On some level she knows she's in trouble, it's why she didn't want to go on that 10 mile bike ride with the bike shop guys. I just don't know why she's wiling to humiliate herself at a dance a thon and not at a bike ride, what difference does it make really. I remember an episode last season where her dad actually ran a 5k (or 10k?) without much difficulty and she was struggling, even though he's probably twice her age and was dressed in some ridiculous outfit. She has to know.
The problem is it's gotten harder to be sympathetic to her because while no body shame and healthy at any size makes sense on a certain level, at this point it just looks like I'm watching someone with psychiatric delusions. I thought it was all her disease but we're beyond that point now. There are many medications or diseases that cause weight gain, but to gain what looks to be over 150-200 pounds in just about a year and a half is not normal. It's depressing. There is just no way you can say you're healthy at that size, none. At 250? Sure, and some people her age are somewhat healthy at that weight, but at 370?!
Even poor Buddy admitted he has high blood pressure, he's probably 150lbs less than she is.
I'm not a skinny guy myself but even at 5'11-220 I feel fairly disgusting and know that the more time I stay overweight the more time I am taking off my life expectancy. It is not a good feeling, pretending otherwise is sending a horrible message to the people out there who take her message seriously.