Man Is Concerned His 650 lb. Sister Is Slowly Dying

We come across a lot of devastating posts on Reddit's Relationship Advice subreddit, but this might be the saddest one yet. A man is seeking advice for how to deal with his twin sister, who's 650 lbs., facing extreme health issues, and seemingly unwilling to even talk about it. 

Last month, he explains, his 33-year-old sister had a heart attack. "This was after a small stroke she had the year before too," he writes. She called 911 and was taken to the hospital, but she doesn't seem to realize she almost lost her life and eventually will die if nothing changes. 

He writes, "She still refuses to move, she spends most of the day/night in bed almost completely immobile at this point. I try to get her to just take a few steps in her room and she refuses." She refuses to walk, see a therapist, or go to the doctor unless her life is in imminent danger. 

She only eats junk food, and there's a couple who lives across the street who buys her whatever food she wants. OP's whole family has tried everything and is at a complete loss for what to do next.

His parents are increasingly unable to help because his dad has early onset dementia and his mom went back to work to help pay for his medical care. His brother and family live too far away and have a little kid, so they don't have time to devote to her. 

OP has pleaded with the neighbors to stop enabling his sister, but they really see her as a "surrogate daughter" and give in to her requests for junk food. His sister has threatened to kill herself if she didn't get a certain food. 

When she was at the hospital for her heart attack, the doctor told her to her face "that she didn't 'almost die,' she 'IS dying' and will be dead by the end of the year if she keeps going like she has been." But she refuses to make any changes. The situation is dire, and he doesn't know what to do. 

It's starting to wear on his mental health. Toward the end of the post, he reveals that she hasn't always been like this, that she ate normally until her mid-20s. In my mind, this points to a trauma or a sudden intense depression. And the fact that she has threatened to kill herself before points to severe mental illness. 

Although everyone around her seems to recognize this, she refuses to acknowledge anything whatsoever is wrong. She clearly needs to talk through whatever happened to her with a therapist, but she won't even take that small step. Not knowing what else to do, he appealed to Reddit. 

"OP," one commenter writes, "you may want to check with your local city/county/ state Adult Services and see what resources are available. Your sister is clearly unable to care for herself independently and has had at least two life-threatening events. She may need to be declared at-risk and professionally assessed in order to receive some care."

If someone was cutting themselves or inflicting physical harm on themselves in any other way, you would take them to the hospital for a psych evaluation. This woman is basically doing the same thing. She's self-harming. The fact that she's doing it with food doesn't make it any less serious or any more her "fault." 

The problem is that, because she's an adult, she could possibly refuse these services, and he might have to go to court to prove she cannot take care of herself. These sorts of situations are really restrictive, and there's no guarantee he would win and be able to force her to get help. 

Ultimately, as one commenter put it, "I think this is beyond Reddit's pay grade and you need a professional therapist / intervention specialist." Even if she won't see a therapist, OP should see one to help preserve his own mental health. 

A therapist could refer him to the best course of action, but most importantly, they could help him navigate his feelings and make sure he's in the healthiest space possible to help his sister when she decides to accept it.