What would you say?

I would say nothing. It's not my business, and I'm sure the person has had more encounters, confrontations, insults, etc than they care to have had with perfect strangers about their weight, whether it be in the form of rudeness or well-meant "caring" comments. It's nice that you want to show somebody that you care, but honestly, I don't think it would be very often that a person would accept being approached in such a way. Just my thoughts.

Obviously, the idea of walking up to someone and saying this out of the blue is contrived, but I'm a physical therapist and when I talk to patients about their weight, I always make sure to tell them that their weight is not the only thing that is causing their pain.

So many health care providers blame everything on weight. My mom was morbidly obese, well over 300 lbs before gastric bypass, and she has never had high cholesterol, high BP or been pre-diabetic. My dad on the other hand is 5'9", probably about 165 lbs, and does have high cholesterol and high BP.

That's not to say that weight doesn't contribute, but I find that patients have been told it's "all my weight" so many times that they start to feel hopeless. Most of them don't want to be overweight, but they don't know how to change it. So blaming other issues on weight alone just isn't productive, even if we know there's a link.

I always ask if the patient has depression or a painful past that makes them overeat. If they do, they are usually very relieved that someone finally asked. Obviously, that's not my area to treat (wrong kind of therapy!), but just acknowledging that can be huge. If they don't think that's the issue, it's important to figure out what the issue is. Sometimes, I can do that... sometimes they needs a nutritionist or a counsellor. They don't always take my referrals, but when they do, you can see some big changes.

For me, the biggest thing is to not make a stigma out of their weight. I treat it a lot like any other medical condition... you can't treat it without knowing the cause and the appropriate treatment regimen. "Just stop eating so much" is rarely the right treatment, but I think it's the one most often used by front line providers, which is too bad really.

I wouldn't say anything, but with non-verbal cues would let my friend know what we both know. Change or die early.

As for the fiance part, that is even tougher. Anything you say is nagging, but his problem will be your problem. It goes beyond weighing food. You may be a very young widow.

Exactly that. My approach is, and my fiance knows it:

I am terrified of being alone at a relatively young age. I know it's going to happen, and I'm already taking precautions including building up my own private savings and looking into mortgages (on the off chance that we ever can afford a deposit) that allow the debt to be wiped if one person of the couple passes away. However, my utmost concern is for his happiness. If the choices are between having him for a long time, knowing he's struggling with his weight and isn't living life the way he wants, or losing him when we're both young but being able to console myself with the fact that he was happy just eating junk food, watching TV and playing games, I'd far rather the second one. Being alone early is something that haunts me daily now that I'm living a healthy lifestyle, but it's likely to happen and I want to be able to sit on my own in thirty years and know that he didn't spend his days feeling tortured by forcing himself to be healthy if he didn't have the right motivation.

If you don't have a real relationship with the person, anything you say will be (rightfully so) seen as easy judgement without knowing their story.

Everyone has a story ...

If you "do" have a real relationship/friendship, it's up to you (knowing the relationship) to decide when and if you say something ... only you will know who and when.

There's a man that started working out at my gym that I would guess is around 400-500 lbs. I want him to know that I cheer inwardly for him, that I respect the mental strength it takes to walk through that door every time.

And yet if someone had come up to me and said ANYthing when I started (5'3" and almost 300 lbs) I would have been mortified - and likely never gone back in again. I didn't want to be singled out, pointed out, noticed - and I still don't. The things that drove me to that point are so very painful - I don't want to look at them myself, much less have others "know" something about it. That's what keeps me from talking to the guy, or anyone, really.

I think if they're ready and willing to let others in, they will initiate the conversation. But please please please don't look over with sympathetic, pitying looks.

Am I the only one that finds this question remarkably condescending? Obese people have the internet too. They can learn how to eat healthy and make changes if they want to, just like you did. And the fact that they're still obese doesn't mean they don't know everything you know. We all make unhealthy choices sometimes, even when we "know better." Obese people don't need you to tell them anything.

Obviously, the idea of walking up to someone and saying this out of the blue is contrived, but I'm a physical therapist and when I talk to patients about their weight, I always make sure to tell them that their weight is not the only thing that is causing their pain.

So many health care providers blame everything on weight. My mom was morbidly obese, well over 300 lbs before gastric bypass, and she has never had high cholesterol, high BP or been pre-diabetic. My dad on the other hand is 5'9", probably about 165 lbs, and does have high cholesterol and high BP.

That's not to say that weight doesn't contribute, but I find that patients have been told it's "all my weight" so many times that they start to feel hopeless. Most of them don't want to be overweight, but they don't know how to change it. So blaming other issues on weight alone just isn't productive, even if we know there's a link.

I always ask if the patient has depression or a painful past that makes them overeat. If they do, they are usually very relieved that someone finally asked. Obviously, that's not my area to treat (wrong kind of therapy!), but just acknowledging that can be huge. If they don't think that's the issue, it's important to figure out what the issue is. Sometimes, I can do that... sometimes they needs a nutritionist or a counsellor. They don't always take my referrals, but when they do, you can see some big changes.

For me, the biggest thing is to not make a stigma out of their weight. I treat it a lot like any other medical condition... you can't treat it without knowing the cause and the appropriate treatment regimen. "Just stop eating so much" is rarely the right treatment, but I think it's the one most often used by front line providers, which is too bad really.

I don't have any serious health issues (only PCOS really), and though I was considered morbidly obese at 270lbs, never felt like I was...it was very frustrating to always have my weight brought up at the doctors. It seemed like no matter what I went in for, check up, cough, boob exam it all came back to "the talk" about my weight, and how if I lost weight I wouldn't have any problems (so apparently I would never catch a cold?). Sorry to take your post and go on and off rant, but I when I read it I remembered the frustration.