When the Heart Causes Obesity

The doctor wrote down “morbid obesity” in my chart. I was mortified. I looked it up. It meant I was going to die from being fat. I was 12.”

This is perhaps the most moving paragraph in Obese From the Heart, a book that everyone struggling with excess weight should read – more importantly, a book that every obesity researcher, health professional and decision maker should read.

Written by Sara L. Stein, a psychiatrist who has struggled with severe obesity all her life, the book provides profound insights into everything that I see in my own practice every day.

In just over 100 pages, divided into chapters that are often not more than a couple of pages long, Stein touches on all of the important human issues that are so often the underlying causes of uncontrolled overeating and excess weight.

From her own seminal experience as a three year old, with clear memories of the ecstatic experience of one day biting into a chocolate chip cookie, which triggered off a life long addiction, Stein writes about how emotions can profoundly influence ingestive behaviour.

With regard to food addiction, Stein notes:

Food addiction is unique among addictions in four ways: Food is unavoidable; Food is essential for life; Food is socially acceptable, everywhere; Food can actually elevate your status if it’s good. …food is the only addicting substance where abstinence is both impossible and unacceptable.
…it’s everyone noticing that you are not eating. Especially the cook.
So begins the brutal cycle of trying to control your additcion while still using. DIEting…

Other chapters deal with stress, depression, anxiety, anger, trauma, and grief. Regarding the later, she notes,

“I can trace my weight gains to anticipating grief, experiencing grief, and reliving grief”.

Her account of growing up as a “morbidly obese” child, teenager, and young woman are both insightful and heart wrenching.

Based on her extensive experience as a bariatric psychiatrist, she discusses the role of bariatric surgery, the problem of anti-fat bias and discrimination (especially amongst health professionals and the media), the important role of sex (or lack of it), and the self-destructive “people pleaser” attitude that reinforces the cycle of nourishing (and respecting?) everyone else but yourself.

Most importantly, Stein shares how she herself found balance – the struggle continues but, down 75 lbs from her highest weight, she has never found it easier to manage her weight since identifying her emotional eating patterns and accepting herself as a wonderful divine being. (“all of us are human with souls, and wants, and emotions, and families and friends”).

While I do not agree with everything Stein writes, such as her views on the role of nutritional supplements (for which evidence is anecdotal at best) or detoxification (whatever that means), the book is nevertheless full of important advice both for health professionals as well as anone struggling with excess weight.

Thank you Sara for sending me a copy of your book – it will definitely be recommended reading for my staff and colleagues – even my patients!

Edmonton, Alberta

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