Despite the controversy, critical responses to the episode were mostly positive; critics praised its storyline, numerous cultural references, and its portrayal of a person with Down syndrome. According to Nielsen ratings, it was viewed in 6.42 million homes in its original airing. The episode featured guest performances by Jennifer Birmingham, Jackson Douglas, Andrea Fay Friedman, Phil LaMarr, Michele Lee and Nana Visitor, along with several recurring guest voice actors for the series. It was nominated for a Primetime Emmy Award for Outstanding Original Music and Lyrics, for the episode's song entitled "Down Syndrome Girl", at the 62nd Primetime Emmy Awards. Both Walter Murphy and MacFarlane were recognized for their work on the music and lyrics. "Extra Large Medium" was released on DVD, along with 11 other episodes from the season, on December 13, 2011.