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Trading Sex for Food – Tiger’s Search for Dopamine?

So Tiger Woods is a sex addict and goes to rehab…and gains 30 pounds.

Maybe the food there is great, but probably not; or maybe he’s sitting around doing nothing, but probably not. The food isn’t as good as fine dining, and certainly not good enough for fine golfing. Plus, he was photographed going for a run.

So why is he eating so much?

He can’t help it. His brain is screaming for “substances”. Not sex – dopamine and oxytocin and serotonin and norepinephrine and endorphins…he has the brain of an addict. Here’s the breaking news. So do we all – it is what enables us to experience blissful pleasure.

I understand Tiger Woods. Well, maybe not his choice in sex partners, but I understand the insane cravings. He craves sex. I craved food. You might crave alcohol or drugs or tobacco or gambling or shopping or working or exercising or rage…

Our brains have a built-in reactor system to determine “things-that-make-us-feel-really-great”. We respond to life’s greatest pleasures with a chemical explosion that rocks our world. Without this internal nuclear reactor, we would ho-hum through every moment of our lives. With the reactor, it only takes one orgasm to love sex. It only took me one chocolate chip cookie to love food.

The moments of an orgasm or a taste of chocolate are fast and fleeting – the natural timing of brain chemicals. Like fireworks. If you blink, you miss them. We quickly return to our baseline mundane and uninspired living. Boring is our neutral. (Some people call it calm, most addicts call it boring).

And here’s the really bad news, known to every addict of any substance. The bliss level is never the same as the first time. Your brain accommodates to stimulation – good, bad or ugly. You get used to sex or chocolate or CSI or winning. And it takes more and more of your substance of choice to get the same level of explosion. When I was four, it only took one cookie to reach nirvana. Nowadays I would need an entire factory. After awhile you can’t get there at all. Unless you keep changing it up a bit.

So why would anyone keep doing a substance that isn’t even bringing them joy anymore?

You only have to look at Tiger to understand. He looks depressed. It’s the day after the binge, and he’s crashing. And while it’s tempting to say ‘of course he’s depressed, look what he’s done to his life’, the reality is that much of what is happening in his depressed brain is a biochemical rebound of misery. It takes a nanosecond to explode feel-good chemicals in your brain; it can take weeks or months or years to replenish them. Forget the highs. He keeps using to stay at neutral. Anything to avoid the crash.

I feel for the guy.

There really isn’t any difference between us. Our brains all crave reward, stimulation, excitement, curiosity, feeling good. Even to point of overindulgence.

Life is filled with joys that can create the same explosion of feel-good chemicals, without destroying your life or health or emotional well-being. Exercise will release dopamine and keep the level high for more than a day, unless you do it for a living and have attached the stress of daily life to it. Music, art, love, petting your animal, aromas, company, movement, prayer, meditation, playing with your children or grandchildren, and many others. It may not be as dramatic or intense the first time around, but it sustains you with a deep and abiding joy.

And it stops the cravings.

Is Kevin Smith Too Fat To Fly? Thoughts on Obese Discrimination

What difference does it make if a fat producer is kicked off an airline? Isn’t that a private issue between the passenger and the company? If he didn’t fit in the seat, he should get off the plane, right?


This one had me from the first tweet. Even if I had to ask my husband who is Kevin Smith other than a guy with 1.6 MILLION followers on Twitter? (Answer: a producer of movies that teen & 20 & 30-somethings love).

A lifelong big guy, returning home after speaking at MACWorld, is seated as a standby on a Southwest Airlines Oakland-to-Burbank flight and then summarily ejected because he is a “safety” problem. One that involves the width of his body in his seat. (I still don’t get that one, what’s the safety problem?)

Of course, they saw his body habitus when they ticketed him at the gate for standby. They sized it up again when they seated him. They saw that his seatbelt fastened without an extender and his armrests went down. They polled the two ladies on either side who didn’t object to his presence.

Yet they made him get up from his seat in front of 150 watching people, retrieve his carry-on luggage from the overhead compartment and get off the plane. Like the bad kid being sent to the principal’s office.

And he was FURIOUS!!! And tweeted all night long.

I’m pretty confused about this. I like Southwest. I fly them, their seats are comfortable, their service is pleasant. They were extremely nice to my 88 year old father who needed some extra assistance last fall. But I am also a person with lifelong obesity. And there have been times in my life, 90 lbs ago, when I needed a seatbelt extender. I did my best to stay within the boundaries of my seat and be invisible and non-offensive.

So why can’t the airline just say they screwed up?

Instead Southwest has created a public relations disaster in which they blog their apology by making fun of his comedic character “Silent Bob” and his real-life angry persona. They titled their blog “Not So Silent Bob”, and defended their customer size policy while intimating that his badmouthing the airline publicly was oh-so-unfair. Unfortunately, they also explain the parameters of the customer size policy which, in this case, appear to have been applied arbitrarily if indeed he successfully buckled and put his armrests down. I’m guessing he was profiled more on his hoodie & pants-on-the-floor look than his actual size.

Blaming the fat guy for discussing the anger-causing events never works well for the merchant. You’d think they would just say, “we made a mistake, you fit in the seat, we’re really sorry, we misapplied the policy, we’ll make sure it doesn’t happen again”. Doesn’t require they rescind the policy, just acknowledges they were overzealous in its application.

The story doesn’t end there – it gets worse.

Smith put up a long, rambling, profane “Smodcast” (his name for his podcasts) of the events. The ‘AHA!’ moment occurs more than 50 minutes into the rant.

On the next flight, he had two paid seats of his own. An obese young woman was seated in the third seat; his paid-for, empty middle seat between them. After she was seated and settled, the attendant took HER to the principal’s office. Where she was told that she had to ASK PERMISSION from our fat producer to spill over into his empty seat, or she would be ejected too. And next time, she should purchase two seats. Different flight, different crew, different passengers (except for our angry producer).

Bullseye! Kudos to the airline. You have now effectively destroyed the very shaky self-esteem of yet another fat person who will invisibly skulk away into the night in shame, never to fly your airline again without paying double.

Now I’m furious. Once is a misapplication of a policy. Twice is a pattern of pointless and opportunistic discrimination. No wonder they didn’t apologize. They feel righteous in their contempt for adiposity.

And so do hundreds, if not thousands, of commenting passengers on forums, blogs, tweets. Thousands are in support of the producer (and by proxy, the woman on the second flight); some vow to boycott the airlines forever. But thousands others have seized the opportunity to be venomous and verbose slayers of fat people. (often anonymously, gee I wonder why).

The language is at best intolerant and unforgiving. Those are the people who are talking about being uncomfortable on an airplane. They have a point, although it could be expanded to include passengers who drink, smell of cigarettes or perfume, have screaming babies, or crack chewing gum among other encroaching habits.

At its worst, however, the language in these comments is frightening and revolting, almost horrific. If you changed the word fat to black or Jewish or female or gay or Muslim….the rhetoric would sound illegal. These people aren’t commenting about their crowded seat. They are taking the opportunity to express mindless, revulsive hatred against a group they feel is inferior to them.

Southwest needs to take a step back from this sizeable group, and from their uneven and discriminatory enforcement of “customer size policy”, and return to the idea of helping ALL people navigate the often difficult world of airline travel. With dignity and respect. Just the way they treated my dad.

If you have been a victim of obese discrimination, you are not alone. It is the last unanswered prejudice. Do what Kevin Smith had the bravery to do. Tell your story, even if just to a friend or a family member. Be assured that you do not deserve to be hated or hurt because of your weight. Or your skin color, religion, sexual preference, gender, political beliefs…

So to answer the question about why we should care because a fat producer got kicked off a plane…

Maybe we should care because it is uncovering the worst in us, both individually and corporately.

Sara L. Stein, M.D.
Author, Obese From The Heart: A Fat Psychiatrist Discloses (2009)

On Childhood Obesity and Genetics – It’s All in The Family!

Today at noon First Lady Michelle Obama unveils a new Nationwide Initiative on Childhood Obesity. About 1/3 of our children are overweight, 1 in 5 are obese. In some states, the numbers are nearing 50%. These numbers go up as people age. Currently 60% of adults in our nation are overweight and 30% are obese.

Clearly this is a progressive condition. It’s getting worse. We’re getting worse. More people are getting fatter and sicker as they get older. The prevalence of obesity has risen 3000% in the last couple of generations. That is NOT an explosion of genetic illness.

It is convenient and absolving of responsibility to think that our DNA is causing obesity. While there are genetic obesity syndromes, they are rare – estimated at 1 in 7000 obese people. These syndromes present very early in childhood and are often accompanied by other developmental conditions. That means that 6999 out of every 7000 obese persons have to find another reason for their overweight besides their genes!

The genetics of obesity is how your body distributes fat, and what shape you are. Apple vs pear is genetic. Gaining weight as a result of eating too much is not.

Still, for those of you who insist on genetics as a cause of your obesity, you’re right. Sort of.

Most of the genetics of obesity involves on-off switches that regulate metabolism, inflammation, energy. Low quality foods, nutritional deficiencies, artificial additives and preservatives can flip the gain-weight or the do-not-lose or even the burn-calories-slower switch. If you are obese and dieting, it may not be your imagination that you are not eating much and still not losing weight.

Obesity IS generational and familial and cultural. We become overweight because we are served certain foods in an environment that encourages us to eat. It might be low quality food, or it might be the highest calorie home cooking of our dreams. We overeat because we attach meaning and emotion to our food, whether it’s the SuperBowl, Christmas or a funeral. Quickly we learn to use food to regulate our emotions, our energy, our happiness on a daily basis.

What about exercise? You need it! Your body is designed to move, and without movement, you become ill. It gets better though. When you combine healthier foods with movement, those on/off gene switches go back to where they are supposed to be, and your body weight begins to readjust. It doesn’t take starvation and boot camp and pain. It may just take a few less preservatives, a little more home cooking, and a walk after dinner. And a good nights sleep.

So what do you do for you and your children and your family? Here’s the good news.

If you come from a family that has always used food as a measure of the joy and sadness of life, try music instead. Use food for fuel, not emotional fullfillment. Use love as comfort, not ice cream. Use movement to blow off steam, not potato chips. Use prayer and meditation to find your bliss, not cookies. Use your family as your support, not your frustration. In the end, all we have is each other. With or without the meal.

Now you can live with that, can’t you?

Introduction to ‘Obese From The Heart’

Who is this book for?

Maybe it is easier to tell you whom it is NOT for.

If you are looking for a good diet, consider these suggestions:

  • If you have a few pounds to lose, try a balanced diet with meal plans or suggestions that suit your lifestyle – join a gym, go for a walk, stop drinking soda, drink tea, find a diet buddy or online support group, practice relaxation.
  • If you have a significant amount of weight to lose, go to your doctor, a nutritionist and start moving, even a little. Learn how to lose weight the healthy way, and try it. Make sure you do not have a medical condition that is causing the extra weight.
  • The rest of you, read on.

  • Read on if you are morbidly obese by medical standards and you have not successfully managed your weight.
  • Read on if you feel hopeless, helpless and defeated by your weight and your attempts to lose it.
  • Read on if your appearance does not reflect the way you feel inside.
  • Read on if others have reacted to your appearance before you even said one word to them.
  • Read on if you feel alone because of your weight or if your weight is a response to feeling alone.
  • Read on if the pounds you gain reflect the pain and emptiness you feel in life.
  • Read on if you have put your life on hold because of your weight or you have resigned yourself to living a better life in some other year or in some other universe.
  • Read on if you believe you are going to die because of your weight and you have not been able to change your ways.
  • Read on if you feel that there is an inner you clamoring to emerge; the you that accurately reflects your soul, the you that looks the way you feel.

This book is as much my story as your story. They are not different. We may have been born in different cities or countries; we may eat different foods or work in different vocations. We may worship with different languages and customs. We may be different ages and different sizes.In the end, all we have are our relationships.

Underneath our exteriors, we are all the same. We love, we hate, we celebrate, we grieve. We play, we learn, we create. We have relationships that sustain us throughout our physical lives – relationships with people, with ourselves, with food, with our spiritual selves.

If I believe that my body serves to keep me separate from you, then I can never be connected to you, even in intimacy. We are connected by our emotions, by our energy, not by our bodies. Anyone who has ever felt another persons joy or suffering, whether in person or in the media, feels that connection. Why else would we weep over illnesses, or wars, or disasters, or crimes that affect those we have never met, in places we have never been?

We are all connected. My health reflects your energy. My love is an expression of your loyalty. My blessing is the song of your heart. And so it goes.

When you are tired, I am in pain. When you are alone, I weep. When I am isolated from the flow of the universe, I cannot fill up, no matter how much I eat.

(from Obese From The Heart: A Fat Psychiatrist Discloses c2009 all rights reserved)

“The Greatest New Year’s Resolution of All: When I Grow Up, I Want to Be A Chocolate Chip Cookie”

I never wanted to be a fat psychiatrist when I was little. I wanted to be a chocolate chip cookie. It never occurred to my 3 year-old brain that some starving teenager might polish me off in one big bite. I didn’t care that it was a physical and spiritual impossibility for a human being to transmutate into baked goods. (Although some people do figure out how to become root vegetables, but they’re not in this blog).

I cared that I became what I loved.

That got me thinking about New Year’s Resolutions. New Years Resolutions are these active, goal-setting, forward-motion plans. Kind of like football games. I’m going to move down the field and beat the enemy. Pumped up and rearing to go! Starting tomorrow, I’m going to lose 50 pounds, work out every day, read 10 books a week,  go to bed early, donate all my extra time and money (even if there isn’t any). Starting tomorrow, I’m going to be a better person. Like maybe Mother Theresa.

Aside from the obvious “it’s been done”, if I became a Saint, would my friends and family and coworkers even recognize me? I think they’d all be standing around watching my stomach and taking bets on when the alien pops out.

I know from the last few decades that New Year’s Resolutions never quite stick with me. The other team always wins in the end.  There has to be a way to improve the odds on these resolution outcomes.

Maybe we could make resolutions for each other instead. They would probably be a lot less stringent (unless you have very rude friends). I can’t imagine my husband saying “You have to lose 50 pounds next year”. Aside from being a nice guy who would never say such a thing, he knows he would be risking his life with a bonehead observation like that. Instead, he would give me a resolution that somehow made us both happier. Like more nookie. Or sleeping in. Or cooking together.

What about my coworkers? Maybe they would nail me. “You should see 30 more patients a week and work until 11 pm every night.”  Nah. They would say, you should make sure you take lunch everyday, you need the break.

Ok then, my sisters. Certainly years of sibling rivalry will takes it toll. “You should cook and clean and no glass slippers for you!” Nope, not that either. They don’t care who cooks and cleans in my house or what high-style pumps I wear. They might say “we should go for lunch” or something like that.

And forget my friends… they are totally there for me. That’s why they are my friends.

So basically, nobody out there is looking at my past 12 months of life and sneering. Nobody is saying I have failed. Nobody is telling me I am a bad person. Nobody is setting crazy perfectionist goals. Except me. I am the critic and the criticized. I am the abuser and the abused. I am my own Cinderella and my own wicked stepmother. (By the way, I am a stepmother and I don’t consider myself the least bit wicked. Ok maybe a little strict, but hey, I like things orderly). And certainly, no one else is saying that the road to self-improvement should be paved with suffering.

Quite the opposite. My family and friends would design New Year’s Resolutions for me that increase their ability to nurture and love and laugh with me. That improve the quality and the heart-centeredness of my days. They would make sure I celebrate my life and time, and I would do the same for them.  Their mandate would be for me to sit back and enjoy the ride.

They would want me to return to the simple joy of being instead of the rigor of becoming. Which is a guarantee that I will move myself closer to my life’s purpose.

I think I might be able to stick to those.

So here are my New Year’s Resolutions… In 2010, I vow:

To follow my heart and do what I love

To do what honors me and brings out the best in me

To do what helps me and nurtures me

To do what makes me laugh

And by so doing, I will love and cherish and honor and help all of us together.

Happy Healthy Prosperous New Year to all of you!

Doctors and Obesity: What Can You Do?

Doctors are as puzzled about obesity as the rest of society. I know this because I am a physician and I am also obese.

For the doctors, you give patients all of the wisdom you gained from years of studying, the best coaching you can muster, and they fail to improve. After awhile, simple human nature takes over. Obese patients seem unable to follow directions, fail to lose and maintain weight loss, keep getting sicker, and they ruin your day. For the doctor that means frustration that turns into anger, then resentment, then resignation and apathy.

The real problem for doctors is that they don’t have the proper tools for treating obesity. Current treatment for obesity addresses lifestyle – portion size, food selection, exercise – all necessary for weight loss. But actual obesity is a brain disease – disordered neurotransmitters trying desperately to manage a very stressed supersized body with toxic and inadequate nutritional substrate for fuel. Pushing the gas pedal harder doesn’t get a broken car to run faster or better. The good news is that brains are plastic, they can heal.

So what can the obese patient do? Your doctor hates fat. If that’s true, you are partners, and can forge ahead trying different options together. Some will work for you, some will not, some will work for awhile. Address the addiction and depression/anxiety and emotional eating that invariably accompany obesity. Watch out for medications that increase your appetite. Move a little, change something everyday, reawaken your curiosity, eat the highest quality food you are craving – you will eat less of it.

Hopefully your doctor is mature enough not to hate fat people. If that is the case, change doctors. You do not need to endure additional suffering.

Go forth in good mental health!

Sara L. Stein, M.D.
Author, Obese From The Heart: A Fat Psychiatrist Discloses

reprinted comment in response to LA Times article October 22, 2009 | 11:23 am

Extra pounds, and attitudes about them, can affect doctor-patient relationships

Posted by: Sara L Stein, MD | November 05, 2009 at 08:28 AM

What have you done for yourself today?

It’s way too easy to forget about your own needs, even when your brain and body are screaming inside you for fresh air and rest and joy and movement.

I was in the ER with my dad yesterday, always sudden and always scary. He’s fine, we left before he got jumped by some lurking virus. I came home and made green minty tea and had dark chocolate and then sat in a hot bath with music and bubbles. Well actually, I turned on the jets and the bath salts foamed like crazy and went all over the bathroom like some bad Lawrence Welk intro, and my 175 lb Newfoundland puppy came in and was trying to catch them with his tongue, but I was afraid the salts would give him the runs so I was trying to get him to quit it, and yelling for my husband who was in the garage installing some computer thing and didn’t hear that this 6-foot dog is trying to climb in the tub with me.

And I laughed and laughed and laughed.

And then I felt better, and slept all night.

(transferred from the Forum, originally posted Nov 2009)

Fat People Don’t Shop In Bookstores & Other Crazy Thoughts

Nice book, says B&N, we’ll keep it online. These types of books sell better online.

Uh-oh. What type of books? FAT BOOKS? FOR FAT PEOPLE???

Fat people don’t shop for diet books. They shop for candy bars. If they’re in the bookstore, they avoid the diet books. When they want to buy diet books, they hide behind their computers and secretly buy fat books in the night.

Been there, done that. It’s true. The Secret Life of An Addict.

I will go anywhere in public to buy my addiction candy – any street corner, any gas station, any fancy candy shoppe, under any bridge. But my rehab book, I will only buy in secret. Not proudly, like those cigarette smokers with the “I’m quitting today” stickers proudly discussing their intent with the cashiers. Furtively. So no one will know. That I want to try again. And I might fail.

So now I’m outed again by a bookstore. That wont carry my fat book in person. But will gladly carry it on the internet for fat shoppers who don’t want anyone to know they are thinking of quitting candy. Not only am I a secret eater, I’m a secret shopper too!

My first reaction was embarrassment. What will I say when people ask when is your book going to be in the store? Some vague non-committal answer. THE SAME FEELING I’VE HAD WHEN I GAINED WEIGHT BACK AFTER PUBLICLY LOSING IT. I’ve failed again.

So here’s what I did. I told the world. I told Facebook, and I told Twitter and now I’m telling you. Fat people don’t shop for diet books in public. They diet in secret. And the bookstores know it.

It is not your fault if you have an addiction. You are not weak or lazy or slovenly. You are human. And I hope if you reach for my book in the middle of the night from the sanctuary of your computer, that it reaches your authentic self. From my heart to yours.

On Being The Biggest Winner

A woman who has lost 200 lbs, with another 100 to go, reaches a weight plateau. Her trainer urges her to work harder in her workouts to bust through the stalemate with her body.

I disagree.

When you apply more force to your body, your body holds onto fat with equal intensity.

I would say to this lovely lady…

You have made a remarkable journey, your body thanks you every moment for moving from illness towards vitality. Losing weight is a healing process that requires gentleness, with careful care not to reinjure the body through emotional or physical stress. Ideally we honor our healing bodies with a combination of movement, stretching and strengthening, good humor and peaceful minds. If you work too hard to lose, you increase stress in your body, increase your stress hormones, and they hold on dearly to every last ounce of fat.

Instead, when you reach a plateau, change something in your movement, something in your food and something in your heart. And weight loss will always follow.

Live on the Internet sites!

YAYYY!!! Live on Amazon.com, BarnesandNoble.com and Kindle! Still waiting for the great state of Ohio to make it official for the e-version. In Powells and Joseph Beth already! In bookstores in later October! Spanish and Russian translations coming in 2009, I promise!

The blog is comment free; please go to the forum page and share your thoughts and feelings with all of us. Coming soon.

I owe alot of people alot of gratitude starting with my husband who is now officially the book widower. Maybe he can take up golf!

So hang in there with me, thanks for your interest, we’re hurrying up and waiting as fast as we can!!

Best, Sara

PS Please see the forum for a typographical error correction in versions published prior to October 12, 2009. My apologies for missing that 🙁

We apologize for the following typographical error in editions of Obese From The Heart: A Fat Psychiatrist Discloses:

ERROR: Please replace the word “gabapentin” with “GABA” on pages 15, 26 and 34. GABA is a relaxing neurotransmitter in the brain. Gabapentin is a medication that may increase that neurotransmitter. We apologize for the error and note that this has been corrected in any version of the book Obese From The Heart: A Fat Psychiatrist Discloses published after October 12, 2009.

Kindle users will be able to redownload the corrected version at no additional charge.

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