West Fargo Pioneer

"HEALTH -- Faces of anorexia," Ryan Pearson, ASAP - November 14, 2006

A new HBO documentary explores the difficulty of eating disorders. RYAN PEARSON looks at  four women's struggles.

Shelly drew a frowning face in a journal entry next to "104.8 lbs." An arrow pointed at the number, which she wrote was "the most I've ever weighed in my life."

During her stay at the Renfrew Center in south Florida, an inpatient center for treatment of women with eating disorders, she'd parted with a PEG feeding tube that had been surgically implanted in her stomach for nearly a year because she refused to eat. She'd gained weight -- some 20 pounds at one point. And she was planning to take up surfing -- needing to beef up even more in order to be able to paddle into the water and stand up.

"I'm just out there and I feel healthy and my body's capable of doing things now," she said some months ago. And yet. She has recently relapsed and shrunk back down to a dangerously unhealthy weight.

Shelly, a Utah native in her mid-20s, is one of several women profiled in photographer/writer Lauren Greenfield's "Thin" -- a new documentary and book about eating disorders and the struggle to recover from them.

Greenfield has visited the Florida center repeatedly and remains in contact with her subjects. Her intimate, cinema verite movie was applauded at the Sundance Film Festival and premieres Tuesday on HBO.

About one to three percent of American women suffer from bulimia or anorexia at some point in their lives. Greenfield's focus is not on statistics, however, but on the unsteady emotions underlying each woman's eating disorder.

She says she realized while making "Thin" just how complex the problem -- and the solution -- was.

"Just when you think someone's getting better, something happens and they get worse. And just when you think someone's hit rock bottom, all of a sudden ... they find recovery," Greenfield said. "It's not a linear trajectory. It's not like there's one prescription that works. It's a real up and down road, and for me still has a lot of mystery. It's a very enigmatic illness. And the treatment often seems enigmatic and elusive."

We asked about the turning points for Shelly and the other women in "Thin" -- some of which Greenfield captured on film and some of which came only later. (Greenfield uses only their first names to protect their privacy.) Her answers are below.

"She forms this really close friendship with Alisa, who's much more on the up-and-up. The treatment team started to be very, very proud of her progress. She also had her tube removed. She was sad to lose it because she saw it as her crutch. ... But her therapist suggested maybe this is the first piece of recovery, and I think she felt relieved too, to not be able to have that easy out. The tube that was meant to be nourishing her, she had learned how to manipulate that, and had learned how to purge through it. ... The undercurrent was that as her weight was going up, she was steadily becoming Shelly again."
"She did quite well in treatment. She's kind of the leader. She plays by the rules. ... After treatment, she had a very severe relapse, which you see beginning at the end of the movie. She hit rock bottom, she got very bad symptoms, she attempted suicide. Her insurance was able to cover her again, and she went back to treatment for several months. Since that second treatment, she has had a very solid recovery. She's really been a kind of point of hope in a way for treatment working."
"She plays by her own rules. She was breaking some of the rules but she didn't feel like she was breaking any of the important rules. She wasn't purging. ... She was actually about to go into extended care, which is a transitional treatment. And then her insurance said they were going to cut her off. This is a very common situation, but it started her acting out and going downhill because it was so stressful. That was kind of the beginning of a turn downward for her. ... Then she got kicked out. That was a major downfall, or regression or relapse. She started purging. And she had no more access to treatment."
"There were times in treatment that she really didn't know if she wanted to get better. ... Her mother had had her own struggles with an eating disorder, and she'd gotten better through her faith in God. Brittany was trying that, and she seemed to have a lot of motivation to try to get better. ... But her insurance ran out and her family did not have the resources to keep her in treatment. She wasn't ready to leave. The clinic didn't think she was ready to leave. Her parents didn't want her to leave, and yet she had to leave because there was no more money. And that was a major crisis and downturn."