LuckyStar

Thank you for your comments Reeger,
They are detailed, informative and add a lot to this discussion. You are right that the physiology of obesity is a complicated and still mysterious area of medicine, that we are in the early stages of understanding the science of obesity medicine and the shortcomings of the procedures. You are much better trained and informed than I to have that discussion with our clients. The word "non compliance" comes from the National Institutes for Health (NIH) research materials I quoted. I did not intend any blame in the use of that word. For me, it is a statement of fact and I took it as such from the NIH. For example, in my first 3 years post-op (2004-2007) when I lived on caffeine and high-calorie liquids (as I wrote about in my article "Vulnerability, Weight Loss Surgery and Cross-Addictions" last August) I was in "non-compliance" with my doctor's care plan for me and my pre-surgery plan and promise to myself. I am acknowledging the fact.
You, as a medical professional, and I, as a coach, have a common goal I believe which is to help our clients become the healthier people they desire to be. I believe our roles are different but complimentary. You have outlined very well the shortcomings of the procedures and how medical science is in many ways in its' infancy in understanding the biological issues that come into play with obesity. That is your area of expertise and I leave that to you and the bariatric surgeons who refer people to me to discuss that with our clients.
I, as a coach, have a different role. My role is to help our clients figure out "where" they are with regard to their health, "where" they want to be, what incremental steps they can take and are willing to take to move that direction and then support them in moving that direction with a intentional plan.
I wrote this article to highlight how people struggle and what steps they can take to positively affect their own outcomes more. I tried to provide strategies for moving through these struggles toward that outcome through patient-driven change. I don't minimize the science. I am glad you are there for our patients to work with them on the science. I am here to help them get focused on their desired, healthier life and break down the achievement of that into incremental, manageable tasks that can be built upon to improve their health and the quality of their lives as they define "quality."

Im going to go with preparation. To often I am seeing so many people not getting the pre surgical preparation work done. They do not know what they are in for. It seems that either there are many unscrupulous practices out there, or its just that people are not reading up on the surgery and what to expect. So many of these surgeons do so many surgeries they don't have the time to educate the potential patients as to what is really involved.
We see lots of people taking advice from non-qualified people. Or they ask very simple questions about topics that should be part of the basic prep work done by a surgeons practice prior to and immediately following surgery. As a result people are not mentally prepared to make this journey count and to use this tool to make those lifestyle changes so that when the "honeymoon" period is over they can still go forth with their new knowledge and their new attitude and lifestyle, and make the most of it.
Now i wholeheartedly agree also with the support reason. I find more and more people here and in other forums etc, that hide their WLS from everyone, because they either fear failure, or they fear some type of stigma. WHen you hide the WLS, you cannot expect support when people don't even know you need support. I am a big proponent of the open and often, method. I have a blog, and I share my WLS story with everyone and anyone. I am proud to be on this journey and proud enough to make myself succeed. The daily or the like, affirmations i get from friends , family and coworkers are truly a way to recharge, when i'm feeling down or feeling that this is too tough. I think people focus on part of the journey , like exercise, and they dont try to educate themselves in things like nutrition and how to cook in smaller portions or t with healthier ingredients. I also see people who think that they just have to summer for a few months then when they hit their goal, and go into maintenance mode, they can just go back to eating whatever they want. Attitude is so important here. Honestly, If i didn't have a breakthrough in my meeting with a counselor, I might not have made it this far either.
Once I did have the counseling, they made sure I understood , why I had failed before, and why i got fat. Yes i use the term fat, I wont hide from who I was, or what I was. I feel it is important not to live in a delusion about where we are/were and where we want to be.