How do they look at themselves, then look at other (human sized) people, look at themselves again and not possibly  realize that,  hey, maybe they're in the fucking wrong? No. I think they do realize.  But they're so overcome with shame at what they've done to themselves that they won't take the blame for it. They'll blame it on skinny people for making themselves skinny instead of bending over backwards to accomodate something that doesn't even belong there.