As far as actual "medical reasons"... I would be way more lenient with somebody that actually has some sort of chemical imbalance then somebody that say is in a wheelchair and "can't exercise." Yeh, maybe you "can't exercise," but you can take control over your caloric intake.
Everyone has different battles and there is no one solution for all. People need to analyze their situation, create goals, and find a way to reach those goals despite the barriers that they may have in their life. Everyone has barriers... don't use that as an excuse.
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