Eating Disorders
Dying to Be Thin: Waltham Program Treats Patients with Eating Disorders

May-Kate Olson has brought more attention to the problem of eating disorders.

(September 14, 2004) -- The cover of last week's Star magazine captured a diminutive Mary-Kate Olsen, startled by a paparazzi's flash, beside a glaring yellow "92 lbs. & Gaining! Can It Last?"

Can the weight gain last for the brunette Olsen twin, who recently was treated for an eating disorder? Possibly, but the relapse rate for anorexia nervosa is approximately 20 percent, according to Dr. James Greenblatt, medical director of Walden Behavior Care in Waltham, the only dedicated inpatient treatment program for eating disorders in New England.

And while more attention is being paid to the epidemic of obesity in America, the need for programs to treat eating disorders has grown to the extent that Walden recently dropped its minimum admission age from 16 to 13.

"It's traditionally very hard to keep eating disorder centers financially viable," said Stuart Koman, president and CEO at Walden. "But eating disorders are at near-epidemic proportions, and they're now affecting young people in their early teen years and men."

Eating disorders fall into three categories: anorexia nervosa, an aversion to eating and fear of gaining weight; bulimia nervosa, when sufferers induce vomiting or use laxatives to purge food; and binge-eating disorder, characterized by uncontrollable, excessive eating.

The National Institute of Mental Health estimates that 1 percent of women and adolescent girls are anorexic. Men account for less than 10 percent of reported cases of anorexia and bulimia, although those numbers are growing. In the United States, more than 1,000 women die of anorexia annually.

The rates for bulimia are actually higher, with approximately 4 percent of college-aged women considered bulimic. About 20 percent of bulimics are male.

"Eating disorders are such a variety of disorders," Koman said. "You can actually be obese and have an eating disorder. In fact, we've seen many patients who have had a gastric bypass operation who continue to binge eat."

Walden, located at the Sterling Medical Center (the former Waltham Hospital), is licensed by the state Department of Mental Health as a free-standing psychiatric hospital and includes mostly staff formerly employed by Waltham Hospital's eating disorder program. It includes a 23-bed locked unit for patients in acute psychiatric distress, a 16-bed unlocked unit for eating disorders and various outpatient programs for eating disorders. As the only eating disorder facility in New England, it takes patients from the entire region as well as from across the country.

"A lot of the patients who come in; they're feeling pretty bad," Koman said. "They have starved their brains and bodies."

"Once they're in a hospital, they have pretty much failed outpatient treatment," Greenblatt added. "They are malnourished, have bad cognitive function."

Catching an eating disorder early is the patient's best hope. Bad habits don't become ingrained, years of bad nutrition or malnutrition don't take a toll on the body and physical development won't be affected.

Greenblatt noted that for those who have the disorder for over 20 years, the mortality rate is the same as for those with leukemia.

"These patients are at a huge risk for death," Greenblatt said. "At the end stage of this illness, the death part doesn't even faze them. Their body image just is controlling them."

Patients with eating disorders tend to have other psychological disorders -- depression, a learning disability, obsessive-compulsive disorder -- and possibly some genetic vulnerability or a history of substance abuse in the family. Most are female, although they have seen an uptick in the number of males seeking treatment. The disorder tends to start in a very simple way: a diet.

"There are only a certain number of these girls that can take that feeling and obsess enough about it to take it to this level," Greenblatt said.

In the case of Mary-Kate Olsen, there was pressure to remain thin for the sake of her acting career. For girls outside of Hollywood, there's the pressure to conform to the thin ideal -- but there is never a time when they believe they are thin enough.

"You're seeing some of the thinnest women you can imagine and they all believe they are the fattest one in the room," Greenblatt said. "This distorted thinking is so profound."

Anorexia and bulimia have even evolved with technology. On the Internet, "pro-ana" sites have popped up to provide "thinspiration" and starvation tips.

"It allows a lot of people to justify themselves," Greenblatt said. "They can take on a whole different identity."

At Walden Behavior Care, patients are first are brought back to health. Then the real battle begins: their food intake is monitored, they acquire a staff nutritionist, social worker and psychiatrist and meet with other patients in support groups.

Sweatshirts with pockets are forbidden -- they're too easy to use for hiding food. Bathrooms are monitored to prevent purging. Exercise is restricted. The best monitors are often the patients themselves, who can recognize their own questionable habits in others.

Once they are ready to leave, treatment continues on an outpatient basis.

A big issue is insurance reimbursement, Greenblatt said.

"The treatment process is long and it just doesn't fit into the managed-care model," he said. "There's a high rate of relapse when there's only a short stay.

"This is a lethal illness," he added. "There's nothing else I treat as a psychiatrist that has such a high level of mortality, and it's all preventable. We have to catch it early."

By Jennifer Lord

Related Information

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• Couple Speaks of Daughter's Fatal Eating Disorder
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•  New Treatment Achieves 75% Remission in Eating Disorders
• Topamax, Zonegran - Treatments for Binge Eating and Bulimia
• Obesity Risk Doubled for Kids of Obese Moms
• New Treatment Program for Eating Disorders: Exercise!
• Thinspiration: Pro-Anorexia Movement Flourishes Online

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