Mental illness, my friend, mental illness. And the problem is, people who look like this to a lesser degree think it's "ok", but actually it's not. It's not ok to have to "buy a size up" because you gained 30 lbs, it's shit, it's unhealthy, it's unacceptable. You don't have to have a stomach her size to suffer from fatty liver, you just need to eat nothing but carbs, carbs, and more carbs. But those people, like her, look in the mirror and say "well, it's not THAT bad". That's what they do, they simply stubbornly deny reality.