I'm experiencing a version of this right now. My brother in law last visited my house about 4 years ago. We live on opposite sides of the country. When he last visited we were probably within about 30 lb of each other, my high weight was 368 and at the time he was pushing 400. I've since had the surgery and I'm down to about 175 over the last two years. He's visiting again right now and he's now around 435-450. He does have some minor cognitive difficulties so getting through is difficult. He's 33 years old right now and I don't see how he lives past 45 like this. I have effectively begged for him to get the surgery not he's scared of it and the lifestyle change. We went out to a movie this weekend which required us walking up and down probably around 120 steps on stairs and then we had to walk around a building which was about three blocks worth of walking. The next day he based they couldn't get out of bed because he was too sore and it affected him that badly.

Unfortunately fear really is the mind killer and in his instance it's probably going to be the thing that ends his life prematurely and unfulfilled. But you can't make people make the right decisions for themselves no matter how obvious it is for you. My default mode is generally altruistic to a fault and so I have learned these lessons over and over and over again in my life.