If her gender dysphoria was that severe, Jay would lose weight to be able to get the surgery. I think they are talking about the rare instances when a super death fat is in such dire condition that the docs determine that surgery risks are lower than risks of being a fat fuck for another year. If that even happens. Even gastric bypass takes a while to provide results. A super low calorie shake diet would be more likely if the patient really needs to lose weight fast for another life saving surgery or to save a leg.