DNA samples from the lab to do the first genetic study of anorexia, an eating… (Matt Bulvony / For the Times…)
April Dunlap was 17 and weighed 165 pounds when she began a diet and exercise regimen. After three months, the 5-foot-5 teen had lost the 20 pounds she had hoped to shed. But she kept going. "It was like a drug," she said. "I always wanted to lose a little more."
When she hit 120 pounds, Dunlap's mother worried that April was losing too much weight. The family's doctor agreed. Four months after Dunlap's diet began, she found herself in a treatment program for anorexia nervosa. After only 10 days, she had gained enough weight to be discharged from the hospital.
"If it wasn't for my mother, it would have taken a lot longer for me to realize I had a problem," said Dunlap, now 28 and living in Charleston, W.Va.
Dunlap's whirlwind experience with her eating disorder is becoming increasingly common today: A new breed of patient is getting treatment well before the disease drags them into a downward spiral toward starvation, sustained heart damage, weak bones, kidney damage, long hospitalizations and numerous relapses.
Health experts are seeing a glimmer of hope that the devastation wrought by eating disorders may be easing nearly 30 years after the illnesses first sprang into the public consciousness with the death of singer Karen Carpenter from anorexia-induced heart failure. Among the encouraging signs: More patients are getting medical treatment based on sound science; they're getting it earlier in the course of the disease; and they're recovering faster, often without the need for hospitalization or residential care.
One eye-opening statistic appears to speak to the trend: A recent government analysis found that hospitalizations for people with the primary diagnosis of an eating disorder plunged 23% between 2007-08 and 2008-09. It was the first such decline since the federal Agency for Healthcare Research and Quality began tracking such hospitalizations in 1999.
"Any little movement is significant, and this is a pretty big one," said William Encinosa, a senior economist at the agency who worked on the report, which was published last year.
Eating disorders, which primarily affect teenage girls, are loosely categorized as mental illnesses centered on obsessive thoughts, emotions and behaviors regarding food. Anorexia involves self-starvation leading to excessive weight loss that damages the heart, bones, nervous system and organs. An estimated 1 in 200 Americans has the disease, and the death rate is 4%.
Bulimia is characterized by bingeing followed by self-induced vomiting, use of laxatives or excessive exercise to purge food and prevent weight gain. It affects 2% to 3% of Americans and is not thought to be as deadly as anorexia, though a 2009 study in the American Journal of Psychiatry found it was lethal in nearly 4% of cases, mostly due to suicide or electrolyte imbalance caused by dehydration.
Another type of eating disorder, binge eating, rarely leads to hospitalization or death.
The stigma surrounding anorexia and bulimia have kept many patients isolated. But for a variety of reasons, eating disorders are coming out of the shadows.
Surveys conducted by the National Eating Disorders Assn. show that Americans are more familiar with anorexia and bulimia now than they were 10 years ago. That awareness has been accompanied by a weakening of the stigma associated with eating disorders that might, in the past, have prevented some people from seeking help quickly, said William Walters, who manages the telephone hot line for the New York-based organization.
"Parents are being more proactive. Coaches are being more proactive about their athletes," he said. "People feel they can ask for help."
Encinosa credits the heightened awareness to a combination of education in schools, TV shows on the topic and public statements by such celebrity patients as Princess Diana and Paula Abdul.
In April Dunlap's case, a made-for-TV movie about two high school students with eating disorders put her mother, Gloria, on alert. When April began her rapid weight loss, Gloria took action.
"I could see it wasn't normal," Gloria Dunlap said.
Some experts are skeptical that the big drop in hospitalizations reflects actual improvement in treatment. More insurance companies are steering patients to outpatient programs or partial hospitalization, in which patients attend day programs but go home at night, said Dr. Ovidio Bermudez, medical director of the Eating Recovery Center in Denver. Perhaps the drop in hospitalizations simply means insurers are being stingy.
Nor does the federal data indicate whether deaths from eating disorders have declined, since mortality rates are not tracked.
There is no evidence that the incidence of eating disorders has dropped, Bermudez said. To the contrary, anorexia and bulimia have been spreading among populations other than white teenage girls.