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It's the idea that "I don't have any serious ailments RIGHT NOW, therefore being 400lb overweight ISN'T UNHEALTHY!!"
Yeah, if I start smoking 2 packs a day, and don't have lung cancer in 2 months, SMOKING IS HEALTHY!!!!
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More like, no serious ailment that they have yet been diagnosed with.
There is almost zero chance that anyone that grossly obese doesn't have a fatty liver, which would mean increased enzyme levels and could also mean a whole host of issues. If said obese person has a body with a good HDL to LDL cholesterol level and overall good cholesterol level that would be a miracle.
Type 2 diabetes is also a serious concern for those individuals. The obese "models" they often show are young people who are likely still in their 20's. I doubt many of them will not be diagnosed with Type 2 diabetes by their 30s.
I can't imagine the amount of pressure placed on human organs and the skeletal structure with that amount of weight. If they can actually walk unassisted for any moderate distance I'd be amazed. Again, many of the morbidly obese people that the media shows are young individuals, if they're under their own power right now they will not be very soon as they'll find themselves confined to scooters or wheel chairs to get around.