No, the picture isn't as rosy...........

But, I would NEVER have lost 80 plus kgs (over 176lbs) and maintain for 4 years any other way.

Having the DS allows me to eat approx 2500 cals per day and maintain within 4 -5kgs with minimum effort, as 80% of the fat is malabsorbed. I equate it to now having the metabolism of a "thin" person.

I eat fairly healthily and I exercise (walk) 3 - 4 days per week, more in summer. However I do worry, what will happen long term. 4 years out if I gain a little, I walk everyday and cut back on carbs and weight goes back to my comfort zone.

It seems to be harder for RNY'ers to lose and maintain without much lower calorie eating.

All I know is that I wish I hadn't needed surgery, but I did. I wouldn't wish "fat" on anyone. I do think it should be covered by insurance, just as any other life saving surgery should be.

I really disagree in regards to anorexia. The medical diagnosis itself requires the patient to be underweight before it can be classified, which of course is a huge problem with anorexia treatment in itself. A larger woman might get told it's unhealthy or unrealistic to maintain such a diet but personally (and quite sadly) I've yet to have a doctor say such a thing to me.

I think the fact is, is America (and most definately Japan) overweight people who commit to an extreme diet really are seen as doing penitence for the wrongdoings of a supposedly gluttonous lifestyle. It's not something to worry about, it's not something to be concerned about by mainstream society really it's almost considered expected.

WLS is scary and crazy, but it still seems to be the best course of action for individuals with what could be life harming obesity. I don't think anyone under the 300 pound mark should even be looking into this and anyone over that should be trying the tried and true (diet + excercise = yay) for a long time before considering it. But that's just it, isn't it -- we live in a society of now, now, now and we can't give anything time to be properly studied before we run and do it, let alone give ourselves time to give a good program a chance.

The fact that WLS has become so popular worries me. The issues surrounding substantial weight gain are more psychological than physical. While the surgery may be a short term extreme way to lose weight quickly, the underlying mental issues are never addressed. I've yet to read about a WLS patient who participated in long term therapy before going under the knife, nor to the best of my knowledge do most WLS doctors require more than a few sessions with a psychologist before operating.

I'm also struck by the notion that no one really knows the long term ramifications of bisecting portions of the intestines. From what I've read, the remaining stomach is not removed from the body. I can't help wondering if there isn't a possibility of atrophy.

To me, WLS patients all seem to end up with an unhealthy look about them, a sort of deathly pallor, one I imagine is caused by the rapid weight loss and mineral loss. I've yet to see anyone look completely healthy a year later, at least in my eyes, more often they look thin and sickly.

Finally, all surgery carries the possibility of death which I just can't ignore. Electively chancing my life under the scalpel for vanity? No thanks.

Janette, here's a picture of a WLS patient one year out. I'd say I don't look any less healthy than the rest of the women in the picture, so there you go, you've seen someone who looks healthy after WLS.

I'm actually glad that there are articles like that Self one out there, because the idea that WLS is a miracle cure is such a bogus bunch of crap. It is not easy, it's not miraculous, it's just a medical procedure. And just like every other medical procedure out there, it doesn't work for everyone. And sometimes it causes really nasty side effects, even if patients follow all the rules they are given (and trust me, there are a LOT of rules!). Every time someone asks me how I'm doing, I tell them I have been extremely blessed to not have any major problems (so far).

I'm one of those patients who will probably never get "skinny". I'd like to lose another 30-40 pounds but there is every possibility that I'm done now. But if this is my new set point, then I'm okay with that because weighing 120 pounds less than I used to is making it a lot easier for me to do things like exercise more to keep myself healthy.

I don't think this is a surgery for everyone to run out and get, I don't think it's something that needs to be advertised, and I wish every patient did as much research as you did about it because then maybe they wouldn't be so surprised when it doesn't turn out to be a simple miracle after all. But personally, it's definitely been worth all the hard work and handfuls of vitamins for me.

I've been an Anne reader for a few years now and followed her writing from pre-surgery until now. She's been an inspiration, mostly because she's shared the good and the bad parts of her experience. Her honesty is fantastic.

I'm five weeks out from Lap Band surgery. I've lost about 15 pounds so far. I've done a lot of research and reading, and have been in therapy for several years. I have battled my weight for 35 years. It's not a decision I took lightly; I went in well educated and very supported by friends, family and health professionals.

As it happens, I was in great health at the time of the surgery. But I couldn't help thinking about the future. Every year the subway steps became a little harder to climb. Diabetes, heart disease and cancer are in my family. I hope that by having this surgery, I've reduced my chances at contracting these. I liked that the lap band is minimally invasive surgery and that, if for some reason I wanted it to be removed, it could be. The weight loss is relatively slow, and I can live with that. It was the right decision for me. Other surgeries -- or no surgery at all -- are right for others.

I've read a lot of the forums too, and have gotten some good advice. And I've been scared by the horror stories. But I realize that in every movement there are unbending zealots and devotees chugging the kool-aid who feel their is one blanket solution for everyone -- the one they believe in. Sadly, I've found this to also be true in some of the fat-acceptance blogs I usually read and am empowered by -- if you make the personal decision to go ahead with a surgery, you're a traitor. And that's been disappointing. Health at every size, isn't it?

Bottom line: It's no one else's business.

WLS works, no doubt, but it's a trade off for many of us.

I don't think that WLS is going to solve obesity. There have been so many people who have lost weight without WLS and I think there is so much more research that needs to be done on this subject before we start mandating it for everyone with a BMI over 25.

I have always said that it is a personal choice. I applaud anyone who can make that kind of a life-changing decision. There was a point in my life when I considered doing it but reading some of the stories of the side-effects, and even deaths from it, I quickly changed my mind.

And, unfortunately, I've known a couple of people who had WLS and neither one was successful; one replaced her food addiction with alcohol and sex and the other needed to have reversal surgery because she was becoming malnourished.

Back in April 2008, I was seriously contemplating having the lap band procedure (http://fatty-fatty2by4.com/?p=19) in a post titled Lap Banding and My Brain.

I've been overweight since the womb. This is NOT an exaggeration. I've tried everything ... several times over.

But then I took a look at some famous (infamous) people's success or failure rate with WLS. I was not impressed.

I came to the conclusion that I don't need WLS, I need my brain fixed. If I can't wrap my brain around the fact that I am eating emotionally, and not because I'm hungry, then all the surgery in the world on my abdomen isn't going to do diddly-squat.

Somehow a lot of folks who've had the surgery manage to defeat it because what's inside their head is so much stronger than their will.

Just MHO.

I knew that even if I did wls, my body image would still be messed up and my feelings about food more so. I went to overeater's anonymous instead, lost over 85 pounds, and feel like my head is on straight to boot. Finally I feel like my insides match my outsides.

Losing weight is a LOT of work. I think people either manage to get their head around that or they can't and then the surgery forces the hard part on them. I'm not saying they took and easy way out, I'm just saying that they removed the option to do what the rest of us do to sabotage weight loss. I've been about 100 pounds overweight for about 10 years and struggling for a lot more than that. I am losing now and the process is hard. I could say that I've tried everything but following a "diet" for even 3 months and only losing 10 pounds and then gaining it all back in a month of binges isn't everything. I know that everyone's story isn't mine but I see a lot of people that "can't" lose weight that truly don't understand the kind of sacrifices and changes it takes to make real progress and get fit.

I had WLS and lost 140 pounds. I still have 20 to go. I've had "issues" with my health but they are nothing compared to what they could be if I hadn't had the surgery. I used to feel it necessary to explain what my motivations were and how "worth it" it was to have the surgery but it is a positive thing for me, a personal thing, so now I don't justify the surgery or apologize for it. I made the best decision I could after research and I agree....if you get the surgery expecting a miracle you'll be disappointed. I worked my butt off to lose my weight and 2 years out I still have to work my butt off. Its a life change