Set in Stamford, Lincolnshire in the mid-1990s, My Mad Fat Diary follows the story of 16-year-old, 16 stone (106 kg) (233 lb) girl, Rae Earl, who has just left a psychiatric hospital, where she has spent four months.

The Guardian's Sam Wollaston called it a "lovely drama – honest and painful, real, and very funny," going on to say "Sharon Rooney's performance in the lead is natural, effortless and utterly believable; she should win something for it.

"[9] The Stage called it "a comedy drama that actually satisfies the criteria of both genres, My Mad Fat Diary offers a unique and uncompromising perspective on adolescent angst that distresses and delights by turns.

Visual gimmicks – flashbacks, fantasies and animated squiggles leaping from the page – are used sparingly but effectively, allowing the focus to stay fixed on Rae and Rooney’s commanding and engagingly natural central performance.

[14][15] In a more mixed review, Robert Epstein of The Independent criticised E4 for relating the program to its other teen shows: "If such comparisons are unfair, blame it on E4, whose continuity announcer declared: 'If you like Skins, The Inbetweeners and Misfits, you'll like this.'