Walk into a bookstore and go to the dieting section for an insight into America’s culture of food restriction.
This widespread dieting culture often can reconfigure into something more harmful or mask the early signs of an eating disorder. According to the National Eating Disorder Association (NEDA), current trends such as “clean eating” might just be dieting in disguise — “a socially acceptable form of food restriction,” which can develop into an eating disorder.
This past week marked National Eating Disorder Awareness week. NEDA reports that 30 million Americans will struggle with an eating disorder at some point in their lives, and 4 percent of anorexia cases, 3.9 percent of bulimia cases and 5.2 percent of unspecified cases are fatal.
Junior Katie Marinis said she has struggled with anorexia and body dysmorphia at least since she was in high school.
“I had a very severe eating disorder,” she said.
Mariam Basma, a dietician in Student Health Services, stresses that eating disorders are not dieting problems, they are psychological disorders.
Marinis said no one decides to be anorexic. It starts with wanting to lose weight then manifests into something worse.
Marinis said at one point she used to eat 900 calories a day and work off 500 of them, or would only eat an apple and a protein bar a day. In less than a year, she went from weighing 150 to 94 pounds.
She said she remembers sitting in chemistry class her junior year of high school and feeling how irregular her heartbeats were. Every once and awhile it would stop and it would hurt.
“I was like, um, Mr. Campbell, I need to go to the nurse,” Marinis said. She left school, went to the hospital where she was given a Holter monitor to observe her heart rate.
At the time, she was in denial about the reason for her health complications and was convinced that “this was just weird.”
That summer, her family took a trip to Greece. It was the first time in awhile that her dad had observed her eating habits over the course of a full day. She would only eat salad and maybe some bread, and she said he showed concern and kept telling her he was going to take her to a hospital.
“I remember taking pictures on the beach. I made my cousins take these pictures like a hundred times because I was like, no I look fat. I look back at these pictures now, and my bones are showing, my arms are like twigs,” she said. “I started off at about 150 pounds and when I lost that weight, I still saw someone who was 50 pounds heavier. People would tell me, you’re way too skinny — I don’t see that.”
Marinis returned home from Greece and was running six or seven miles a day. She had been training to run varsity cross country in the fall, but on July 23, 2013 — “I remember the exact date” — she went for her annual physical. The doctors came back into the room and told her they would not sign off on her physical to let her run cross country because she was “too unhealthy.” She was 17 years old, her blood pressure and heart rate were low and she was underweight.
“I was shocked,” she said. “[The doctors] took my dad out into the hall and they were like listen, you need to get her admitted into a hospital.”
According to the American Psychological Association, a 2011 study reported that less than 13 percent of adolescents with eating disorders receive treatment. Basma added that she is skeptical of the accuracy of numbers like that since many people who suffer from disordered eating may not even realize they have a problem.
“I kept telling them they were wrong and my dad was just quiet,” she said.
A few weeks later, Marinis started seeing a therapist and a nutritionist.
“I wasn’t allowed to do anything — I wasn’t allowed to run, I wasn’t allowed to go to the gym and lift weights, I wasn’t allowed to do anything that would increase my heart rate,” Marinis said. “When you don’t have any fat on your body and you’re not eating enough anyway, your body starts to eat away at your muscles and that includes your heart. My heart already wasn’t functioning correctly.”
During her first couple of therapy sessions, Marinis was convinced she didn’t need to be there. After a while, she started to make the connection between her behavior and the symptoms of an eating disorder.
“The deeper you get into an eating disorder, the later you choose to receive help, the harder it’s going to be to pull yourself out of it. And I’ve had these ideas ingrained into my mind for years,” she said.
Marinis remembers watching a video of a group of women who all had eating disorders. They did an exercise where they had to draw what they thought they looked like and guess their weight. When the therapist went around and got their real measurements, they had overestimated their measurements.
“That made me realize like, maybe I do have a problem,” she said.
Marinis said she has had an eating disorder throughout her life but said no one caught onto it until she was skinny and sick.
Basma said dieting or restricting food intake has become so acceptable, that signs of an eating disorder, especially in its early stages, can be overlooked or dismissed as ‘normal’ dieting.
“You don’t have to be the poster child for anorexia to have anorexia,” Marinis said.
When Marinis fell underweight, her body started to shut down.
“Your whole body is affected by anorexia,” Marinis said.“Eating that little and working out that much has more of an impact than losing weight. You will lose your hair, you’ll ruin your skin, your bones will be weak. I probably was on the verge of getting osteoporosis.”
Marinis said the physical side effects of an eating disorder are relatively easy to help but the emotional struggle is there forever. She describes anorexia as an addiction.
“I read in a book that anorexia is unlike any other addiction,” she said. “Alcoholics don’t go to a website to figure out how to be the best alcoholic but anorexic people will go on websites and look up the symptoms and they’ll make sure they’re hitting all the symptoms. It’s weird how it works because no other addiction wants to be the best addict of something but with anorexia, you want to be the best.”
Marinis said it is a very irrational way of thinking. When she was first diagnosed, she said her friends didn’t know how to talk to her. They told her she was way too skinny and that they could fit a hand around her thigh. Instead of accepting their comments as concern, she’d take it as a compliment.
“I knew they meant well. They were trying to get me to see that I was sick,” she said. “But you can’t tell someone with anorexia that they look sick because they like that.”
“If somebody had told me ‘oh my God, your skin’s clearing up’ or something when I was recovering that would have helped me,” Marinis said. “But when people came up to me and said ‘oh my God, you have your ass back’ or ‘oh my God, you have boobs again,’ I was like, ‘please don’t remind me. I don’t want this.’”
She said people would tell her that she was going to die if she did not get help.
“And I was like, ‘I don’t care because I would rather die than be fat.’ And that’s irrational,” she said. “You can’t use reason to reason with somebody that’s not reasonable.”
Marinis said there is a lot that people don’t understand about this disorder — it’s not a choice.
“When you’ve gone over a year without eating over 1,000 calories, your body just can’t eat anymore,” she said.
Like other mental and psychological disorders, Basma said there is a stigma attached to having an eating disorder. It’s often hard for people unfamiliar with eating disorders to understand why someone has one in the first place.
“Many people think it is about weight loss or managing your weight, when in reality, it is about so much more,” Basma said. “If a person with restrictive eating, for example, loses a significant amount of weight, the response of loved ones is often to try to feed them more, and they may not understand the mental struggle that person goes through when they face food, and how difficult it might be for them to ‘just eat.’”
A huge part of coping with an eating disorder, is that people struggling feel like an eating disorder is part of them. To this day, Marinis said she still struggles with gaining weight because she feels like she won’t be herself anymore.
Young women are most likely to feel pressure to look a certain way and are therefore more susceptible to developing an eating disorder, Basma said. However, that does not mean other demographics are not at risk. For example, Basma said there has been an increase in male eating disorders.
She said the rise could either be a result of being more willing to seek out help or the result of social pressure to look a certain way.
A college environment can be especially triggering for someone who suffers from disordered eating.
Basma said in college, students have the freedom to make their own food choices, some have that freedom for the first time.
“Let’s face it, many people gain some weight that first semester or two, whether it’s from more late-night eating, giving up a high school sport, not making the best food choices in the dining halls, experimenting with alcohol,” she said. “Some people try to compensate for this by controlling what they’re eating, and may finding themselves taking it too far.”
She said some people are more susceptible to academic stress and that may indirectly trigger a preoccupation with weight or exercise.
The university does not keep information regarding the number of students on campus struggling with eating disorders. There is not an accurate way to calculate that number and it may compromise confidentiality, Basma said.
Basma said Student Health and Wellness acts as an outpatient facility — it is not a treatment center — but it does coordinates with the counseling center by providing body image groups, as well as individual counseling and nutritional counseling. There is also a physician available to monitor eating disorders medically but when a student needs a higher level of care, they refer the student to a treatment center where they would provide an assessment for that student to determine what level of care would be appropriate.
Marinis’ treatment began July 2013 and she said recovery “took a long time.” She said she fought her dad, who was trying to help the best he could, the whole way there but he didn’t give up.
“If he gave up I would not have recovered,” she said.