Trying (and dying) to be thin

cThere’s a well known saying: You can never be too rich or too thin. One famous actress in Hollywood apparently has too much of both.
Courtney Thorne-Smith, costar of “Ally McBeal,” recently quit the hit television series, citing the pressure to lose weight.
“I started under-eating, over-exercising, pushing myself too hard and brutalizing my immune system,” she says in the Dec. 11 issue of Us Weekly. “The amount of time I spent thinking about food and being upset about my body was insane.”
Courtney Thorne-Smith won the lottery. She fit Hollywood’s standards of thinness, beauty and talent. Although she never admits in the article to having an eating disorder, her anguish over her body is typical of the approximately 10 million women in the United States (and thousands here in Minnesota) with eating disorders.
Anorexia Nervosa, the compulsion to starve yourself or drastically lose weight through obsessive exercise, vomiting, or use of laxatives, diuretics or diet pills, is the most dangerous of all psychiatric illnesses. Up to 15 percent of people with anorexia die of complications, such as heart arrhythmia, kidney or liver damage and organ failure. Between two and five percent of people with anorexia commit suicide.
Many skeptical people think eating disorders are a fad of the rich and famous (and those who want to be). In reality, eating disorders are serious illnesses that have been with us since ancient times. The early Romans were well known for binging and purging food. In the 9th century, followers of St. Jerome starved themselves in the name of religion. Today, emaciated models and celebrities have made eating disorders glamorous.
The recent national broadcast of the PBS program “Dying to be Thin,” part of the NOVA documentary series, effectively challenges the “glamour” of anorexia. Written, produced and directed by Twin Cities film maker Larkin McPhee, and partly filmed at Methodist Hospital in St. Louis Park (where I treat patients with eating disorders), the program shows the stark consequences of this condition.
Anorexia is predominantly an illness of young women (although some men also,have eating disorders). The most poignant moments in the documentary, however, concern a 54 year old woman. Erika Goodman, an accomplished former dancer with the Joffrey Ballet, spent decades starving herself to achieve the idealized image of a ballerina. She now suffers from extreme osteoporosis (loss of bone mass, leading to a weakened skeletal frame).
One of the medical complications of anorexia is loss of menstruation. Extreme loss of body fat can cause a woman’s body to stop producing adequate levels of estrogen, which is essential to menstruation and bone growth. According to statistics used by NOVA, a woman who goes five years without menstruation loses nearly one third of her bone density. A women in her 30s who stops menstruating for 15 years has the bone density of a 70 year old woman.
NOVA’s cameras show Erika Goodman on the ballet stage 30 years ago: a young, lithe woman of remarkable dexterity, balancing her tiny body on the toes of one foot, while the toes of her other foot stretch high above her head. The image we see of Ms. Goodman today is shocking: hobbling on grossly misshapen legs, stacking cans of food in the wire basket of the walker she uses for support as she slowly and painfully makes her way through the aisles of a grocery store.
The woman whose life revolved around dancing acknowledges the irony of losing her legs, but her awareness came too late.
“You’re paying for it then,” she says, referring to her youth, “but you don’t know. The cash register hasn’t rung. It’s ringing now.”
Unfortunately, the image of a cash register is an apt metaphor. Treatment of eating disorders, which have many complex medical and psychological components, is expensive. Effective treatment requires many specialists: a medical doctor, psychiatrist or psychologist, nutritionists, nurses, social workers and other medical professionals. It costs money to assemble such a team, but scientific literature supports this treatment. In-patient care is clinically effective and cost-effective. (Patients who receive appropriate in-patient care have been shown to require fewer re-hospitalizations.)
“Dying to be Thin” shows an in-patient group therapy session where a young woman dissolves into tears when she discusses her illness.
I’m just punishing myself,” she says. “I’m killing myself. And it’s so stupid, because you don’t win.”
These are not the words of a famous television star like Courtney Thorne-Smith. These are the anguished words of someone who wants to be a normal kid. If adult Hollywood actresses, who are accustomed to people judging them by their appearance, renounce fame and fortune and walk away from “the pressure to be thin,” how can we expect teenage girls to handle such pressure?
It’s time we took eating disorders seriously. This young woman is right: when eating disorders go untreated, nobody wins – in Hollywood or in Minnesota.

Joel P Jahraus, MD, is Medical Director of the Eating Disorders Institute, a partnership of Methodist Hospital and the University of Minnesota Physicians. This is Eating Orders Awareness Week in Minnesota.