Toledo Blade

"When the demands of beauty become a matter of life and death,"
Mike Kelly - November 14, 2006

Thin is in, or so we're told by a culture that puts quite a premium on body image, particularly for females. Girls learn from an early age that much of a woman's power comes from her body and the way she presents, decorates, reveals, and manipulates it.

We're told that to be thin is to be beautiful and disciplined, while being overweight is equated with laziness, slovenliness, and a lack of self-control. With such a distorted emphasis on appearance, is it any wonder that more than 5 million people in the United States, the vast majority of them female, have eating disorders - commonly anorexia or bulimia - and that one in seven of those afflicted with a disorder will die from it?

A grim documentary called Thin puts a very human face on those statistics, providing an intimate look at the struggles of four women at a Florida treatment center who are literally dying to be thin. The 105-minute film, made by award-winning photojournalist Lauren Greenfield, premieres at 9 tonight on HBO.

Greenfield began documenting eating disorders in 1997, first for a Time magazine story, then for a book called Girl Culture. Having shot photos at the private, 40-bed Renfrew Center in Coconut Creek, Fla., she returned to the facility to make her documentary. She lived at the center for six months, earning the trust of patients and staff and getting unusual access to meetings, therapy sessions, and other activities. She was even with patients in their most private moments in their rooms.

At the center of the film are four young women struggling with anorexia.

Fifteen-year-old Brittany started having problems when she was 8, first being a compulsive overeater, then becoming anorexic and bulimic. Her mother, too, has an eating disorder.

Shelly, 25, is a psychiatric nurse who has been anorexic for six years. For much of that time, she's been kept alive by means of a feeding tube surgically implanted in her stomach.

Alisa is a 30-year-old divorced mother of two who has been binging and purging for years and says she joined the Air Force "just so I could lose weight." She admits she has little interest in recovery, except for the sake of her kids.

Finally, there's Polly, a moody, rebellious 29-year-old who has attempted suicide several times and been in and out of treatment for years. She quickly emerges as a leader among the patients.

The cameras follow the women through their daily routines, from early morning weigh-ins to tearful group therapy sessions to sometimes tense encounters with staff and family members. We even see them sneaking cigarettes in each other's rooms, standing together on a bathroom sink and exhaling smoke directly into the ceiling vents overhead.

Some of the therapy is eye-opening. One patient is asked by a therapist to draw on a wall a life-sized outline of what she perceives her own body image to be. Then the therapist has the patient stand next to the wall while she traces her actual outline. The result is startling, looking like a small person trapped inside the body of much larger person.

An inevitable bonding takes place among the women, and as they scheme to bend the center's rules - hiding food they should be eating, sharing prescription drugs and cigarettes, and giggling through all-night bull sessions - it's possible for a viewer to forget why they're all there and equate the whole thing to a female version of One Flew Over the Cuckoo's Nest.

But then something happens to help bring things sharply back into focus. Brittany is forced to leave the center when her insurance benefits run out, but she knows, as do the therapists, that she's nowhere near ready.

"I want to still lose 40 pounds to get to my ideal weight," says the 93-pound waif. "I have my first day [home] planned out, and there's no food involved."

When Polly is expelled for disrupting the treatment of other patients, her mother implores the Renfrew staff to reconsider. "Please give her another chance," she sobs over the phone. "There is nothing here to help her … no support system for anorexics. Please, I'm begging you!"

During the course of the film, some of the patients at the center make progress toward recovery, others backslide, and still others seem to sabotage their own treatment. But through their emotional journey, viewers will gain a better understanding of eating disorders, learning that they encompass not just issues of food or body image or self-esteem, but also a sometimes crushing mix of personal, family, cultural, and mental health issues.

Thin is the centerpiece of a campaign to explore issues of body image and eating disorders. It includes a companion book, a traveling exhibit planned to begin next year, and an educational guide for individuals, educators, and community groups. It can be found on a Web site,