There’s a scene in the first episode of Shrill’s third and final season where Aidy Bryant’s character, Annie, is taken aback when her gynecologist suggests she undergo gastric bypass surgery. The appointment wasn’t about her weight; Annie is there simply for her annual pap smear. But this medical professional (whom Annie has never seen before) takes it upon herself to make a completely unrelated suggestion that takes none of her individual health information into account.
At a panel earlier this year, the first question asked of Bryant and fellow executive producers Alexandra Rushfield and Lindy West, whose book served as the basis for the series, was about this scene. Was it inspired by any of the panel’s real-life experiences?
The short answer: Yes.
“I went to a doctor for a physical just to be in a movie and he had never seen me before, had never done any blood work, and told me immediately that I should do gastric bypass,” Bryant revealed. “I think for a lot of fat people that’s a huge experience [when] going to the doctor—this massive advice that is life-changing that doesn’t always feel like the right fit for you.”
The longer answer, universal among pretty much every fat person in your life: Uh, hell yes.
Ask your fat friends how many times a doctor has been surprised when their blood pressure was normal. Or has suggested “going on a walk every day” without asking anything about their actual fitness routine. Or has brought up bariatric surgery in an appointment set specifically to discuss anxiety medication. Honestly, an easier task might be to mention a doctor’s appointment where weight wasn’t brought up at all, even at a specialist like the gynecologist or the dentist—or a doctor in the back of a weed shop issuing medical marijuana cards. (Yes, a true story).
In Shrill, Annie ends up yelling at the doctor in the parking lot after her appointment. (Of course, she doesn’t hear Annie’s rant because she’s wearing headphones.) In real life, your fat friend probably cried or quietly seethed or just shrugged and continued about her day. But medical bias, meaning medical practitioners’ implicit bias toward certain groups that often lead symptoms and complaints to be dismissed or ignored, is a very real issue that often leaves patients with little recourse.
“The whole medical enterprise is really built around ideas of normativity,” explains Tina K. Sacks, an associate professor at UC Berkeley’s School of Social Welfare who studies racial inequities in health, social determinants of health, and poverty and inequality. “So if you fall outside in any way of what they consider to be normal, there is bias and there is stigma against people who are not quote-unquote normal to them. This goes for people who are disabled, people who are fat. Even the phrase ‘overweight’—over what weight?”
If your body isn’t “normal,” your abnormality is the problem to be solved. This approach is far from the actual health care that smaller people take for granted. Have high blood pressure? If you’re fat, that’s probably related to your weight. If you’re not, then you have the luxury of doctors considering other causes: maybe it’s due to kidney disease or a tumor or a thyroid imbalance. For fat people, it always comes back to fatness. (Black women, by the way, have it even worse.)
Sacks, the author of Invisible Visits: Black Middle-Class Women in the American Healthcare System, spoke to one woman in the course of her research whose complaints about knee pain were attributed to her weight for 15 years—until doctors discovered two tumors growing there and almost had to amputate her leg. Examples of doctors ignoring overweight patients’ symptoms can be found documented all over the internet: breathing problems that were actually undiagnosed asthma; fatigue that was actually severe anemia requiring twice-monthly intravenous iron infusions; a persistent cough that was actually related to cancer.
Medical shows, however, have only started to broach the topic of medical bias. The Good Doctor took on race in its fourth season when a doctor misdiagnosed a patient because the protocol she was taught in medical school led her to assume that the patient was lying. But no TV shows have examined weight stigma in this manner. The scene in Shrill is a very clear example of a medical professional looking at a person’s weight rather than actual markers of their health. And it’s important for two very specific reasons, said Sacks. First, it shows people that they’re not alone and should not be ashamed if this happens to them. And second, it reckons with the image of medical professionals in entertainment, similarly to how 2020 saw the reexamination of the ties between policing and Hollywood.
“Critiquing the medical profession is important here, because we’ve typically just seen it being lauded, like, ‘Oh, these people just do good and their sex lives are interesting too,’” Sacks said. Showing an encounter like Annie’s on television that’s treated in both a serious and humorous way has the potential to inspire people “to think more critically and broadly about the medical industrial complex as it is in the U.S.”
TV’s history with fat characters is abysmal—quick, name one fat character who isn’t just the sassy sidekick or so sad she’s fat that every single storyline has to do with her fatness—which is why Shrill has been a cathartic watch for many. This is a show that is groundbreaking for showing two fat women (Annie and her BFF, Fran, played by Lolly Adefope) with robust sex lives that have nothing to do with their size. So it should not be surprising that showing such a common encounter at the doctor’s office is actually a revolutionary depiction of a real, systemic problem.
But that’s kind of the point of the show, said executive producer West during the February press conference.
“We were careful not to think of it as activism because we wanted it to be effective as a story, because that’s the best way to secretly feed people activism,” she said. No disrespect to activists, of course. But instead of force-feeding sappy life lessons, “You wanted to care about this person because you cared about them. That was top of mind always,” West said.
Added Bryant, “Even when we were pitching the show and talking about all these fat experiences, it was always really important to us that that was just a piece of [Annie’s] story. I know Lindy has had a lot of these experiences too, where sometimes you’re just there to do your job—I felt this at SNL—and then suddenly people are putting more on to it because you are a fat person. Or suddenly it is an act of defiance, that you exist on television because you’re fat. That’s an insane way that we’ve had to operate, but I think we really tried to approach it just from telling her story. I think we did that, and we’re really proud of it. I think people will be excited to see these final episodes that not only talk about where she started, but talk about where she’s landed. And there is no finish line. It’s kind of a forever marathon, and you can only deal with it how you can.”