This seems to be a recurring theme: "Help! My obese friend is losing weight and I think it might be too fast!"
When they were eating enough to gain and maintain that weight did you feel compelled to play armchair dietitian?
Were you running around posting about how you're worried they'll pick up an ED even though BED is the strongly correlated to obesity?
Were you worried about the health risks of the weight the same way you're worried about the health risks of their weight loss?
Were you worried about the low energy and mood issues from excess food intake the same way you're worried it now with their reduced food intake?
If you did, congratulations, you're in a minority and a very open friend. Most people will say "No. I'm not a doctor and/or I didn't feel it was my place". And there's two common excuses for why they feel differently for weight loss:
"Well it's not sustainable! they'll just gain it back and then some!!!" — Regardless of method, a lot people will regain some weight after weight loss at some point. It sucks to hear that, but if there's anything that the many studies on long term weight loss have shown, it's that you need to confront the reality that there's a chance you will regain some of your weight lost, and need to try again, to keep your weight off.
A lot of us have gone through that cycle, and probably realize each time you either get a little closer to lasting transformation or you don't. If your friend is acting like you're killing yourself by dealing with the medical condition that's killing you, what are the odds that you'll be able to build up the mental capacity to keep trying it?
If all you get out of a weight loss attempt is negative feedback from those around you, and the scale rebounds, what's left to drive you for next time?
"I'm worried they're going to hurt themselves!!!" — The number one risk the CDC lists for obesity is "mortality". It increases your risk of death so drastically they need to use an umbrella term for "all causes of death".
The number one risk the CDC lists for malnutrition? Obesity. Followed by Type 2 Diabetes and Cancer, just like obesity itself.
If you draw a Venn Diagram of the risks of malnutrition and obesity, you practically get a circle. So your friend who's been eating to maintain hundreds of pounds of excess weight, has been taking the same risks you're suddenly concerned about. If anything the sudden change in diet, regardless of if it's sustainable, is a break for the stressors their body has been dealing with from excess food intake.
Seriously, not all of us here are losing weight to get a killer beach bod. When someone posts about their friend losing double digit pounds in a few months, I guess maybe there is a chance that this is a 140 lb person who just lost 40 lbs in two months and is about to be admitted to the ER... but it almost always seems like they're just dealing with obesity or morbid obesity.
And the reality is, obesity is not "some" excess weight. Those of us struggling with it are not going to have the same outcomes that a study on "overweight" people shares. We're past the point where you can argue maybe BMI is just a bad measure of body comp. There's less room for "it's just poor body image, you're actually fine". And that's why while you'll find 100s studies implying crash diets don't work... but if you look at obesity specifically, the most recurring treatments with results are "unsustainable" things like LCDs and VLCDs (https://www.nature.com/articles/0800355 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442323/).
The strategies that lose the weight and the strategies that keeps the weight off are not likely to be the same thing for us, and for that reason "drastic" diets like VLCDs do much better for long term weight loss than more moderate diets: https://pubmed.ncbi.nlm.nih.gov/11684524/
At the end of the day the best thing you can do for your friend is be there for them no matter which way things go, and if you're really worried about their health, focus on specific symptoms and not their general actions.
Don't say "you need to eat more" because you didn't see them eat or they seem hungry, at most point them to a doctor if they happen to share a specific problem with you. Sometimes this process going to just feel like crap, and sharing that fact doesn't mean they're dying or they need you to stop them. Sometimes they just need emotional support.
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