They are lying to themselves, absolutely true. How can someone be happy when you get out of breath climbing 1 flight of stairs? How can you be happy when you have to use tarps instead of clothes.  How can they look at the mirror and find happiness in an amorphous reflection? How can you be happy when standing for 5 minutes makes your body ache? How can you be happy with HBP, diabetes, etc? It's an act.