“Good morning, fatties!” I hear as I enter the second-floor veranda of a glassy hotel in downtown Seattle. A large woman in a green tulle skirt and tank top is waving me into the ballroom behind her. “The opening ceremony is about to start,” she says, “if you would like to join us.” A number of other heavy women are floating near a registration table set up outside the double doors of the main event, collecting their swag bags and eyeing the products on offer in the vendor booths: Chub Rub, the Plus Bus, bubblegum-pink T-shirts with “Fattie” printed in the Barbie film font.

This is Fat Con, where we are promised a respite from the January sleet with a long weekend of “fat joy” and “fat liberation.” I duck inside and take a seat at the back, shuffling my purple merch bag and media pass. The chairs are sturdy, padded, spaced out a bit more widely than usual, and there’s room for a couple hundred people. On my way in I hear two women bonding over complaints about weight limits for hospital beds. The director of the event is Mx. Pucks A’Plenty, a fat activist and burlesque performer. There will be a number of events running simultaneously, she says, and there’s a color-coded system for what’s full and what isn’t, for the Covid-cautious. There are trigger warnings for the panels and speeches: trauma, stigma, disordered eating. She assures us that organizers vetted media carefully (The Lamp didn’t seem to pose a threat, but the Daily Mail, which wanted to send a photographer, was rejected).

I skim the schedule: two days of panels, comedy shows in the evenings, a burlesque festival called “Fatlesque,” a trip to a plus-size clothing store, and brunch and a fashion show on Sunday. The proceedings begin with a preview of an upcoming documentary from the fat activist Aubrey Gordon. Cheers go up at the mention of her name. Gordon became the face of “fat positivity” after she wrote a Medium post in 2016 titled “A request from your fat friend” that went viral for condemning the way in which the “diet industry” vilifies fat people. Now she’s repeating the same message on screen. “I need you to say the word ‘fat,’” Gordon says. “About me. Because I am.” More cheers.

The people at Fat Con love the f word. They say it all the time. They insist on having it applied to them. In fact, they have devised a whole hierarchy of fats, based on clothing size. “Straight size” is someone who can find clothes pretty much anywhere. “Small fat” is someone who can mostly fit into plus sizes. “Mid fat” are people who fit into the upper ranges of plus sizes; they often have to shop online. “Infinifat” or “superfat” (terms vary on this end of the spectrum) are those who require custom clothing. This is territory occupied by Gordon, Roxane Gay, Lizzo. On the veranda there’s a quote wall on which many women describe their bodies in purple ink. “My body is . . . ” Ample. Luscious. Sexy. Resilient. Flourishing. Worthy. Jelly love. Some of the descriptions are more risqué. Most are positive, with a touch of the therapeutic: Going thru some things.

There are also taboo phrases in this taxonomy, words that are declared anathema at Fat Con—“obese” and “overweight” chief among them, terms that medicalize or euphemize fat. These are the words most people outside this hotel use. And they represent uncomfortable statistics about contemporary life in America: two-thirds of adults are classified as overweight, and half of those are considered obese. The World Health Organization estimates that nearly three million people worldwide die as a result of obesity each year. A study funded by the National Institutes of Health and the Centers for Disease Control and Prevention estimates that excess weight led to about half a million deaths in the United States in 2016, a higher mortality rate than complications from smoking. Medical researchers consider those who are classified as obese to be far more likely to develop type two diabetes and heart disease, with women, and especially minority women, particularly at risk.

Of course, all of these studies are contested (just as the smoking studies are), and there is much debate over how directly fatness leads to death. The common diagnosis is that the trouble starts with eating, which leads to overeating, and then eating to cope with the overeating, and so on until you die. The common prescription is dieting, drugs—anything to keep off the weight. It’s a violent cycle. First you inflate your body with food, then you shrink it back down with drugs and starvation. You consume; you are consumed. But here at Fat Con, we are told it need not be that way. Here, fatness is a lifestyle. It’s an ideal unto itself, something to be indulged in, sought after—an alternative to thinness—complete with its own attractions, hang-ups, and struggles.

This is the sort of thing you can only really understand, experientially, once you spend a weekend surrounded by hundreds of people who weigh more than three hundred pounds. I am what those at Fat Con would call “straight size”—and what most other people might call “rather thin.” So for three days, I am the oddball. Weirdly, the “fat joy” has some effect on me: when you’re hanging out with seemingly happy, healthy fat people, their very fatness starts to seem normal. And once I see past the weight, I notice many other similarities: rainbow-colored hair, for example, an impressive number of tattoos, and the highest per-capita undercut rate I’ve ever seen in one place. This isn’t trailer trash; it’s central casting for a John Waters film. These women (and it is mostly women here) are comfortably middle class, geeky, and, to use their preferred term, queer. They are perfectly content to shell out a couple thousand dollars to shake off the post-holiday stupor in one of America’s most expensive cities.

And they’re alike not only in their size and sense of style but also in what brought them together: the Internet. Like the people in many other online communities, they’ve had the leisure to redesign their whole lives around their interests. Out in the vendor plaza, I hear women saying they found Fat Con through curating their Instagram feeds to cut out all the fat-shaming and to be more “body positive” or “fat accepting.” There is an intra–fat community power struggle between these terms: The body positive movement claims to accept people’s bodies no matter their size, and it’s dominated by smaller women coming to terms with their little muffin tops. The fat acceptance or fat liberation movement is about real fat people: people whose size impacts their daily life. Fat Con is largely made up of the latter. These women represent their Instagram niche more than they do the average fat American. There’s something cliquish about the whole thing that betrays them as detached from those outside their bubble, perhaps not the best representatives of a significant subset of Americans.

Not that Fat Con speakers and attendees have nothing to say to fat people outside their bubble. In fact, they seem to see themselves as fat America’s saviors. Everywhere I turn, it seems, I hear homilies about food deserts, health-care injustice, and the racism at the heart of anti-fatness. It’s all expressed in a tone and register familiar to anyone who follows activist movements. There is an organization for fat justice, the National Association to Advance Fat Acceptance (N.A.A.F.A.). Just like the National Organization for Women or the Human Rights Campaign or so many other similar groups, it aspires to replicate the civil rights movement in its strategies and aims. These include implementing laws prohibiting “size discrimination” at the state and federal level. Only Michigan and Washington have them so far; legislation is pending in a handful of other states. The dream is a federal law expanding the Civil Rights Act, banning all discrimination based on weight, adding fat people to the protected classes under Title VII.

It’s an ambitious project, and the centerpiece of Fat Con. For the convention’s keynote address, Tigress Osborn, the chair of N.A.A.F.A., takes the stage and envisions for her audience a world where the fat have at last been liberated. It’s a pleasant dream: No more getting passed over for promotions because of poor performance in the workplace wellness program. No more lease renewals denied because of “wear and tear” on the property. No more misdiagnoses blamed on “obesity” or refused prenatal care based on B.M.I. No more spilling over airplane armrests. “This is a civil rights issue, not a public health issue. The public health crisis is anti-fatness,” Osborn declares to a rapt crowd. “That’s what’s killing fat people. Not fat.”

But it appears that very few people outside the Fat Con world want to fight that battle. A word that, rather impressively, gets zero mentions at Fat Con but is unavoidable anywhere else right now is “Ozempic.” On the East Coast it’s a buzzword, and big business, as it and its sister drugs take off as weight-loss treatments—the latest magic potion to shrink people. So I hear more about drug shots than civil rights when a few weeks after Fat Con I attend a book launch in Washington, D.C., for Unshrinking, the latest in a round of new books criticizing “fatphobia.”

The book, by the feminist writer Kate Manne, is part of a mini-trend in criticizing diet culture and the profitability of the weight-loss industry. In a rousing Australian accent, Manne gives her stump speech, starting with a somewhat unwieldy definition of fatphobia: “the unjust down-ranking of larger bodies.” She cites research finding that anti-fat bias is the only implicit bias that is on the rise and that it is the explicit bias that is decreasing most slowly. The gist is that, health concerns about fatness aside (though she challenges the validity of these too), it’s morally wrong to consider people lesser based on their size. The Ozempic craze is an interesting time to come out with a book titled Unshrinking, she admits, since shrinking seems to be what people are really interested in: “I’m publishing into a room where no one wants what I’m selling.”

Manne tries to have it both ways on the moral meaning of taking weight-loss drugs. She offers caveats about the users of Ozempic at first, bowing to personal choice above all as a good feminist must: “I’m a big fan of bodily autonomy, and I also think people need to do what they need to do to survive in a deeply fatphobic world.” But her comforting assurances conflict with her skepticism of the pharmaceutical industry: “It worries me that there’s a lot of profiteering involved.” Manne calls the drug companies’ marketing methods “condition branding”: “You have the cure. So you invent the problem.” And then you make money off of it. This is not a new formulation: critics of opioid manufacturers have said the same thing for decades.

There’s another way in which these drugs are analogous to Oxycontin and its siblings. The sales are staggering. The revenue of Novo Nordisk, the manufacturer of Ozempic and the similar drug Wegovy, exceeds that of its native Denmark, and a competitor in the United States, Mounjaro, is set to surpass it in sales before long. “Ozempic” is actually a catch-all term for a group of drugs, including Wegovy, Mounjaro, and Zepbound (the last two of which are produced by the American drug manufacturer Eli Lilly). There are differences between the medicines, but they all work by slowing down the emptying of the stomach and stimulating the receptor of a hormone in the intestine called GLP-1, which makes people feel full. While they were created mostly for the treatment of type 2 diabetes, and Ozempic and Mounjaro aren’t cleared by the F.D.A. for non-diabetics, their counterparts, Wegovy and Zepbound, respectively, have been approved.

The drugs are new enough that long-term data on users’ maintenance of weight loss doesn’t exist (though the Wall Street Journal, seeing dollar signs and sensing its readers’ hunger to spend it on a social advantage as valuable as a svelte figure, has been reporting on every promising study with the zeal of a prophet). But some trials have found that the majority of patients regain the weight they lost within the year, and their metabolisms become slower than before. And, as with previous weight-loss drugs, there are what appear to be rare but serious side effects: stomach paralysis, bowel obstruction. Class action lawsuits are on the way, Manne assures us.

The problem underlying these health concerns for Manne, and for many others, is “people feeling obligated to shrink their body.” Another attendee at the book launch says that some of his friends have shifted from asking why he doesn’t work out to asking, “Why aren’t you taking shots?” If people think “you can just take pills and not be fat anymore,” he worries, people who remain fat could be seen as an even bigger problem: now they’re not just a public health risk, but a recalcitrant one. Murmurs of agreement ripple around the room, and Manne nods enthusiastically. And all this assumes that these drugs have significant effects, which is far from certain, Manne says. An “optimistic” estimate from Novo Nordisk says that its products can take off around fifteen percent of a person’s starting weight. Which means that, however much money Novo Nordisk and Eli Lilly make, there will still be fat people.

It’s no surprise then that some people just throw up their hands. This is the impulse that drives the Health at Every Size (H.A.E.S.) movement, which says that fat is natural, determined more by genetics and societal factors than lifestyle, and that “diet culture” is the real culprit for many people’s problems with weight. In its place, H.A.E.S. advises “intuitive eating”: following your body’s cues instead of a diet’s restrictive rules. This is Manne’s school of thought, but she’s far from unique here. The 2019 book Anti-Diet is often cited as the bible of intuitive eaters; in it, Christy Harrison describes how she struggled with an eating disorder until she gave herself permission to eat whatever she wanted. It changed her life.

There are fair criticisms to be made of the book’s sweeping approach (one blogger asked how much Big Sugar has to pay you to write that you should eat as many Oreos as you want), especially its skepticism of all health-based eating guidelines and its clichéd self-help idea that by “letting go” of society’s unfair expectations people can reclaim the four cardinal virtues of “time, money, health, and happiness.” But its proponents—Virginia Sole-Smith, the author of the book Fat Talk: Parenting in the Age of Diet Culture and the popular Burnt Toast newsletter; Evette Dionne, the author of Weightless; Amanda Martinez Beck, the Catholic host of the podcast “Fat & Faithful”; the Fat Friend Aubrey Gordon; Manne; and others—highlight a gaping hole in most discourse about weight in America. That’s the role of mental health in people’s relationship with weight.

To a woman, almost everyone I read or talk to in my months of researching this piece confesses a history of an eating disorder and points to some sort of societal disapproval about her size that sent her in a weight spiral, whether up or down on the scale. This is a familiar story: she’s a chubby kid or she gains weight during puberty, she diets, she binges, she purges, she eats the plastic-covered pre-portioned meals and binges again. She doesn’t eat for days. Her will breaks, but she tries harder, and punishes herself more, each time. She signs on to the most restrictive weight-loss regimes and tries to do them one better. She fails, but her will gets stronger. Next time it will work; next time she’ll get thin enough. Finally it ends, usually in the hospital or with some other serious come-to-Jesus moment. This, according to these women, is what’s going on behind the statistics that claim that over ninety percent of diets fail and that most people tend to gain back more weight than they lost while dieting.

It doesn’t help that diet rules tend to be absurd. A representative sample of diet books from a branch of the D.C. public library includes plans for intermittent fasting (for metabolic health—and weight loss), the “Mojito Diet” (for weight loss, feat. Mojitos), the “DASH Diet” for heart health (and weight loss), and How Not to Diet (avoid all meat and dairy, for health—and weight loss). And this is just the free stuff from the public library. This isn’t the food-tracking app Noom, which helps you “stop dieting” by tracking every bite you take, or the chief enemy of the anti-diet contingent: Weight Watchers, formerly led by Oprah Winfrey, who has since switched her allegiance to Ozempic.

The conflict between these two approaches to weight loss—the radical acceptance on display at Fat Con and the radical, medicated control of Ozempic—is on full display online. Since weight-loss drugs took off, some influencers who built their images promoting fat acceptance on social media have suddenly become small. In one typical example, the plus-sized model Dronme Davis shrank dramatically over the course of a few months. Her fans wondered if she was on Ozempic or had an eating disorder; the transformations are often similarly dramatic. For Davis, once she reached her current weight, she stopped promoting fat acceptance and body positivity to her admirers. New trends demand new fits. For Davis and others in her position, there is nothing inconsistent in expanding and then contracting. What’s more important is personal autonomy—control. The decision to be fat and the decision to be thin are governed by the same dread logic: my body, my choice.

It’s not just social media and the entertainment industry, though. Ozempic is wherever people can afford it. There are hundreds of personal essays by those experimenting with medical weight loss (very likely you know someone who is on Ozempic). One striking account is by Bradley Olson, a technology editor at the Wall Street Journal’s San Francisco bureau, who had struggled to lose weight for his entire life. His desire wasn’t for anything dramatic: he dreamed of wearing a plaid Western shirt that was several sizes too small for him. This January, he started taking Mounjaro. Soon after, he wrote in the Journal about his rapid weight loss, complete with before-and-after photos and a shot of him in the beloved shirt. It’s got to be one of the saddest success stories ever written.

“Although the evidence of rapid weight regain has led many clinicians to believe the best course is staying on the medicine permanently, that may not be sustainable,” Olson writes. “In the past few months, it has been difficult at times for me to eat more than 1,000 calories in a day.” One thousand calories is below the subsistence level for someone half his size. He may keep losing weight if he keeps living this way (though it seems weight loss tends to plateau after a certain period on the drugs), but if so the question will soon be how much longer he can stay alive. Olson admits that the Mounjaro diet seems unsustainable, and besides, the drug isn’t covered by his insurance for weight loss, so he, like many Mounjaro users, likely won’t be able to afford it in the long term. “I know the odds, but I choose to believe,” Olson writes. “Sometimes, it’s all we have.”

This is a dismal choice. But it is the only one you have, if radical control over your body is the goal. It’s a driving, totalizing quest. And it never ends in satisfaction, only more hunger.