Sarah, a local high school student, started out on Weight Watchers last year. "I just convinced myself I was on a diet," she said. However, her diet soon developed into eating at most one or two times a day, if she ate at all. Before long, she was down to 300 calories a day, equivalent to a bag of potato chips, eating mostly fruits, vegetables and chicken. In September, she was hospitalized, the first of five hospitalizations, as part of a nine-month battle against anorexia nervosa, a debilitating eating disorder that students face in the Bay Area and nationwide.
According to Laurie Linscheid, director of the Paly branch of Adolescent Counseling Services’ (ACS) on-campus counseling program, 17 students from Palo Alto Unified School District’s (PAUSD) secondary schools have come forward to ACS to get help for an eating disorder this year. Eleven out of the 17 are from Paly. In comparison, last year, 14 students from Palo Alto’s secondary schools came to ACS with an eating disorder, 12 of which were from Paly.
"Eating disorders are definitely an issue that occurs at Paly," Linscheid said. "It [the amount of eating disorders in Palo Alto] has definitely been on a gradual increase."
Speaking to parents in an ACS parent education class at Mitchell Park about eating disorders, Linscheid stated that five to 10 million 13-year-old girls and one million 13-year-old boys have an eating disorder. In addition, 85 percent of American women are dissatisfied with their bodies, Linscheid said.
This was the case for Sarah.
"I had an intense fear that anything I ate was going to make me fat, whether it’s a grain of rice or a hamburger," said Sarah, who asked that her real name not be used. "It got to a point where if I did eat something, I would feel so bad about it that I would throw it up anyway."
Linscheid described the three types of eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder.
According to Linscheid, signs of anorexia include being unable to stay above a minimal healthy weight, having an intense fear of gaining weight, seeing oneself differently in a mirror than how others see them, and excessive exercise.
Symptoms of bulimia include recurrent episodes of binge eating, lack of control over how much one eats, purging, poor tolerance to cold and use of laxatives or diet pills.
"Often bulimics gain weight since they don’t purge as much as they take in," Linscheid said.
Common signs of purging include eroded teeth, swollen salivary glands and scabs on the back of the hand, she said.
Binge eating disorder is similar to bulimia nervosa, but without purging. As a result, excessive weight gain is common. Like those with anorexia nervosa and bulimia nervosa, those with a binge eating disorder, ironically, often have an extreme fear of gaining weight.
According to Linscheid, factors that contribute to the development of eating disorders include low self-esteem, stress to be thin, the media and fear of loss of control.
Linscheid explained that adolescents are at a stage between childhood and adulthood. They are given more independence and responsibility, yet they still do not have total control over their lives, like adults.
"With a lot of people I met in the hospital, it was a control issue," Sarah said. "The only thing they can control is how much they eat. It could be an extreme way to make you feel good about your body, but a lot of it is control."
The media also plays a role in bringing on eating disorders, she said. The exposure that girls have to society’s image of the ideal woman’s body in magazines and on television often leaves girls feeling inadequate about their own bodies. For instance, according to Linscheid, between 1959 and 1978, the body weights of Miss America winners decreased to 78% of a healthy body weight.
However, the media did not always promote unhealthily skinny bodies. According to ACS intern Amy Moscovitz, Marilyn Monroe, one of America’s most famous beauty icons, was a size 10.
"Larger bodies were considered shapely, voluptuous and womanly," Moscovitz said.
In addition to the media, eating disorders can arise from certain sports where there is stress to be a certain weight, such as wrestling, dance and gymnastics.
According to Linscheid, there are serious health risks involved with eating disorders, some which are irreversible, like osteoporosis, caused from lack of calcium. Also, damage can be done to the central nervous system, heart, gastrointestinal system and digestive system. Sarah now deals with irreversible heart damage after her eating disorder.
"Part of me still wants to strive to lose weight because I know I can, but I don’t relapse because I know that if I do, then I won’t be able to go to college or play sports," Sarah said.
Linscheid emphasized that parents play a significant role in preventing eating disorders.
"Parents are the first line of defense," Linscheid said.
Linscheid described how parents should model healthy behavior, refrain from playful teasing about body shape, encourage healthy eating instead of dieting and not forbid certain foods. If teenagers are not allowed to eat certain foods, it is likely they will binge on the "forbidden fruit," she said.
According to Linscheid, the first step of recovery from an eating disorder is for parents to talk with their child. ACS offers advice in how to handle this often-challenging conversation.
"An eating disorder is a coping mechanism," Linscheid said. "If you take the coping mechanism away, fears come to the forefront and it can be a challenge to get someone to get help."
The second step to recovery is for parents to take their child to the doctor to make sure that vital signs are normal, Linscheid said.
Linscheid suggested being involved with a nutritionist to help plan a healthy meal plan, as well as joining a therapy group.
"It [a therapy group] helps normalize the issue because there are others at the group with the same problem," Linscheid said.
Linscheid recommended the organization Association of Professionals Treating Eating Disorders (APTED) as a resource for finding support groups and treatment centers.
In addition, ACS offers on-campus counseling at all four of Palo Alto Unified School District’s (PAUSD) secondary schools.
For Sarah, months of therapy and realizing the consequences of her eating disorder have helped her overcome anorexia. "Therapy helped, as well as realizing how much it [my eating disorder] has taken away from me and how serious the medical problems actually were," Sarah said. "It would affect me the rest of my life and prevent me from doing what I wanted in the future."
Sarah did not know she had an eating disorder until her first hospitalization in September.
"I didn’t realize I was that bad. I think a big part of it was denial," Sarah said. "I didn’t think I had an eating disorder."
In order to prevent one from going down the same destructive path as Sarah went down, it is important to know when a harmless diet turns into an eating disorder.
"If it becomes obsessive, if all you think about is food and what you’re going to eat, and it gets to the point where other people have said something to you to get help, it is no longer a simple diet," Sarah said. "Once you pass that line there’s no turning back. If you can catch it early, that’s the best thing."
According to Linscheid, if a student thinks they have an eating disorder, they should talk to a professional, since there is a lot of wrong information out there, she said.
Although Linscheid tends to see more cases of eating disorders in high school, she believes there are just as many cases in middle school, just in earlier stages. In fact, 70% of seventh graders want to be thinner, Linscheid said.
"When I see high school students, they often say, ‘I’ve been doing this since sixth grade,’" Linscheid said.
Besides on-campus counseling, ACS runs the Caravan House, a residential treatment facility for girls ages 12 through 18, which offers parent education classes and works with schools to respond to crises. In addition to eating disorders, ACS helps youth deal with peer relationships, depression, divorce, academic stress and anxiety.
"If I had known about the resources offered by ACS, it would have been really helpful," Sarah said.