If everything you know about anorexia comes from Lifetime movies and high school health class, you might want to check out this week's Newsweek cover story.
In "Fighting Anorexia: No One to Blame," reporter Peg Tyre debunks many common assumptions about the disease, starting with the stereotype that it afflicts only overachieving, wealthy, white girls. In fact, Tyre tells readers, in the past decade doctors have encountered an increasingly diverse population of patients, including blacks, Hispanics, Asians and boys, from preadolescence to middle age.
Most disturbing are Tyre's accounts of child anorexics like Matthew Cornwell, who, at age 9, starved himself down to 39 pounds by limiting his daily caloric intake to one carrot topped by a tablespoon of peanut butter. Or 10-year-old Katherine Krudys, whose parents begged, pleaded and even promised to buy her pony if she'd eat, but still stuck to "portions that could be measured in tablespoons." In the end, both of their downward spirals ended in emergency room visits -- and extended stays in eating-disorder treatment centers.
Indeed, anorexia, while always debilitating, can wreak particularly brutal harm on children's bodies. Tyre explains, "While adults can drift along in a state of semistarvation for years ... in the preteen years, kids should be gaining weight" -- weight they need to foster bone and muscle growth, strengthen their hearts and brains, and lay down the new neurological "pathways" that are an essential component to adolescent growth spurts.
No matter the age, anorexia is a serious -- indeed deadly -- battle, a chronic condition that can be treated but rarely cured. The statistics Tyre shares are not encouraging: "About half of anorexics get better," she writes. "About 10 percent of them die. The rest remain chronically ill -- exhausting, then bankrupting, parents, retreating from jobs and school, alienating friends as they struggle to manage the symptoms of their condition." Some doctors believe "anorexics use starvation as a mode of self-medication," Tyre reports, since by "eating less, anorexics reduce the serotonin activity in their brains ... creating a sense of calm, even as they are about to die of malnutrition ... It has the highest mortality rate of any mental illness, including depression."
The parallels to depression are worth noting, and are the key to understanding some of doctors' new theories about the source of the disease. As Tyre writes, for years, "conventional wisdom [has] held that adolescent girls 'got' anorexia from the culture they lived in," specifically from unrealistic body images presented in the popular media. Now doctors have begun to equate anorexia to other afflictions like alcoholism and depression -- diseases "that may be set off by environmental factors such as stress or trauma, but have their roots in a complex combination of genes and brain chemistry."
"In other words," Tyre writes, "many kids are affected by pressure-cooker school environments and a culture of thinness promoted by magazines and music videos, but most of them don't secretly scrape their dinner into the garbage." Adds Cynthia Bulik, director of the eating-disorder program at the University of North Carolina at Chapel Hill, "The environment 'pulls the trigger' ... but it's a child's latent vulnerabilities that 'load the gun.'"
This new theory has both absolved parents of stigma and exposed them to new fears, since while poor parenting may not the cause of their child's suffering, genes very well may be. For Amy Nelson, 14, the realization that her disease might be hardwired came when her father recovered a diary kept by his younger sister, who died of "unknown causes" in 1980. In it the young woman chronicled her attempt to lose 13 pounds in a month by keeping her diet to 600 calories a day. "No salt, no butter, no sugar, 'not too many bananas,'" the woman had written in her journal.
With that in mind, doctors now believe that a family-centered approach to therapy and treatment is the most humane and most effective way to rehabilitate youths with eating disorders. Regular family dinners -- already touted for their power to prevent obesity, depression and drug addiction -- are also heralded as the perfect opportunity for parents to model healthy nutrition to their families and keep track of children's eating habits.
The silver lining in Tyre's story is that progress, while fragile, is possible. Remember Katherine Krudys, who at 10 measured her meals in teaspoons? She's home now, in sixth grade, eating three meals a day -- even baked potatoes with sour cream.
And she finally got that pony.