My Friend Has Become Obese. Should I Intervene?

Health Information Lifestyle

My friend of 50 years has recently become morbidly obese. She now must be 100-plus pounds overweight on a very small frame. She has great difficulty breathing, and her legs are bowed out from being crushed under her weight. She can no longer perform simple household tasks like cleaning.

I love my friend, and have tried several times to speak to her gently about her worsening condition. But to no avail. She says she cannot afford the new diet-drug-by-injection everyone is using; she has given up trying to lose the weight any other way.

Food is her drug. It is clear she lives for it as an addict would. She steadfastly refuses to talk to me or her family about it. She apparently skirts around the issue when talking to her primary-care provider, and nothing ever changes: Her weight continues to go up.

I have thought about approaching her children about this. But if that doesn’t work, and the children tell my friend I tried to intervene, I am sure that would be the end of our friendship. She has told me, “Don’t talk to me about this.” What, if anything, can I do to help her? I am watching her kill herself slowly. — Name Withheld

From the Ethicist:

Your description suggests that your friend has Class III obesity (“morbid obesity” is no longer the clinical term), a chronic, complex condition that is impairing her ability to carry out certain ordinary functions of daily life, and putting her at serious risk of debilitating disease and premature death. Of course you’re concerned; any friend would be.

But you’re not telling her anything she doesn’t know. The cost of the promising new weight-loss drugs is perhaps something of a red herring on her part. Insurers, public and private, will generally cover medically necessary bariatric surgery, which is substantially more effective than the drugs are. (With surgery comes a risk of major complications, but the perils of living with Class III obesity are greater.) There are forms of therapy that address eating disorders, including binge eating, associated with severe obesity. In any event, a competent primary-care provider will already have informed her of her medical options.

As for the risk of approaching her children? If you think they have a good chance of succeeding where you have failed, that’s a risk that a friend should take. Yet they can surely see that she is suffering because of her obesity, so a safe assumption is that they have already tried to get her to seek medical help — and that she’s told them what she’s told you.

Unlike her primary-care provider, you have no special knowledge of complex conditions. (One such complexity: the vicious cycle that can arise between depression and obesity.) You may not be the right person to make a difference here. She has explicitly asked you not to raise the issue with her. As someone who cares about her, you obviously have reason to want her to get healthier. But you can’t insist on it.

If the time comes when she cracks the door open to a conversation about her health, there’s plenty of good advice out there (including from the federal site about how to get into it — keeping your focus on her well-being, not her eating habits; avoiding fault finding, judgment and shame; talking with her, not at her. I’m glad you’ve made it clear that you’re concerned about her welfare and want to be helpful however you can. I wish she’d listen to you. But as her friend, you also have to listen to her — and take notice of the boundaries she has set.

The last column’s question was from a reader whose wife was in a nursing home. He asked if he could take a lover: “My wife will never leave the nursing home. She has full mental capacities but is also the most narcissistic person I know. … Am I wrong to seek love, intimacy and companionship with another woman? My wife has had affairs while we were married.”

In his response, the Ethicist noted: “If you and your wife were willing to release each other from your marital obligations, there would be no moral reason not to seek a relationship elsewhere. It sounds, though, as if you think she won’t release you from them. … You say there has been no love between you for the past decade; is this also her perspective?” (Reread the full question and answer here.)

My 87-year-old husband had dementia, and I, 11 years his younger, had a smart, kind, loving boyfriend. Nobody suffered. Life is there to be lived. Marian

The letter writer has a strong sense of loyalty to his marriage, if not much empathy for his institutionalized spouse. Telling his wife about his needs first and then proceeding to meet them seems reasonable, regardless of her agreement. — Caroline


I would also advise the gentleman to speak to the social worker at his wife’s home. Often we do not see clearly through our own emotional clouds, and a professional can provide strategies to work in everyone’s best interests. — Jan

My curiosity lies with what the husband said toward the end of his question: He said his wife was unfaithful. Assuming this is something from his wife’s past, is he saying he should have the right to have relationships now? Is there deeper resentment than her just being in a nursing home? — Angela

This is a perfect existentialist dilemma. You want someone to give you permission, but only you can give yourself permission. You want to have your cake and eat it too (be a faithful, loving spouse, and have a lover), but you can’t have both. You are, as Sartre would say, condemned to be free. You can take a lover, but you have to deal with the guilt that comes with that choice. You have to own your decision. — Denis, GO TO SAUBIO DIGITAL FOR MORE ANSWERS AND INFORMATION ON ANY TOPIC

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