Dying to Be Thin

( piano playing Chopin mazurka )

Instructor: And up... back.

Narrator: A ballerina must have more than grace and flawless technique

to be successful.

She must also be abnormally thin.

It is a dangerous obsession for many dancers.

Woman: "If they want thin, I will give them thin."

And I did-- I dropped more weight in two weeks

than I'd ever done in my life.

( practice music continues )

Woman: "Dancer thin" is not like thin on the street.

We're talking about 15% below your ideal weight for height

which is basically an anorexic weight.

If your career is on the line, if the roles are on the line

whether or not you reach that ideal

you will do practically anything.

Narrator: Starving herself for nearly a year

Katey Tracey weighed 20 pounds less than she does today.

The bones in her chest began to protrude.

She had developed anorexia nervosa--

the deadliest of all psychiatric disorders.

Tracey: It was going from one extreme to the next

and people around me in the dance world--

they were praising it.

They were saying, "Gosh, you look so good.

"It looks nice, you know, you have a new body."

Narrator: The dance world was stunned

when a member of the Boston Ballet, Heidi Guenther

died at age 22 when her heart gave out.

The cause appeared to be an eating disorder.

Woman: I remember always watching gymnastics and figure skating

and all of these sports

and having them talk about eating disorders

and how thin these gymnasts have to be.

And I would just think to myself

"Look at what dancers have to go through."

You know, and it's kind a dirty little secret--

nobody talks about it.

Narrator: Eating disorders are common in the dance world

but they are spreading

as the pressure to be thin intensifies.

Tracey: Everybody wants to know the secret to being thin

because that is... that's success

that's love, that's glory, that's power-- that's a crock.

Woman: Today, we're told to believe that we, too, can look this way

if only we work hard enough at it.

So there's this whole myth

that everybody can achieve the impossible

and that's very damaging

because if then you don't achieve this look

something is wrong with you.

Sarandon: Erin is 14 years old.

Tormented by an irrational fear of fat

she has been starving herself for three months.

Woman:Erin...

What is your reaction?

Just that it's true.

Can you kind of look in the mirror

with your image kind of reflecting back

and kind of tell me

what you see about yourself--

your physical self also--

when you look in the mirror?

I see somebody that is fat... and ugly

and a disappointment...

I know that this is hard for you.

Mm-hmm.

Sarandon: Erin is beginning treatment

at DePaul-Tulane's Eating Disorders Unit in New Orleans.

Her mother brought her to this specialized center

after she almost died of malnutrition

at a hospital near their home in Texas.

Mother: She's so into to being skinny, to being slim.

She thinks she's fat.

She's not.

I just think she's going to die and she doesn't believe me.

I had to tell her in the hospital--

I go, "Erin, you're going to die."

Nurse: Go ahead and step up.

Sarandon: At 20% below her normal weight

Erin has already suffered medical complications

which will only get worse without treatment.

Man: This is a very deadly illness.

It's the highest death rate of any psychiatric illness.

Approximately half a percent of people with anorexia nervosa

die every year from malnutrition or other kinds of complications.

So over the course of 20 years

ten percent of people with anorexia

are going to die from this.

Sarandon: Prolonged starvation can cause a number of medical conditions

including dangerously low blood pressure, severe osteoporosis

damage to the kidneys and liver, and ultimately heart failure.

Erin stopped eating

when her mother, who works for the military

took a job in Korea for a year.

Feeling alone and abandoned

she became obsessed with her appearance.

Erin: I know I would be thin, and everybody would like me

and, you know, I wouldn't... be having to worry

about, you know, my weight and all that stuff.

I felt like I'd be loved more... and everything.

Karen Carpenter: ♫Talkin' to myself and feelin' old...♫

Erin: I saw a Karen Carpenter movie.

And that taught me a lot about how, you know... how not to eat

to lose weight and stuff, the water diet and everything.

So that actually was pretty much what I got from it--

you know, "I can live without eating," you know.

Sarandon: After struggling for years with an eating disorder

Karen Carpenter died of heart failure at the age of 32.

At the time of her death in 1983

most people had never heard of anorexia nervosa.

But today, it's a different story.

An alarming study from the Mayo Clinic shows

that anorexia has been increasing

by 36% every five years since the 1950s.

Today, some eight million people--

mainly women but some men--

suffer from anorexia and bulimia, a related disorder.

Young women ages 15 to 24 are the most vulnerable.

I had been very overweight

and I had exercised and eaten right and, you know

my mom was so proud of me, and it was the compliment thing.

And I thought, "I'm so close to being able to model."

And I thought, "Well, maybe I ought to try it.

"It's okay be a little skinny--

the camera puts on ten pounds anyway, it won't matter."

Just even the idea

"Hey, I wear a number one, I am the top."

Young woman: I saw a TV movie

on bulimics.

Leader: Mm-hmm.

I was watching it

and I said, "Wow, look what she's doing--

"she's, like, eating all that food, throwing up

and still losing weight."

And that night I went into the bathroom

and I started.

I didn't think there was anything wrong with it

because it's on TV, and sometimes they glori...

make it look so glamorous to have an eating disorder.

Sarandon: It has become a self-fulfilling prophecy.

The popular television series Friends

played on anorexic chic in an ad which was soon pulled.

Woman: In some ways we all have distorted views

of what is beautiful.

And the repeated exposure to a particular image

teaches you to like that particular image.

And we have become so used to seeing extremely thin women

that we have learned to think that this is what is beautiful.

Sarandon: The mystique of thin began with the arrival

of the British model Twiggy in the late 1960s.

Standing five feet, six inches tall, she weighed only 91 pounds

and was dubbed Britain's top "mini-model."

Since then, fashion models have become increasingly thinner

with body weights nearly 25% less

than the average American woman, who weighs 140 pounds.

Woman: I think there are two primary things going on right now

with the cultural availability of eating disorders.

First, the whole society is involved

in the perfection game, all right--

that we all can fix our bodies, make our bodies over.

And then I think among young women

they're increasingly tuned in to a celebrity culture

where the models' and actresses' bodies are considerably thinner

than they have ever been in the past.

This is very seductive and hard for young girls to resist.

This is not about illness.

This is about idealized beauty

and perfection of a certain type.

( fast music playing )

( audience whooping and applauding )

Sarandon: These plus-size models are boldly challenging

contemporary ideals of beauty.

Ranging from size 12 to 18

they are much more in tune with the average American woman.

Now a plus-size icon

Kate Dillon started out as a skinny model.

Dillon: I think it happens to everybody at some point

where you feel one way about yourself

and that your initial... your intuition about who you are

is that you're a good person, that you're beautiful

that you're strong, that you're capable.

And then at some point, it's met with an outside force

that's telling you, "No, you're none of those things."

( confusion of voices )

Dillon: I remember getting ready for my first day of junior high

and I was sitting at my mirror

putting on my electric blue mascara

and my frosted pink lipstick.

And I was thinking, I was, like, "Yeah, I'm fine.

I'm looking good, you know."

And when I got to school it was just...

they were just horrible to me, telling me I was fat

and whether it was in P.E.

or coming home on the bus every day

they'd stand up and they would jump up and down

and they would chant "Overweight Kate, Overweight Kate."

And I remember just, like, you know

I'm, like, sitting in the front seat.

I would always wear these massive sweaters.

And I was sitting in the front seat

and just like trying so hard not to cry

because I was so embarrassed and horrified.

Sarandon: Desperate to fit in, Kate took extreme measures.

Dillon: By the end of my seventh-grade year, I'd lost 30 pounds

and I grew, like, four inches, and I was cool.

Suddenly everyone liked me.

My plan worked, sadly and unfortunately.

But it seems to be

that that's the way the culture is, you know.

You sort of... you do what they want

and they'll say, "Cool, good, you're good now."

Sarandon: Kate became not just thin but anorexic

and she caught the eye of the fashion world.

Weighing 50 pounds less than what she does today

Kate's image before the camera

concealed a painful inner struggle.

Dillon: I look beautiful.

I mean, it's not like... You would not look at that picture

and see somebody who was feeling bad about themselves

or see somebody who hadn't eaten in two weeks.

I mean, I look at my face, my face looks so hollow.

I look so... my eyes look like they're bulging out.

And I just look so weak.

That was the day that they told me

to lose, like, ten or 20 pounds

and I kind of knew that that was crazy.

Like, I remember thinking, "From where?

Like, 20 pounds?

How am I going to lose 20 pounds?"

And I remember thinking, "I don't have to do this.

"Like, what have I been doing the last couple years?

What have I been doing my whole life?"

Sarandon: A year later, Kate walked away from modeling.

( "doors closing" signal chimes )

She was in search of a life

where starvation was not the price of success.

Historical images and accounts of anorexia

date back hundreds of years.

In the 14th century, the mystic St. Catherine of Siena

starved to death at the age of 33.

An extreme ascetic, her self-denial was quite different

from that of most young women today.

Woman: Certainly during her lifetime, she engaged in food refusal

and a number of other penitential acts.

But her pathway into that behavior

is so markedly different.

It's motivated by her faith.

She also often gave away the food that she didn't eat.

So in many respects

she's not at all like a contemporary anorectic.

In the 19th century, it is also possible to envision

middle- and upper-class girls who want to be very thin

for a totally different set of reasons than today.

They didn't want to be thin because it was sexy.

They wanted to be thin

because it meant that they were spiritual.

They wanted to be thin because it meant

they had kind of conquered their carnal appetites

such as food and eating.

I see the common theme in all of this

is that women are using the appetite as a voice

and they're using the appetite to express different things

depending upon their historical situation.

Sarandon: Today, at least three out of every hundred girls

will develop anorexia or bulimia

often in the wake of puberty.

Woman: I believe there are these separation, individuation

identity-formation problems that are occurring.

And I think that that has to do with fears of maturity.

I think that development

of someone from a child into an adult

the adolescent process, has a glitch somewhere

and that the eating disorder

is born out of the struggle to grow up.

Instructor: It's okay if you're not finished...

Sarandon: But why do some girls

develop eating disorders and others don't?

Striegel-Moore: There are a lot of precipitants.

You know, it could be the parents got divorced.

It could be a breakup with a boyfriend.

It could be any number

of what may seem to be very small stresses

to most people, and yet for a particular girl

is somehow the straw that broke the camel's back.

But you won't have those onsets

unless the girl already is vulnerable in some way.

So simply because parents divorce doesn't mean

now their daughter is going to develop an eating disorder.

Those events have to sort of occur

in the context of an already existing vulnerability.

Sarandon: Erin's personality made it especially difficult

for her to deal with upheavals in her life.

Kaye: From a biological standpoint

we're actually finding that people with these disorders

actually share some common personality traits.

And that is both bulimics and anorexics

tend to be people who are kind of obsessively perfectionistic

and they're concerned about doing things right.

Things have to be done kind of with symmetry and exactness

um, and that they tend to be people who are what we call

"harm-avoidant"; that is, that they worry

about the consequences of their behavior.

They don't want to do things wrong.

I just like everything to be controlled

just in control, you know, it's kind of like...

I don't know, I just...

Like traffic-- I hate when people try to cut on you

and they're sitting right here, and traffic's, like, right here

and people are, like, right here

because they're trying to get in another lane

and I'm just, like, "Keep the lane straight."

That's just me, that's just how I am.

Now, when we go back and we start looking

at families of people who have eating disorders

we actually see a very high rate

of a spectrum of eating disorders in their families.

And we see that roughly about... seven percent

of the family members have anorexia or bulimia nervosa

and we see roughly maybe another five to seven percent

of family members have a spectrum of eating disorders.

They don't have anorexia or bulimia

but they have some variant of eating disorders.

Sarandon: In search of a biological explanation

Dr. Kaye peered inside the brains

of recovered anorexic and bulimic patients.

He discovered unusually high levels

of a brain chemical called serotonin

which is well known for the role it plays in mood and appetite.

Kaye: Overactivity of the serotonin system reduces appetite.

The other thing about having increased serotonergic activity

is it seems to be-- at least in animals and human studies--

goes along with having

kind of obsessive, anxious, harm-avoiding kinds of behavior.

Sarandon: Dieting, even starvation, may be a way

for people with eating disorders to lower their serotonin levels

in an attempt to reduce their intense anxiety.

Kaye: This may explain the vicious cycle

that people with anorexia get in.

They have too much serotonin.

They starve themselves, that drives down the serotonin.

Sarandon: But the brain quickly adapts by adding more serotonin receptors.

Kaye: So even a little bit of serotonin

sets off these receptors.

So people have to keep starving themselves more and more

to reduce the serotonin, but the receptors keep up-regulating

so they can never really escape from it.

Sarandon: For patients with anorexia, weight gain

is a crucial first step toward recovery.

So we have about... ten minutes, okay?

Sarandon: Anorexia is one

of the most difficult psychiatric illnesses to treat.

Nearly 50% of patients will relapse within the first year.

But new research shows that these rates

can be dramatically reduced if patients like Erin

reach their normal weight before leaving the hospital.

Man: There is ample evidence

that the lower the weight, the greater the risk of death

and the greater the risk of medical complication.

So I think what we ought to pay attention to

in the treatment of anorexia nervosa

as sort of an index of how someone is doing is the weight.

And if their weight isn't back to normal

treatment isn't ended.

...seems to be doing a little bit better today...

Sarandon: But weight gain alone is not enough.

Anorexia is a complex mental and physical illness

that requires a multidisciplinary team to treat it.

Willard: Okay, why don't we go ahead and staff Erin?

Sarandon: Psychotherapists, a physician, nurses

art therapists, body image specialists and nutritionists

will work together to tackle Erin's eating disorder.

Willard: In order to treat eating disorders effectively

we need to address both parts of the problem.

We need to address

the underlying causes and issues

and we need to address the symptoms

the eating behaviors that are so dangerous.

And I believe as an inpatient

people need to address these things simultaneously

and address them both with a vengeance.

Sarandon: Five weeks into her stay at the hospital, Erin is gaining weight

and has begun to face some traumatic issues in her past.

She admitted to having been sexually abused--

not uncommon among these patients.

Erin: Trauma is what really hit if off.

Bringing up my trauma issues really made me want to...

just...

I wanted to get rid of it somehow, the feelings

too many feelings, way too many feelings.

Flush them down the toilet.

Striegel-Moore: Having been sexually abused

teaches a girl a number of things.

One is that she's powerless.

It's just a horrendous experience to go through

and one way to cope with that sense of powerlessness

is to try and find some way of having power and control.

And by managing one's weight

that can be one way to have power and control.

Some women will overeat quite explicitly

as a way of making themselves less attractive.

Others will diet

as a way of starving themselves into an unappealing small size.

So there's sort of any number of explanations that...

that women then come up with

but they all have to do with trying to cope

with what has been an extremely traumatic experience.

Sarandon: Talking about the abuse

marks a significant turning point in Erin's treatment.

Erin: Secrets, you don't keep secrets, you know, secrets are bad.

And I was keeping it a secret.

And if I would have kept that and went home with it

I would have just gotten sick again.

Sarandon: Group and individual therapy

are critical components of the treatment process.

Girl: I just thought that I could live the rest of my life

not eating, and it was, like, a power thing.

I was, like, "Look, Mom, I don't have to eat.

I can piss you off, I don't have to eat," you know.

And it works, it works.

I mean, that's the last thing your parents want

is for you to die.

And so when you sit there and you're, like

"I'm not going to eat, I'm just going to slowly kill myself"

it works-- you can get back at anybody.

And I guess...

I don't know, I guess I need to find...

a way to forgive her, you know

because...

( voice breaking ): I'm just punishing myself.

I'm killing myself.

And it's so stupid, because you don't win.

Woman: Losing your life isn't winning, is it?

It hurts her, but it hurts you more.

How does it feel to be looking

at all those feelings from back when they got divorced?

It just makes me mad.

Woman: Mad because...?

Because I didn't tell them.

Willard: These are not generally kids who can scream and yell

and say, "I hate you, why did you do this to me?"

They're very sweet and they're very kind.

And they're parent-pleasers.

And so they are aggressive in the sense

that they are driving the knife deeper into the family

and the family watches them die.

But they are very sweet and very kind

and very quiet about the process.

( ballet music plays )

Sarandon: At age 21, Eleena Melamed

has also paid a heavy emotional price.

A gifted dancer, she was told to lose weight at age 12.

Melamed: I remember having a teacher come up to me and pinch my back--

pinch the skin on my back and say, "What is this?

"Are you drinking milk?!

You know, you need to lose weight."

Sarandon: Eleena eliminated fat from her diet.

In time, she became anorexic.

Melamed: "My anorexic year," I call it.

I was the happiest I had ever been in my life.

I was getting all the good parts in our performances

at the school, I was getting all the attention

I was not being ignored anymore.

When I was heavy, I was ignored instead of nurtured.

And when I was really thin

I, you know, all of a sudden was nurtured and taken care of

and the teachers loved me and they cared about me.

It was like I was a whole new person.

Sarandon: After starving herself for over a year

Eleena lost control and began to eat.

Melamed: Gaining weight... was...

for me, the worst thing, I was just so...

ashamed of my body.

I felt like I was the biggest failure

and the weakest person, just the worst person.

I remember picking up a knife from the kitchen

and starting to cut myself on my arms, on my legs.

I had so much pain inside of me, and so much hatred

and animosity towards myself

that feeling the pain and making it real pain

as far as being able to see the blood and see the cut...

it was calming.

I did that for a long time.

Sarandon: Despite her fragile state

Eleena's talent did not go unnoticed.

( piano playing ballet practice music )

At age 17, she was invited

to join the prestigious American Ballet Theatre in New York

by artistic director Kevin McKenzie.

But her struggles with weight would continue.

Melamed: All of a sudden

there's that added pressure of being on stage every day

next to these amazing, beautiful dancers.

And I just...

I buckled under the pressure.

I could not lose weight.

It made me eat more because I got very depressed.

I felt horrible about myself.

Sarandon: Eleena now faced one of the most difficult decisions of her life:

whether to pursue her dream to be a professional dancer

no matter the personal cost.

Erika Goodman made that decision many years ago

and now, at age 54, she lives with the consequences:

a lifelong struggle with anorexia

and severe osteoporosis.

A former Joffrey Ballet dancer

she is no stranger to extreme dieting practices.

Goodman: The scale becomes your altar.

It becomes the site where you pray every morning.

You pray that it will be down another pound or another ounce

or anything to show that the work that you're doing--

and the work is starving-- is working

because other things in your life aren't working.

And it's the one thing you have control over.

And that is a major thing.

I think that's what keeps a lot of these people

in this anorexic mode.

It's control.

Nobody else can control that for you.

Sarandon: Described by a critic as a treasure of her generation

Erika danced in an era when anorexia was a silent threat

and all too easy to overlook.

Goodman: The really perverse irony of this is

that what has been taken away from me are my legs.

And for somebody who had always been very flexible

I'm very stiff.

And it's only now that I know.

It's only when you're paying for it.

You're paying for it then, you see, but you don't know.

The cash register hasn't rung.

It's ringing now.

And it's not until it rings.

It's like sleeping.

You can have your alarm clock set

but it's not till it goes off that you're going to awaken.

This tendency to diet is eating disorders.

Sarandon: Eating disorders are too prevalent to ignore today.

Dancers at the New York City Ballet attend a seminar

on health issues.

Anorexia and bulimia are rare among men, but increasing.

Woman: I think women get more eating disorders than men

because we have such a focus on our appearance

although it's changing a little bit--

men have to have the abs now and more muscle tone.

But if you look at professions

like jockeys, for example, or weight lifters

you'll often see a higher incidence of eating disorders

because their careers are on the line

based on their weight.

If you don't have normal periods

you don't have this increase in peak bone mass.

Sarandon: For women, a loss of body fat

from dieting or even strenuous exercise

can shut down the production of the hormone estrogen

which is crucial to bone growth and menstruation.

This is a total bone density scan

of a healthy 25-year-old woman

compared to a woman of the same age

who has gone five years without menstruating.

Nearly a third of her bone mass is irretrievably lost.

This woman in her 30s has gone 15 years without a period

transforming her bones into that of a 70-year-old woman.

( women chatting )

As a preventive measure

the ballet offers its dancers bone density scans.

Katey Tracey lost her period for nearly a year

when she had anorexia.

Is that your dominant leg, your stronger leg?

Are you right-handed or left-handed?

I'm right.

Tracey: Being a woman, being an athlete

I realized that I was susceptible to bone loss.

The potential for injury

the potential for loss of reproductive abilities

scared me.

Woman: Dancers are at particular risk for developing osteoporosis

because they do everything to exaggeration.

They diet to keep their weight down.

They avoid foods with fat in them

and unfortunately a lot of food with fats have calcium

and you get bones that are thin and fragile

essentially osteoporotic bone.

Looks pretty good.

Your value is...

Sarandon: Getting help right away

probably made all the difference for Katey.

For woman of 30...

Sarandon: Her bone scan is normal.

Somewhere between 20 and 30.

Mm-hmm.

All right...

Sarandon: Strenuous exercise can lead to another form of anorexia.

In a 26-mile marathon

the finish line comes too soon for Jennifer Schmid.

Schmid: At about three miles to the end of the race

I knew I was in danger with this disorder

because all my thoughts were consumed

with "How soon am I going to get to the gym after this?"

Sarandon: Unlike most patients with anorexia

Jennifer has no issues with food.

She has always eaten voraciously but got into trouble

when her workouts burned more calories than she could consume.

Schmid: I think my personality has a lot to do with this.

I've always kind of had a perfectionist personality.

It kind of runs in the family

being a little bit obsessive-compulsive

and very...

I'm kind of self-critical.

"Self-disciplined" is how a lot of people describe me.

Our lab and other laboratories have found retrospectively

that if you ask people-- and their parents--

who have developed anorexia

what they were like when they were children

a majority of them developed an anxiety disorder

before they ever developed anorexia--

as a child from around the age of eight years old.

Schmid: I've always had anxiety since I was a little child.

It's just been in different ways and different situations.

But exercise was the one thing for me

that could take that anxiety away.

So the more I worked out, the better I felt

and then little bits wouldn't be enough.

I'd have to go more, and it just spun out of control.

Sarandon: When Jennifer's heart rate plummeted after working out

she was admitted to the eating disorders unit

at Methodist Hospital in Minnesota.

Her mother was grateful

to have Jennifer's marathon workouts brought to a halt.

The day room.

Woman: Until now, up until she's been in the hospital

there hasn't really been anything I can do.

I've tried being real supportive.

I've tried backing away and not having anything to do with her.

I've tried a lot of different things to see what would work

and really nothing did work until she got in the hospital.

How are you feeling

about where things are going?

I'm feeling better, still...

Sarandon: Now that Jennifer has been hospitalized for a week

her vital signs have improved.

She is taking a drug called Paxil

which helps to regulate levels of serotonin in her brain

and lessen her anxiety.

Schmid: I haven't worked out in two weeks

and that's the longest span I've gone since I can remember.

And I haven't had any anxiety at all

or experienced anxiety or obsessive thoughts

since I've been on this medication.

Can you take some big breaths?

Sarandon: Drugs like Prozac or Paxil act on the serotonin system

but they are not always effective

especially in patients who are severely underweight.

Let me just check down here

for any swelling at the lower part of your back.

Walsh: The studies that people have done

including our own group have done to date

have not found that medications like Prozac, or Prozac itself

is very helpful in the treatment of anorexia nervosa.

Perhaps one reason is

that most of the trials of medications

for people with anorexia nervosa

have been done while they're underweight.

And it may be that the effects of starvation on the brain

prevent Prozac from working.

Sarandon: But as patients gain weight

medications like Prozac appear to help them avoid a relapse.

Schmid: I want to live.

I'm going to live.

I'm going to live though this.

This program has taught me that

and given me the nutrients and things

to start thinking clearer.

And there are so many things I want to do.

I'm young.

I've got a whole life out in front of me

and I plan to live it to its fullest.

( grunting and laughing )

Sarandon: In today's image-conscious world, surveys show

that 80% of women are dissatisfied with their bodies.

Girls as young as nine and ten years old are dieting

even though they are at normal weight.

Announcer: Lisa dropped an amazing 48 pounds in just 12 weeks!

Striegel-Moore: The diet industry is a very, very big industry.

It sells the myth of transformation:

"If you do our product, you, too, can be Princess Diana.

"You, too, can marry your prince.

You, too, can be wealthy."

And it's amazing how people can suspend disbelief

and buy into anything--

you know, lose 30 pounds in five days.

Again, I think it gets nurtured

in a culture that values extreme thinness.

And of course underneath that is what's the basic message.

The message is "You're not okay the way you are.

You need to be transformed."

The first generation and second generation

of most ethnic groups in America

there isn't much anorexia nervosa...

Sarandon: At Cornell University, Dr. Joan Brumberg is conducting a seminar

on the history of female adolescence in America.

The pressure to be thin is keenly felt

by these college women

and is spreading across all racial and social classes.

Woman: When I grew up in a predominantly black neighborhood

it just wasn't an issue.

It never affected me before I came here.

And all of a sudden now

everyone's so little, you know.

( laughter )

Brumberg: And yet there is...

I mean, we know now that there are eating disorders

in the African-American community.

These observations about cultural difference

are really interesting

and yet everybody seems to say around this table

that the pressure is pretty intense right now.

I believe

that very few women escape a battle with their bodies.

I think that it's to varying degrees

but I think that many women at different points in their lives

are unhappy with their bodies.

I don't think there are a lot of women who could say honestly

they love their bodies.

Sarandon: For more than a decade

Anne Chavarro has faced a particularly difficult battle

to overcome bulimia nervosa

which is characterized by binge eating and purging.

Most people who develop this secretive illness

are around the age of 18 and of normal weight

but the obsession with food and dieting begins earlier.

Chavarro: In high school, it was how little you could eat

in order to make it through the day, you know

and what size pants you were going to fit into

because we all were trying to lose weight.

When I moved to Manhattan

and my friends were actors and actresses and models

almost all of them had eating disorders.

So you kind of get the hang of it

then you start reading some books

on trying to get help for your eating disorder

and in reading those books, you find techniques that work.

Sarandon: Bulimia nervosa is a relatively new disorder

medically recognized only in 1979.

Walsh: Certainly the behavior was well recognized

for centuries or even millennia.

I mean, we know the Romans were doing some strange things

with food and vomiting at the time of Christ.

But from a clinician's perspective

it was very rarely talked about.

Binge eating and purging just weren't on the radar screen

until about 20 years ago.

Sarandon: For Anne, bulimia seemed to offer a perfect solution

to her conflicts over food.

Chavarro: You realize that you can eat whatever you want

and get rid of it.

It's sort of like a high.

Emotionally, it makes you strung out.

It's almost like being on drugs.

You're totally strung out.

And because you're constantly depleting your body of food

in between the binges

you're so lethargic, you're so tired

you're so... you know, drawn out

that you can't do the things that you even want to do.

So it becomes like a cycle.

It's a cycle, you know, and you can't break out of it.

( children chattering )

Sarandon: Anne's life became consumed

with hiding her bulimia and fighting depression

which frequently accompanies this illness.

She ate enormous amounts of food

and purged up to 20 times in a single day.

Chavarro: It doesn't only hurt you;

it hurts whoever is in your family

that you're very close to.

So your friends, it hurts all them

even though you do not mean to hurt them, you know.

The self-loathing comes in.

You start hating yourself.

And then if you're, like, the types who hide it

like I used to hide it, and then it's, like... it's even worse.

Sarandon: For the past three months

Anne has been receiving treatment

from Columbia-Presbyterian Medical Center's psychiatric institute.

Just do a blood test?

Sarandon: Dr. Walsh has put Anne on Prozac

which helps with her mood and appetite

by acting on the serotonin system.

You're in here.

Walsh: For many patients with bulimia

taking Prozac helps them both feel better emotionally

and gives them better control of their binge eating and vomiting.

And that's... that's a fact.

I mean, we... it's one of the things

we can now take advantage of in our treatment of patients.

Sarandon: Anne has changed her behavior dramatically

but breaking the cycle of bingeing and purging

is like giving up an addiction.

Walsh: During a binge, people typically will report something changes.

At least they feel numb-- they're not thinking

about whatever it is they were worrying about.

So what... there is a reward there.

They don't feel good, but they feel different

and they feel some relief, I think

from the distress they were experiencing.

And one wonders if that isn't a critical component

that keeps this behavior recurring.

You've got a period of time now...

Sarandon: In addition to medication

most people with bulimia benefit from psychotherapy.

One of the best-studied techniques

cognitive behavior therapy

is designed to break bad eating habits

and establish a healthier body image

and a new approach to food.

I actually had, like, a banana nut muffin

and that was taboo for at least two years.

Unless I was going to throw it up, I couldn't eat it.

Sarandon: To understand more about bingeing

Dr. Walsh and his colleagues designed an experiment.

They provided a large amount of food

and allowed patients to eat whatever they wanted.

The result was an average of 3,600 calories

or nearly two days' worth of food in a single sitting.

Woman: There's something disturbed about their satiety

or satisfaction as it relates to food.

It seemed to be a general disturbance

in feeling satisfied with a meal

the way that you and I would just feel stuffed

and stop eating from.

We felt maybe they're not experiencing that sensation.

Sarandon: Anne is participating in a study

to see if her treatment has had any impact

on her stomach's ability to handle food more normally.

Guss: Okay, so... no, I'll hold it.

Just like always.

As quickly as you can...

Sarandon: Anne is given a liquid meal

that is tagged with tiny amounts of radioactivity.

Okay, just lay really still.

Sarandon: This machine, a gamma counter, detects emissions from the meal

and will monitor the rate at which food leaves her stomach.

After food enters the normal person's stomach

small amounts begin to empty into the small intestine.

This triggers the release of cholecystokinin, or CCK

a hormone that helps transmit sensations of fullness

to the brain.

As more CCK is released

the person starts to feel full and eventually stops eating.

In the case of bulimia, it appears that over time

bingeing on large amounts of food causes the stomach

to empty more slowly into the small intestine

so less CCK is released.

The message to the brain to stop eating is weaker

so the person does not feel full and keeps eating.

After three months of treatment

Anne's stomach is emptying at a more normal rate

compared to three months ago.

Guss: I can see

that there has been an increase in her gastric emptying rate

which is what we would want to see.

It's more typical of a normal control subject

a normal individual, so at least from that perspective

the gastric emptying data look to be improved

in the three-month period that she received treatment.

Whoa, whoa.

Whoa, go ahead.

Sarandon: About 50% of patients

who receive treatment for bulimia are cured

while the remaining half, like Anne, are substantially better

but it still may take several years

before Anne fully recovers.

( piano playing classical piece )

Sarandon: At the American Ballet Theatre, life is looking up for Eleena.

She admitted she had an eating disorder

and director Kevin McKenzie

offered her a medical leave of absence.

( directing her quietly )

Melamed: After years of being yelled at

and made to feel ashamed and ugly and hideous

to have Kevin McKenzie tell me that it was okay

and that it didn't mean that I wasn't a valuable dancer;

it just meant that I had a disease, that I needed to heal

and he was willing to wait for me.

And...

( piano starts playing )

McKenzie: I have learned not to tell somebody just to lose weight

but "You do need to address this and you need professional help.

"It may be something as simple

"as you not understanding what to eat.

"I'm telling you this on the same level

"that if you were walking in here with chronic tendinitis

"I would eventually say, 'You have to go

to the physical therapist and take care of this'"

and equate it on that level

and give them the name of a doctor and send them.

So, how did tour go?

It was okay.

Sarandon: A former dancer herself

Dr. Linda Hamilton understands

the extremes to which a dancer will go.

Hamilton: They're so phobic about fat at this point

when, by the time I get them

they've maybe not been eating fat for five years.

What is always so wonderful

is when I get them to eat enough calories and fat

and suddenly their bodies start working again

their metabolism speeds up, they start to lose weight.

And they look at me in amazement

like "Come on, this is working."

I think, are you ready?

Get your... get your weight checked?

Let's go.

Melamed: My weight dropped.

I mean, I lost, I think, like, five pounds

within the first two weeks or something just by eating fat

by having 30 grams of fat a day.

It was the most amazing thing.

I would have never believed it if somebody had told me that.

Step, two...

( piano playing )

Okay, good.

Sarandon: Eleena is back with the company now, rehearsing a soloist part

for a 60th-anniversary presentation of Swan Lake.

McKenzie: I think getting the support has helped

on the level that she's happier, she's... enjoys her dancing.

And if she can be guided properly

and... and then really fully realize her talent

the potential is there to be wonderful--

is to be absolutely wonderful.

( yelling )

Sarandon: After leaving her life as a supermodel

Kate Dillon spent the next two years searching for a new career

to fit the person she has become.

( yelling )

Dillon: I wanted freedom from this... this ideal...

from these cultural ideals.

I wanted freedom to be who I was, whatever that would be.

If I was the biggest dork in the world

well, then, that was going to have to be okay.

If I was a big mess, that was going to have to be okay, too.

And if I was beautiful, that would be fine.

And if I was ugly, that would be fine

but that I didn't want to fight myself anymore

that I really wanted to just, like, unzip this suit

that I'd been wearing of, like, "Like me, like me, like me.

"Think I'm interesting.

I want to be perfect," and just take it off and just expose

and just be, like, "I'm just who I am."

( audience cheering )

Sarandon: No longer at war with her body

Kate has settled into a comfortable weight

and a new career in modeling.

Dillon: Plus size is no different than skinny.

It's just another way of being beautiful.

Many of these girls have been struggling with their bodies

their whole life

and suddenly they're being told that they're beautiful.

So when you get 25 women up on stage

with curvy, beautiful bodies

walking around feeling beautiful

it's infectious.

And everybody is sort of drunk with that.

And when I think about the impact

it could have on a young girl like me, maybe

who is 12 years old

and... and... and isn't going to fit into the right size

and isn't going to fit into that mold

and she is going to grow up in a world

where things like that exist

maybe she's not going to feel so bad about herself.

Sarandon: Back at the DePaul-Tulane Eating Disorders Unit

Erin is preparing to leave.

On the right track

she will have to continue treatment at home

for at least another year or two to ensure a full recovery.

Well, we have Erin being discharged Friday.

Woman:Okay.

Willard: The best insurance to prevent relapse

is continued care in all dimensions of treatment.

With her aftercare plan set with a good therapist

a good nutritionist and an excellent family therapist

with all of that in place and these people

pursuing health with Erin and her family

her chances are far better.

Erin: "Dear Treatment Team, I just want to tell you all

"thank you so much for what you have done for me.

"I know that I can need and ask for help

"and assert myself because of you all.

"I know that there will be rainy days ahead of me

"and I am ready to fight them.

"You have helped me so much

"even though I sometimes got pissed off.

"If I ever need help again, I will come to you all

because I trust and believe that you can make miracles."

You've really made some great strides forward

and you just have to keep up the good work

and you have to keep up with your therapies, all of them...

Mm-hmm.

and start to enjoy a real life

because I think it's all out there for you, okay?

You ready for it?

Yeah.

Okay.

I'm so proud of you.

Thank you.

Erin: "Everyone has given me an opportunity to a new life

"and I thank you for that.

"Thank you for being my family-- I love you all.

"Now I am starting on my journey now.

Love always, Erin."

[Captioned by The Caption Center WGBH Educational Foundation]

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CA2BH BOST AT 1-8004.

NOVA IS A PRODUCTION OF WGBH BOSTON.