I haven't read all the answers. I was your daughter at 19, in the late 1980s. The fat friend. I was (am) by nature a cheerful, positive person but being overweight at 19 made me miserable and embarrassed, and I was seemingly unable to do anything about it. I tried everything, normal diets, Weight Watchers, Cambridge diet (paid for by my mum) but I could only ever last for about 3-4 weeks maximum, never lost more than a couple of pounds and the overwhelming urge to eat ice-cream, chocolate, cake, was always more powerful in that moment (not in the long-term, I desperately wanted to be slim) but in the moment the ability to delay gratification was just non-existent. I just wanted the sweet treat more. We now understand this as food noise. I thought it was gluttony and a lack of self-control. I felt such shame and humiliation.
My mum (and dad to an extent) didn't know how best to help me. I'd moan about it, cry sometimes, and my mum would even try bribing me as she knew how unhappy I was. "After you lose a stone I'll buy you some new clothes" or she'd offer to give me money towards a holiday etc. My dad once told me that I needed to lose weight before leaving uni as I wouldn't do very well in job interviews as people would make assumptions about me. Their words crushed me but I forgive them, they were doing their best.
When I was 21 I was diagnosed with PCOS. Is that a possibility for your daughter? Back then (before the internet) you were given a sheet of A4 and just told to get on with it. The doc basically just said come back if you ever want children, and you'll probably struggle with your weight on an ongoing basis. Try and eat less. See ya!
I'm mid-50s now. My weight has been the dominant 'feature' of my adult life. I've spent from my late teens to very recently yo-yo dieting, managing to gain and lose a few stone on repeat, but never being anything less than a size 16. Spent most of my life as a size 22-24. It has really affected my life. The shame and humiliation has never left me. I've always felt less than, in pretty much every aspect of my life. I've been super-fit (have run three marathons, multiple halfs and 10ks in my thirties before injury put paid to that) but I've never been slim. I'm a good person (I like to think), I've excelled academically and have a great job and great friends and in many respects a great life, but it was all tainted by being fat and feeling a failure. Why could I just not achieve this one thing that other people found so easy?
Boringly, as most of these stories go, yes, I am now on mounjaro. I've lost six stone and am now slim-ish. I lost it painfully, painfully slowly - about 2lbs per month prob due to being menopausal and having PCOS. I'm still on it. Have another stone to go, and then will remain on a low dose.
I think about how different my life could have been if I've had the opportunity to do this at 19. I know some people will baulk at this, but I'm speaking as someone who was like your daughter at 19 and remained that way for another 35 years. I think about how carefree I could have been in my 20s, enjoying nights out with my friends, rather than dreading every event and shrinking in the corner. I think about how I could have gone clothes shopping in normal shops and not had to buy everything I owned from Evans. I think about holidays, pretending I didn't like swimming or sunbathing, so I wouldn't have to wear a swimming costume. I think we know enough about obesity now to know that, while lifestyle changes are the ultimate answer, some people are just not able to maintain them. Otherwise yo-yo dieting would not be a thing, and we'd all be slim.
I have only been able to maintain those lifestyle changes due to this new, enormous cavern in my brain where the food noise used to be. For me it's been the equivalent of having 36 hours in every day instead of 24. A whole new world of time and space to make and embed those changes. I don't think because someone is only 19 they should be denied this opportunity, though I appreciate others will strongly disagree. But I'm just saying, I wouldn't rule it out. I would maybe research it, and consider the fact that she may also be able to make the same changes once she doesn't have the chocolate demon breathing down her neck. Then weigh it up against the quite strong possibility that she just stays on the same trajectory she's on now and nothing changes. And she spends the best years of her life feeling inferior and unhappy.