The assumption that people actually mean 'unlovable' or 'unworthy' when they describe themselves as 'fat' reveals the harsh bias we have against bigger bodies, says writer and podcaster Aubrey Gordon.
"It's rare that I say I'm fat without someone saying 'no, you're not, you're beautiful' which is a wild assumption to make that those things can't coexist," she tells Susie Ferguson.
Aubrey is the subject of a new documentary Your Fat Friend, which takes its name a viral blog post that Aubrey wrote back in 2016.
She says the anonymous post – A Request from Your Fat Friend – was inspired by a letter to a dear (thin) friend who was so keen to relate that she would "erase the differences" between them.
"I would say 'I had a really hard time going to the doctor's office today because the doctor refused to treat me and refused to make eye contact with me'. And she would say 'I'm also having a tough body image day'.
"I thought, well, this isn't really about how I see my body, it's about how other people treat my body. And I just wanted to bridge that gap with a good friend with some tenderness and some understanding because I wanted to stay connected to that person and sort of help her understand where I was coming from."
In the States and the UK, fat people make up between half and three-quarters of the population, Aubrey says, yet their doctor visits are only about a third to half the duration as those of people who are not fat.
"Doctors and nurses and healthcare providers of all stripes go through an immense amount of technical training and that technical training does not challenge their existing biases.
"Doctors are less likely to believe us when we tell them our symptoms and they're more likely to tell us to go away and lose weight and come back when we're thinner.
"Quite a bit of the concern for our health that gets expressed is not based on knowledge of our health status, it's based on assumptions that are based on our appearance."
The concept of body mass index (BMI) as a measure of healthy weight was invented centuries ago and based on a white male 'ideal', Aubrey says.
At 330 pounds (150kg), she's been given just a 0.8% chance of "attaining a BMI-mandated weight" in her lifetime so it doesn't seem a relevant health goal.
"If we can shift our perspective to understand that there is a 99.2% chance that fat people are not going to magically become thin people I think that gets us pretty far and really sort of shifts the frame that we're using.
"What are the health care treatments that folks need now? What are the ways that we ought to be treating each other if our bodies are just our bodies, if we just are the size and shape that we are, what does that change about how we treat each other? That feels really important to me."
Your Fat Friend filmmaker Jeanie Finlay says questioning the "faulty mechanism" that is the BMI was part of her motivation for making the film.
"I could see that there was a difference between the way that fat people lived and wanted to express their lives [and] the stories that were being told in the media.
"I always want to look afresh at things. And it seemed to me what if bodies just are? What does it mean to extend compassion for all people? And how can we examine the way that bias has influenced the way that we may treat people in our lives, even if it's unconscious bias."
UK screenings of Your Fat Friend have been laughter-filled and also left audience members in tears, Jeanie says.
"One of the things that has really moved me is parents who have stood up and said 'I hope my children forgive me for the terrible things that I've said to them'.
"For me, the thing that feels really compassionate and endearing in the film is Aubrey's relationship with her parents. And Pam in particular - Aubrey's mum - is able to take the opportunity to say 'hey, I don't think I got things right' and to progress a conversation."
It's easy to feel frustrated with parents who fall in line with "deeply anti-fat visions" of what their kids ought to look like, Aubrey says, but those pressures are so prevalent in our culture.
"I just read a quote from [British chef Jamie Oliver] the other day, telling a parent that feeding her kids pizza was no different than a cigarette burn.
"Those are really strong, powerful and damning messages to parents who are overwhelmingly just trying to do their best and there's not really much of anybody saying, 'hey, it might be okay that your kid's a little fat … your kid might be just fine. It seems like they're really bright and really fun and really sweet and really charming. And that could be enough."
Aubrey's own parents have become "more and more full-throated" in their support of fat people and her work.
"Watching my parents' perspective shift on this has been hugely inspiring."
Upon the release of Your Fat Friend, Aubrey is highly aware of how people tend to "lose their sense of empathy, often gladly and proudly" in response to fat people.
She is concerned backlash against the film could lead to a relapse of the restrictive eating disorders she has struggled with.
"Every moderate-to-high-profile fat person I know who has talked about their eating disorder has been met uniformly with ridicule. And I know that when this is released more widely, that's what's coming for me."
Currently, only people with a BMI in the underweight category can be diagnosed with many restrictive eating disorders, Aubrey says, even though those with high BMIs are the likeliest to develop them.
It's very hard for "fat folks" to get effective eating disorder treatment which doesn't focus on weight loss as the most important thing, Aubrey says.
"Until about a decade ago, in order to be diagnosed with anorexia nervosa, you had to have missed a period. if you never had a period to begin with, that automatically cuts you out, right, of people who qualify for this diagnosis, regardless of your behaviours regardless of anything else.
"So regardless of how much weight I drop, regardless of how troubling my behaviours are, I don't qualify for that diagnosis. And it's really important to talk about it and also sometimes feels really lonely that people have not really thought about, hey, when you make a point to tell fat people what to eat at every turn, over time fat people stop eating, and over time, we learn to eat alone or not at all."
You can stream Your Fat Friend until 31 January via the Doc Edge Virtual Cinema.
Aubrey Gordon is the author of the bestselling books What We Don't Talk About When We Talk About Fat and You Just Need to Lose Weight And 19 Other Myths About Fat People. She co-hosts the popular wellness-critiquing podcast Maintenance Phase.