My 600 lb. Sister-in-Law

It is very sad.  I'm so sorry.  I used to weigh well over 700 pounds and that alone was horrible, even without mental illness.  

There really isn't much you can do other than protecting your husband and yourself as you already are.  Keeping good boundaries and not allowing yourselves to be abused, while still being compassionate, is vital.  If she is calling you too much, many crisis lines do supportive counseling.  One option is to direct her there for some more support.  

I don't think she would ever get approved for surgery if her illness prevents compliance or self-care.  It can't hurt for her to see a surgeon, as it might start a process where she does get the care she needs.  If she's in supportive housing (I am a counselor and know exactly what you mean), I'd encourage her to talk to her case manager about that.  Where I work the case managers help organize medical care.  If she has Medicaid they also often have case management services and would be able to help get the process started.  That way you don't take the responsibility of it on your shoulders.  In fact, I would advise not doing so, if the relationship is already strained.  

I hope things work out as well as they can!

Thanks, Meep. You've got it - supportive housing - that's what it's called!  She's on Medicaid and does have a case manager, but she's probably not on the best of terms with this person either.  I'm very glad that DH has clear boundaries set with her and learned many years ago to not take on too much of her issues.  I try to just follow his lead and have learned a lot about boundary setting from watching him in action.  

Your success with WLS is amazing and your comments are always so helpful!  PS:  I grew up in the Palos area, but now live in Virginia. :)

Aww, thanks :)  And hey, that's so neat!  I actually would gladly trade you for Virgina in the winter months!  Beautiful country out there.  I'm originally from New Jersey.  It's interesting where we end up!

You're definitely on the right track, though. There's also a huge correlation between being severely mentally ill and obesity.  Quite a few schizophrenics and individuals with more severe developmental disabilities often become obese, both from a combination that's often made up of neglect, their medications, and poor executive functioning.

I feel very sad about your sister-in-law, but as other people said, mental illness truly affects the whole family.  It is why it's so painful to deal with the comorbidities here.  I know it must be doubly hard for your husband, especially with his father being so very ill.  I will definitely keep you all in my thoughts.  I'd definitely suggest guardianship, but that becomes tricky especially with older parents.  I also often will suggest someone acts as the payee.  I mean, not to be morbid, but we see this all the time - no one sets anything up for their children, and then bad things happen, and people end up homeless.  Rather than giving her money directly, they should consider setting up a special needs trust for her.  That disburses money regularly and not on demand, so it would help offset that, somewhat.  

A family member should also check the staff and the apartment, to make sure she is getting her needs met.  For example, here at work on the residential side (I work in crisis intervention) one of the clients here with a severe developmental disability and very low IQ was making her grocery lists and they had only potato chips on it.  Like, the whole grocery list was just 30 bags of potato chips, and the staff actually bought them even though she was on salt restriction (the fact that she needs to eat more than just potato chips being the point as it is.....)  Your SIL may not get along with the case manager, but we are trained to be accepting even with difficult clients.  If she truly wants help, a good case manager won't turn her away.

It's a very hard situation to be in, though, she must be severely enabled.  I see things like this all the time, though perhaps to not as high a degree of weight.  Using just myself as an example, when I was over 700, eating was actually super expensive.  I definitely would not be able to maintain that on just disability and food stamps.  I was eating over 7,000 calories a day, and that costs money. Like, hundreds of dollars a week of money, to gain it by 45.  I think what may happen is as her parents become more infirm, the money (it does sound like there is money being sent/given/etc) will reduce - cancer is expensive, even, perhaps especially, if her father is on Medicare.  They definitely should make a plan or discuss what the plan is with the agency, though.  At any rate, I predict a breakdown because she will lose the food as a coping mechanism.  I wonder if they have addressed the food issues in her mental health treatment?  Medications will cause weight gain, they stimulate appetite and others affect the metabolism more directly, but nowhere near that much weight.  Something is fishy.

I know she is difficult, but my heart aches for her.  I will keep her in my thoughts for sure.  Perhaps she will be able to get the "spark" to inspire her to change.  Even if most of it isn't reversible, there is a LOT that can change for the better.  I'm actually surprised how mobile I am now, even needing a knee replacement, and I'm 39 now, so our ages aren't that far apart.  

You sound like an amazing and compassionate person.  It's wonderful you are there for your husband through all this!  I wish you both the best. :)

Thank you for sharing more of yourself, Meep!  You've got some great insight into this, and I appreciate it.  It helps to be able to understand it a bit better.  It's so inspirational to know that you're working so hard to make your life better.  

I've always thought something is fishy and I wouldn't be surprised if her parents provide her with the extra money (with varied excuses) and she buys more food.  I think she has VA benefits as her ex husband was ordered to provide her with some support in the divorce. Maybe it's not medicaid at all, I'm just not sure.  But somehow she has some money.  He was disabled from the military.  I know her parents (esp. dad) feels guilty that she is this way.  I didn't really realize that she would need to eat THAT much in a day, but it does make sense.  I think her Drs. would have to at least try and address her food issues.  She does move between doctors pretty regularly, either they can't handle her, or she pushes them away.  But, there's only one hospital here that has a psych ward, so she's kinda limited that way.  Her parents have refused taking on guardianship for many years, and that's not going to change.  My heart aches for her too, and at times I do struggle with keeping the boundaries in place, but DH is really good at it, and when I talk to him he always sets me straight!  We're a good team.  

I have both my knees replaced at 45 and 46, it was the best thing I ever did for myself - well, that and the RNY!

Mental Illness effects everyone in a family. If she is in disabled housing, and as you said a frequent flyer on the psych unit, there are people who know her number, and there are people to help her. This is beyond anything you and your husband can step in and do. You can love her as best you know how. Don't worry if she sees a Bariatric Doc, it is their responsibility as to whether she is fit for surgery or not. I am saying this as someone who has worked in Mental health for almost 40 years.

It is very sad. Take care of yourself. Prayers and Hugs....

Five words I try to live by that you may find useful:

DON'T LIVE SOMEONE ELSE'S DRAMA

I am sorry that your SIL is in such a bad situation (and it does not sound like there is anything that can be done). I am glad to hear you and your husband are on the same page and sound like a good team. From my personal observations, couples who are not in agreement over how to handle tough family situations like yours are the ones who have problems.

Hugs!!