When you're that big (and never stopped along the road to ask yourself "why") there must be some sort of psychological problems ingrained in their mind. Take Tess for example, with her mother being abused/shot.  Still doesn't excuse their bad choices. Personally if I was queen in an utopian world I would forbid Healthcare to someone past a certain BMI number (probably below a certain one too) - they'd be redirected to professional help (dietitians and gym, primarily) so they could have access to Healthcare again and once they reached a healthy weight. /rant (I'd eventually have my head cut by a revolutionary movement of fats)