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The Enemy Within

11/08/2001 AT 12:54 PM EST

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.

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