Ok, so I've always been a heavy guy. Lately, a really heavy guy. So last December, I took the plunge and had gastric bypass surgery. I started the process at 411 pounds and was down around to around 390 when I hit surgery. Consider it the ultimate 'case mod'. You can read a lot about the surgery (including stories of people who didn't survive it) on this page.
I have survived and I'm down to around 300 pounds now. It is a big surgery and a big life change, but I am doing well with it.
I'd be willing to talk to anyone about the procedure if they are interested. There have to be at least a couple people here who want to drop some weight and have failed at all the diets. Email me with WLS in the subject line or post here if you want more information.
When you are working hard, get up and retch every so often.