"death by a thousand cuts" is perfect!  Comorbidity is a difficult thing to explain to someone who doesn't WANT to listen in the first place. No, there is no direct causation, you will not drop dead immediately over a BMI of 35 but your RISK increases exponentially. And you will be sick, miserable and losing out on so many experiences.  About your question. I mostly can guess pretty well now, who will manage it. I don't have any medical/hard fact indicator though. The psychiatrists  are extremely good at predictions which also supports my theory of an addiction/mental illness pathology behind all this.  The fats who make it are: ashamed. Often humble. Disciplined  on some other level or area of their life (dedicated to their job or family, something like that) so they know how to pick up responsibility. Massive food intake is sometimes their only weakness. They are intelligent enough to learn.  They just needed a bit of guidance, hope, whatever.  The ones who don't make it have never ever learned that nothing in life is for free. That there is no easy way out. That surgery is not an easy way out, it's just slightly easier that dieting because we are tricking physiology for you. They can't muster the energy or discipline.  And the ones who have loads more problems in life that "just" obesity. They get overwhelmed by drug-addict families, criminal "friends", losing jobs, caring for sick parents, spouse or children dying.. They can't focus, can't keep their appointments, pay the (small) fees for treatment.. Drop out Oh and the stupid ones. They are hopeless. Some people are so unbelievably stupid, you just lose faith in humanity