So your post sounds just like me...add a few advanced nursing degrees AND the fact that I had RNY done 25 years ago to make me feel like even more of a failure. I'm back going through the process of considering a revision to my original surgery at my highest weight ever. IF insurance will approve. While it would be awesome to get a total do-over with the RNY process (not just the reducing the stomach which is essentially what I'm not a candidate for) I don't regret my decision 25 years ago. I am sad that back then there was little/no follow-up, no real rules on diet/caffeine/timing of water intake/etc --maybe I'd have had better long term success. BUT I did lose just over 100lbs. Felt better than I had in my entire life and did more than I'd ever done - travel, marriage, shoppig in normal size clothing stores, etc. I have been morbidly obese since 6th grade and overweight since I was 7. That surgery got me closer to "normal" than ever.
No diet I did before that or since then has been so successful- a year long protein shake diet did result in 70lbs lost but then I regained all + some much faster than after surgery. But, I realize now that I half-assed the process and expected that it would just magically work on its own. I'm sure deep down I probably still sort of think that way.
I'm older have a couple kids that wish mom was more active and am restricted from doing things because of my weight and that makes me sad.
This time I'm throwing everything at it...sort of feel like it's my last ditch effort. After my mandated psych eval for surgery I opted to continue working with the counselor who specializes in all types of eating disorders and am seeing a bariatrician who will prescribe WL meds. I've long thought until someone fixes the chemicals in my brain WL will never be long term, so I believe in meds. I'm taking the process so slow unlike in the past where I jumped into huge lifestyle shifts that were only sustainable for short-ish periods of time. I didn't even start a legit "diet" until just this week even though I've been going through the pre-cert process since October...and it's not really a diet- just replacing one meal a day with a shake per the changes prescribed by the bariatrician. On the advice of the counselor I've been setting one really small goal each week that is hopefully attainable and I'm able to maintain.
Who knows what will happen with the WLS approval process. I'm hopeful the other adjuncts I'm working on will help me be successful for the long term. IF surgery is approved, it's really just another piece of the WL puzzle though a really nice one in terms of the ability to lose weight rapidly. It's up to me to keep it off though.