Dying to be Thin

For many, an apple is an apple – a fruit, something to eat.

For Sarah, an apple is 80 calories. 80 too many.

Sarah is anorexic, and discusses regularly her struggle with food in the chat room of a website on eating disorders.

According to a recent report by the medical association in Lower Saxony, 220,000 people between 15 and 24 suffer from the severe eating disorders Anorexia and Bulimia in Germany and two thirds of all young women have been on a diet at least once in their life.

In addition, 3.7 million people are critically underweight, a report by the German Institute for Nutrition Medicine said. Of the 100 000 young people suffering from anorexia and 600 000 from bulimia in Germany, between 5 and 10 per cent are men – and the rate is growing.

Painful hunger

Serious eating problems are on the increase in Germany. According to the Frankfurt Centre of Eating Disorders (ED), the number of school leavers suffering from EDs has doubled from 1990 to 98.

"The prevalence of this illness has risen sharply since the 70ies, and still is", the Federal Ministry for Women and Youth warns in a recent study on women's health in Germany.

However, Anorexia Nervosa is no new disease. It was first described in detail back in 1873. The name of this illness is surprisingly misleading: Anorexia means "loss of appetite". But those suffering from the illness force themselves not to eat, despite painful hunger.

Distorted body image

Anorexics suffer from a dangerously distorted body image: Even at half the normal body weight, anorexics feel "fat".

Bulimia, on the other hand, is characterised mainly by secret binge-eating. Up to 18 000 calories can be consumed in a binge, more than a profi cyclist needs for the hardest alpine climb. Vomiting, and the abuse of laxatives, diet pills and drugs to induce vomiting follow.

Both illnesses mean a constant preoccupation with food, weight and the body, and are a serious danger to health. Dehydration, malnutrition, hair loss, muscle deficicieny, anemia and osteoroposis – after months of dieting, Anorexics suffer serious body damage, eventually leading to serious illnesses such as diabetes, cancer and heart problems. And - according to the German Institute for Nutrition Medicine, 15 per cent of Anorexics do not survive.

Barbie-doll figures

According to the Federal Ministry for Women, one of the main reasons for the recent considerable increase in women with EDs in Germany lies in society, in the rebellion against the stereotypical role of the woman and beauty norms.

In addition, fake images are propelled by Barbie-type dolls, children’s books and teenage pop stars. Experts say a growing number of young children, especially girls, fret about body image, some of which are "on a diet" – at the age of four.

"Eating disorders and the refusal to eat is not uncommon to four-year-olds" Cornelia Götz-Kühne, chairmann of the Federal Association for Eating Disorders says. "Children are increasingly confronted with eating disorders in families, and they copy it". In many families, parents begin the day by weighing themselves. Many mothers are afraid of their children becoming too fat.

Underlying issues

But while all these images, advertisements, and role models may be counterproductive to self-image and society’s acceptance of sizes and shapes, they are not the main reason for eating disorders.

Anorexia and Bulimia are not neccessarily about weight and food. They are complex disorders where those suffering are plagued by low self-esteem, an inability to cope with emotions and other, far deeper underlying issues. Though there may seem to be nothing more than a dangerously obsessive weight concern on the surface, for most men and women suffering with an eating disorder there are deeper emotional conflicts to be resolved.

Public awareness has grown considerably in recent years. More and more famous people have publicly admitted to EDs, including the former Princess Diana, and Geri Halliwell of the Spice Girls. And extensive research has increased on the illness, too.

A global problem

With some ten million people across the globe suffering from eating disorders, and the estimated number of unreported cases expected to be much higher, there is still much to be done to fight this problem.

In Britain, the government invited teen magazine editors, fashion model bookers and nutrition experts to a "Body image Summit" two years ago. A fashion "council" was founded to watch over what kind of signals fashion industries send out to consumers. This year, the government launched an Eating Disorders Awareness Week, with events taking place across the country.

In Germany, anorexia is still somewhat of a tabu. According to the Federal Ministry for Women, "there is still a great need for and information, in order to discover forst symptoms".

In Germany, help and advice still comes mainly from the numerous self-help groups and medical associations. But already, anorexia and bulimia are costing the country money (according to the initative "Hungry Online", an annual € 533 mill.) - and more importantly, lives.