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- November 19, 2001
- Vol. 56
- No. 21
Beating the Odds
Though Relapse Is Still a Risk, by Combining Psychotherapy, Good Nutrition and Family Support, These Anorexics Made It to Recovery
That question confounds not only the nation's 8 million anorexics—88 percent of them young women, many of whom are perfectionists or suffer from low self-esteem—but health care professionals as well. According to a 1999 Harvard study of 136 anorexics seeking treatment, such as hospitalization and psychiatric help, only 33 percent achieved full recovery (defined as maintaining 95 percent of optimum body weight, among other criteria, for eight weeks) within the 90 months they were followed. Moreover, 40 percent of those who had succeeded suffered a relapse within four years. "The chronic course of eating disorders...suggests the need to identify these problems early," the Harvard team wrote, "and to intervene before the disorders become intractable."
Despite these odds, people such as Jenny Lauren (see page 105), and the five others featured on the following pages, are battling back—successfully—from their years-long bouts with anorexia. "It's a long, hard road," says Lauren, 29, who has been in recovery since 1997. But, she says, "I don't see food as the enemy anymore. Food helps me now. It's taken four years to feel like I'm finally coming up from the dead." Sargent agrees: "Some people ask, 'When did you wake up and have some magical revelation and were recovered?' Unfortunately it doesn't work that way. It's a gradual process." But one that to them is well worth the effort.
Treatment based on trust brings her back from the brink of suicide
Standing atop a snow-covered hill in Amesbury, Mass., last January, savoring the chilly winter air, Jennifer Shortis, 20, felt that she was on the edge of a revelation. With her at the Amesbury Sports Park was a group of 12 fellow patients from the eating-disorders program at Hampstead Hospital in Hampstead, N.H. They were there for a day of inner-tube sledding. The intended lesson: Exercise can be fun.
Shortis, however, also walked away with brand-new insight about the toll her anorexia had taken—and the progress she had made. "It's things like this that make me so grateful," she told program director Monica Ostroff. "I couldn't have had this experience before."
In fact, just six months earlier, Shortis was far from enjoying the pleasure of a winter day's play. Distraught over her inability to beat anorexia and the financial burden it was placing on her family, she was threatening suicide. Starting in 1996, the 5'3" Shortis had wasted away from 124 lbs. to 70. And despite repeated medical intervention, her condition was so intractable by the summer of 2000 that her parents' insurer—which had already paid more than $100,000 in anorexia-related costs—balked at paying for more treatment.
Terrified that her parents might have to mortgage their house in Baldwinville, Mass., Shortis told her family that she "was just going to end it all, that I wanted to die so this would all be over with."
But Shortis's mother, Marlene, 56, a teacher's aide, father, Thomas, 59, an engineer, and six older siblings refused to let her give up. They had her admitted to Hampstead and persuaded the insurance company to cover a roughly $18,000, one-month stay. Shortis believes the experience saved her life: "From the minute I walked in the door, everybody was so happy and so welcoming that I knew it was going to go right."
Until that point, Shortis felt as if little had gone her way. Shy and sensitive, she was frequently teased in school. "It could be about the kind of clothes I was wearing or some remark I'd made," she says. "It made me feel like something was really wrong with me." Then, in August 1996, she began training with her high school field-hockey team. Soon exercise became a compulsion. "I'd ride a three-mile loop on my bike three times a day, then go for a walk, then go for a run," says Shortis, and every day she would do at least 2,000 stomach crunches. "She thought if she lost weight, she'd have more friends," says her sister Carrie, 27, a physical-therapy aide.
At the same time, Shortis reduced her meals to little more than rice cakes, yogurt and fat-free turkey sandwiches. "I'd aim for 800 calories," she says, "and if I ate 801, that was too much." By October she had lost 20 lbs. Her concerned parents, on the advice of their pediatrician, took Jennifer to a psychologist. "She told us, 'This is a quick fix, a couple of visits,' " says Marlene. She was wrong: Shortis would spend 3½ years going from one treatment center to another. At one facility, she was treated alongside patients with severe psychiatric problems. In another, being watched 24 hours a day by a staff member proved so stressful, she says, "I wet the bed because I didn't want to go to the commode in front of somebody."
All the while, she continued to get thinner, until her suicide threat led to her stay at Hampstead. "Jennifer was very willing to do the work once she knew people believed in her," says Ostroff, who herself spent 10 years as an anorexic before recovering in 1994.
One of only 10 Hampstead inpatients, Shortis bonded with the staff. "They sat and watched you, but they ate with you too," she says. "The conversation at the table was normal." Shortis also flourished, she says, because the program atmosphere was positive, not punitive: "At other hospitals I'd hide food I didn't want."
After a month she was released on an outpatient basis. "I felt trusted," she says, "like they didn't look down on me as some kind of low-grade person with a problem." By May Shortis was deemed recovered, and now she speaks to other patients at Hampstead about her experience.
With her weight up to 95 lbs. (her target weight is 100), Shortis eats three meals a day and snacks in between—fuel that comes in handy now that she's a full-time student at Mount Wachusett Community College in Gardner, Mass., and a part-time aide for special-needs preschool students. "I even feel hungry," Shortis says, "which I didn't for a long time."
For her family, no words could be sweeter. "It was a hard road," says her mother, "but we're on the other side of it now. It's real nice to have our daughter back."
Far from her glamorous roots, a famous fashion family's scion finds a place to heal
Santa Fe is a long way from New York City, which is how Jenny Lauren, 29, the niece of fashion designer Ralph Lauren, likes it. Tucked behind the walls of her one-story adobe home, she paints and writes and continues to heal from an eating disorder that, four years ago, devastated her 5'4" body. "It's all about simplifying my life," she says. "My motto is Live Like a Kid—the kid I stopped being early on."
As a child, Lauren was striking. With raven hair and mesmerizing blue eyes, she looked as though she had stepped out of one of the picture-perfect American-lifestyle ads for which her uncle is known. In fact, at age 7 she modeled for his company runway shows. "People would gape at her and say, 'My God, look at that beautiful child,' " says her father, Jerry, 67, Ralph's brother and head of the fashion dynasty's menswear division. "She didn't understand that attention and it upset her."
Then, at 10, Lauren entered a world where she was considered less than perfect. At summer dance camp in Lenox, Mass., she noticed that, while she was talented, her muscular frame did not measure up to the slim figures of her classmates. "I was looking in the mirror feeling this intense loneliness," Lauren says. "I thought right then that I was going to starve myself." In retrospect she believes she got the idea from the 1981 TV movie The Best Little Girl in the World, about anorexia. "I remember thinking, 'Wow, I could do that,' " she says. "It was about having control."
"I started getting letters from her," recalls her brother Greg, 31, a Los Angeles actor and painter. (Another brother, Brad, 34, is a film editor in Manhattan.) "They would say, 'I'm really nervous because the other girls are skinny, and I'm scared about how many calories are in toothpaste.' " Back at home Lauren continued to be plagued by thoughts of having an imperfect body. Her family's involvement in the fashion industry didn't help. "I got mixed messages," Lauren says. "They would say, 'We want you to be healthy,' then, in the same breath, 'Oh my God, you look so beautiful, so chiseled.' "
By ninth grade Lauren was exercising obsessively, running six miles a day and doing calisthenics at night. That December she dropped to 85 lbs. "My lifestyle was so tiring," she says. "I went from being a popular, fun girl to just not caring." Soon after, she met a bulimic classmate who introduced her to Ipecac, the vomit-inducing medication usually intended to treat accidental poisonings. "I thought, 'Wow, I can eat all this chocolate and then just get rid of it,' " she says. Instead, dehydrated and weak after two days, "I got really sick. My dad found me lying on the bathroom floor," she says.
Still, Lauren continued using Ipecac, and in the winter of 1987 her family had the 11th grader hospitalized for four months. "I was so upset," says Lauren's mother, Susan, 59, a guide at New York City's Metropolitan Museum of Art. "You want to tell her, 'You can't do this, you're going to kill yourself.' "
With the counseling of her high school principal, Lauren's outlook improved enough for her to finish classes and enroll at Manhattan's Barnard College in 1990. But soon, again fearful of gaining weight, she slipped into old patterns. After graduating in 1995 with a degree in art history and fine arts, the then-105-lb. Lauren moved to Santa Fe, where the cycle continued. "I felt like I was doomed," she says.
Within eight months Lauren moved back to New York City and soon developed severe bloating and weakness in her lower abdomen. By 1997 she could barely walk. It took doctors months to diagnose her with small-bowel enterocele, a condition in which the space between the rectum and the vagina stretches and the small intestine falls into the larger cavity. Doctors say the condition was likely caused by Lauren's bingeing and purging and the resulting strain on her digestive system.
Surgery and months of painful rehabilitation to learn to walk again ensued, which Lauren says forced her into recovery. "I was stripped of all my addictions," she says. But it wasn't until late 1997—when she met Dr. Richard Pico, a psychiatrist at New York City's Mt. Sinai Hospital—that Lauren rebounded. "He was the first to validate my physical pain," she says. "That helped me to start healing."
Lauren began seeing Pico three times a week, taking antidepressants and keeping a diary of her thoughts and activities, all of which helped her progress. Food, though, remained a challenge. "Everyone was telling me to eat normally, but I didn't know what that meant," she says. "I was living on laxatives and, at some points, chocolate sorbet and alcohol."
For years following the surgery, eating proved physically painful, but Lauren gradually pushed herself to consume easily digested foods like boiled chicken and scrambled eggs. By 1998 Lauren felt strong enough to move back to Santa Fe. She no longer takes medication but sees a therapist once a week. To ease the pain that remains in her pelvic muscles and back, she does gentle exercise, like Pilates and swimming, and has regular sessions with an osteopath.
Still working on accepting her size 8 body, Lauren no longer weighs herself. But she often wonders whether she would fall into old habits if she were to move back to New York City, which she finds too fast-paced and rife with images of thinness. "I'm not going to lie and say I look great and feel great," she says. "If I could be a size 6 and be comfortable, that would be the Jenny I'd like."
From glam '70s flight attendant to Las Vegas grandmother, she still fights the demon that killed her sister
Flipping through a photo album, Toni Tahoun comes upon a picture. There she is, head-turningly slim and the height of 1970s chic in miniskirt and boots. By her side: her leisure-suited and sideburned boyfriend du jour. "This," she says wistfully, "was in the years when being a stewardess was still very glamorous."
And when airlines, including TWA, for which she has worked for 30 years, insisted that female crew members maintain a fashionable image that had little to do with their actual job description. "In those days," says Tahoun, "they were very strict about weight. I was so scared about those weekly weigh-ins." Trying to make the grade—in her case, about 130 lbs. on her 5'5" frame—says Tahoun, started her long, downward spiral into anorexia. "My weight was the one thing I could control," says the now 57-year-old grandmother of two, "and my favorite diet was absolutely no food. Then I tried to eat only fruit for a long time. That screwed up my digestive tract. Sometimes I'd eat only a few vegetables a day. And I loved diet pills."
The daughter of truck driver Eddie Harvey and bookkeeper Nina, Toni was 3 when her father died—and 14 when she eloped with Army helicopter pilot Odis Henley. Divorced from Henley in 1969 (they have four sons), the Tacoma, Wash., native embarked on her dream job at age 28. "I got started flying late," she says, "so it meant a lot to me. I was going to do whatever it took." As she traveled the world, Tahoun became conscious of something else. "I was," she says, "a black woman in a white world, and I was always alone and insecure. I was dating rich men only and I had to make weight."
As anorexia and its common companion bulimia—chronic bingeing and purging—took hold, Tahoun began sharing weight-loss tips with her 13-year-old stepsister Nina. Even after Nina moved to West Germany with husband Dennis Clinton, an Army sergeant, she continued to follow Tahoun's advice. When they returned to the United States in 1986, Tahoun could see that Nina had learned the lessons too well. "She was about 80 lbs. and 5'9"," says Tahoun. "I knew she was in trouble and I knew I was in trouble."
Married to Manhattan restaurateur Mohamed Tahoun in 1980, Toni weighed just 105 herself. She was diagnosed in 1981 with bulimia and anorexia, and not long afterward she even checked into an eating-disorder treatment center in San Juan Capistrano, Calif., for three months, telling her family and friends that she was going to a spa. Once out, though, she says, "I started all over again."
After her second marriage foundered in 1986, Tahoun, down to less than 90 lbs., sought help again—and this time she meant it. "I called the special health section of TWA," she says, "and they found me this great doctor I have to this day. I called my sister and told her that we would fight this thing together. I told her to hang on."
But Nina couldn't hang on. The next morning, her husband called Tahoun to tell her that her sister—25 and the mother of 2½-year-old Tasha—had died of a heart attack during the night. She weighed 80 lbs. "We couldn't believe it," says Toni's mother, Nina Johnson, now 75. "How could someone that young die like that?"
Determined that she would at least save herself, Tahoun continued seeing Dr. Robert Lynn Home, a Las Vegas-based psychiatrist who specializes in eating disorders. She also began taking Prozac to counter the obsessive aspects of her personality. Tahoun—who lives in Vegas, around the corner from her mother and stepfather, when she's not flying—now follows a regimen of meditation and in times of stress keeps a daily food diary. "When a patient is in the anorectic phase," says Dr. Home, "they tend to overestimate what they eat. Someone like Toni might think she's eaten 2,500 calories in one day, when in fact all she's eaten is 300. If she keeps a record, she sees what she's really had." To maintain a healthy weight, Tahoun needs to consume at least 1,600 calories a day.
Horne has helped in other ways. "We've worked with Toni on her feelings of low self-esteem," he says, "and we've done a lot of work helping her realize she was not responsible for her sister's death."
Even so, Tahoun has relapsed. When her weight drops dangerously, as it last did in 1996, Horne has her hospitalized for supervised feeding and psychiatric treatment. "I've been in and out of the hospital at least 10 times since 1987," she says. Weighing in at a healthy 128 lbs. today, Tahoun continues to fight her fear of being fat. "I think I'm pretty fat now," she says, "so I have to work on knowing that I'm not."
For Tahoun, there is no such thing as a cure; there is just the daily struggle. "I am an anorexic in remission," she says. "My mother has buried one child from this disease, and I can't do that to her again. I have to stay alive."
Amy, Douglas and Jennifer Battista
Three siblings tackle anorexia—with different results
When the three Battista children—Amy, Douglas and Jennifer—were growing up in New Castle, Pa., the family's kitchen housed a Weight Watchers cookbook, boxes of Sweet 'N Low and cans of diet cola. The children's mother, Rudelle, 55, an elementary-school reading specialist, admits to her fat phobia. "We're an Italian family," she says. "As soon as you come into people's houses, it's like, 'Come in, have a cookie.' So I was always watching my weight."
Her children noticed. Says Amy, 32: "We all became good at dieting." As adolescents, she and Douglas, now 29, "would get on the scale and weigh each other," she says. And at age 9, Jennifer, now 28, wore a belt to bed "to keep my stomach flat."
Over the next several years, the siblings' behavior became even more troubling. At 14, the 5'6" Douglas—who felt insecure about his height and, he says, "lacked confidence about who I was"—began working out obsessively, pumping iron up to four hours a day. "I wanted to be buff and fit. I'd even shake my leg under my desk at school to burn calories."
At the same time, he started eating less, and in six months his weight fell from 120 lbs. to 80. Still, he says, "my midsection looked fat to me." His parents were similarly unimpressed by his weight loss. "He seemed to be getting taller while he was getting thinner," Rudelle says. "We just thought it was a growth spurt. We didn't think anything was wrong."
But when Douglas came home one day in May 1987 and told his mother he felt his heart was going to stop, she rushed him to the pediatrician—who diagnosed anorexia nervosa. "I had no idea what it was," says father Frank, 57, an engineer. "We didn't know if we had done something wrong."
Within days Douglas was admitted to a local psychiatric facility, where he underwent four months of inpatient group therapy. "I fought the treatment all the way," he says. "I was eating so I could get out."
Back home, Douglas resumed his old habits. After five months he weighed less than 90 lbs. and landed in the eating-disorders program at Johns Hopkins Hospital in Baltimore. It was a 10-hour round trip for Douglas's parents, who joined him once a week for six months in therapy. At one session, "Douglas became angry at something we said, walked out and slammed the door," Rudelle recalls. "The therapist said, 'Don't follow him. Go home.' We did, and from that time on, he came to realize that he had to take control of his problem."
Rudelle and Frank realized they had to take responsibility as well. "With anorexia there's clearly a learned pattern, like substance abuse," says Dr. Angela Guarda, who heads the Hopkins program. "When parents make comments that the less you weigh the better, it can be a trigger."
By the time Douglas, weighing a healthy 125 lbs., returned home in April 1988, the diet foods and cookbooks were gone. Unfortunately the changes came too late to help Amy, who had started starving herself in high school, around the time Douglas entered Hopkins. "My brother was ill, and my family was torn apart," she says. "Things just got the better of me."
Her parents, now alert to the symptoms, tried to get her to eat. "Since she was a cheerleader, we told her if she lost weight, she couldn't cheer," Rudelle says. That didn't work. Amy struggled with her disorder until February 1996. Down to about 90 lbs., she checked into Hopkins. "I didn't spiral down like Douglas did," she says. "I just never was where I should have been weight-wise."
After a month of group and individual therapy as an inpatient, Amy spent six weeks living in the hospital's halfway house. There, in addition to participating in therapy that focused on food issues, she cooked, shopped for groceries and ate in restaurants—all to prepare her to reenter society.
Around that time, Jennifer, then 24, moved to Baltimore to teach elementary school, a job she still holds. Separated from family and friends, she says, "I didn't know what to do with myself." Like her siblings, she fixated on food. "I used to eat onions, sliced like an apple, and dip them in mustard, which has no fat," says the 5'1" Jennifer. Without her parents around, her anorexia became full-blown; by the summer of 1998, her weight had dropped from 113 to 83 lbs.
After repeated entreaties from her family, Jennifer checked herself into Hopkins that July, moving into the halfway house two months later. "The turning point was looking around and realizing that everyone in the group was doing worse than me," Jennifer says. "I saw the other girls as being out of control, and it just clicked."
Today Jennifer checks in at a healthy 111 lbs., a weight she has kept for the last 18 months. She still hesitates when it comes to eating fats, but, with the support of a therapist she sees every two weeks, she makes sure to eat 2,000 calories a day. "Food is an issue we can't ignore," says her husband of four months, restaurant-kitchen assistant Seth Michaels, 26. "But if she's not in check, I'll tell her."
Douglas, too, still has anorexic thoughts. "They don't ever go away," he says. But thanks to therapy, Douglas—who is single and works as a human-resources manager for Disney in Pasadena—has maintained his 140-lb. weight for five years. "I'm in control now," he says.
Only Amy, a married mother of two in York, Pa., still struggles. She refuses to say what her weight is, other than that it's stable, and she continues individual therapy at Hopkins once a month. "I know where I was 15 years ago, and I've come a long way," Amy says. "But I'm not there yet."
THE ENEMY WITHIN
A medical expert explains anorexia's dramatic rise—and why a cure remains elusive
Dr. Ira Sacker, head of the Eating Disorders Clinic at Brookdale University Hospital and Medical Center in Brooklyn, learned early that eating could be fraught with emotional complications. "I came from a family where food was an issue," says Sacker, 57, author of 1987's Dying to Be Thin. "My father and I would share coffee and cake, and the next day my mother would remark that I must have gained weight. As a child the Culver City, Calif., native—the son of Harry, who managed a plumbing-supplies company, and Lottie, a bookkeeper—developed a habit of overeating that stayed with him until his college years. "As I began to feel better about myself and found I had other passions, food no longer became an issue," he says. Now Sacker, who lives in Jericho, N. Y., with his wife, Marianne, 55, a video producer, uses his own experience to connect with others. "Much of what I'd experienced in my own life about perfectionism and control problems are a major part of what people with eating disorders are all about," he says. PEOPLE contributor Debbie Seaman talked to Sacker about the increasing incidence of anorexia and what he has learned in his 26 years of treating the disease.
Q: We think of anorexia as a disease of teenage girls. Is that true?
A: No. We're dealing now with kids as young as 5 or 6. We're also seeing anorexia in men dramatically increase. It used to be 20 to 1, female to male; now it's 10 to 1. Males are becoming preoccupied with body image, with the concept of being buff. African-Americans, who 10 years ago were not preoccupied with the thin look, have begun to develop eating disorders.
Q: What causes anorexia?
A: No one is really sure. There are probably genetic precursors. We see it running through families. It can be triggered by the example of parents who are preoccupied by their own body images. It certainly is caused by nature as well as nurture.
Q: What are anorexia's long-term effects?
A: They include bone loss, possible cardiac irregularities, kidney failure and sudden death. There's also a link to infertility in women.
Q: How hard is it to recover from anorexia?
A: It's very difficult to recover from any eating disorder. We use the word recovery; we never talk about a cure. The underlying eating-disorder mentality is always there. Weight gain is not in itself recovery—it is often the last thing that occurs as the eating disorder stabilizes. Recovery comes from beginning to understand oneself and beginning to accept that person.
Q: Are anorexia recovery rates improving?
A: Actually, relapse rates are getting worse. According to studies, up to two-thirds of recovering anorexics relapse on a regular basis.
Q: Why do anorexics relapse?
A: Medical care focuses on getting back into eating, allowing the person to reach an ideal weight. They look normal, but emotionally they're not able to deal with the environment. People say, "You look so much better." Well, "looking better" terrifies them because to them that means they look fat. A patient needs a transitional place, somewhere to go after leaving the hospital and before going home, where he or she can learn what is required to function in the environment outside.
Q: What should you do if you're an anorexic and have relapsed?
A: One, you have to be aware your weight is dropping. Two, you have to want to get help. The key is in the relationship with the therapist. There has to be a team of therapist, physician and nutritionist, and they have to be on the same page.
Q: How long does recovery take?
A: I've treated some people for a year, and others for as long as 10 years. It depends on age, how long they've been ill, how invested in the illness they are—and how much they want to get better.
Q: Why is this such a difficult illness to beat?
A: We are in a media-motivated society. We focus on the illustration of body image as it is placed in front of us. The majority of adolescents I speak to look at size 2 as normal, when in fact the average adolescent is a size 10. There is a study which shows that young girls are more frightened of being fat than they are of nuclear holocaust or their parents dying. That's scary.
- Vickie Bane,
- Nancy Day,
- Anne Driscoll,
- Maureen Harrington,
- Zelie Pollon,
- Melody Simmons,
- Trine Tsouderos,
- Debbie Seaman.
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