It's all about personal responsibility. You're responsible for being aware of your situation as you are responsible to rectify said situation, if it is at all undesirable. Sometimes it takes people to make you aware. Fine. But that's where the line is drawn.
Drug addicts are responsible to help themselves. If they need help, they should GET help. You're willing to suck dick for some crack but suddenly you're too proud to take your life back?
Same thing with the morbidly obese. So they aren't lazy. Apparently doing this to their bodies makes them feel good, like they're high. Fine. But their lack of control, information, willpower, whatever -- is the reason they're there in the first place. Like you said Des, it's a culmination of choices. Choices only they made.
I think the reason people tend to think of morbidly obese people as lazy instead of lumping them in with the drug addict crowd is because simply -- everyone eats. If everyone did coke and the majority of people weren't addicts, then the addicts would be weird-- freaks. So everyone eats, and most of us enjoy it...and we can control our desires. Why can't they?
Whatever your answer to this question is irrelevant. It's all up to them to get help if they need it -- to be aware of their situation.
On this same TLC show, they had a few morbidly obese people discuss what they thought of their situation. Some of them didn't care -- some of them didn't want to change. That's totally fine for them to make that decison for themselves. They don't have to be anything they don't want to be...but it IS a destructive action, not just to the people, but to their loved ones, those who take care of them. And most importantly, to those who feed them.