With this family, the complications arose from a niece who grew up with weight and diet issues. OP’s niece went through a trauma as a kid but did the hard work to heal and get through the emotional eating response. The niece was miserable, but her parents were adamantly against plastic surgery. When she turned 18, with the approval of her therapist, OP offered to pay for a tummy tuck surgery. Last year I decided that I would give her the tummy tuck for her 18th birthday as long as she cleared it with her counselor.