Fighting Anorexia: No One To Blame

"I told my daughter, 'You're going to hate this'," says Mitzi Miles, whose daughter Kaleigh began struggling with anorexia at 10. "She said, 'I could never hate you, Mom.' And I said, 'We'll see'." The first dinner at the Miles home outside Harrisburg, Pa., was a battle--but Mitzi, convinced by Kaleigh's doctor she was doing the right thing, didn't back down. After 45 minutes of yelling and crying, Kaleigh began to eat. Over the next 20 weeks, Kaleigh attended weekly therapy sessions, and Mitzi got support from the medical team, which instructed her to allow Kaleigh to make more food choices on her own. Eleven months later, Kaleigh is able to maintain a normal weight. Mitzi no longer measures out food portions or keeps a written log of her daily food intake.

Critics point out that the Maudsley approach won't work well for adults who won't submit to other people's making their food choices. And they charge that in some children, parental oversight can do more harm than good. Young anorexics and their parents are already locked in a battle for control, says Dr. Alexander Lucas, an eating-disorder specialist and professor emeritus at the Mayo Clinic in Minnesota. The Maudsley approach, he says, "may backfire" by making meals into a battleground. "The focus on weight gain," he says, "has to be between the physician and the child." Even proponents say that family-centered treatment isn't right for everyone: families where there is violence, sexual abuse, alcoholism or drug addiction aren't good candidates. But several studies both in clinics at the Maudsley Hospital and at the University of Chicago show promising results: five years after treatment, more than 70 percent of patients recover using the family-centered method, compared with 50 percent who recover by themselves or using the old approaches. Currently, a large-scale NIH study of the Maudsley approach is underway.

Mental-health specialists say the success of the family-centered approach is finally putting the old stigmas to rest. "An 8-year-old with anorexia isn't in a flight from maturity," says Dr. Julie O'Toole, medical director of the Kartini Clinic in Portland, Ore., a family-friendly eating-disorder clinic. "These young patients are fully in childhood." Most young anorexics, O'Toole says, have wonderful, thoughtful, terribly worried parents. These days, when a desperately sick child enters the Kartini Clinic, O'Toole tries to set parents straight. "I tell them it's a brain disorder. Children don't choose to have it and parents don't cause it." Then she gives the parents a little pep talk. She reminds them that mothers were once blamed for causing schizophrenia and autism until that so-called science was debunked. And that the same will soon be true for anorexia. At the conclusion of O'Toole's speech, she says, parents often weep.

Ironically, family dinners are one of the best ways to prevent a vulnerable child from becoming anorexic. Too often, dinner is eaten in the back seat of an SUV on the way to soccer practice. Parents who eat regular, balanced meals with their children model good eating practices. Family dinners also help parents spot any changes in their child's eating habits. Dieting, says Dr. Craig Johnson, director of the eating-disorder program at Laureate Psychiatric Hospital in Tulsa, triggers complex neurobiological reactions. If you have anorexia in the family and your 11-year-old tells you she's about to go on a diet and is thinking about joining the track team, says Johnson, "you want to be very careful about how you approach her request." For some kids, innocent-seeming behavior carries enormous risks.

Children predisposed to eating disorders are uniquely sensitive to media messages about dieting and health. And their interpretation can be starkly literal. When Ignatius Lau of Portland, Ore., was 11 years old, he decided that 140 pounds was too much for his 5-foot-2 frame. He had heard that oils and carbohydrates were fattening, so he became obsessed with food labels, cutting out all fats and almost all carbs. He lost 32 pounds in six months and ended up in a local hospital. "I told myself I was eating healthier," Ignatius says. He recovered, but for the next three years suffered frequent relapses. "I'd lose weight again and it would trigger some of my old behaviors, like reading food labels," he says. These days he knows what healthy feels like. Ignatius, now 17, is 5 feet 11, 180 pounds, and plays basketball.

Back in Richmond, Va., Emily Krudys says her family has changed. For two months Katherine stayed at the Omaha Children's Hospital, and slowly gained weight. Emily stayed nearby--attending the weekly therapy sessions designed to help integrate her into Katherine's treatment. After Katherine returned home, Emily home-schooled her while she regained her strength. This fall, Katherine entered sixth grade. She's got the pony, and she's become an avid horsewoman, sometimes riding five or six times a week. She's still slight, but she's gaining weight normally by eating three meals and three or four snacks a day. But the anxiety still lingers. When Katherine says she's hungry, Emily has been known to drop everything and whip up a three-course meal. The other day she was startled to see her daughter spreading sour cream on her potato. "I thought, 'My God, that's how regular kids eat all the time'," she recalls. Then she realized that her daughter was well on the way to becoming one of those kids.

With Karen Springen, Ellise Pierce, Joan Raymond and Dirk Johnson

© 2005