According to the U.S. Department of Health and Human Services, nearly thirty-one percent of the American public is obese; obesity accounts for 300,000 deaths a year, making it the second-most common preventable cause of death after cigarette smoking; individuals who are obese have a fifty to one-hundred percent increased risk of premature death from all causes.  On the opposite end of the scale, so to speak, is anorexia, which, as one of the deadliest of psychiatric diseases, claims up to fifteen percent of its sufferers who either die of suicide or complications related to starvation; about one-third spend their lives dominated by their obsession with food, and almost half never marry. 

How can we ever understand the psychological, physical, emotional, cultural and spiritual complexity of eating disorders, whether they result in morbid obesity or in a starving body digesting itself?  Ann Pai's memoir opens a window to reveal the inner world of a food obsession, her own, and holds up a mirror to reflect the outer experience of a dying, five hundred fifty pound woman, her sister.

The narrative weaves together three strands:  the sweet but unsentimental history of two sisters growing up in the midwest--Joyce, the elder of the two, and Ann, younger by almost five years; the detailed and horrific account of Joyce's sudden hospitalization on September 11, 2001, and her inexorable decline through multiple, undiagnosable and fatal illnesses as the result of her obesity; and the stream-of-conscious and raw monologue of Ann's own struggle to manage a compulsive eating disorder.


The "shared skin" of two sisters, Joyce and Ann, begins when Ann's crib is moved into the bedroom of four-and-a-half year old Joyce.  Along with childhood memories, adolescent secrets and adult disappointments, the sisters also share an obsession with food.  Joyce's eating disorder will eventually spiral out of control until her world is reduced, once again, to the small bedroom in her parents' home, a space that she fills to bursting with compulsively purchased cameras, books, magazines and tapes and with the waste of compulsively eaten food:  "the litter that had been her life."

On September 11, 2001, Ann gets the phone call that she has been expecting yet dreading: her thirty-eight year old sister is hospitalized in critical condition.  Because Joyce weighs over five hundred pounds and cannot fit into the MRI scanner or the CAT scan, her doctors cannot even properly diagnose her.  The shock and terror of the nation provides a backdrop for Ann's panic and fear as she rushes to the bedside of her sister.  This symbolic connection of exterior events to interior states is used most effectively with the intertwined narrative strands of Joyce's physical decline because of morbid obesity and Ann's personal struggle to avoid it.

For instance, the revulsion and frustration expressed by those who encounter Joyce, whether it be hospital staff or Ann's own husband, is mirrored in the italicized monologue that expresses the self-loathing and hypercriticism of the narrator encountering herself in those awful moments of compulsive eating and social embarrassment.  What we come to understand about eating disorders by reading such a candid and difficult memoir is that the discomfort, the confusion and the impatience that we as onlookers feel about obesity is infinitesimally small in comparison to the pain and the helplessness of those who are, themselves, suffering with an eating disorder. 



Sunspot Press

Place Published

Overland Park, Kansas



Page Count