Thank you for your original heartfelt post and your direct and honest reply.  I have a close friend who started becoming obese right after high school, had open heart surgery around age 30, continued to get obese, had a pacemaker installed around age 40, and he kinda tries to lose weight now and again but I think his BMI is about 50.  It breaks my heart to see him do this to himself, and I've tried to be constructive in helping him but he gets mad and I realize that nobody can make him see the light - I mean, actually he does see the light, but it doesn't last.  He had a lap band surgery about age 45 which went well, but he learned how to overeat despite it.  He sometimes chokes on his food but it doesn't stop him.  He has hypertension and I can't believe it but he doesn't have diabetes -- yet.  Maybe because he's a blue collar worker and gets a lot of physical activity that way, but when not at work he's not very active.