My thoughts on this sad man.
His smug attitude during the entire episode made me curious if he was on drugs and we quickly learn that he is. They kept pumping him full of painkillers while he was in the hospital. His attitude to the world is also very suspect of painkiller addictions. If you do some research on him and go back about 5 years ago, he is a very different person. (he has multiple youtube channels.) He's got some personality and mental issues.. No one, even a morbidly obese person is immune to getting addicted to painkillers. (if you don't know what happens to people addicted to heroin/pain killers, go look it up.)
I personally think that he has completely abused/lied too TLC and "My 600lb life" to obtain more drugs. On his youtube channels, it's very clear that he has no intentions on losing weight and is perfectly happy being obese. His "act" we saw in the beginning of the episode is just that, an act for us.
The reaction of his brother when he called his father once was "He sounds high, are you high? Yep he's high on drugs again." makes you think this isn't some rare thing in their household. Once he was placed in Texas alone, the first thing he did was get his script for painkillers filled and took over 100 pills in a short period of time! Then he rushes to the E.R. to get more!
No one sees him as a drug addicted until Dr. Now figures it out at the end of the episode and says he's going to rehab. I honestly hope in my heart that he finds the help he needs. His true side often shows and he is caring and loves his family but it's overshadowed by a deep addiction. I understand addiction and it runs in his family. His Mother was an alcoholic. I just hope he gets help, he seriously needs it.