Jerry Seinfeld was a big fan of the show, and wanted to do a voice. So he was offered to play the part of Turkey #4. But Seinfeld's people objected to having him play such a small role and wouldn't allow him to do the show.
The episode was partially inspired by the commercials for the Christian Children's Fund, in which Sally Struthers encourages viewers to donate money to provide food for starving children in Africa. Trey Parker said he did not really believe Struthers was hoarding food from the charity, but he came up with the concept because he found it funny that such an obese woman would make a public plea for food for others.
Trey Parker said he had always wondered how a starving African child would react if they were taken to a large buffet dinner at an American restaurant, with "people leaving tons of food on their plates", which served as inspiration for the restaurant scene.
Trey Parker and Matt Stone originally planned for Sally Struthers to die at the end of the episode and have the African children eat her and live off her fat; Comedy Central executives told the duo they could not kill Struthers, although celebrities have been killed off in subsequent episodes without any objections from the network.
After the episode aired, Trey Parker and Matt Stone received feedback that audiences felt it was especially unkind to Sally Struthers. Although they did not speak to her themselves, the duo received word that Struthers was a fan of the show until this episode aired, after which she was very upset and reportedly reacted emotionally over her portrayal. Struthers was particularly saddened by the fact that her character steals food from the same starving children she had been working to help. Parker and Stone were slightly remorseful when they learned of her reaction and have said they did not have anything against Struthers personally. Nevertheless, Struthers was portrayed in an even less flattering way in Starvin' Marvin in Space (1999) as a Jabba the Hutt-like creature. In a DVD commentary track, Parker said of Struthers, "Dude, you're really setting yourself up if you're going to be that fat and go on the air talking about [starving children]. ... We don't think she's a bad person, she's probably nice to try to do this, but cut down on the Twinkies a little bit before going on the air."