My long distance girlfriend is somewhere above 450lbs, complete shut in neet, and the biggest limitation that's made is for sure her mobillity. When we first got together she could walk 500m and even a little further without breaks, after 2 years of sitting on her ass, these days a quick 5 minute walk has her exhausted and gasping for air.
During my recent visit I convinced her to leave the house a total of 3 times in a 3 week visit, I had to get out on my own often just to make the most of the trip, while she'd lay in bed at home napping or playing video games. The other reason I needed to get out and some fresh air was because of something u noticed immediately, the smell... second I walked through the door, whole place smelled sickly sweet, she'd made a small effort to clean the place with assistance of her mother who came to stay, yet there was old recycling and bins everything, with open snack containers and old drinks littering her desk. This isn't even mentioning her own smells, sticky folds of fat she'd go days without cleaning, not uncommon for rashes to follow.
It really is the little things that surprise me, how much effort it takes her just to roll over or move around in bed, always followed by a series of grunts. She cooked a total of 2 times while I there, turns out her back is strained from her weight and lifestyle she can't stand without being in pain, always leaning on something when she has to. Shower chair is also a must by this point, all her clothes are old, baggy, and full of holes, but has no money for anything new, the entirety of her income going straight to almost exclusively junkfood.
Recently she's been having concerns about health problems, her family have a history of heart issues, and has been talking about what sounds like palpitations and other sensations around her heart, along with being frustrated at having become nearly immobile.