While the nation struggles with an epidemic of obesity, some American teenagers have the opposite problem. They're literally starving themselves. Anorexia affects about one out of every 100 teens. It's a complex and potentially deadly psychiatric condition.
Bella's problem with eating started in eighth grade. She stood about five feet tall and weighed 120 pounds. She felt fat and gross. Last year, when she entered high school, her concerns about her weight intensified.
"I started comparing myself to other girls," Bella recalled, "noticing, like how much bigger I was, and my pant size, and stuff. And that was really uncomfortable, so I started to try and go on like a diet."
First, Bella, which is not her real name, cut out junk food. Next, she eliminated other food she thought wasn't healthy.
"Then I started cutting back on portions, and then I started skipping breakfast," she said.
Before long, Bella skipped lunch, too, and ate just a tiny bit at dinner.
All the while, Bella was playing soccer, and running a lot. It wasn't long before things really got out of control.
"It didn't really become so much as about being fat and gross," Bella said, "it just became where I don't want to eat. I just don't want to eat."
Bella's mom, Wendy, could tell something was wrong. She noticed Bella wasn't eating things she used to, and her behavior was becoming erratic. By the time Wendy realized what was going on, Bella had lost 30 pounds.
"Most of it, the last 20 pounds or so, in about a month, month and a half," Wendy remembered. "Maybe even less. So it was a very, very scary, dark time because she was losing weight daily, telling us she was eating enough, but according to my observations was probably eating 400 calories a day, but trying desperately to persuade me it was enough. And I knew it wasn't enough, but I didn't know what to do."
Anorexia is a psychiatric disorder that causes people to think they're fat, even while they're literally wasting away. The vast majority of people who are anorexic are girls 12 to 15 years old.
Pediatrician Joyce Adams said she occasionally has to hospitalize a child with anorexia.
"Well, when I admit kids to the hospital, it's because they have developed signs of severe malnutrition," Dr. Adams pointed out. "They're basically starving themselves to death."
Adams said anorexia usually strikes teens at a stage when they should be gaining weight and growing taller. The condition disrupts puberty, and stunts growth. It can cause permanent heart damage and osteoporosis.
Dr. Walter Kaye directs UCSD's eating disorder program.
He said teens who develop anorexia seem to have certain traits.
"These are kids that tend to be kind of perfectionistic, sometimes anxious or obsessional, very achievement oriented," Dr. Kaye said. "And these seem to be vulnerabilities that allow anorexia to take hold, and really flourish into a very severe illness."
Kaye said there are few effective treatments for anorexia. He said studies suggest a family-based treatment called the Maudsley Approach has the best results. It helps create a support system for the child, where parents help them regain weight.
"We work in alliance with parents to help them understand the symptoms," Kaye explained, "and develop better ways of kind of managing and interacting with their children with anorexia, so that they have a more successful outcome."
In the first part of the treatment, parents sit with their teen at least three times a day and make sure they eat a full meal. Over time, parents cede control of eating back to their child. When the teen has regained enough weight, the focus shifts to helping them reestablish a healthy identity.
Bella and her family are going through the program now.
It's been a year since Bella was diagnosed with anorexia. She's gained ten pounds since she's been in treatment.
"I don't feel overweight now," Bella said, "but I definitely do feel like I could lose weight, and I could be skinnier, and that would be awesome. But I won't, because that's too dangerous for me."
Bella thinks she has anorexia licked. But she's facing tough odds. By some estimates, more than half of all teens in treatment for anorexia suffer a relapse. About one out of 10 kids with the disease dies within a decade of their initial diagnosis.
