Honey Boo Boo appears just before she goes to hospital for a heart transplant. She and her mom Mama go to a pig farm to get a pig with just the right attributes to keep Honey Boo Boo competitive in pageants. Mama does what she can to keep Honey Boo Boo in pageants, even at Honey's risk, and this includes sketti and butter dinners, By the end of the episode she wonders how she let herself get as big as she is, and how she let her daughter follow in her footsteps.
At Wall*Mart the first obese man wants to get past the boys, and they make way for him. The obese lady asks Cartman if what he's holding are candy corn Oreos. He says they are, then tosses them into her basket and walks away. The second obese man becomes the first victim of Rascal-tipping.
The farmer shows Honey Boo Boo all hispigs and has her choose one or another for her new heart. The Denny's greeter offers Cartman a window booth. The legless boy is in the express line for a Disney ride, and Cartman wants him out of line because the boy is not fat.
Randy Newman writes the theme song for Here Come Fatty Poo Poo and appears in the opening credits of that show, then appears later on at the bottom of the deepest ocean trying to keep the bar as low as possible so he could stay employed. The ticket teller announces that pre-boarding was now on and Cartman rolls right on in. Michelle Obama's aide notices that she's not looking very well. Michelle then snaps out of it and puts a stop to the sketti wrestling match.
Before he goes on to Avatar 2, James Cameron takes it upon himself to raise the bar of decency from the depths of the ocean. He finds that it is lower now than it was when Bill Clinton had relations with Monica Lewinsky (or at least blew his load on her dress after receiving a blowjob from her). Crewman 1 is the leader of Cameron's crew and tries to convince him that he doesn't have to raise the bar. After Cameron has been at the bottom for far too long (much of it fighting Randy Newman), Crewman 2 wonders if he's dead; the Crewman 3 hopes so. Crewman 4 is surprised that Cameron actually found thte bar. Crewman 5 tells Cameron that the crew can't believe that he found the bar and raised it, and Crewman 6 wonders if anyone will ever know what James Cameron did for them. James responds somewhat enigmatically that he does what he does because he is whom he is, but not for himself.