The procedure could be performed, and I have specialized techniques that can obviate some (but not all) of the inherent risks in operating on an obese patient. But a bigger part of the art of surgery is knowing who to operate on. A special snowflake that refuses to even shake my hand is a big red flag. Said patient will likely wipe their ass with any and all of my post-surgical advice, won't participate in PT, won't lose weight postop, and will essentially set themselves up to fail. In this case, the only winning move is not to play.