This movie attempts to show empathy and understanding toward those with morbid obesity or mental challenges. The obesity of the mother of the family is indirectly linked to the depression she experienced over the suicide of her husband and her oldest son running away from their family's difficulties.
A developmentally-disabled teenage boy is slapped in the face repeatedly by his older brother during a moment of overwhelming frustration. This same boy is arrested by the police after climbing the town's water tower one-too-many times; he is forced into the back of the squad car and bumps his head upon entry. Reference made to the hanging suicide of the family's father. A stressed-out father has a heart attack (not shown) that is discussed among characters. Three friends discussing the mortician work one of the friends does leads to a talk as to whether or not the morticians "mess with" the bodies. A house is set ablaze by the lead characters.
The lead character is having an affair with an older married woman. Oral sex is nearly initiated by her as he's on the phone with her husband.
Occasional profanity: "s--t," "a--hole," "hell." One use of the middle finger gesture by a teen. Jokes and cruel remarks whispered or mentioned offhand by people in the town at the expense of the Grape family's morbidly obese mother and developmentally-disabled son. The developmentally-disabled son laughs maniacally at the mention of their father, then repeats over and over again "He's dead!" while holding his hands to his neck in imitation of the father's suicide in the basement of the house.
The theme of the homogenization of America is explored through minor subplots: a large supermarket chain that has opened outside of the small Iowa town in which this movie is set is hurting the business of the long-time mom-and-pop store, a fictionalized fast-food chain restaurant opens in the town to great fanfare.
Cigarette smoking from adults. Some beer drinking from adults -- no one acts drunk.