I used to weigh almost 400lbs and even though I was self-conscious and self-loathing, I truly did not realize how fucking fat I was. It was like reverse body dysmorphia and it didn't go away until I lost 150lbs. Only then did it become apparent how fat I was. I've heard lots of other fat and formerly fat people talk about a similar experience.
You take this phenomenon and tack on what a delusional, narcissistic, and spoiled piece of shit Trump is, he absolutely does not have the capacity to accept that he is morbidly obese. He just knows it's another thing he can use to bully others with.
Spongebob is not a contraceptive.