The cynical critic in me wants to point out the flaws in this book, whereas the rest of me wants to praise its emotional resonance. This book makes me want to use all those horrible cliched words like "poignant" and "touching", words that I usually avoid like the plague, but words that are apt in this case.
Cynical critic says: odd and awkward metaphors. The simplistic tone reminiscent of so much of contemporary writing. The oft-repeated message "I was told growing up would be great, but it isn't" from virtually every character's mouth as if the author just invented disillusionment. Occasional hyperbolic accounts of events that stretch the reader's belief.
Otherwise: florid descriptions of Malcolm's body that literally made me nauseous (not sure this is really a positive, but it took talent!) Emotional content spanning all sadness-related feelings in a very truthful fashion. Satisfactorily semi-triumphant conclusion without over-doing it. I enjoyed the the contrast of perspectives between the brothers. Actually, Malcolm's obesity has a different effect on every character in the book, giving them each a unique perspective.
Overall this story was sometimes hard to stomach but also hard to put down.