The faces of eating disorders. (Barney Taxel for The New York Times, Darren Hauck/New York Times, Jeremy M. Lange for The New York Times, Ruth Fremson/The New York Times, Stuart Isett for The New York Times, Brendan Smialowski for The New York Times)In a country where many people struggle with eating too much, it can be hard to understand a disorder in which people basically starve themselves. In the latest Patient Voices, my colleague Karen Barrow explores the daily challenges of men and women battling anorexia, bulimia and other eating disorders.
You’ll meet Gillian Craig, a 17-year-old from Shaker Heights, Ohio, who still struggles with anorexia.
“People so don’t understand this disease,” she said. “As much as it seems like a choice, it’s not conscious. This is not something I’ve chosen. This is something I’ve been dealt.”
Her mother, Lauren Craig, also talks about the challenges of mothering an anorexic.
“It has been totally devastating,” she said. “It’s all consuming. Even when things are going well, you’re really concerned. When things are bad, everything revolves around it.’
Click here to listen to the voices of eight men and women struggling with eating disorders, including Kirsten Haglund, 19, who was named Miss America for 2008 and hopes to use her position to raise awareness of the problem.
And to listen to the many other Patient Voices features, click here.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
The easiest and most pleasurable way to eat well is to cook. Recipes for Health offers recipes with an eye towards empowering you to cook healthy meals every day. 
From 1 to 25 of 169 Comments
My sister-in-law has been battling anorexia for 20 years and still shows no signs of recovering from this awful disease. It’s painful to see the toll anorexia has taken on her body. Osteoporosis affects her posture, her teeth are decaying, her heart is damaged, and she looks much older than her 43 years. At this point, her family doesn’t expect to her ever recover. They’ve slowly come to realization that anorexia will eventually take her life.
— RunningI have no doubt that individuals with eating disorders have a propensity for their disorder.
However, since the prevalence of these disorders has increased dramatically over the last 50 years, we cannot blame genetic changes for this increase, since genes don’t change that fast.
Our society has somehow enabled the increase in this behavior. If we can identify how, and reverse it, we can decrease the prevalence of these disorders.
— jackJack, I understand where you would get that impression - of an increase. But if you ask the scientists doing the research they can tell you that we really don’t know how common eating disorders are now, or how common they were in the past. Too common, considering the devastation, even if rare.
We know people are diagnosed more - but that has a lot to do with public education and the availability of specialized treatment.
What HAS increased, and may explain an increase if there is one, is dieting. I think most people are unaware that dieting - just normal dieting - can trigger this mental disorder. Certain people are genetically predisposed to react to a diet with these severe brain disorders.
I head an international network of parents of eating disorder patients and most of us can pinpoint the beginning of the mental symptoms to the exact time an innocent attempt at dieting began.
Some people refer to dieting as a “gateway drug” to anorexia or bulimia.
http://www.FEAST-ED.org
— Laura Collinsfor parents of eating disorder patients
The problem with all of the interviewed is that, at this point, their weight is fine. So for a dieter it may look appealing to go anorexic, as when you recover, you end up just right.
It is not always so. I had a friend in high school who became anorexic. You could literally count her ribs. Her skin turned yellow. That might have had something to do with the fact that she was a Type I diabetic.
She did recover and started putting on the pounds, looking better all the while. At a certain point I said now you’re good, hold it there. But no, she went on to the other extreme and became fat, and remained so. She also dropped out of school.
— Susannaa written transcript would be nice. Not everyone can listen.
— MimiI totally agree that dieting can trigger obsessive thinking and eating disorders. Our brains are wired to obsess about food when we lose even a little weight. If you think about it, in a perverse way, the obesity epidemic has wrought the weight consciousness and super thin models. No one liked thin models when people struggled to get enough food.
The key is activity and cutting out certain (but not too many!) concentrated/processed foods. If you stop eating a food group you actually stop craving it after a while. Moderation is actually harder. If you eat a Tastykake, i think that it starts the cravings all over again. I know many people who do not eat potato chips for that reason.
The other key is formal exercise. This will, very slowly, lower your set point over years. The reason that this is not scientifically accepted is that the long range studies needed are not done. A prospective study, where people are put into to groups and told to exercise or not would not get many volunteers if it was a ten year study. A retrospective study would show that the active people are thinner. However, then you don’t know what is the cause and what is the effect or if the two factors go together for other reasons, such as genetics.
— rini10It’s hard for me to say I “was” anorexic because, as all anorexics know, it’s a life long disease.
I lost a lot of opportunities, friends and years to the worst of this disease. I think the hardest part was that anorexia isn’t like cancer. People don’t tend to take you under their wing, offer support, etc. Instead, anorexia scares people. I remember my friends basically saying that they “couldn’t deal” with me being like this.
If this article tells people anything, it should be that *anorexia is not a choice.* I would have given anything in the world to eat with freedom, and even now I would love to just appreciate my body the way it is.
Anorexic need the same attention and support as any other disease; it certainly has an appreciable mortality rate (5-10%). I’m fortunate to have had a few friends who stuck with me through everything and they’re probably the reason I’m still around.
— ReiA somewhat ignored topic is the opposite of anorexia, so called muscle dysmorphia or “bigorexia,” that is plaguing more and more men, driving them to psychological problems and the use of steroids. The size of action figures has increased dramatically over the decades, so that boys now play with figures whose musculature dwarfs the largest bodybuilders, whose physiques are steroid and growth hormone enhanced (with their unusual genetics), and plastered on magazines, in films as heros, and on everything from underwear ads to romance novel covers. Now men too have impossible ideals to live up to, and many are harming their lives by obsessive gym time (bigorexics spend hours a day, working through injuries, obsessing about eating enough and growing, wrecking their personal lives and careers). Because many are very muscular (yet see themselves as small, the reverse of the anorexic), few think of them as “unhealthy”, and they are not pushed to seek help. The quiet culture of men also leads to far less turning to others for help with this psychological problem. The truth is, there is a growing population of men who have set impossible goals for their bodies, and suffer from depression, obsessive behaviors, and ill health in the end from this problem.
— charlesEating Disorders are not given enough attention. They are a struggle for those diagnosed with the disease and torture for those who love them.
My mother, aunt and grandmother ALL have had some form of an eating disorder. My mother’s bones are now practically gone and my grandmother is more obsessed with her weight now in her 90s than she ever was since her 20s. She has come full circle.
They are in constant physical and mental anguish over how others perceive them.
If people think teenage eating disorders are a problem, look for signs of those folks in theor 40s and fifties and older flying under your radar! They suffer too!
— PamelaListening to their stories, you can hear the pain in the voices of these six people. It’s very sad. Take it day by day, be gentle on yourselves, I wish you all the best.
— Caroline…dieting doesn’t work.
You have to change your life style..
Be Active.
Eat good nutrtious fresh food.
Exercise.
Lots of veggies and fruits.
Avoid Junk.
TB
— Terry BrennanLots of veggies and fruits.
Anorexia and bulimia are mental health disorders. Treating only the physical manifestation- the weight loss- falls short of a full recovery. My smart, beautiful Ivy League educated 22 year old cousin recently died of suicide after an 8 year struggle with bulimia and anorexia. The self-imposed perfectionistic compulsiveness took over her mind and led her to believe she could not cope any longer. If someone you love has this disease, insist they get help and don’t leave them alone. She was 95 lbs at 5′7″ tall when she died. Do whatever it takes to help– they may not like you for it, but you might just save their life.
— ElenaI’m continually puzzled about why overeating is discounted as a disorder. With all due and the greatest respect for those dealing with anorexia and bulimia, overeating has psychological, sociological, and physiological impacts that can be equally devastating for the victim and their family. But because society values and admires slimness, regardless of its extreme, the element of disgust and contempt for the obese is given a pass by the community, including the medical community. Doctors insist that the obese are responsible for their plight in ways that they do not diagnose and label those with ‘real’ disorders. If one of those faces in the article was fat perhaps the discussion could begin with some empathy and balance.
— eileenpottsdawsonE. Dawson, Wisconsin
I have a friend who clearly has an eating disorder, but will not acknowledge it. She too is 43 and is skin on bones and very unhealthy looking. She talks frequently of food and pigging out but in the 9 years I have known her I have yet to see her consume anything but diet soda, coffee and frozen yogurt. I rarely can get her to do anything socially other than to go for coffee. The few times I have suggested lunch over the years have been turned down for various reasons. It is sad and I don’t dare confront her about it. I’m not sure it would do any good and I would probably lose the friendship.
— SusanSusanna, your comments come across as insensitive. “Hold it there”? Eating disorders are often about control, and, on the other extreme, the loss of it. Hence your friend’s substantial weight gain.
And why add that she dropped out of school? Are you shaming anorexics or overweight people?
— Brett#4 Susanna - maybe you and a few other people hurt her feelings. Or maybe I’m just projecting, because the same thing happened to me. Although I didn’t drop out of school because I was fat.
— emilyI read a research paper a few years back that showed how the numbers for anorexia have remained constant over the past few decades.
Surprisingly the numbers for bulimia had steadily increased over the same period of time.
Based upon this data, the researchers took the position that anorexia may have a strong genetic / epigentic link while bulimia is being driven by societal pressures.
I wish I could lay my hands on this study. If I can locate it, I will comment again and provide the link.
Maybe someone else out there has access to this study.
— DRWhat do you call an eating disorder where you don’t really starve or binge, or you do both at once
For 15 years, I’ve chewed up my food and spit it back out. Some years, I’ve done this in lieu of eating meals altogether. Now, I do this in addition to trying to eat one proper meal a day. But never can I find any info on it. I went to a counselor once, but she was so shocked by it, I never went back.
— Don’t want to sayJack: As someone who’s had all the eating disorders, including anorexia and bulimia. overeating, pica, and EDNOS, well before they were fashionable (and is now smack-dab normal weight and revoltingly heatlhy), I say that you are both right and wrong. Contemporary cultural factors may encourage anorexia but it has always been there.
Famous (probable) anorexics of history include Joan of Arc, Bernadette of Lourdes, and Simone Weil, as well as Josef Kafka, whose work supplied the epigraph for my own notebook: “I always wanted you to admire my fasting.”
I’m hardly the first to remark on the connexion between starvation and spirituality. The traditional Christian hatred of the body, especially the sexually mature female body, and its glorification of asceticism, is mirrored in the secular glorification of the skinny body as fashionable. Skinny is holy or skinny is glamourous: either way, skinny is desirable.
It doesn’t help that for most of the last 50 years women’s fashion is, excuse the ironic adverb, largely dictated by men who have no erotic appreciation of the normal female frame and that the normal manifestation of a womanly shape is considered undesirable, as it detracts from the line of the clothes.
Mental disorders, in their larger shape, are common across all cultures, but the specific social circumstance surely determine the manifestation.
May I recommend also a new anthology, “Going Hungry.” (It’s better than the NYT lukewarm review would have you think.) Most of the psychological literature on anorexia is disappointing at best; at worst, counterproductive malarkey.
I would add that conventional therapy leans toward trying to cram junk food into anorexics, rather than stressing healthful eating. The girl who looks forward to the day when she can mindlessly eat a “chocolate chip cookie as big as your face” is setting herself up either for obesity or a relapse, or both. Pollan’s Law: Eat food. Plants, mostly (or in my case exclusively; _pace_ Frank Bruni, a vegan diet doesn’t have to be built around fake meat). Not too much.
— ACWWhy are all these people white?
I think that somewhere I read that it’s more prevalent for whites, but is that why? All those interviewed are white, middle class and no explanation why. Does it only happen to white middle class people? As a person of mixed race, as an American, I would be able to understand more with something more diverse. Maybe Im being picky, but personally I just can’t relate at all to these women.
— sara a.Thanks to everyone for there comments. My name is Patrick and I am one of the 8 who shared there story. Eating Disoders are not about FOOD and we did not choose to suffer from this disorder but you can recover day by day. Gaining back your physcial strength allows those struggling with eating disorders to have the strength to fight the mental issues we struggle with. Thank you to the NY Times for helping break the silence to this disorder that is so misunderstood by our society. NEDA is a great resource to better understand and get help of eating disorders. Please feel free to go to my site http://www.ichosetolive.com I has my entire life story on there as well as poetry I wrote while in treatment that explains the mindset of a person fighting an Eating Disorder from the start to the recovery process. Also, thank you to the other 7 people who shared there stories, the more people who speak out, the better others will understand and the more people with know that they are not alone in this. I consider anyone fighting this disorder a friend and teammate and please feel free to contact me at anytime. What saved my life were those amazing other females who stood right beside me in treatment and kept pushing me forward. My prayers are with all those who are fighting this disease and there families. Stay strong and do the next right thing.
Believe,
— PatrickPatrick
patrickb@ichosetolive.com
Obesity cannot physically force a cupcake down your throat. Anorexia and related eating disorders, however, can over time make it very difficult to go through the physical process of eating due to nausea and other reactions. I’m sure there are strong mental influences involved in overeating, but it’s not the same as your body rejecting food.
— Rickas someone who had a bought with anorexia I can say that it was not all in my head. When I fasted for a short time or significantly cut calories my body adjusted and cravings decreased. At the same time if I ate anything big I would become ravenous and binge eat for days, making myself sick (hiccups, bloating, stomach upset, etc.) and severely unhappy. I would feel shame at my erratic eating habits - and some amount of (somewhat rational) fear of the weight gain they would bring on.
It took a very long time for my body to recover and I had a significantly decreased metabolic rate for well over a year. This meant I was always cold, and got tired more easily than most. I also gained a huge amount of weight (to the point of being well overweight) eating a reasonable number of calories - though I could never eat them in a reasonable way. I’d start eating and not be able to stop, so I ate all my calories for the day or most for two days at a sitting.
It starts as a psychological problem, but I think for many they end up in long battles with their bodies and uncontrollable hunger drives even after they begin to heal mentally.
On top of this every doctor I saw refused to acknowledge these very physical problems and would insist I needed counseling for my binge eating. This caused a lot of unnecessary distress. I did need counseling, but it was useless against my insane cravings, only time healed that. I think doctors need to focus on preparing recovering anorexics for the tough physical battle they have ahead, and reassure them that these things are part of the healing process and not entirely in their heads.
— arsMany people with eating disorders including anorexia, bulimia, and compulsive overeating find peace through Overeaters Anonymous, a 12-step program modeled on AA. I’m surprised this organization doesn’t get more coverage in articles about eating disorders and the obesity epidemic. For many people food is their “drug of choice” and have lost control in their relationship to it.
— PFTo #18 (don’t want to say): Chewing and spitting is an eating-disordered behavior. (The DSM-IV would classify it as “eating disorder Not Otherwise Specified.”) It’s not as common as textbook anorexia or bulimia, but it’s a known phenomenon. Of the talks I’ve attended for physicians on eating disorders, most of them have mentioned this behavior.
I hope that you will seek the help of a provider (psychiatrist, other physician, psychologist or counselor) who specializes in eating disorders. There really are people out there who know about this behavior and are equipped to help you with it.
— Cheryl