Dying to be thin: eating disorders are ugly. Here's why.

To people who don't know her story, Jen S., of Boca Raton, Fla., is like many teenagers who balance schoolwork and friends. But unlike most teenagers, she nearly starved herself to death. At age 13, Jen began struggling with anorexia. "It just kept downward spiraling," she recalls. "But no one really knew. I was really good at hiding it."

There are many young people, like Jen, who struggle in silence. About 1 million males and 10 million females in the United States suffer from eating disorders. Of those, about 660,000 die from their illnesses.

Food Feels Like an Enemy

Eating disorders are illnesses that cause a person to adopt harmful eating habits. Anorexia nervosa and bulimia are the two most common types of eating disorders.

Anorexia is a condition in which a person purposely starves herself or himself. He or she is percent below normal body weight and has an intense fear of gaining weight or becoming fat, even if he or she is underweight.

Bulimia is a condition in which a person repeatedly overeats and purges--that is, vomits on purpose, exercises more than is healthy to burn off the extra calories, or abuses laxatives.

Anyone can develop an eating disorder. Anorexia and bulimia have been diagnosed in every race, culture, and age-group. In fact, anorexia is the third most common ongoing illness among young teens. Forty percent of newly identified cases of anorexia are in girls 15 to 19 years old, according to the National Eating Disorders Association (NEDA).

A combination of factors can bring on an eating disorder, including personality (such as how well a teen handles problems) and family issues. Sports that pressure athletes to be a certain weight and exposure to images of super-thin celebrities also may play a role. Emotional issues, perfectionism, stress, alcohol and drug abuse, depression, and relationship or family problems can be factors too.

Looks Can Be Deceiving

Just looking at someone's weight doesn't necessarily show whether he or she has an eating disorder. For example, many people who have bulimia are of normal weight or slightly above-normal weight, according to Doug Bunnell, clinical psychologist and director of the Connecticut office of the Renfrew Center, which specializes in treating anorexia, bulimia, and other eating disorders.

"You have to look at what they're doing with food and what their thoughts and feelings are," he says. "My greatest concern is that people think these are relatively mild disorders," Bunnell says. "[Teens] think they're really not at risk for anything serious."

In reality, eating disorders have the highest death rate of any mental illness, including depression. Anorexia nervosa kills more females ages 15 to 24 than anything else, according to the Renfrew Center Foundation for eating disorders. These conditions can cause dangerous physical problems, including malnutrition (not having enough nutrients) and dehydration (a lack of fluids). They can also cause serious damage to the stomach, heart, kidneys, liver, gums, teeth, esophagus, and even the reproductive system. Many people with eating disorders also lose muscle and feel weak. Their heart muscle can break down and become damaged over time, increasing the risk of heart failure.

Eating disorders can cause emotional problems, such as mood swings and damaged relationships with family and friends. "It's hard for the people around you because they really have to walk on eggshells," says Jen. "I was very defensive. I wasn't the person they'd had as a sister or daughter before."

One Teen's Struggle

Before she developed anorexia, Jen says, she was a fun, carefree person and, in general, happy. "But with my eating disorder, my personality fell away, and I became a ridiculous perfectionist," she explains. "I also began to lie and manipulate ... so people wouldn't know how little I truly ate."

In addition to the changes in her personality and character, Jen suffered physically. She had severe acid reflux (a painful burning in the chest and throat) from a lack of food in her stomach. Her hair fell out in clumps. Tiny hairs grew all over her body. Her nails became very brittle and sometimes fell off. "Those effects scare me every day," Jen says. "How much did I permanently damage my whole body?"

She remembers dangerously limiting her food in eighth grade; her weight fell dramatically. Finally, in ninth grade, Jen realized she had to either get help or risk dying. At half her pre-anorexia weight, she checked into the Renfrew Center in Florida. Through therapy, Jen came to understand that her father's death from cancer when she was 7 might have triggered her eating disorder.: "You look for something else to get your mind off [your problem], so you start controlling things. For me, my controlling was my schoolwork and my food."

Recovery Is Possible

Addressing body image or eating problems in their beginning stages can be difficult. But that recognition gives the best chance for working through the issues and becoming healthy again. To recover, Jen says, she had to change the way she thinks: "I used to be very hard on myself and very competitive and never felt like I was good enough."

She continues to go to therapy. "I dealt with so much in treatment and learned so much about myself--probably the biggest thing was to be proud of myself." Just as Jen battled back from the brink of starvation, hope exists for others suffering from eating disorders too.

10 Signs of Eating Disorder

If you or a friend has one or more symptoms, seek help. See page 22 for resources.

1. Extreme weight loss

2. Obsession with counting calories

3. Stepping on the scale several times a day

4. Excessive exercise

5. Episodes of bingeing followed by purging

6. Food rituals, such as taking tiny bites, skipping food groups, or rearranging food on the plate

7. Avoidance of meals or only wanting to eat alone

8. Use of weight-control pills

9. Use of cigarettes to curb appetite

10. Feeling fat despite significant weight loss

Source: National Eating Disorders Association

Jenni's Story

"I would sleep on the floor for days at a time because I was so disoriented;' recalls Jenni Schaefer, author of Life Without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too. "I didn't know what day it was because I had been not eating for days, and I was completely depressed"

Schaefer is now 29 years old and continues to recover from her illness. She had body image and food issues as a child, then struggled with anorexia and bulimia for many years. As a result, she suffered serious medical problems, including malnutrition, dehydration, muscle loss, and loss of menstrual periods. Schaefer also had a slow heart rate and low blood pressure, which increased the risk that her heart would stop.

As she adopted healthier eating habits, most of the medical problems went away. But Schaefer still is at risk for a decrease in bone mineral density, which is a precursor to osteoporosis. "You have to get help," she says, adding that recovery can take years and often requires inpatient treatment, ongoing therapy, and patience.

"The key was just to absolutely never, ever give up;' according to Schaefer. "You don't have to be perfect; you just have to get back up every time you fall down"

WHERE TO FIND HELP

National Association of Anorexia Nervosa and Associated Disorders Hotline, 1-847-831-3438; www.anad.org National Eating Disorders Association Helptine, 1-800-931-2237; www.nationaleatingdisorders.org

Discuss

* What are anorexia and bulimia? (Anorexia is self-starvation; bulimia is overeating followed by purging.)

* Why are eating disorders dangerous? (They can harm physical and emotional health and kill more people than any other mental illness.)

* Of the people in the United States who have eating disorders, about what percentage are males? (roughly 10 percent)

Do

Early in November, HBO is scheduled to debut the documentary Thin, a look at the lives of people struggling to recover from eating disorders at a clinic. The program profiles 15-year-old Brittany, along with some adult patients. Bring a copy of the film to class, and use it as a springboard for a general discussion on eating disorders. What motives did Brittany have for wanting to lose weight? How do her thinking and behavior differ from those of a person on a typical diet? How has her eating disorder disrupted her life? What does the recovery process entail? How likely is it that she will recover from this condition?

Resources

The two main eating disorders organizations are the National Association of Anorexia Nervosa and Associated Disorders (www.anad.org) and the National Eating Disorders Association (www.nationaleatingdisorders.org).

The Something Fishy Web site (www.something-fishy.org) offers information, resources, discussion boards, links, and helpful tips for people with eating disorders and those who love them.

The PBS program It's My Life hosts a companion Web site to its eating disorders episode. You can access it at www.pbskids.org/itsmylife/body/eatingdisorders.