Anorexia

Recipe for Life

UPDATED 12/15/2003 at 01:00 AM EST Originally published 12/15/2003 at 01:00 AM EST

For many teen girls, picking out a gown for a formal dance can be a fairly traumatic experience. But when Abbie Kleber, 17, tried on a black strapless number with a pink train for a Christmas party in Fort Wayne, Ind., she looked into the department store's dressing-room mirror and liked what she saw. "You could tell I had a little tummy," she says, "but it wasn't way out there. I looked proportional, and it felt good."

That simple observation marked an astounding achievement, not only in Kleber's hellish four-year battle with anorexia, but also for the dramatic new treatment that probably saved her life. In 2000, like an estimated 1 percent of American women who suffer from anorexia, Kleber was in the grips of one of the least understood and most intractable of all mental illnesses. Self-starvation had whittled her weight to just 68 lbs., her hair was falling out in clumps, sores and bruises covered her body, and her face was wrinkled like that of a woman 60 years her senior. "My anorexia was gnawing at me nonstop," she says. "It got to a point when I could feel my body eating itself."

But that was before experts recommended a radical new treatment program called the Maudsley method. Devised in the early 1980s by doctors at the Institute of Psychiatry and Maudsley Hospital in London, the family-based approach is just now making inroads in the States, where at least 170 young girls are being treated at Columbia, Stanford and the University of Chicago. "Maudsley provides families of adolescent patients a great chance at full recovery," says Kleber's therapist Dr. Daniel le Grange, who runs the program in Chicago.

Unlike traditional therapies, which tend to treat anorexia as a child's attempt to wrest control from overbearing parents, Maudsley places no blame for the illness. Instead, it coaches parents to help their kids gain weight by whatever means necessary—by preparing favorite foods, with 24-hour monitoring to prevent purging and hours of cajoling at the dinner table.

During Kleber's years of traditional treatment, "I felt like a failure as a parent—it was overwhelming," says her mother, Maggie, 52, a medical technologist. But with the Maudsley approach, says Kleber's father, Carl, 53, a research scientist at Purdue University, "we didn't just have permission to step in. We were commanded. That was our duty."

For the Klebers, the intervention came just in time. With standard treatments—antidepressants, individual therapy and hospitalization—overall mortality rates for anorexia still hover at between 5 and 20 percent. At Abbie's lowest points, "she had sores all over her body, even the bottoms of her feet, because she didn't have any padding on them and they'd get infected," says Carl. Taken kicking and screaming to the hospital in the winter of 2000, "she looked like a breathing skeleton," he says. Yet when doctors had a feeding tube placed in her nose, Abbie repeatedly pinched it to stop the flow of nutrients.

Then, in April 2002, after her third hospitalization at the University of Iowa, Kleber's parents rushed Abbie to Le Grange's Maudsley program. At that point, family dinners were a nightly battle. In the throes of the disease, Abbie, the third of the couple's four children, compulsively handled her food as an avoidance tactic. She would wring the grease out of a pizza slice or squeeze butter out of toast and smear it on her hands like lotion—anything to avoid putting it into her mouth.

Within weeks of starting the program, Abbie was given her mother's formal white dinner gloves to wear during meals, with the understanding that she could not soil them. As another means of keeping her from playing with her food, she was required to eat everything—even toast—with utensils. And napkins, because they could be used for hiding food, were forbidden. Whenever Abbie deliberately spilled food to avoid having to eat it, "we didn't wipe it up or clean it," says Carl. "If she slopped some milk on the table, she'd lick it up. She knew that, no matter what, she had to eat it all."

Those techniques may at first sound brutish. But the doctors who use Maudsley are quick to point out that cruelty and humiliation have no place in the program. Explains Dr. Katharine Loeb, who in January will bring Maudsley to Mt. Sinai Hospital in New York City: "In these cases, parents need to think about food as a bitter medicine. The question isn't whether it will be eaten, but how."

Though statistics are limited, one 1997 study of 21 adolescent patients treated with the Maudsley method found that 90 percent were still fully recovered five years later. Still, even Maudsley's proponents acknowledge that the treatment isn't right for everyone. "It's more effective on younger adolescents," says Dr. Ira Sacker, who heads the eating-disorder clinic at Brooklyn's Brookdale Hospital. "They're not as entrenched in the disease, and the younger mind is still very much connected with the family."

But for another of Le Grange's patients, Sara Genrich, 18, of Collins, Wis., the program has proved to be a lifeline. After two years of revolving-door treatments for an eating disorder that began when she was 13, Sara's low point came in 2000, when, due to potassium depletion, she was rushed to the hospital in shock and suffering from seizures. "We were terrified," says her mother, Colleen, 40, who works in a cheese-processing plant. Adds Sara's father, Myron, 41, who works for the local school district: "We thought we were going to lose her."

Under Le Grange's tutelage, the Gen-riches changed their work schedules last year to oversee Sara's mealtimes and coordinated with a high school guidance counselor to make sure that she ate the snack and lunches that they prepared for her daily. Now, says Colleen, "if she says, 'I don't want to eat,' we say, 'Yes, you have to.' "

At 5'2", Sara weighs a healthy 114 lbs. today and is prepping to study veterinary medicine at the University of Minnesota next year by volunteering at the Lincoln Park Zoo in Manitowoc, Wis. She remembers how, in the depths of her illness, her dad once asked her what would happen if animals wouldn't eat. "I said they'd probably die," she recalls. "And he said, 'Think about what you're doing to yourself.' " These days Genrich's favorite chore is feeding bales of hay to the llamas at the zoo. "I throw out the feed and say, 'Go eat,' " she says, laughing. "And they just go for it."

By Susan Schindehette. Barbara Sandler in Fort Wayne, Margaret Nelson in Collins and Debbie Seaman in New York City

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