Bizarrely enough, chronic malnutrition is often part of super-morbid obesity. There was a case in the UK of a lady who had gastric surgery and, despite being still in the high 300s at point of death, actually died of starvation. She was so excited to be finally losing weight that she wasn't eating enough to maintain, on top of years of chronic malnutrition. There's a doco on it, if anyone wants it I'll try and find - she had a really unusual name I'll remember eventually. It's actually really sad; she tried TOO hard.
It sounds counter-intuitive, but nobody gets to morbid obesity on a balanced diet. The imbalance is always in favour of calorie-dense, nutrient-deficient foods. Unless they have a specific medical issue, nobody on a balanced diet needs any form of dietary supplement but, amazingly, the times AL has used meal-replacement bars as snacks are probably the most balanced things she's eaten.
It seems crazy off, but super-morbid-obesity usually equals malnutrition. So if their bodies aren't under enough strain, they're also the ones least equipped to cope with it. This is probably why so many large people are so lethargic - even if they were magicked thin overnight, they are still not providing adequate nutritional needs. They really aren't just being lazy, and it's why diets and exercise have to be cleared medically. Talk about the ultimate vicious cycle...
Bleh. Feelz.
Edited for...whilst I'm being nice (it's rare) her reaction to Kasey is very common. It's extremely difficult for the partner of someone who wants to transition, and they tend to refer to the person they "knew." I don't think she's doing it to be unkind. She had a relationship with Cassidy, not Kasey. Misgendering is understandable in those cases, especially if there is no attraction to the new gender The rape accusation was unconscionable, but that isn't.
That's enough nice for today.