You are to be commended for being there for your fiancé with all he has been through and he is very fortunate to have you. I have been through a lot medically during the past 4 years, and my wife’s support meant everything to me. It is my understanding that the Cleveland Clinic has some very highly rated doctors that deal with problem J pouches. A consultation there might be very beneficial. A low carb diet could reduce his gas problems and there are numerous posts on this board addressing that issue. As regards weight loss, I found diet supplements like Boost and Ensure helpful in stabilizing my weight after surgery and until my appetite returned. Issues involving depression should be brought to the attention of his doctor. I hope everything works out well for the two of you!