Your weight Loss success depend on compliance

—If diets worked you wouldn’t be reading this

One day a rather large biker came into my office. He was six feet tall and weighed over four hundred pounds. He had never been on a diet in his life. He had never even thought about weight loss until his bike needed some repair and another biker pointed out the dent he was making in his bike seat. When he came to see me, he didn't even know that surgery was Surgery is a way of get-ting your inner biology to work for you.  an option. He had to wait for his surgery, however, until he had been on a physician-supervised diet for six months.

Some people are super organized, save a copy of every diet they have ever been on—with physician supervision and without—and they know how many pounds they lost and how many they regained. Such individuals are rare. As difficult as it may be, put your diet history together. It will be helpful to your surgeons as they approach the insurance company.

Remember, your obesity is not a personal failure, it is not lack of willpower. It is simply a matter of your biology not working in your favor. Surgery is a way of getting your inner biology to work for you.

Results Not Typical

Disclaimer seen underneath most weight loss advertisements

About every fourth infomercial is about some diet or weight loss program showing a very attractive person who has lost 60, 80, or 100 pounds. However, look at the bottom of the screen—"results not typical." My favorite involves one of my employees. Mary is a very attractive woman who had settled into a routine of eating out and cleaning her plate. A few extra pounds crept on—not enough to warrant surgery, just enough to be concerned, so she went into this rather expensive program. She lost the weight and the sponsors of the program liked her so much they used her for one of their commercials. One day I was sitting in the doctor's lounge, getting ready to do some weight loss surgery when I looked up at the television and saw my employee in this ad—now that was a bit of irony.

I always enjoy seeing those commercials. Usually you see a person jogging on a beach and telling the world how this drink, program, or device made them into the slim person they are now. Again, these results are not typical, but the commercials generate income from people hoping it will work for them.

Compliance with your gastric bypass or Lap-band surgeon's program

Compliance means that you, the patient, will do what your doctors asks you to do. If you do that, you have the optimal chance for success with the surgery. Compliance is almost impossible to measure pre-op. I ask patients to sign a contract with me. In it, they agree to come to support groups, stop smoking, and do a number of healthy things. Some insurance companies want an indication that a patient will be compliant following surgery, but this is, at best a guess. Ask any bariatric surgeon—we are surprised at how well some patients comply and how others buy donuts at the corner store on the way home from the hospital. There are always patients who will not be compliant even though they know the risk of harming themselves is staggering.