In a letter to the Food and Drug Administration (FDA) dated October 15, 2024, Cecil H. Smith, the chief science officer of Monstera BioSciences, protests the agency’s decision to deny approval for a new weight-loss drug, ephaloma-copiramate (EmaC-8). Smith argues that the drug is a necessary solution to the nation’s obesity epidemic, which he claims educational efforts have failed to solve. 

Smith addresses the FDA’s concerns regarding clinical trial participant 82941, who famously acquired a taste for human flesh. Smith insists that this violent side effect was unrelated to the drug, claiming that the participant was morally compromised and disordered long before the trial began. To prove this, Monstera has hired an independent firm to investigate the participant’s background. Smith informs the FDA that he will use the firm’s findings in a formal appeal and vows that the company will eventually succeed in getting the drug approved for the health of the nation.

Emmett Truesdale, a 28-year-old Target employee living with severe obesity, feels deep shame while buying chips from a breakroom vending machine. He reflects on his lifelong, painful struggle with his body image. 

While scrolling through Instagram, he sees an ad for a clinical trial for a weight-loss product that offers generous compensation. Later that day, his manager, Rick, humiliates him by reprimanding him for sitting down on the job and for his body odor in front of his coworkers. Feeling defeated, Emmett returns to his car, finds the ad again, and decides to apply, believing he has nothing left to lose.

The novel presents an excerpt from the investigative report prepared for Monstera BioSciences by the law firm Prentice & Darrow LLP. This excerpt is taken from Part 1 of the report, entitled “Background,” and explores the life of clinical trial participant number 82941, identified as Emmett Truesdale. 

The report details Emmett’s history as a blogger, which began five years before the trial with a weblog called The Messy Adventures of Emmett Truesdale. After the blog went dormant in 2020, Emmett revived it in late 2022 with a new title, The True Me. The rebranded blog’s stated purpose was to publicly document his weight-loss journey, maintain accountability, and confront his lifelong struggles with shame and disordered eating. His goal was to reveal his “true” self, who he felt was hidden beneath his excess weight. The report notes that Emmett’s own posts are attached as evidence.

In this blog post, Emmett explains why he works at Target despite his master’s degree in education. After his mother moved away, he took the retail job to afford rent while completing his 600 hours of unpaid student teaching, which he needed for his California credential. During his second teaching assignment at an affluent middle school, students relentlessly bullied him over his weight. Emmett bonded with one student, whom he nicknames “Oddish,” tutoring him and confiding in him about his own experiences with being bullied. The constant mockery from students, combined with the stress of working nearly 70 hours a week, began to wear on him. This culminated in his discovery that Oddish and other students were mocking him in a shared online document, using a cruel childhood nickname that Emmett had shared with Oddish in confidence. Feeling betrayed, Emmett quit the student-teaching program, abandoning his lifelong dream. 

Five years later, Emmett is still working at Target with no prospects for advancement. He has found fulfillment volunteering as a tutor for an organization called Future Makers but remains financially stuck while holding out hope that his life will improve.

The novel returns to Emmett’s narrative. He goes home to the apartment he shares with his best friend, Lizette Castillo, an aspiring fashion designer and body-positivity advocate. After dinner, Emmett tells her that he’s considering joining the weight-loss clinical trial he saw advertised. Lizette is strongly opposed, insisting that he’s perfect as he is and doesn’t need to lose weight. Emmett argues that he is unhappy and needs her support, reminding her of how he stood by her when she wanted to get a tattoo he disagreed with. Lizette reluctantly agrees to accompany him to the information session to ensure his safety.

Emmett and Lizette attend the information session at the modern headquarters of Monstera BioSciences. Dr. Jenni Saito, the company’s director of product development, presents a new treatment called Obexity. She explains that it’s a combination of a gene therapy and a drug, EmaC-8, that rewrites a person’s DNA to accelerate their metabolism, allowing for rapid weight loss without changes to diet or exercise. While the future commercial cost of the treatment will be astronomical, participants in the 14-month clinical trial will receive it for free, along with a stipend of $1,500 per month.

In this excerpt from its introductory section detailing Emmett’s background, the investigative report notes that he actively chronicled his weight-loss journey on Instagram. Monstera collected Emmett’s posts as part of its “standard participant monitoring procedures” to assess the impact of EmaC-8 on participants (31).

This interlude reproduces an Instagram post from Emmett’s account, @etruesdale94, captioned from Torrey Pines State National Reserve in San Diego, California. The profile identifies him as a “California boy. Aspiring educator. Burrito connoisseur” and promotes his blog, The True Me (32).

The photo, described as a selfie of participant 82941 and a Latina woman with severe obesity smiling in front of a floor-to-ceiling window overlooking a canyon, has drawn four likes. In the caption, Emmett hints coyly at attending an information session for a weight-loss system that “sounds too good to be true,” declining to name it while the “jury’s still out” (32). He thanks his best friend, @gordita_official (Lizette), and his followers for their support, framing weight loss as an act of endurance. 

In the comments, user @joanna_225 gushes over Lizette and the new hair color. She mentions that she will see Emmett in a couple weeks, to which Emmett replies, “Thanks mom,” dated April 6.

After the presentation, Lizette confronts Emmett, calling the procedure “offensive” and “fatphobic.” They argue in the car, where Lizette insists that Emmett has been brainwashed into self-hatred and should accept himself as he is. Emmett counters that he feels like he has no choice and expresses deep frustration that she doesn’t understand his desire to be what he considers “normal,” despite her knowledge of his past trauma. The argument ends in angry silence. 

That night, Emmett has a disturbing nightmare in which surgeons carve slabs of fat from his body, mirroring Lizette’s dismissive words from their fight. The dream intensifies as the surgeons use a circular saw on his head, remove his brain, and declare that he won’t miss it, with Lizette’s voice agreeing that he’s worthless.

The morning after his nightmare, Emmett receives an email inviting him to formally apply for the Monstera clinical trial. As he fills out the online application, he continues to check his email for a response from Future Makers, where he has applied for his dream job as an achievement coach. He submits the trial application, answering a series of personal questions about his life and family. Shortly after, he receives an email from Future Makers requesting an interview for the coaching position.

Emmett goes to Future Makers for his interview with Georgina Hodge, the senior director of programs. The interview goes poorly from the start. Georgina makes a series of condescending remarks about Emmett’s appearance, including his untucked shirt. She pointedly states that the organization expects its coaches to set a good example for the at-risk youth they serve, who are predisposed to issues like obesity. She shares her own weight-loss story to imply that Emmett’s size is a result of being “lazy and undisciplined” (43). Emmett leaves the interview feeling shamed and defeated.

In November 2022, Emmett blogs about his history of yo-yo dieting. He details the time after college when he lost nearly 80 pounds using the dangerous human chorionic gonadotropin diet, which restricted him to 500 calories a day. Though he was thinner, he remained deeply insecure and was too shy to act on his crush on a classmate, Aaron Wolfe. 

After a health scare forced him to stop the diet, Emmett quickly regained all the weight and more. He describes the shame of running into people who knew him when he was thin and ends the post with a renewed determination to lose weight and find the “true [him].”

Emmett attends the birthday party for his four-year-old niece, Harper, at the home of his half-brother, Chris Truesdale. Having been rejected from the Future Makers job, Emmett has started a new diet and feels out of place among the fit, affluent guests. 

Emmett speaks with his mother, Joanna Rossi, and his sister, Abby. Overwhelmed by cravings, he later hides in the kitchen and binges on leftover burgers and cake. Abby discovers him mid-binge, and Emmett, mortified, flees the party without a word.

The novel presents an interview between investigator Frank Darrow and Abby. Abby describes her and Emmett’s childhood, explaining that Joanna used food to express love, while their stepfather, Hank Stauder, was a strict health fanatic who constantly shamed them for their weight. Abby recalls Hank once starving five-year-old Emmett for an entire day. She expresses deep guilt, suspecting that Emmett endured worse abuse from Hank when she and their mother weren’t around and that she should have done more to protect him.

Emmett receives a letter from Monstera BioSciences confirming that he has qualified for the next stage of the Obexity clinical trial. He must now undergo a medical assessment at a facility called Cronus Health to ensure that he’s healthy enough to participate. He shows the letter to Lizette, who, despite her disapproval of the trial, offers her support.

Emmett goes to Cronus Health for his medical assessment. The physician, Dr. Halleck, is condescending and immediately shames Emmett for his weight, informing him that his body mass index (BMI) is categorized as “Class Three obesity” (68). When Emmett tries to discuss his struggles with disordered eating, Halleck dismisses his concerns, advising him to simply stop eating sugar. 

After a humiliating physical exam, Dr. Halleck orders a full panel of blood tests, including a check for diabetes, to be sent to Monstera.

This appendix contains another Instagram post from Emmett. The photo is a selfie taken in the doctor’s exam room. In the caption, he discusses the constant fear of chronic illness that accompanies living with obesity and judgment from others. He admits that he’s terrified of being diagnosed with diabetes and has avoided doctors out of fear, but he knows that taking control of his health is the right step. Joanna comments on the post, revealing that Emmett’s aunt had diabetes.

Emmett and Lizette visit the Museum of Us, an inclusive anthropological museum in Balboa Park. In an exhibit on the history of cannibalism, Emmett is unsettled by a painting entitled Portrait of a Man-eater, which shows Sir Percival Blount, a 17th-century aristocrat who claimed that a medical tonic gave him an insatiable appetite for human flesh. 

While leaving the museum, Emmett runs into Aaron, his crush from graduate school. Aaron now works at the museum and offers them a private tour of the adjoining California Tower. Panicked at the thought of appearing unfit while climbing the tower’s stairs, Emmett lies and says that he’s afraid of heights to decline the offer. Before they leave, Aaron offers to give Emmett career advice, and they exchange phone numbers, leaving Emmett feeling hopeful.

The next day, Emmett receives a call from Dr. Halleck with his lab results. Halleck informs him that his average blood sugar level is 8.9%, confirming that he has type 2 diabetes. Emmett is devastated by the diagnosis. However, his despair turns to shock and then relief when Halleck clarifies that having diabetes does not disqualify him from the clinical trial. 

With his participation officially approved, Emmett realizes that the trial is now critical for his long-term health, raising the stakes of its success significantly.