@dr.garthdavis08: And this is why I love my job so much. 2 years ago Jesse was over 430 lbs. he was sick and tired on multiple medications. Two year later and he is living a new life down to 270, and continuing to lose. Meds have decreased, labs and vitals are amazing, and most of all he is now enjoying his life. He had the newest surgery, SADI, but it takes two to tango. It is never just about the surgery or meds. He has changed his lifestyle and follows up with me regularly. He is winning!! And I LOVE it!!