Risking everything to be thin

By Maggie Pingolt  Photos by Daniel Friedman

Maggie Pingolt, a senior at ASU’s Walter Cronkite School of Journalism and Mass Communications.

If feel like I always fall short of painting an accurate picture of what it was like, how it felt and why I did what I did when I was at the height of my struggle with an eating disorder.

One hot summer night four years ago, I slept outside on my parents’ porch beneath a down-feathered sleeping bag because I was cold. Right before I fell asleep, I swam 20 laps in our backyard pool with a broken foot, challenging myself with each lap to not come up for air. I was hoping I wouldn’t make it out alive.

By the next afternoon, I was admitted to the Intensive Care Unit at Phoenix Children’s Hospital for fatal arrhythmia, or bradycardia, due to full-blown anorexia and binge exercising. A normal heart rate range is between 60 and 100 beats per minute; hospital records say my heart rate was in the low 30s.

I’d been struggling with this deadly disorder for nearly four years and I remember thinking the doctors were out of their minds for hospitalizing me. I had no desire to be put on psychiatric watch or bed rest, let alone be forced to eat. I wanted to be left alone. I wanted to be left to my own reality.

But the reality wasn’t pretty. My heart was beating dangerously low and couldn’t get blood and oxygen to the rest of my body. The breakdown of my body manifested itself in broken bones, irregular heartbeats and irrational behaviors. The science of my health is easy to comprehend. But the deep-seated disappointment and hatred I had toward myself can only be felt. It’s impossible to explain.

Deteriorating health after four years of battling my eating disorder brought me to the end of my rope.

A dangerous reality

My experience is not unique. Nearly 24 million Americans of all ages and genders suffer from eating disorders, according to statistics from the National Association of Anorexia Nervosa and Associated Disorders. Even more frightening, research from the American Academy of Pediatrics shows a 119 percent upswing in hospitalizations for eating disorders in children under 12 years old over a five-year period from 1999 to 2006.

“Eating disorders have the highest mortality rate of any diagnosable mental illness,” says Michelle Klinedinst, executive vice president of Rosewood, an eating disorder treatment center in Wickenburg. The effects of starvation or binging and purging can lead to “extreme medical damage inside a person’s body.”

When individuals starve themselves or purge their food (through vomiting, exercise or laxative use), the typical metabolic functions are no longer relevant. With no nutrients coming in, and no fat to use as backup, the body takes from itself—“eats” muscle—to fuel basic life functions.

According to the National Institute of Mental Health, anorexia nervosa is notorious for damaging the heart and brain, as well as eliminating a woman’s menstrual cycle. Bulimic exercise mimics a lot of the same psychological symptoms of anorexia. Classic bulimia (binging and purging) is known to develop acid reflux disorder, gastrointestinal problems, intestinal distress and electrolyte imbalance that can lead to heart attacks.

Binge behaviors are also considered among the disorders recognized by the National Eating Disorders Association. According to NIMH, symptoms often include guilt, shame, high blood pressure and an increased risk for developing cardiovascular disease.

What causes eating disorders?

The reasons people starve themselves or binge on large quantities of food cannot be pinpointed to any one moment or situation.

“The research is showing that anywhere from 50 to 82 percent of an eating disorder may be the result of a genetic predisposition,” explains Dena Cabrera, manager of educational outreach at Remuda Ranch, a residential treatment center in Wickenburg. “That doesn’t necessarily mean there’s one gene for anorexia, or one gene for bulimia.”

“If a female has anorexia or bulimia, her daughter or sister is 12 times more likely to develop anorexia,” says Cabrera. Daughters or sisters are four times more likely to develop bulimia.

For someone who may already be genetically predisposed, the combined pressures of familial and societal expectations, idealistic media imagery and relationships with friends and loved ones can have an incredible impact.

“It may be a peer of the opposite sex saying, ‘You’re a little chubby’…or ‘Those jeans look a little tight,’” says Klinedinst. Comments like these can be trigger points for someone who is vulnerable.

“I think we have to always be very careful,” says Klinedinst. “Words can hurt.”

The verbal and nonverbal messages parents send to their children can be very powerful. Without even knowing it, parents convey attitudes toward eating that influence how someone relates to food. If a father or mother is very diet-conscious or is trying to lose weight, feelings of shame toward an overweight child could irritate any anxiety the child already feels about food, Cabrera explains.

One young woman’s story

Diana Inzunza, a sophomore at Arizona State University.

Diana Inzunza, a sophomore studying nutrition at Arizona State University, has struggled with anorexia and occasional bulimia since sixth grade. She remembers beginning to diet before her cousin’s quinceañera, and learning how to throw up with a friend who wanted to “get skinny.”

For two years, she used a myriad of excuses to explain her continuing weight loss—pain from her braces, fatigue from soccer and cheerleading and the pressure of being the oldest. Her family didn’t have meals together every night and it was easy to throw away breakfast when her parents were getting ready for work. Lunch was the only meal she had to truly hide, so she’d go to the library to study.

“My younger brother tattled a lot,” says Inzunza. “He knew why I was going to the bathroom after meals, but my parents didn’t believe him and I was the older girl. I had all the attention—the highest level of expectations. They wouldn’t expect that from me.”

The principal at Inzunza’s K-8 Catholic school was first to recognize Inzunza’s situation. She threatened to call Child Protective Services unless Inzunza’s parents sought help. Soon after, Inzunza was taken to Remuda Ranch for 60 days of inpatient treatment.

Recovery

One of the biggest obstacles to recovery is rebuilding an identity and value system apart from the eating disorder, Cabrera says. In treatment, patients must learn how to eat healthfully, make clear, rational decisions about food and let go of unrealistic ideas of perfectionism.

Most inpatient and outpatient programs use a combination of nutritional education and therapy to combat the psychological and physiological obstacles of an eating disorder. One of the biggest struggles is learning how to differentiate between using food as nourishment and using it as a mechanism for control and feeling better about oneself.

The personality traits of those who struggle with an eating disorder often include low self-esteem, the desire to excel and a drive to control, explains Klinedinst. Recovery requires a complete manipulation of those personality traits and how they are manifested through food.

“What’s really the scariest part about this particular illness, unlike any other disorder I’ve ever worked with, is that these individuals strive for perfection,” explains Klinedinst.

Inzunza’s struggle with anorexia and occasional bulimia didn’t end with treatment. Some of her earlier behaviors—binging and purging, severe restriction of food—continued to plague her throughout high school. Her desire to be perfect sometimes overcame the healthier ways of thinking she learned in treatment.

She still finds it difficult at times, especially during holidays, when there is such a strong cultural focus on food.

“I know I shouldn’t eat a lot because I like to be thin,” she says. “Becoming lazy is my biggest fear.”

Cabrera points out that each person’s struggle with an eating disorder is individual and unique.

“Recovery varies from person to person,” she says. “I think the hardest part is accepting that there is a problem. It’s really committing to recovery.”

The unknown of what comes after an eating disorder is unsettling for most people.

“There’s such a loss of identity that they’re not going to be special anymore or they’re going to lose control,” says Cabrera. Part of recovery is learning to get past that fear. It’s really about rebuilding your identity and value system.”

My own recovery began a week into inpatient treatment at Remuda Ranch nearly four and a half years ago. During treatment and for months afterward I challenged myself to eat normal portions, participate in healthy amounts of exercise and practice positive self-talk.

Since my time there, I’ve learned how to accept my feelings and let go of what I can’t change, give up my irrational desires for physical perfection and find peace in knowing that I can’t write my own future.

Through recovery I’ve learned that every day cannot be perfect. Today I live by the idea that “It’s just a day,” because I believe there’s always tomorrow.

Eating Disorder Awareness Walk

The Valley’s first Eating Disorder Awareness Walk will be held from 6 to 9 a.m. Sunday Feb. 26 at the Phoenix Zoo. A one-mile loop through the park will be followed by refreshments, children’s games, motivational speakers, book signings and live music.

The event is being organized to increase awareness about eating disorders and raise funds for the National Eating Disorder Association. Registration fees ($30 per adult, $10 per child) include a T-shirt and full-day admission to the zoo.
To register or get involved, visit phxeatingdisorderwalk.wordpress.com.

Sobering statistics

• Up to 24 million Americans of all ages and genders suffer from an eating disorder.
• Only one in 10 men and women with eating disorders receives treatment.
• Eating disorders have the highest mortality rate of any mental illness.
• The body type portrayed as ideal in advertising is possessed naturally by only five percent of American females.
• Studies of adolescents have found that although boys report less body dissatisfaction than girls do, significant numbers of boys (five to 20 percent) report restrained eating, vomiting, laxative abuse or smoking cigarettes for weight control.
• Most women say they would trade one year of their lives to be thin.

Sources: National Association of Anorexia Nervosa and Associated Disorders, Journal of American College Health, Fox News

Getting help for eating disorders

If you suspect a family member has an eating disorder, talk with your primary care physician to learn about options that are available. The following Arizona treatment centers offer varied approaches to treatment.

A New Beginning
9825 N 95th St #101, Scottsdale
480-941-4247 • anewbeginning.com
Outpatient treatment of eating disorders (anorexia, bulimia, binge eating, male eating disorders, exercise bulimia, obesity and weight management), depression, anxiety, abuse, trauma, and marital/relationship difficulties.

Healthy Futures
9449 N 90th St #210, Scottsdale
480-451-8500 • healthyfutures.ws
Outpatient program includes nutrition education, meal planning, group therapy, family education and support. Family therapies also are available.

Mirasol
2954 N Campbell #157, Tucson
888-520-1700 • mirasol.net
Residential treatment facility offering medical and psychiatric interventions for eating disorder recovery.

Remuda Ranch
1 Apache St, Wickenburg
888-739-4205 • remudaranch.com
Inpatient treatment focused on helping women and girls reflect, regain health and discover the inner strength required to recover from an eating disorder. Remuda Life, a transitional program between inpatient treatment and home, is offered on a campus in Chandler.

Rosewood Ranch
36075 S Rincon Rd, Wickenburg
800-845-2211 • rosewoodranch.com
Residential treatment programs focused on helping male and female adults and teens suffering from anorexia nervosa, bulimia nervosa, binge eating disorder and other complex disorders. Also offers outpatient and transitional services from offices in Wickenburg and Tempe.

Sierra Tucson
39580 S Lago del Oro Parkway, Tucson
800-842-4487 • sierratucson.com
Residential treatment center that provides individualized treatment for eating disorders as well as alcoholism, drug addiction, depression, anxiety, trauma, sexual compulsivity and other mental and behavioral disorders.

Maggie Pingholt is a senior in the Walter Cronkite School of Journalism and Mass Communications at Arizona State University. For her honors thesis, she partnered with entrepreneur and mother of three Lori Price of Phoenix to organize the Valley’s first Eating Disorder Awareness Walk.

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