When you fuck up your insulin levels beyond repair so that you always feel hungry and never feel satiated. Overtime you also elongate your stomach so the sensory sites that gauge fullness based on volume are not responsive. Then consider the level of fat at the midsection is so vast that it is interfering with hormone response, worsening everything.  The science is pretty straightforward and anyone with a basic understanding of nutrition and human anatomy will know eating irresponsibly overtime will fuck you up. For them they are as backwards and anti science as it gets and they will expectedly die thinking that it was "fatphobia" that killed them.