`THIN' DOCUMENTS DEADLY OBSESSION.

Byline: Valerie Kuklenski Staff Writer

The terms anorexia and bulimia are usually associated with startling tabloid images of such celebrities as Nicole Richie, Kate Bosworth and Keira Knightley.

But the documentary ``Thin,'' premiering Tuesday on HBO, takes those eating disorders beyond headlines and statistics for an inside look at a Florida clinic and four patients in a life-or-death battle over food.

Photographer Lauren Greenfield makes her film-directing debut with a cinema-verite exploration of the 40-bed Renfrew Center in Coconut Creek, and the women who go there in a desperate attempt to recover from a disease that impacts every aspect of their lives.

``I think there is a sense that even people who have lived for many years with them (anorexics or bulimics), like their family members, don't really know what it's like to deal with this on a day-to-day basis, and why it's not easy to just get rid of,'' she says.

Witnesses to the struggle

During the shoot, Greenfield and her director of photography, Amanda Micheli, were allowed access to nearly all aspects of the program, from the pre-dawn weigh-ins to the soul-baring therapy sessions and the difficult mealtimes, at which residents struggle to eat and keep down the minimum amount of food prescribed by the nutritionists.

``The symptoms are strangely familiar to most of us,'' Greenfield says. ``Most people know what it's like to be on a diet, and when you're on a diet you obsess about numbers and food and weight. So I think it's something you can relate to, and yet there is kind of a chasm, and on the other side is a form of slow suicide and kind of the heart of darkness of mental illness.''

The film's four subjects

Greenfield's story focuses on Alisa, a 30-year-old, divorced, working mother who undereats and purges meals; Polly, a 29-year-old veteran of various treatment programs who tends to rebel; Brittany, the 15-year-old formerly overweight daughter of an anorexic mother; and Shelly, a 25-year-old psychiatric nurse who has survived for years with a feeding tube, first in her nose and later implanted in her stomach.

All are slender or dangerously thin, and all see themselves as fat or fear that they will become fat. A scale reading over 100 pounds can cause them extreme anxiety.

Their stories are eye-opening for anyone who believes an eating disorder is the result of ignorance, defiant behavior or both.

``Thin'' is airing just days after the National Institute of Mental Health publicly declared that anorexia nervosa, marked by poor appetite, excessive activity and a misconception that one is overweight, is a ``brain disease'' with a biological core. A lawsuit filed Wednesday in New Jersey against Aetna Inc. cites that assertion in challenging the insurer's refusal to fully cover anorexia treatment.

``That's the paradox of eating disorders,'' Greenfield notes. ``In some ways, we feel like it's similar to dieting, or that it looks like something we understand and that's even sanctioned in our culture. And on the other hand, it's so counterintuitive to our most basic survival instincts, to eating. It's so irrational.''

Greenfield points then to Alisa, whom she describes as an articulate, intelligent woman who had a good job making a lot of money as a pharmaceutical rep and who raised two beautiful children.

According to the director, Alisa's response was, ``I've tried to find satisfaction in other accomplishments, but nothing measures up to this goal of being thin, and that's all I really want. And if it takes dying to get there, so be it.''

``That's a completely irrational statement,'' Greenfield says, ``and the way it's spoken by this intelligent, articulate woman, it's almost like a double take.''

What can trigger it

Experts say an eating disorder's triggers may range from a major trauma like sexual abuse to an offhand remark about her figure that the subject magnifies to the point of obsession. ``Thin'' shows Renfrew patients in private and group therapy sessions aimed at addressing the underlying causes.

Emmy-winning documentarian R.J. Cutler produced the project with Greenfield, Micheli and Ted Skillman. He said the whole crew approached the production with more questions than preconceived ideas about what they would capture on film in the six-month shoot.

``What we discovered,'' says Cutler, ``and what one sees in the film, is that this is a woefully misunderstood disease that is primarily a mental illness in spite of the fact that it is primarily treated as a behavioral disorder.''

Carolyn Costin, a marriage and family therapist at the Eating Disorder Center of California in Malibu and author of ``The Eating Disorders Source Book,'' viewed ``Thin'' Thursday at a professional conference in Philadelphia.

She said the public could benefit from seeing ``how bad the disease is so people can see it as a real disease.''

On the other hand, Costin was concerned that the less-than-successful outcomes for the Renfrew subjects may cause other sufferers to believe treatment can't help.

``I hope that it's not representative of what happens in treatment centers,'' Costin said. ``It seems to me that the editing has put things in a very unfavorable light.

``And some people will see it and think, `I'm not that bad, so I don't have an eating disorder,' '' she said.

Greenfield, who previously published a collection of photos in ``Girl Culture,'' has put out a hardcover from Chronicle Books titled ``Thin,'' which includes portraits of the four central characters in the documentary as well as many others of all ages and backgrounds in Renfrew. It includes the text of interviews with the patients and some diary excerpts. There are also often dark, revealing creations from art therapy classes.

With eating disorders still primarily affecting girls and young women, the film's web site, www.thindocumentary.com, includes resources for student discussions.

Greenfield also is preparing for a multimedia exhibition based on the book and film that will open in February at the Women's Museum in Dallas and then will tour the country. Plans for a Los Angeles exhibit are pending.

Sharing at Sundance

Greenfield has kept in touch with the women and their ongoing struggles. Polly, Alisa and Shelly took part in a panel discussion last January when ``Thin'' was screened at the Sundance Film Festival.

``I think it was really exciting for them in terms of seeing how their sharing of their stories affected other people,'' Greenfield says. ``I'm sure at times they wondered whether they were doing the right thing by being filmed and sharing their stories so openly. And I think when they saw how moved people were and met people who said it helped them ... they were really clear that they had done the right thing by sharing their stories.''

Valerie Kuklenski, [phone]

[e-mail]

For more information

If you need additional information or guidance about eating disorders, here are some places to check:

Academy for Eating Disorders (aedweb.org) says most clinicians consider a body weight of 85 percent of normal to be a sign of anorexia nervosa. It describes characteristics of various eating disorders and posts the latest developments in diagnosis and treatment.

National Eating Disorders Association (nationaleatingdisorders.org) has a toll-free live help line, [phone], and links on its site to other resources, including several books on healthy eating and body image.

The Web site edreferral.com is a locator guide for eating disorder experts and treatment facilities arranged by region. It is an advertising database, with no implied endorsement by any umbrella organization.

Lauren Greenfield's site, www.thindocumentary.com, has a resource guide as well as a discussion forum, additional scenes from the film and information about the upcoming multimedia ``Thin'' museum exhibition in Dallas. Images from her book are on view through Nov. 22 at Fahey/Klein Gallery, 148 N. La Brea Ave., Los Angeles; www.faheykleingallery.com or [phone].

-- V.K.

THIN

What: A cinema verite documentary about the Renfrew Center and its patients, who fight a life-or-death battle against eating disorders.

Where: HBO.

When: 9 p.m. Tuesday. Replaying on HBO at 11:15 a.m. Friday, 1:30 p.m. Sunday, 5:15 p.m. Nov. 22, 3:30 p.m. Nov. 25, 12:15 p.m. and 10 p.m. Nov. 27, 2:45 p.m. Dec. 5 and 1:15 a.m. Dec. 11.

CAPTION(S):

4 photos, box

Photo:

(1 -- cover -- color) I HATE MY BODY

HBO documentary chronicles eating disorders

(2 -- 3) At top, Alisa, a 30-year-old divorced mother of two, said she may not be better, but she's ``come a long way.'' Above, Brittany, 15, stands next to a tracing of her body she made in art therapy. Words on the drawing express her feelings about her image. Brittany was admitted to Renfrew at 97 pounds.

(4) Photographer Lauren Greenfeld, right, with 25-year-old Renfrew Center patient Shelly. Greenfeld directed ``Thin,'' a documentary about the clinic, which treats eating disorders.

Box:

For more information (see text)