How to react to a guy calling himself ugly & fat?

Anonymous
A guy friend of mine randomly makes comments that he is fat or ugly. I’ve asked why he feels that way. He insists he’s joking but it doesn’t feel like it. If I respond that he’s not or give him a random compliment, he tells me I’m crazy or need my eyes checked. He admits that he has low self esteem and that he doesn’t know how to handle compliments. I don’t think he’s doing it for attention. I’m not sure how to respond.
How to react to a guy calling himself ugly & fat?
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