The argument in https://i.sli.mg/cCmxDZ.png is that the show is fake somehow, but in reality it's very accurate to ham behaviors seehn on Tumblr.  Like the 400-pounder in this album, Sean in Season 4 Episode 12 complains that he's "starving" on an 800-calorie diet, saying that he "has no idea what 800 calories would even mean in terms of real food"--so he gains a lot of weight after Dr. Nowaradzan sends him home with a diet plan. If anything, it's delusion fuel for fat TLC viewers because the enablers who take care of the 600-pounders are never held accountable for their morbid obesity.  Instead of being healthy being the goal, being obese-but-not-confined-to-a-bed is the goal.  The reality is that even the weight of Sean's mother or Penny's husband is very dangerous for your health, which is why humans are hardwired to find people who look like that repulsive.