My friend has become obese. Should I intervene?

My boyfriend of 50 years recently became morbidly obese. She must now be over 100 pounds overweight on a very small frame. She has great difficulty breathing and her legs are bent outward because they have been crushed under her weight. She can no longer perform simple household tasks such as cleaning.

I love my girlfriend and have tried several times to talk to her kindly about her deteriorating condition. But in vain. She says she can’t afford the new diet drug-by-injection that everyone is using; she has given up trying to lose weight any other way.

Food is her medicine. It’s clear she lives for it like an addict would. She steadfastly refuses to talk to me or her family about it. She apparently sidesteps the problem when she talks to her GP, and nothing ever changes: Her weight continues to rise.

I’ve been thinking about approaching her kids about this. But if that doesn’t work, and the kids tell my friend that I tried to intervene, I’m sure that would be the end of our friendship. She has said to me, “Don’t talk to me about this.” What can I possibly do to help her? I watch her slowly commit suicide. – 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 impairs her ability to perform certain ordinary functions of daily living, and puts her at serious risk for debilitating illness and premature death. Of course you worry; any friend would be.

But you don’t tell her anything she doesn’t know. The cost of the promising new weight loss drugs may be something of a red herring on her part. Insurers, public and private, generally cover medically necessary bariatric surgery, which is significantly more effective than the drugs. (Surgery carries the risk of major complications, but the dangers of living with grade III obesity are greater.) There are forms of therapy that address eating disorders, including binge eating, associated with severe obesity. In any case, a competent primary care provider will have already 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 failed, that’s a risk a friend should take. Still, they can definitely see that she’s suffering because of her obesity, so a safe assumption is that they’ve already tried to get her to seek medical attention – and that she told them what she told you.

Unlike her GP, you have no special knowledge of complex conditions. (One such complexity: the vicious cycle that can develop 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 matter with her. As someone who cares about her, you naturally have reason to want her to get healthier. But you can’t insist.

When the time comes for her to throw open the door to a conversation about her health, there’s plenty of good advice out there (including from the federal site health.gov) on how to get into it – focus on her well-being, not her eating habits; avoiding debugging, judgment and embarrassment; talk to her, not to her. I’m glad you made it clear that you care about her well-being and that you want to help her the best you can. I wish she listened to you. But as her friend, you also need to listen to her – and pay attention to the boundaries she has set.

Readers respond

The question in the last column came 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 capabilities but is also the most narcissistic person I know. … Am I wrong to seek love, intimacy and companionship with another woman? My wife had affairs when we were married.”

In his reply, 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. However, it sounds like you don’t think she’s going to rid you of them. … You say that there has been no love between you for the past ten years; is this also her perspective?” (Reread the full question and answer here.)

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My 87 year old husband had dementia, and I, 11 years his junior, had a smart, kind, loving boyfriend. No one suffered. Life is there to be lived. — Marian

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

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I would also advise the gentleman to speak to the social worker at his wife’s home. We often fail to see through our own emotional clouds, and a professional can provide strategies to work in everyone’s best interest. — Jan

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My curiosity lies with what the man said towards 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 be entitled to have relationships now? Is there a deeper grudge than just being in a nursing home? — Angela

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This is a perfect one 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 husband 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 must make your decision. — Dennis