fatso" was a name they fondly split.

"Bye, So," she said.


Liu worried as he walked out of the hospital that night, 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. As music from David Gray's "White Ladder" album poured into the operating room, 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.

The long hours that Liu, 40, spent playing video games while growing up chagrined his Chinese immigrant parents, but they paid off professionally. Eyes glued to the monitor, he maneuvered the tools.

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 Sheila's 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 reveal the stomach.

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

At 11 a.m., Liu finished the 2 1/2 -hour procedure. It had taken five times longer than usual.

"I'm hungry," the fit, 6-foot, 1-inch Liu declared. He repaired to the hospital's cafeteria for a two-hour break.

Cyrus' abdominal wall was softer and his liver much smaller. Liu finished his 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 the size of a dime, made the siblings feel stuffed. At first, they could down just liquids, then soft foods, like tofu and yogurt.

For the first month, Sheila was depressed. "I don't know what it was — whether it was that food was always my outlet and now it was taken away or if it was because, being healthy all my life, this was the most I'd ever seen a doctor," she said.

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.

Sheila mentioned to Liu that she had eaten pasta and bread, albeit in tiny portions.

He reacted with horror.

"You ate bread?"

He told her it was time to tighten the Lap-Band.

"He's punishing me for eating bread," she joked as Liu filled a syringe and pumped saline into the barely visible port opening in her chest, which was attached to the Lap-Band device.

Cyrus began walking more around the neighborhood with his children.

Two months after the surgery, both Tehranis had dropped below 500 pounds. Cyrus had lost 97 pounds and Sheila 85. The whole family rented an RV and went camping at Lake Perris, 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.

Sheila considered it a victory that she got by with just one tiny box of Junior Mints for Halloween. Cyrus carried his children's trick-or-treat bags but abstained.

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 some turkey and splurged on a dollop of homemade cranberry sauce.

He has become downright militant about sweets and starches, much to Sheila's chagrin. She believes that eating a little of something she loves will prevent her from feeling deprived, then binging.

Cyrus has become zealous about going to Bally's gym in Pasadena several nights a week to lift weights and walk on the treadmill. His children are asleep when he returns home.

"Every day I wake up and look into the faces of my motivation," Cyrus said of them.


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 1/2 pounds. All told, Cyrus had lost 146 pounds and Sheila, 101.

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

"There's only so much you can eat, even if you do eat crap," she said.

Liu told her she must start exercising. She vowed to get a treadmill. Cyrus suggested an elliptical trainer.

"Are you kidding?" she replied. "I'd start a fire with my calves" rubbing together.

Cyrus, meanwhile, complained to Liu that he was losing muscle as well as fat, despite his workouts and increased protein intake.

" 'Boohoo, I'm losing weight,' " Sheila mocked.

She later said she felt "like we're having two completely different experiences. He stands up at support group meetings — and he happens to be wearing a T-shirt that says 'I had an IQ test and it came out negative' — 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."

Though everyone praises her accomplishment, Sheila said she still imagines them thinking, "Oh, my God; you're still so fat."

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 healthier. Sheila walked up a steep hill at Eagle Rock Hillside Park on Thanksgiving with the rest of the clan. She played in the inaugural 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.

A few weeks after the operation, Karen called Guarderas to thank him for saving Cyrus' life.

On New Year's Eve, she reflected on how much better life is now that Cyrus can join the rest of the family in so many activities.

She choked up as she recalled the cardiologist's grim 2004 warning that Cyrus wasn't likely be around much longer and how she tried to protect the children from that prediction.

They sensed the looming threat, she believes: Jillian hated to leave Cyrus' side, not wanting to go to kindergarten, sometimes even trying to sneak home. Now, she loves school.

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

*


The Times will follow the Tehranis' progress with occasional articles in the paper and on latimes.com. The writer can be reached at Valerie.Reitman@latimes.com.

Copyright © 2014, Los Angeles Times
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    MOTIVATED: Cyrus Tehrani, spotted by half-brother Jacob, lifts weights at a gym in Pasadena six months after his surgery. Cyrus is committed to regular exercise, despite time away from his children.

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    A REACH: Nurse Caroline DeOliveira measures Cyrus Tehrani’s waist during his monthly checkup six months after surgery. Before the Lap-Band procedure, he had been wearing 78-inch-waist pants.

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