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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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  1. Hey Dr. Sharma,

    No doubt Dr. Stein’s book will be helpful for some obese people and those treating them, but I don’t entirely get her approach. I listened to an interview with her, and she says that obesity is a disease. You yourself have said that many obese people are healthy. I am technically obese, but I have not health problems related to my weight and I don’t I’m addicted to food. I don’t find it helpful to be told I have a disease when I think I’m actually pretty average!

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  2. Jennifer: as you correctly note, I have previously said that you cannot measure health on a scale. Yes, there are indeed people who meet the BMI criteria for obesity but are perfectly healthy (EOSS Stage 0) – but with increasing BMI this is certainly the rare exception – if you are one of those – Congratulations!

    Regarding food addiction, I have also previously noted, that there are many paths to obesity, food addiction being one of them. But I can readily think of 50 other causes of obesity that have nothing to do with food addiction – this is why obesity is so complex. This is also why one treatment does not fit all.


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  3. OK, so here we have a book written by Sara L. Stein, a psychiatrist blaming it on her past. However, what about today. It’s true that for many emotions and past history lurks in our minds that drive us to compulsive over eating. It truly is a disease that unfortunately many family doctors do not consider compulsive over eating a disease. How can they ? they only have five minutes to spend with their patient. It’s time that the medical profession take obesity to be a serious health problem and stop waving the “obesity” chart in our faces. A fat person knows that they are obese. When a doctor has a person who is overweight the doctor should be able to refer them immediately to a dietitian as a start and the dietitian after spending serious time with the person be able in turn refer the person to a health wellness centre for any additional guidance and help.

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  4. Walter: I agree that time is often an issue – but the simple message here is that it is important to look behind the facade to see what is really driving over eating. In many cases (as pointed out by Dr. Stein) the reasons are psychological – here the reflex of immediately referring every patient with excess weight to a dietitian (who in the majority of cases is not a trained mental health professional) is exactly the wrong solution (and therefore so often ineffective). In many cases the psychologist can be of far more help (especially for compulsive or binge eating).


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  5. A multidisciplinary team is often the approach with the best chance of being helpful. Unless there is a parallel increase in psychiatric conditions that mirrors the rise in obesity, the environmental and lifestyle change factors still seem to account for a higher percent of the average weight increase from 20 years ago. Psychiatric care without involvement of a nutrition professional is a limiting approach as well. To start there is a need for an increase in the number of psychiatrists who are knowledgeable and comfortable with obesity treatment.

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  6. Obesity is certainly a much more complex problem than most health professionals and lay people would believe. Those who are within a normal weight range and have never struggled with being overweight simply cannot understand how difficult it is for an oveweight person to lose that weight, and it gets even more difficult the more obese someone is.
    In this culture we lead people to believe that it is just a matter of willpower, just eat more healthy foods, just exercise. But when you are emotionally stressed and often physically in pain, perhaps even taking medications that slow your metabolism, it become more difficult to exercise and it becomes more inviting to eat foods that you view as comforting.
    This book seems to address many of the important and often overlookd issues.

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  7. Which came first, the chicken or the egg? Did the weight cause the psychological problems or did the psychological problems cause the weight gain? As has been stated previously, it is rarely as cut and dried as that. There are too many factors that contribute to obesity to simplify it, and attribute it to one, or even two or three, causes. Time is definitely an issue, as are things like untreated AD(H)D, genetics, social/family pressures and traditions, even possibly placement in the family of origin. If a person has a combination of several contributing factors, treating just a couple of them won’t help.

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  8. Sara Stein twitters and is on facebook passing on links of interest much more frequently than she blogs. I find that every obesity blogger has his/her favorite theories and following any one person is not enough to get an overall perspective. I’m thankful I found Sara because there aren’t a lot of psychiatrists specializing in obesity issues and because she has had a lifetime personal struggle with obesity. It’s a bit like childbirth – there’s the study of obstetrics and there’s what one learns by growing a baby inside one’s body and feeling each stage of labor and delivery. The puzzle is huge with many, many pieces required to get a complete picture. Not everything can be learned through the brain – there are a few pieces of the puzzle that can only be understood by one’s cellular memories.

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