It was 13 years ago when a Seattle-based writer by the name of Lindee West published an essay that took the internet by storm. It was called simply, Hello, I'm Fat.

There was this way that calling myself fat publicly made me fat. Whereas before I was operating like, I am going to be thin. That's the cultural narrative, that fat people are thin people who are failing. So I was bought into that. That was scary to, in a certain way, announce I'm throwing in the towel of trying to be this other thing and waiting for my life to start.

Lindy's writing is vulnerable. It is honest. It is confessional. If you're familiar with her at all, you know that her writing is also pretty funny. She really opens up about living as a fat person. It's a provocative message, and it was particularly unusual back in 2011. In fact, at the time, it caused a fair amount of controversy.

People are cru-I mean, this was the beginning of internet commenters, too. So I'm at work, and then I have to see under every piece of my work a list of all the most horrible things people think about my body.

But we really wanted her on the podcast because Lindy's work also resonated with a lot of people, people she'd never even met. In fact, that single essay led to a New York Times bestselling book called Shrill: Notes from a Loud Woman. In 2019, Hulu took that book and created a TV show, starring comedian Adi Bryant.

You should think about gastric bypass for your weight. I'm sorry. Think about what? Hey, you're going to look at me for 10 minutes and tell me to cut my stomach out? You're a bad person.

Nowadays, Lindy is still writing about her experiences. In fact, she was kind enough to take a break from her writing of her second memoir to sit down for this episode of Chasing Life. As an award-winning author, she's giving the ways we think about weight a lot of careful thought. She doesn't shy away from the difficult conversations or from opening up about the stigma she has faced. Some of it is hard to hear. Today, Lindy and I are going to discuss how the way we talk about weight has changed.

I went to the doctor and I said, Is there a nutritionist that I could see? And she was like, You know what would be great for you is Wegovy. And I was like, What?

Today, I think you're in for a really touching conversation, one that challenged some of my own thinking. She taught me a lot about what it looks like to show empathy and kindness no matter anyone's size. I hope it does the same for you. I'm Dr. Sanjay Gupta, and this is Chasing Life.

Twelve years ago, you wrote this essay, Hello, I'm Fat. It's that essay That led to the book. It led to the creation of this Hulu TV show. Obviously, a lot of people got to know you. That was 12 years ago, roughly 12, 13 years ago. How have things changed, do you think, since then?

I think things are different and the same. Twelve years ago, I don't think there was any generalized cultural awareness that maybe it's bad to stigmatize fat people. I don't think that had entered the chat at all yet. Michelle Obama was like, Let's get these fat kids moving. It was not just normal, it was honorable to try to eradicate fat people. That's not exactly the case anymore. There's still just a lot of structural barriers to fat people being able to fully participate in public life. A lot of that has not gone away in terms of hiring discrimination, the way fat people are treated at the doctor, the way that people think about accessibility, stairs and chairs. I've been doing some live performances. I wrote a one-woman show, and basically every theater, I have to call them and say, Hey, a lot of my fans are fat. So if you have 16-inch-wide vaudeville theater seats, you're going to have to take some of those out and put some chairs without arms. People want to laugh at that and say that it's your fault for being so gluttonous that you can't fit in a chair. It doesn't matter whether you think that or not.

It's not true, but it doesn't matter because the reality is that those people exist and they deserve to participate in public life, whether you want them to go on a diet or not.

It seems like over the last 10, 12, 15 years, whatever, certainly since the time you wrote that essay, there have been these movements almost at the opposite extremes. There's been this body positivity movement. At the same time, the AMA has classified obesity, a person who has obesity in and of itself as a disease. Frankly, I've always struggled with that. Is it a disease? I mean, and if so, are we medicalizing things in an inappropriate way? What would you say?

That's what I would say. I I would say that you're right on. That's why I say fat, and I don't use the word obesity. It is pathologizing, and I don't have a disease. I mean, how could it be a disease when it is often a symptom of other medical conditions? If it's a disease, then it seems like there would be some unifying factor across all fat people as to why we're fat, some mechanism for how this disease works, and that's just not the case. People's bodies reflect so many different aspects of their lives. If I'm fat because I have PCOS or something, then don't I have PCOS? I don't have fatness. I think that's the issue is that it flattens fat people into what they want us to be, which is just fat, lazy glutton. That's why fat people can go to the doctor with cancer, and the doctor tells them to go jogging. This has happened to me. I didn't have cancer, but I've gone to the doctor with an injury and said, My ankle hurts and I can't walk. And they've said, Well, You probably just need to stretch and strengthen your ankle so you should go walk.

And then it took years before I managed to get an X-ray, and then I had a big bone spur, and I had to get orthotics, and it was a whole thing. But I saw the doctor multiple times, and they were like, Just get out there. That's a very, very minor example of a thing that happens to fat people all the time because we see fatness as a disease in itself. What about all the other diseases that people actually need treated? If that gets erased.

I think with these medications, these GLP-1 agonists like Ozempic and Wegovy and Monjaro is another one. I think I know how you're going to answer this based on what you're saying, but What role do you think they have? What we're hearing, Lindy, is that they're likely to become the biggest class of drugs actually taken in the developed world. $100 billion. They're super expensive, as you know, $1,000 a month or more than that. A lot of people are taking them already. What do you think? Where does this go? Are we missing something here? Are we missing the forest through the trees, do you think?

Yeah. I want to say up front that I do believe in bodily autonomy, and I know how hard it is to live in a fat body. I understand when people don't feel like they can do it anymore. It's really, really exhausting. It's hard to live in a fat body in society. It's really grueling. You feel really surveilled all the time. You feel like you have no privacy. Having had my weight fluctuate, I know for a fact that the smaller you are, the nicer people are to you. It's just heartbreaking to know that. I understand why people are tired and don't want to do it anymore. I get it, a thousand %. I think the dangers are in the way that pharmaceutical companies market these medications to really vulnerable people, exploiting those vulnerabilities, knowing that people are desperate to change their bodies because they're treated so poorly because the same industries perpetuate that hierarchy. That's just all of marketing. Wouldn't you be happier if you had this different body?

I just have to say this comment you just made that when you are thinner, people are nicer to you. I don't know if something... I don't know, that touches me for some. I mean, that's a really powerful comment. I don't know, it makes me a little... Chokes me up a little bit. I don't... I mean, I'm sorry. I've never heard it put You've said that before. You lose weight and people will be kinder to you. Yeah.

People will be kinder to you. They will take you more seriously. They're friendlier, they're more welcoming. Think about what it's like to live your life and no one's ever kind to you. Then you're also told that this is your fault and that the fact that you haven't changed your body in the way that society wants you to says all these negative things about who you are and your capabilities. This is why I don't engage in debates about this stuff anymore, because it doesn't matter. It doesn't matter about your insurance premiums. It doesn't matter about Whether people are eating fried Twinkies at the fair. This is so cruel to treat other human beings like this, to rob people of basic respect and joy, and like I said, participation in the the full spectrum of life. It doesn't matter why people are fat. It doesn't matter. You should treat people with respect and kindness, regardless.

I totally agree with you. I think I'm a pretty tolerant, empathetic person, but you've made me think today, Lindee. I just think it's going to stick with me, your comments. What happened to the body positivity movement? Did it end up working? Where is that, do you think?

That's a great question. I think it got swallowed up by capitalism and everything does. Then, of course, the people who are the closest to the ideal became the most successful influencers, the smaller fat people, the fat people with hour glass figures make most of the money and get most of the brand deals and the opportunities. That positivity started out as, which is really, I think, a movement for liberation and more of just a way to sell products, which is fine. But that's why I think you're going to hear, if you pay attention in these spaces, you're going to hear a lot of fat activists now really abandoning the label Body Positive and saying specifically fat liberation. I'm not saying I don't like to look at cute outfits on Instagram or that I don't buy products from affiliate links, but it's not a radical movement for social change at this point. Maybe it felt radical, and maybe it was radical 10 years ago and contributed to people's idea of fat bodies shifting a little bit. But at this point, it's not moving the needle in any substantive way for the most marginalized people, which are fat disabled people, fat, Black people, super fat people, people who are really not represented in media, who are really stigmatized and excluded from life.

It can be a hashtag, but it doesn't mean a lot to me anymore.

You are someone who's written a lot about this and then had TV shows that were created around this. I think the language and how it's communicated is something that you obviously know a lot about, you're quite knowledgeable about. I'm not comfortable still using the term fat. Yeah. Should I be... You were comfortable. That was the title, obviously, of the essay, and you embraced the term, but should I be? I mean, What do you think about that? I think so.

You have my permission if you want to.

It feels demeaning to me. I know overweight have obesity. It's not even obese. A person is not obese. I remember a I'm thinking I take care of children with epilepsy, and we would not call them an epileptic child because that defines them by their epilepsy. Rather, you say a child with epilepsy, someone who has obesity as opposed to an obese person. I don't know. Am I getting hung up on this? Is it worth really nailing the language down here?

I think so. I can tell you that I bristle, but I shiver when someone describes me as obese or a person with obesity. I don't like hearing the word obesity because of what we already talked about. It feels like it's playing into this false narrative of why fat people are fat and the idea that we have a disease But fat people also don't use the term overweight, or at least fat people who are accustomed to talking about this stuff, who are engaged in fat politics. Overweight implies that there's an ideal weight that we can somehow identify for each person to reach. And that's also not the case as far as I am aware. I totally understand why people who aren't fat are uncomfortable with it because You've been trained not to. It's an unkind thing to say. But the alternatives are, to me, less kind. I think fat people have worked really hard to take the stigma off of the word fat and make it into a descriptor that doesn't have to have a value judgment attached. I do think you could say plus size if you don't want to say fat. That seems based in real measurements.

But if you don't want any fat people to get mad at you, I would avoid saying obesity or overweight, because personally, I'm not mad at you, but it just alerts me to the fact that this is not a person who is familiar with any of this discourse. This discourse is about whether or not I am a human being deserving of respect. And so that makes me nervous. It makes me nervous.

As a doctor, I've thought a lot this season about getting the language around weight right. I think what Lindy had to say about empathy here is key. We probably just need to be kinder to one another, and maybe the language follows. Coming up after the break, my conversation with Lindy West gets even more personal.

Now I'm in eating disorder treatment, whereas my doctor wanted to put me on freaking Semaglutide or whatever. It's like, that is a disordered system.

That's coming up in just a moment.

Say, screw you if you don't want to answer this next question, but would you ever take it? Would you ever take Ozempic?

My doctor recommended it to me. I was in a really depressive episode, and I went to the doctor. I had been thinking a lot. I'm writing a second memoir, a follow-up to Shrill. Almost 10 years later, it has a lot to do with my body and how I feel about my body and what I've learned What I've learned about my own mental health and that I have depression. I was feeling really depressed. I'd been thinking about this. I went to my doctor and I said, I feel like I have a very unhealthy relationship with food. I feel like I rely on it in this way that is emotional and compulsive. I think I should take a look at that. I hadn't before, because Being a public fat person, you're on the defensive. Everyone's constantly telling me that I must eat 14 cheeseburgers a day, and that's why I look like this or whatever. I've spent the last 10 years being like, No, I don't. I don't have any issues with food. I eat normally. I eat the same as my husband, and he's skinny. That's true. But then it's also not true that there's this way that I feel emotionally unsafe if there's no food in the house or if I don't know what I'm going to eat next, I feel afraid.

I was like, I think that's bad. I went to the doctor and she wanted to put me on Wegovy. I explained, I described this to her. I'm a person who writes about being fat, writes about body positivity. I feel really uncomfortable even asking this question about exploring my relationship with food because I feel like it plays into stigmas about fat people that I've been trying to eradicate, and I need help. I said, Is there a nutritionist that I could to help me take the anxiety out of deciding what to eat? Because I feel like I have no idea how people eat. I don't understand it. She was like, You know what would be great for you is Wegovy. I was like, What? It was pretty new at that point. I didn't know that much about it. I was super deep in, like I said, this depressive episode. I was at the end of my rope and I was like, You know what? Fine. Fine. I give up then. Fine. Sure. Then I got about one step down the road and I was like, $1,000 a month? Then I was like, What am I doing? Then she was like, Hey, I could get this coupon for you so you could get it for 200 a month.

I was like, Absolutely not. Never mind. I don't know what I don't know how you got me even this far. And then I finally got her to send me a list of nutritionists that they work with. I picked the only one that had health at every size credential, like some familiarity with people. And then she was like, Yeah, you have an eating disorder. I was like, Oh, so now I'm in eating disorder treatment, whereas my doctor wanted to put me on freaking Semaglutide or whatever. And it's like, that is a disordered system. I was so close to getting the opposite of the care that I needed. I would have just been sent further down this spiral of disconnection from my body and shame. Absolutely, I'm sure it would have ruined any healthy relationship with eating because you can't eat in the same way at all. I was like, tempted by the devil for one second because like I said, it's hard. I'm tired. I'm tired of people being mean to me. It really messes with your head, man. But at this point, no, absolutely not. I would never. I couldn't do it. You would not take it.

First of all, it would undermine my eating disorder treatment. But also, I know for a fact from my own life that it's not the solution to my problem. I have lost weight and I have gained weight, and it only made me worse. That cycle, because people do gain weight back if they stop taking these drugs. And nothing has damaged my psyche more than getting slightly smaller and then getting fatter again. Because then all of a sudden, you have this shame compounding everything. You have this feeling of failure. You have this feeling of hopelessness. The only answer, at least for me, is to continue to connect with my body, learn how to live in my body, move my body in ways that feel good, eat foods that nourish me. I will never take I take it unless, of course, if I get diabetes and I need it for some other reason, of course, I would take it. But I would never take it for weight loss for many reasons, but primary among them is that it would not solve any of my problems.

I appreciate that answer. It's tough. It's complicated to navigate through all that. But I think, again, going back to the idea that we pathologize or medicalize all these things, if there's a medical need, then that's one thing. But Obviously, when you wrote the essay and then there's the book and the TV show, there's a lot of people who were listening to you. It resonated with a lot of people out there, most of whom you've probably never met. But I'm curious, what is the advice to people out there who are where you were maybe back in 2011? They want to make peace with their bodies. They want to be able to talk about their bodies the way that you just did. What advice would you give them?

So hard. Go to therapy for sure. Spend time with other fat people. Seek out fat people in online spaces and read their work and listen to what they have to say, specifically centering the most marginalized fat people who really understand the extent of the trauma and damage that the system can cause, and people who are working and really creative ways to fight back against it and to live happy lives despite it. I saw a TikTok or something where someone was saying, Okay, don't get mad at me, but I want to know what you think. It said Something like, when you speak negatively to yourself, your nervous system interprets that as a threat and shuts down as a threat response and makes it impossible to make any changes in your thinking or in your life. It slams this wall down between you and the ability to change. If you do want to change your life, if you want to change your body, if you want to change the way that you think about yourself, the only path to doing that is to start from thinking kind things about yourself and being kind to yourself. That self-criticism and being cruel to yourself will never actually lead to change.

Not just because it's a poor motivator, but according to the neuroscience of TikTok.

I think they got it right so far, what I'm hearing. Okay, great. I agree with that. Yeah.

What else is there to say? The answer is to fake it till you make it is free. Therapy is expensive, but if you Can you just change the way that you speak to yourself, this is the thing that therapists always say, think about your child self. Would you say that to your child self? If she was standing right in front of you here, would you say, Wow, you look disgusting today? I wouldn't.

Have people said that to you?

No. But people say it to me now as an adult. No. Oh, my God. Every day on the internet? Are you kidding? Not real people. Oh, do you want to do an episode about internet trolling? I think I have PTSD, I swear.

I hate people sometimes. I really do.

They're pretty bad.

You're an optimistic-sounding person. I am sitting here talking to you. We're having this delightful conversation. You're smiling, you're laughing. Are you optimistic? I mean, do you think the conversation about weight and do you think this changes in the future? Yeah. I don't know.

I hope so. I think that the fat people that I know who are living joyfully and defiantly are so inspiring, and there's so many of us. I aspire to count myself. That's not going away. As much as people would love to, I think, put Ozempic in the water supply and never have to look at a fat person again, that's not going to happen. We're We're always going to be around, and we're always going to keep fighting for our community and for each other and taking care of ourselves because we only get one life. Sorry, you're not going to back me into a hole and make me hide for the rest of my life. I just get one, as far as I know.

Is this part of what you're writing about in your new book?

Yes, definitely. It's not even up for pre-order yet or anything, but it's called Adult Braces because I had braces during the pandemic, and then I realized that was a great metaphor for what I'm trying to do, straighten out my life using tools and aids that can be embarrassing and painful and pushing through that. It's really like reassessing everything that I thought I knew about my life and what I wanted and the ways that I was wrong about stuff that I wrote about in Shril. I think I was pretty confident when I wrote Shril I had done the work and I was cool with my body and I was done. And that was not true. I've done a lot of learning since then. I was just barely in my 30s when I started writing Shrill, and now I'm about to turn 42. So my life's different now, and I have more perspective. It's really just about all of those things and trying to figure out, how do we figure out who we are and live in such a way that actually makes us happy.

I got to tell you, this conversation is going to stick with me for a while, and I hope it does the same for you. A big thank you to Lindy West for her honesty and her perspective and her sharing so much of her personal story with me. Coming up next week, there are so many products out there that promise to help you lose weight fast. Body wraps, cleanses, juices, tummy tease, more. But do they work? They know that if they trigger that insecurity, they could sell a product, especially if that product comes with a shortcut, and that shortcut doesn't really exist. I'm going to ask Dr. Mikhael Vashavski, and you may know him better as Dr. Mike if you've seen him on TikTok or Instagram. We're going to talk about the latest internet trends and do some myth-busting. We're calling it Fat versus Fiction. That's coming up next week. Chasing Life is a production of CNN Audio. Our podcast is produced by Erin Mathieson, Jennifer Lai, and Grace Walker. Our senior producer and showrunner is Felicia Patinkin. Andrea Cain is our Medical Writer, and Tommy Buzerian is our Engineer. Dan Dizula is our Technical Director, and the executive producer of CNN Audio is Steve Ligtai.

With support from Jameis Andrest, John Dianora, Haley Thomas, Alex Manasari, Robert Mathers, Laine Steinhart, Nicole Pessereau, and Lisa Namerot. Special thanks to Ben Tinker, Amanda Sealy, and Nadia Konang of CNN Health, and Katie Hinman.