February 27, 2008

Bariatric Surgery

I am overweight. I lost 50 pounds, and I am still 50 pounds overweight. The terrible thing is, I am starting to gain the weight again, and I’m terrified. I exercise, but it seems I would need to do three or four hours a day to keep the weight off.
I have a friend who had surgery, and I’m wondering if that may be the answer.

We sense how painful this is for you, and pray that you will be spared additional pain. Some folk feel they have all the answers, and that the solution is simply to adhere to this or that program. The fact is, almost all of us know what to do—it is actually doing it that’s the problem.
Nearly all weight loss regimes work in the short-term. The problem, such as yours, is sticking with them. We have written of the benefits of those programs that involve group support. Clearly, group support helps—be it CHIP (Coronary Health Improvement Project), Weight Watchers, or others—but the real difficulty is that there has to be a permanent lifestyle change. This takes a total commitment, not to weight loss but to a different lifestyle.
Vegetarians are usually lighter in weight than omnivores, but not always. One can become very overweight on really good food! Just because the bread is 100 percent whole grain doesn’t mean it has fewer calories; it may actually have more! Brown rice is a healthful food, but a plate stacked high will make anyone gain weight. Fruits are relatively low in calories, but a couple of pounds of grapes are really packed in calories. Nuts are heart-healthful and their fats seem to be protective, but any fat has nine calories for every gram.
2008 1506 page22Despite our belief that temperance in eating is the key to weight control, we know many find it difficult to be temperate. Temperance is a fruit of the Spirit, so we need to seek help from the Lord. Ellen White wrote: “Many professed health reformers are nothing less than gluttons” (Counsels on Health, p. 160), but on the next page she also cautions against extremists who try to get others to conform to their false standards.
We would encourage you to examine your eating with an open mind that tells you if you are overweight, you eat too much. Consider the size of your portions, how often you eat between meals, your use of sugared drinks, and the rate at which you “gobble your grub.” Eating slowly allows the body time to signal “enough.”
But we haven’t answered your question, have we? Perhaps we don’t really know the answer.
“Bariatric surgery is the only health-care intervention that facilitates significant and sustained weight loss,” reads the opening sentence of David R. Flum’s commentary in the September 26, 2007, issue of The Journal of the American Medical Association.
In fact, we read in a Johns Hopkins publication that gastric bypass surgery gave a 25-percent long-term (10 years) weight reduction, and gastric banding provides a 14-percent weight reduction over 10 years. One should note, however, that complications attend this kind of surgery.
Having the intervention is almost like admitting defeat, yet the heart attack and cancer rates 
in those undergoing surgery were also reduced—especially compared to the control group who were of similar weight.
This surgery is not for the mildly chunky, like so many of us. It is for the morbidly obese who have tried and failed all else.
This may sound like we’re defining bariatric surgery as the resort of the “failures,” but we don’t want to leave that impression. We know only too well that 95 percent of people who lose weight regain it within two years. So if you and your doctors feel that bariatric surgery is your best option, don’t let others who can be pious in their success or genetic makeup make you feel bad. We are all individuals struggling with a variety of disorders—and Jesus loves us all. Let’s love ourselves a little, too.


My daughter was given the human papillomavirus vaccine at school. Does this mean she will not need Pap smears? I am interested as to whether she is fully protected now.

It has been more than 60 years since Drs. Papanicolaou and Traut published their seminal paper on vaginal cytology in 1943. Since then, in developed countries, special programs for screening (the now famous Pap smears) have successfully reduced death rates from cervical cancer. By finding early stage lesions, the invasive, life-threatening forms of cervical cancer have largely been avoided. Nevertheless, infections with HPVs (human papillomaviruses) have not decreased, and because of sexual permissiveness, have, in fact, increased. The vaccine is active against the four most culpable viruses, but obviously not against all—nor will it be 100 percent effective. This means screening remains important, especially of those who have had more than one sexual partner or whose partner has had more than one sexual partner.
The interesting debate currently going on is whether the time-honored Pap smear is ready for archiving. It is a successful test and has a proven track record. It does require trained cytologists, and we believe it will never be totally discarded. Currently, a liquid phase-type of cytology is being used and is very accurate. What has happened to change the landscape with that is now it is easy to screen for the DNA of the HPV virus with a swab.
Two studies recently published in the same issue of The New England Journal of Medicine (October 18, 2007) tested the Pap smear versus the HPV test. Researchers found the HPV test to be more sensitive to the presence of the virus, but the Pap smear more specific to precancerous changes.
The question then is, Do we gain by greater sensitivity, even if it’s not 
as specific? The problem becomes one of economics. Which is more cost-effective: one test or the other—or both tests at the same time?
Follow-up on the presence of the virus when only mild cellular change exists may cost more than looking at cellular change from the outset and avoiding a lot of follow-up on mild change.
The exact recommendations will have to await more studies such as the two discussed here (one Canadian and one Swedish); but regardless, we are sure periodic screening for cervical cancer will persist. The vaccine may alter the scheduling of such screening, but the effectiveness of the vaccine throughout prolonged years is another factor that has not yet been evaluated.
In a nutshell, the answer is that your daughter will need periodic screening, and we cannot say she is fully protected.
Allan R. Handysides, M.B., Ch.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.
Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland, 20904. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.