When an obese 10-year-old girl has a heart attack, House and the team initially suspect an adverse reaction to diet pills is responsible, but soon realise there is another cause. Guest starring Jennifer Stone, Alyson Morgan, Chi McBride.
Tropes include:
- Artistic License – Medicine: Cushing's Syndrome is fairly rare. However, if a patient claims to not have lost weight despite diet and physical activity, it is one of the first diagnosis to exclude. Moreover, it is not the blood levels of cortisol that is the index used to rule it out, but the urinary or salivary one EXACTLY because eventually, whether phasic or not, excess cortisol eventually ends up in the urine and saliva. For this, Foreman's claim that it could not be Cushing because the blood levels were low is a rather serious medical error.
- Beautiful All Along: Jessica, once cured and consequently slimmed down. Chase in particular is amazed by the transformation.
- Big Beautiful Woman, Chubby Chaser: The relationship between the clinic patient of the week and her husband and her many extramarital lovers
- Double Take: House and many others are in shock and disbelief when they learn that their patient who had a heart attack is a 10-year-old girl.
- Kids Are Cruel: One kid continues to taunt Jessica for her obesity. The gym teacher sends the kid to run laps as punishment. Another kid flat out tells Foreman that she is not friends with Jessica and was just paired with her as a "school buddy".
- "Eureka!" Moment: House realizes that the girl's obesity must be a symptom, not a cause, of her illness.
- Five-Second Foreshadowing:
- Jessica lying in bed telling her mom she's not feeling well.
- While doing jump rope as health exercise, Jessica complains that her arm and her chest really hurts before collapsing from a heart attack.
- Foreshadowing: The patient had been suffering from fatigue, muscle pain, and difficulty concentrating for over a year.
- Hollywood Genetics: The worried devoted husband of House's clinic patient shows her the pictures of their six kids and begs him to convince his wife to have surgery to remove her non cancerous ovarian tumor. House notices that both parents are Mexican and have brown eyes while two of their youngest children have blue and green eyes, cluing House in on the wife's infidelity. It is possible for two brown-eyed people to have a blue-eyed child, as long as both parents have the recessive gene for blue eyes.
- Nice Job Breaking It, Hero: Because Cameron and Chase are more worried about which one of them was House supposed to have fired, they accidentally give the patient Jessica too high a dosage of warfarin, leading to her developing painful lesions on her chest.
- O.O.C. Is Serious Business: At one point, Jessica gets really hostile, violent and aggressive, lashing out at her mother and the doctors and shouting obscenities. Her mother comments that she's never like this.
- Title Drop: The title has a triple meaning:
- A reference to the patient’s weight (she is heavy)
- A reference to Vogler acting as the bad guy (in movie slang, the bad guy is often referred to as "the heavy").
- A reference to emotions (as in hard to take in) note
