Dying to Be Thin [Preview]

Eating disorders cripple--literally--millions of young women, in large part because treatments are not always effective or accessible

I don't own a scale. I don't trust myself to have one in the house--maybe in the same way that recovered alcoholics rightfully clear their cabinets of cold medicines and mouthwash. At 5'7", I know that I usually weigh 125 pounds, and I know that is considered normal for my frame. But 22 years ago, when I was 15 years old and the same height, I weighed 67 pounds, and I thought I was grossly, repulsively obese.

My own bout with anorexia nervosa--the eating disorder that made me starve myself into malnutrition--was severe but short-lived. I had a wonderful physician who worked hard to earn my trust and safeguard my health. And I had one great friend who slowly, over many months, proved to me that one ice cream cone wouldn't make me fat nor would being fat make me unlovable. A year later I was back up to 95 pounds. I was still scrawny, but at least I knew it.

I was--am--lucky. Eating disorders are often chronic and startlingly common. One percent of all teenage girls suffer from anorexia nervosa at some point. Two to 3 percent develop bulimia nervosa, a condition in which sufferers consume large amounts of food only to then "purge" away the excess calories by making themselves vomit, by abusing laxatives and diuretics, or by exercising obsessively. And binge eaters--who overeat until they are uncomfortably full--make up another 2 percent of the population. Since the 1960s the incidence of eating disorders has doubled, and clinicians are seeing an increasing number of cases among preadolescents, women older than 30, nonwhites and men.

In addition to the mental pain these illnesses cause sufferers and their families and friends, they also have devastating physical consequences. In the most serious cases, binge eating can rupture the stomach or esophagus. Purging can flush the body of vital minerals, causing cardiac arrest. Self-starvation can also lead to heart failure. Among anorexics, who undergo by far the worst complications, the mortality rate after 10 years is 6.6 percent, reports Katherine A. Halmi, professor of psychiatry at Weill Cornell Medical College and director of the Westchester-based Eating Disorders Program of New YorkPresbyterian Hospital. After 30 years of struggling with the condition, nearly one fifth die.

Because studies clearly show that people who recover sooner are less likely to relapse, the push continues to discover better treatments. Eating disorders are exceedingly complex diseases, brought on by a mix of environmental, social and biological factors. And the current prognosis is grim. Among anorexics, only one quarter make a full recovery; for bulimics, the statistic is only one half. In recent years, however, scientists have made some small advances. Various forms of therapy are proving beneficial, and some medications--among them the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs)--are helping certain patients. "SSRIs are not wonder drugs for eating disorders," says Robert I. Berkowitz of the University of Pennsylvania. "But treatments have become more successful, and so we're feeling hopeful, even though we have a long way to go to understand these diseases."

Weighing the Risks
WHEN I BEGAN working on this article, I phoned my former physician, a specialist in adolescent medicine, and I was a little surprised that she remembered my name but not my diagnosis. In all fairness, my illness was a textbook case. I had faced many common risk factors, starting with a "fat list" on the bulletin board at my ballet school. The list named girls who needed to lose weight and by how much. I was never on it. But the possibility filled me with so much dread that at the start of the summer, I decided I had to get into better shape. I did sit-ups and ran every day before and after ballet classes. I stopped eating sweets, fats and meat. And when I turned 15 in September, I was as lean and strong as I've ever been.

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