Obese from the Heart: A Fat Psychiatrist Discloses

By Sara L Stein, MD

Review by Vincent J Felitti, MD, FACP

Fall 2010 - Volume 14 Number 3


This is an unusual book. It is an autobiographical approach to obesity, written by a perceptive and unusually open psychiatrist who describes herself as fat since second grade, and still fat. Its great virtue is that it focuses on basic emotional causality, not avoidantly escaping this by discussions of consequent intermediary biochemical mechanisms. Moreover, Obese from the Heart is highly readable and easily understood, equally useful for physician as well as patient. A free chapter can be read at the Web site: http://obesefromtheheart.com/

The tone is set in the early pages: "The only difference between the food addict and the alcoholic or cocaine addict or gambler or the shopaholic or the sex addict is the drug of choice: Food."1p11 Sara Stein, MD, then goes on to point out repeatedly that something is being treated and that the treatment almost works—at least for a brief while. That something typically is depression: "This isn't a story of genetics. This is a story of separation and loss. And the bottomless hole it leaves inside of you. Is it possible that the genetics of food addiction are related more to our family stories than to our chromosomes?" 1p16

Various short chapters help one understand the role of eating in dealing with trauma, anxiety, anger, stress, and grief. Most of us are not comfortable discussing these in ourselves, much less with patients. That's where the value of this book lies: it is an exemplar, it bears witness to what we might do in everyday practice. When did we last ask a patient how they felt about having cancer or a stroke or dying? What is the price that we each, as doctor or as patient, pay for this?

1.    Stein SL. Obese from the Heart: a Fat Psychiatrist Discloses. Cleveland, OH: Quantum Psych INK; 2009.


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