The day at the state fair, when the sisters rode in separate roller-coaster cars because when they tried to squeeze into one together, the safety bar wouldn't latch.
Annette, closing the bathroom door and purging after mealtime binges.
Gracie, escaping to her bedroom, crying, after their father grabbed her flabby abdomen and insisted she quit eating so much.
Like many of the estimated 72 million obese Americans and millions more who are overweight, the 25-year-old Orange twins have struggled with food, fat and the accompanying emotional baggage for as long as they can remember. One or both tried Weight Watchers, the Atkins Diet, Medifast, Slim Fast, Overeaters Anonymous, counting or restricting calories, keeping a food journal, walking, running and other calorie burners.
Like that roller-coaster ride from their childhood, their weight repeatedly climbed, dropped and climbed again.
This year, they took a radical new tack -- one they're discussing publicly to help erase the stigma linked to it: The sisters joined the growing ranks of patients choosing a surgical solution to shed pounds.
Annette, who lives in North Portland and works at Macy's, had gastric bypass on March 28. Gracie, a Southwest Portlander and Portland Community College student, had gastric sleeve surgery on Oct. 30.
Each had distinctly personal reasons.
Each independently researched procedures considered the best options.
And each says she had faith that surgery would finally help her win the battle with weight, lead her onto a healthier path, and, in some ways, set her free.
**
Weight-loss surgeries have been around since the 1950s. U.S. surgeons will perform about 200,000 of them this year, up from an estimated 63,000 a decade ago.
According to the American Society for Metabolic & Bariatric Surgery, only about 1 percent of those who meet eligibility requirements for the operations choose them.
That percentage may rise as acceptance grows in clinical and research circles.
A 2004 study published in the Journal of the American Medical Association indicated bariatric surgery patients showed significant cuts in hypertension and high cholesterol; nearly 86 percent of patients in the study group got rid of their sleep apnea; joint disease, asthma and infertility improved or resolved. Other studies show the surgeries control Type 2 diabetes in the obese and overweight more successfully than standard treatments.
A study reported in the Oct. 17 issue of the journal Heart indicated gastric band surgery and other types of weight-loss operations can significantly reduce risk for heart disease and stroke, and improve the heart's health in those who are obese.
Complication-wise, bariatric surgeries are about as safe as other major surgeries, according to a large, 2009 clinical trial backed by the National Institutes of Health; study centers included Oregon Health and Science University and Legacy Good Samaritan Medical Center.
Yet, the operations are far from risk-free.
Infections occur, as do nutritional deficiencies and bowel obstructions. A recent review of literature, published in the journal Obesity Reviews, raises concerns that some gastric bypass procedures may lead to bone loss, increasing risk for fractures. The worry elevates when the surgeries are performed on young people who haven't reached peak bone mass.
Some of those who have surgery lose lots of weight, only to gain it back.
Still, the buzz around bariatric surgery grows, particularly as celebrities -- TV's Al Roker, Star Jones and Roseanne Barr, to name a few -- undergo the procedures. Even pop culture's best known physician, Dr. Mehmet Oz, pushes weight-loss surgeries on TV, his Web site and in magazine interviews.
Still, they continue to carry a stigma -- one that's "greater outside the medical community than within," says Dr. Valerie Halpin, the Legacy Weight and Diabetes Institute surgeon who operated on Annette and Gracie Orange.
"People think the person choosing surgery is taking the easy way out, despite the fact they're undergoing a major gastro surgery that's life-threatening," Halpin says. "That's an unfortunate misconception."
**
Looking back, Annette and Gracie recognize the roots of their weight problems. Raised by a busy single father in Richmond and Hanford, Calif., money was tight. The kitchen cupboards and fridge usually held such low-cost items as ramen noodles or TV dinners, rather than fresh produce, whole grains and lean protein.The sisters ate whatever was quick, cheap and easy, they say, including frequent meals from Taco Bell or McDonald's. When grocery money was more abundant, the family celebrated with junk food.
Annette, always the bigger twin, kept to herself in high school. "I felt," she says, "like no one really liked me."
Her self-esteem, confidence and social life suffered. After school, she'd come home, turn on the television and park herself in front of it.
Gracie says her weight didn't bother her much until she reached high school and "I wanted to look, like everybody else."
She tried cutting out food altogether, but binges followed.
Their blended family included 14 children; their half- and step-siblings teased the twins, the only two who were heavy.
Annette is about 5-foot-10 and Gracie is 5-foot-8. Each topped out at more than 300 pounds.
**
Annette moved to Oregon at 19, in May 2006, after a difficult first year of college. Her grandparents lived in Portland and they offered her a rent-free room, as long as she worked and went to school. Gracie followed that July.
Happy as Annette was to have her sister in town, she says, she felt a twinge of regret. After a lifetime as an "Orange twin," she'd enjoyed carving her own identity in a place where few knew she had a sister who was her elder by one minute.
The two bear a powerful resemblance, with similar easy smiles, engaging personalities and conversational styles that brim with intelligence. One sports short dreadlocks while other wears her hair elegantly braided. Annette loves fashion, while Gracie, who works as a nanny, is happy in jeans and sweatshirts.
Gracie says Annette's the bossy one. Annette, who took on something of a mothering role as she and her sister grew up, doesn't disagree.
"I like to say we're frien-emies," Gracie says. "I don't mind picking on her but don't let anyone else pick on her ... I can't say she's my best friend -- but she is."
While both are go-getters, Annette is a "let's-just get-it-done" person, Gracie says. "I take longer to think about things."
No surprise, then, that Annette set her sights on weight-loss surgery first.
**
About a year ago, the twins say, their aunt Carolyn Scott, always one of their most fervent supporters, told them how worried she was about weight's detrimental effect on their health."She wasn't negative," Gracie says, "but she would ask what I ate for breakfast."
Before the twins tried out in January 2011 for NBC's "The Biggest Loser" reality show, Gracie weighed about 280 pounds. She remembers thinking it would enhance chances of being selected if she put on 10 more.
"Then it got out of control," she says. The number on her scale shot up to 325.
They made it through the show's first rounds, but never onto TV.
Meanwhile, Annette says she binged, sometimes three times a day. She says she lied to friends, telling them she was hungry, even if she wasn't. If food was in front of her, she wanted it.
She says she slipped deeper into depression.
After describing her behavior and mood to her primary care physician, the doctor pointed her toward the Legacy Weight and Diabetes Institute, which specializes in diabetes education, nutrition counseling, weight management and weight-loss surgery. A handful of Portland-area hospitals and clinics offer similar treatment options. ?
She met with a surgeon, psychotherapist, nutritionist and physical therapist. The team, says Halpin, the surgeon, works to ensure patients "understand what they're about to undertake and are prepared to deal with the life changes that will come -- how they'll be eating, the change in their appearance, in how others will perceive them. ..."
Weight-loss surgery patients are most likely to be women in their 40s or 50s, who have had a few children, have high blood pressure or diabetes, Halpin says. They're typically 125 to 150 pounds overweight. Women choose the surgeries about three times as often as men do, she says, "but men need it more."
Surgery on women in their 20s is less common, though younger patients tend to do well, Halpin says. "They don't have the chronic disease that make it harder to maintain physical activity, or have medical problems that put them at risk for complications after surgery."
In mid-February, Annette spilled the news to her sister: She planned to have gastric bypass; her medical insurance would cover it.
The surgeries range in price from $25,000 to $38,000 for gastric bypass, $15,000 to $25,000 for the gastric sleeve procedure.
In gastric bypass, the stomach is divided into two parts. The surgeon reroutes a portion of the small intestine to the upper pouch, which has been reduced to the size of a chicken egg. When patients eat, the food goes into that small upper pouch and out the rerouted intestine, limiting calorie absorption. Weight loss -- lots of it -- is inevitable, at least for awhile.
Gracie remembers telling Annette: "Don't do it. You don't need this. Just eat less."
Annette's mind was made up. She attended the clinic's counseling sessions and a support group. On a pre-surgery diet, she lost 18 pounds, dropping to 300.
The last Wednesday in March, Halpin operated on Annette.
The month that followed, Annette says, "was probably the worst month of my life. I had a lot of regret. I was in so much pain. I couldn't keep anything down. I couldn't move."
Slowly, she improved. Each week, she lost 2 1/2 to 3 pounds.
At every weigh-in, she texted her Aunt Carolyn, thrilled to share her progress.
**
Gracie planned to prove her sister wrong -- to show she could lose weight without surgery.She took up running, putting in miles at least three times a week until an injury sidelined her. She tried a community center's aqua boot camp class, which she loved, but couldn't afford once her free trial membership expired.
She still ate poorly and didn't pay enough attention to portion sizes. Finally, she focused there.
Her aunt advised her on ways to incorporate many more vegetables into her diet. She bought a blender and turned to fruit and protein shakes for breakfast. And she settled on a new base for nearly every dinner: salad.
In July, she lost eight pounds.
In August, keeping up a disciplined diet and exercise routine, she gained it back; her aunt told her not to despair, that the weight gain might be added muscle.
Meanwhile, Gracie watched her sister transform. "I'm working so hard," she remembers thinking, "and the weight is melting off Annette. ... She was getting the body I wanted."
Online, Gracie read about weight-loss surgery. On Aug. 16, she told her aunt she planned to talk to a doctor about it. "Not because Annette," she recalls saying. "This is for me."
She took an online seminar and applied for surgery at a clinic near Legacy's. But as she waited for her insurance company's OK, she accompanied Annette to a counseling session. She liked what she saw, met with the Legacy team on Sept. 28, began pre-surgery counseling and stood in the office for her "before" photo. She weighed 290 pounds.
She continued eating healthfully and employed strategies she picked up at the clinic. She learned, for instance, to rank her hunger on a one-to-10 scale, with one being starving and 10 being Thanksgiving-full. She discovered it's best to eat when her hunger was at three and stop when it reached seven.
The strategies and discipline worked, even out one night at a Thai restaurant. Gracie skipped the noodles but indulged in the vegetables. "I never thought," she says, "I'd actually get a handle on food."
She scheduled her surgery for Oct. 30.
Second thoughts crept in.
"For a couple weeks," she says, "I felt like I was giving up on myself." To reach a healthy weight, she'd need to lose 130 pounds.
She finally decided: "I have tried it my way and it's not working my way. I need this extra push."
The week before the surgery, she felt nervous, saying. "I've always been the big kid, the big girl. What will it be like on the other side of the fence ... will I like who I see in the mirror?"
The last Tuesday in October, Halpin performed a vertical sleeve gastrectomy on Gracie, removing most of her stomach, leaving behind a banana-shaped tube. The procedure limits the amount of food patients can eat, making them feel fuller.
For Gracie, the days that followed were pure misery, the pain excruciating. As regret washed over her, she says, "I kept reminding myself: I know why I did this."
This month, she has reintroduced foods slowly, starting with a couple weeks of only clear liquids, then pureed foods. Moist but solid foods come next. At the three-month mark, she should be back to regular food, though not much of it.
At last check, she'd lost 16 pounds.
Though still recovering, Gracie is back to work. If she follows her sister's lead, by the fourth or fifth month she'll be running up stairs without giving it a second thought.
Her goal weight: 155 to 160 pounds.
"I feel like me again," she says. "I can't stop staring at myself in the mirror."
As Annette has, she may wonder from time to time, "Could I have done this on my own?
"Those days," Annette says, "are few and far between now."
By mid-November she'd lost 113 pounds, enough to fit into size 12 or 14 clothes. Her goal: size 8 or 10.
"This was not just about losing the weight," Annette says. "I was waiting to meet the Annette on the inside and show her to the world."
- Katy Muldoon; twitter.com/katymuldoon
Source: http://www.oregonlive.com/health/index.ssf/2012/11/weight-loss_surgery_is_the_bes.html
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