I'm pre-op too and have similar questions; I actually went back and forth two times (scheduled consultations twice and backed out) and tried losing weight on my own. Somewhat successful....but VERY VERY slow weight loss. Like 4lbs in three months. I was doing weights though, so I know I gained a lot of muscle. Then my doc had me focused on cardio, which didn't do much. Most everything is based on the diet anyway. I lost 10 lbs on a medication she put me on, basically made me not eat. Then I gained 6 of it back. Third time around, she sent me to the bariatric surgeon. Yes, you can do it on your own, but it is SO VERY HARD to do with having kids (I have three) a hubby and a job, etc. I do my best to incorporate healthier foods for my family. My husband eats it, but my kids won't touch anything. I have to sneak stuff in to their food, or they can eat Cereal. But anyway, the surgeon told me that "Sure, you can lose the weight all on your own, but realistically, only 2% of people who lose over 100lbs on their own, actually keep it off. The rest of them eventually gain some or all back." Which makes sense to me, because if we're overweight, it's usually from a lot of dieting and/or eating disorders. Usually. As for skin, I'm not really too concerned, even though I do want plastics , if it's going to be the case. I look at it from the standpoint of my health is WAY MORE IMPORTANT than my looks these days. I'll be near 40 and I just don't really care too much on the outside as much as I would have if I was still in my 20's. I'll be healthier for sure, that's what counts for me. Social gatherings...I've just decided to condition my mind that food is fuel and yes, I'll be able to have a few treats here and there further out, so it won't have such a negative impact on my social life. But it will also make me not focused on the food and more on my family and friends. As for shakes, I saw someone post a website for people to see if their insurance covers Protein shakes for them....it's www.insurenutrition.com and there is another one for supplements, www.nascobal.com. Check out the websites and see if you can get free or reduced costs for the things you need.