First appearance of Sheriff Donna Hanscum, portrayed by Briana Buckmaster.
Dean asks if this could be a "Thinner" type of situation. "Thinner" is a book by Stephen King where a gypsy curses an obese man to become deathly thin.
This episode is called 'The Purge'. The employee who tells Dean to 'quit flirting and keep scooping' is a main character in the latest installment of The Purge franchise.
The alias Sam is using in this episode is Agent Frehley. This is a reference to guitarist Ace Frehley of the hard rock band Kiss. Sam uses this alias again in the season ten episode "Hibbing 911", where Dean calls himself Agent Criss, named after Kiss drummer Peter Criss.
Jared Padalecki, who plays Sam, weighing 220 pounds in real life, actually weighs more than most of the patients due to him having lots and lots of muscle.