When Thinness Becomes Illness

If someone you know truly believes one can never be too rich or too thin, it may be cause for alarm. Rich is O.K. But people who force their bodies into unnatural slimness can seriously harm their physical and mental health.

It's a mistake, too, to think that malnutrition affects only poor people. About 11 million women and 1 million men in the U.S. suffer from one of two conditions that physicians classify as eating disorders. Those with anorexia nervosa compulsively restrict the amount of food they eat. Those with bulimia nervosa may eat normally or "pig out" frequently--but to avoid gaining weight, they immediately regurgitate the undigested food or down huge quantities of laxatives for a purging effect.

Widespread study into the problem of undereating began just about a decade ago, and an increase in treatment methods and centers is one result. But many anorexics and bulimics, like drug or alcohol addicts, are so secretive that they manage to avoid treatment until their health reaches a critical stage. Celebrity and status is no shield from the problem. For example, a recent biography alleges that Britain's Princess Diana is a bulimic.

"Typically, bulimics--especially vomiters--are quite skilled in hiding their condition," says Mary Bellofatto, clinical director of The Willough at Naples (Fla.), which specializes in treatment. Many wear clothing that's too large, so no one realizes how thin they are.

Influenced by the slender, good-looking people they see in ads, films, and TV programs, teenagers seem particularly susceptible to bulimia or anorexia. A 1990 study of seniors in 20 high schools in 18 states found that 11% fit one of the classifications. So parents should be alert to early signs of trouble, says Dr. Joan Barber, director of the George Washington University Medical Center eating disorders program.

MISERY CYCLE. About 95% of the 3,000 patients who have undergone treatment at the center are females from middle- and upper-income families. "Almost all have low self-esteem, are greatly concerned about what others think of them, and tend to be very nice--very compliant and passive--rather than say what they think," says Barber. Usually, their relationships with their peers are poor. "They say, `I'm miserable, maybe because I'm too fat,' " says Barber. "They diet to lose 10 pounds. Dieting makes them feel more miserable, so they think they should lose more. It's a dangerous cycle."

Some anorexics become exercise fanatics and work out for hours. At the same time, they limit their food intake. That can weaken muscles, strain the heart, and make bones brittle. Bulimics may embark on refrigerator-raiding binges or consume a week's worth of groceries in a single day. Researchers say the influx of carbohydrates can affect brain chemistry to produce a pleasurable "high." Afterward, a bulimic may gulp laxatives or diuretics to offset the binge.

Anorexia and bulimia are treated similarly. Since bouts of depression frequently cause people who suffer from these disorders to think that a slimmer figure will bring them happiness, physicians may prescribe Prozac or other antidepressant drugs. Routinely, patients undergo psychotherapy to uncover the underlying reason for their depression. Many cases, says Bellofatto, involve childhood sexual abuse. Adult children of alcoholics are also prone to eating disorders. To relieve the stress they feel, they focus all their attention on food.

COSTLY CONTROL. Some studies, says the National Anorexic Aid Society (NAAS) in Columbus, Ohio, suggest that eating disorders result from genetic factors or variations in brain chemistry. So treatment begins with a medical checkup and family history. Then comes individual, group, and family therapy.

The cost to change beliefs and modify eating habits can run high. A full day at the Willough facility costs $800. For $400, patients can participate in a plan that includes five or six hours of intense treatment. "That's enough to give them control over their eating, but they will still need support and therapy outside," says Bellofatto.

Although most medical insurance plans cover hospitalization costs, Dr. Barber says the trend is toward outpatient treatment. Hospitalized patients often revert to their old eating habits upon leaving the institution's control, she says. "A small segment of young anorexics do well in the hospital--simply because they're away from their peers, which relieves the stress they feel by not conforming" to an unrealistic standard.

Free pamphlets on bulimia and anorexia are available from both NAAS and the National Association of Anorexia Nervosa & Associated Disorders (ANAD) in Highland Park, Ill. They can also advise patients and families about local self-help and support groups such as Overeaters Anonymous, which can help before a problem becomes serious or prevent a relapse after treatment. "Their members understand that an actual illness is involved," Bellofatto says. "To the average person, an anorexic is someone who should just eat more."

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