Beloved, I pray that in all respects you may prosper and be in good health, just as your soul prospers. - 3 John 1:2
Pastor Douglas Yancy left his physician's office pondering his advice. Yancy weighed 330 pounds, was diabetic, had high cholesterol, suffered from sleep apnea, and had recently had an attack of angina. The doctor's recommendation: bariatric surgery.
When Yancy returned that day to his master's program classes at Palmer Theological Seminary, he mentioned it to his professor of Christian education.
"She told me she had had the gastric bypass," Yancy recalls. "And she looked really good. And she told me, 'You've got to do something for yourself.' "
An odd coincidence? Not in Yancy's line of work.
"I thought it was a sign from the Lord," Yancy said in an interview at Mt. Moriah Apostolic Church in West Philadelphia, where he has been pastor since 1994. "I saw it as a confirmation from God."
Soon after, in early 2011, he had gastric bypass at Fitzgerald Mercy Hospital in Darby. Since then, he has shepherded through the procedure his wife, his sister, about 15 other congregation members, and perhaps a dozen other people.
"I talk about how God requires us to be good stewards of our bodies," said Yancy, 51, who is down to 242 pounds. "And how we need to ask God what to do when we're overweight."
Yancy has preached on the subject, using the passage above from John's third epistle with his own special variants, invoking life before the age of supersize portions.
Mostly, he leads by example. "People saw me have" the operation, he said, "and they saw me have good results."
Andrea Jennings was one of them.
"I was watching him and how he reacted," said Jennings, 48, of Upper Darby, "how much energy he had. It was me seeing it rather than him telling me."
Jennings has lost 80 pounds since her own operation. "I have a lot more energy," she said. "I'm at my goal."
About 180,000 Americans a year have bariatric surgery. Just 15 years ago, the figure was around 10,000, said John Morton, president of the American Society of Metabolic and Bariatric Surgery.
The operation was first performed in the 1950s, but Morton, chief of bariatric surgery at Stanford University, says that it became vastly more common in the late 1990s when it could be done through the small incisions of laparoscopic surgery.
New types of surgery, such as the simpler sleeve gastrectomy, have made weight-loss procedures more popular.
But the "typical" bariatric patient has changed little over the years, Morton says. Most are in their 40s, and about 80 percent are women.
While no surgery is risk-free, supporters of the bariatric procedures say they are far less dangerous than extreme obesity. Insurers often require patients to document that they have tried dieting before the surgery will be covered.
National Institutes of Health guidelines recommend bariatric surgery only for patients 100 pounds or more above their ideal weight, or with a Body Mass Index (BMI) of 40 or more, 10 points over the obesity threshold. Patients with conditions such as diabetes may be considered if they are less overweight.
Prashanth Ramachandra, chairman of surgery and director of bariatrics at Mercy Catholic Medical Center, attributes the growing popularity of bariatric surgery in part to the growing awareness of obesity's dangers.
"People are significantly better educated," says Ramachandra, who operated on the Yancys and Yancy's sister, Rose Hollis. "The fear has gone down significantly. The stigma has gone away. A lot of them felt it was taking the easy way out. Surgery is never the easy way out."
Recent studies by the Cleveland Clinic suggest that bariatric surgery presents no more potential complications than procedures such as hysterectomy, gallbladder removal, or knee replacement.
Still, it takes place against a more complicated emotional landscape and requires significant lifestyle changes.
"It's like planting a tall tree," Ramachandra said. "We plant the first six feet. The rest, you're on your own."
Postsurgery, patients can't eat as much. For Yancy and his wife, Lisa, this has meant splitting a standard restaurant meal and perhaps taking some of it home. Or just ordering an appetizer. Jumbo cups of Mountain Dew are a thing of the past.
"You've got to be disciplined to do this," Yancy says.
He has also adopted a regular exercise program emphasizing water aerobics and says most of his congregation's members have joined a gym.
Yancy says that being in a group makes the entire process easier, and medical professionals agree with him. A lot of patients "have used food as a support, and you're taking that away," Ramachandra says. "There's a deep psychological impact."
With diabetes, hypertension, stroke, and cardiovascular disease particularly prevalent among African Americans, government and nonprofit groups have targeted weight control and other health interventions to that population. Often, they are centered on churches such as Mt. Moriah because of the emotional, social, and spiritual support they can offer members.
The American Diabetes Association's Project POWER "seeks to integrate diabetes-awareness messages and healthy-living tips into the life of the family and church." It offers a six-workshop series with a facilitator trained by association staff.
The American Heart Association offers a similar church-based program, Search Your Heart.
Under a 12-week church-based weight-control plan, 16 of 35 members of the Gospel Water Branch Baptist Church near Augusta, Ga., lost 5 percent or more of their body weight, and most kept it off for six months, according to a 2009 study. The program, Fit Body and Soul, was adapted from the National Institutes of Health-sponsored Diabetes Prevention Program.
More modest weight loss was reported in another study in 2005 in Baton Rouge, La.
A 2007 study by the Kaiser Permanente health-care organization of its church-based weight-loss initiative in Ohio said, "These programs might be more effective if they partnered with other community health resources, rather than relying solely on internal church resources."
Whatever the source of weight-loss support, and whatever the means chosen to drop pounds, realistic expectations are a cornerstone for success.
In almost all cases, the bariatric-surgery process starts with a psychological evaluation and education on what to expect in the months and years afterward.
"Many patients expect to lose more weight than we typically see after surgery," said David Sarwer, a psychology professor at the University of Pennsylvania's Center for Weight and Eating Disorders.
"On average, patients lose about one third of their weight within 12 to 18 months after surgery.''
Quality of life, self-esteem, body image, and sexual functioning all increase as the weight comes off.
Potential negatives: loose, hanging skin; a resurgence of old emotional issues around eating; depression; or substance abuse.
Sarwer doesn't put much stock in reports that divorce can be a by-product of bariatric surgery, saying that if marriages end, it's due not to surgery but to "situations where individuals ended unhealthy relationships as they began to feel better about themselves." Still, the Penn program mentions the issue to preoperative patients.
Though most patients put about 10 percent of lost pounds back on, about 20 percent regain even larger amounts and may even reach their presurgery weight.
Even with a smaller stomach, it's possible to work back into old habits - another reason to stay active in a support group.
Despite the drawbacks, Sarwer says, bariatric surgery remains medicine's most powerful weapon against severe obesity, and often leads to dramatic improvements in weight-related health problems such as Type 2 diabetes, high blood pressure, and sleep apnea.
In any case, there seem to be no shortage of candidates for the treatment. The American Society of Metabolic and Bariatric Surgery estimates there are about 32 million Americans who meet the guidelines for the procedure.
Some, Yancy says, are in his congregation, and he still hopes to convert them to surgery patients in order to achieve a healthier future. He's uniquely positioned to reassure them.