I'm back with my girlfriend

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At this point I am more concerned about her than about you. I hope you can continue to be her friend.

What I think is happening is, in the US, before getting that sort of surgery (we call it "bariatric surgery", yes I know it's typical of Yanks to use an overblown term) one must undergo therapy for quite some time. Both before and after. You can't just go get the surgery and expect to become thin.

If the Australian health system provides such therapy, she should be getting it. Perhaps she isn't.

AFAIK it doesn't reduce your hunger, it just physically limits the volume of food you can ingest. So if all you ate was lettuce, then you still would be limited how much you could consume. I know as much as I do because my wife is considering it for type 2 diabetes; the surgery was just approved here for that purpose, although I don't really want her to lose a huge amount of weight.

What occurs to me is that sugar-laden food such as cake is the most efficient way to take on calories if your stomach capacity is limited. I think that is what's happening. Unless she does something like this, probably she is hungry all the time, which can be depressing.

I think your girlfriend has been ill-served by the medical establishment. She should be getting medical help now, psychiatric or otherwise. Exactly what, I couldn't say as I am not a physician.

Since I believe you are genuinely her friend, you should try to talk her into seeking help. Probably a fool's errand, but one can hope.

I try but she keeps pushing me away.

We still talk on the phone a lot. It's very obvious that she still has a lot of affection for me. She still calls me by pet names, etc. She still wants to know me but she always makes excuses not to meet me.

This is troubling. We think of all sorts of fun activities we should do together and if I don't set a date, if it's just vaguely in the future she'll be enthusiastic and say "Yeah, we should definitely do that" But if I say we should do it this Saturday on some other specific date, she'll make an excuse. She'll vaguely say we should do it later without defining a date. Later never comes.

Lately she sounds much happier and much less depressed. She says it comes and goes. But even while she's happier she still makes excuses not to see me. Here's the thing. She still goes to see her other friends every weekend.

An example of her excuses? If she sees one her friends for an hour on Saturday, she'll say she can't see me that day because she's busy. An hour? What about the rest of the day?

The way she never sets a date for doing something makes me think she has extreme B-type personality. If you don't set a date for a task it never gets done.

But the thing that frustrates me is it feels like she's never straight with me. I don't think she's intentionally lying to me. I think it's that her thinking is so muddled she doesn't know what the truth is anymore.

That was what made it hard to be with her. The feeling that she doesn't really know what she's doing in life. One of my friends told me that if she wanted to lose weight she'd just do it, otherwise she's one of those weak minded people with no willpower and no notion of cause and effect. Those people who say they want something but don't take steps to get it. Yesterday on the phone she told me that she wanted to be petite "If only I could start eating right" she said. That's an ok thing to want but why not start eating right straight away? Why do it "later". Later never comes. If you have a goal, why put it off. It's like she'll do it next week but two weeks later she'll still do it next week. That's a B-type trait.

But this isn't all about weight, it's about her personality in general. The way she puts things off. The way she seems to have zero willpower. Extreme B-type. This applies to other areas of her life. Like seeing me. She says she wants to see me but puts it off and puts it off. If she wants something why not just do it? There's no time like the present. Every week she puts it off by another week. She'll never get anything done like that.

She told me she doesn't like her job and she wants to train for another job. No problem, a different job would be good for her. But again she keeps on putting it off. At this rate she'll be in the same job 'till Ragnarock.

So that's the difficult thing. I feel like she's never straight with me not because she's lying but because she's never straight with herself. She doesn't understand herself. Some wise old Chinese guy with a long white beard named Lao Tzu said “Knowing others is intelligence. Knowing yourself is true wisdom. Mastering others is strength. Mastering yourself is true power.”

So there you have it. She doesn't know herself and she can't master herself. She's unable to make herself do things she wants to do for reasons she doesn't understand. It's painful for me to watch her hurting herself. It's difficult for me to know her when she spends most of her time in her room. And I don't understand why she still sees her other friends but not me. She never said she doesn't want to see me, she just makes excuses why she won't every weekend. I don't think she knows the real reason herself because she doesn't know herself.Yes she had that therapy. She told me all about it. The thing is, the therapy was mostly aimed at preventing her from becoming anorexic. It didn't actually have that much advice about losing the weight. I think our culture thinks in false dichotomies. It's like we must either accept being obese or they fear we will become anorexic. Our culture doesn't recognise the middle ground between obese and severely underweight. I think this false-dichotomy treatment is part of the reason why there is such an epidemic of obesity. It's very common, affecting a large percentage of the population, damaging their physical health as well as their self-esteem. But one of the reasons why we can't deal with this disease as a society is because of our false-dichotomy thinking. Our culture doesn't distinguish between overweight people who want to get down to a healthy weight and underweight people who want to get even more underweight. No middle ground.

You know back when I was obese and losing weight some people called me an anorexic even I was still overweight. At no point did I become underweight. But to make fat a taboo topic means we can't talk about it medically and it is a medical problem. It's like how genitals are taboo so men don't get their prostate examined or women don't get a pap smear because having some stranger look at your privates is taboo. Taboos are harmful. They prevent people from getting treated for diseases such as prostate cancer or obesity.

Anyway, she's not getting the therapy now because she had the gastric band put in 6 years ago. I don't know if the therapy is continuous in the States but down here it stops after you get it put in. It seems very strange to me that she gained weight since she had it put in. After all the reason she got it was to lose weight. It must be very hard to gain weight while eating only tiny portions. I think it shows her tiny portions were very highly concentrated sugar.

I want to help her with this problem but since most people are inherently irrational (myself included) I must do it using Dale Carnegie methods of positive reinforcement rather than criticism. A truly enlightened person could take criticism for what it is, advice. Most people can't do that.Maybe. She says she doesn't get hungry much but who knows. It might explain why at restaurants she orders far more than she can eat. If sugar is so concentrated it allows her to consume a large amount of calories without exceeding the reduced capacity of her stomach, which is contrary to the goals of getting the surgury in the first place.

What is worse than that is her near total lack of fruit and vegetables has given her a vitamin deficiency, which leads to her having very little energy. You she eats sugar so she can get more calories. Maybe so but it means she gets no vitamins. I think it's more important for her to increase her vitamins. Maybe vitamin deficiency is worsening her depression.

But if, as you say, she gets hungry all the time than she should have used the thing I used to lose 120 lbs. Phentermine. It worked very well for me. No surgury required but I didn't feel hungry on it. I figure it's better to have an appetite suppressant like Phentermine rather than bariatric surgery because you can still feel hungry after having bariatric surgery but on appetite suppressants you never get hungry.

It also had the effect of speeding up my metabolism far above normal levels, which also helped me to lose weight. I felt very energetic so I was able to exercise harder and longer than I normally can. In the first month I took it, I lost 37 lbs.

Since it worked so well for me I recommended it to Heather. She said she didn't think she can take it because she has the gastric band and she didn't think she could have both at once. If that is true then the doctor should have given her Phentermine instead of the gastric band. That's what my doctor did. He never suggested a gastric band, just put me on Phentermine. Even my Kung Fu coach says Phentermine is the best way to lose weight. He'd know because he has a PhD in sports science. He's a very smart man.She sees a psychiatrist regularly. She prescribed her antidepressants. I don't know what sort. The best antidepressant for her would be Modavigil. It is a stimulant. It would give her energy and make her want to go out and socialize more. Socializing reduces depression. It would also give her energy to exercise more. Exercise reduces depression.

I think the terrible thing about the psychiatric establishment is that many of the antidepressants are sedative. So in the short term they make the patient happy but they reduce her energy so she doesn't socialize, doesn't exercise and doesn't leave her room. In the long run this makes her more depressed.

Depression already robbed her of most of her energy but these sedative antidepressants robbed her of what little remained.

I think when the psychiatrists write a script they solve one problem but don't notice if the side effects cause another problem. Years ago they wanted to put her on an antidepressant known to cause rapid weight gain. This was when she was obese and she had already told the psychiatrist that her obesity reduced her self-esteem so the doc prescribes something that will make her twice as big? As for energy levels, I know from experience you have less energy when you're obese. After she found out it was the same medication they give to make anorexics gain weight she refused to take it.Of course I want her to have help but she's already seeing a psychiatrist. What other type of help can she seek?