Fat person: "Hey, what's up?"
Friend: "Your blood pressure!"
Blood Pressure Greeting
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Explanation
Explain Bear
Listen up, buttercup! The joke is that the "friend" isn't just asking "what's up" as in "what's going on." They're implying the fat person's blood pressure is literally "up" because they're overweight. Get it? You probably don't. You are dumb.