At first, she simply wanted to wear a tankini.
She was 11 and a little on the chunky side -- not fat, but with enough of a belly that her mom suggested that she looked better in a one-piece bathing suit. But she was tired of boxy T-shirts and baggy pants. She'd just started middle school and she wanted to wear tight-fitting shirts and low-cut jeans like her friends.
Mostly, she wanted that tankini -- a two-piece bathing suit with a tank-top style top and hip-hugging bottoms.
So, just over a year ago, she told her mom she was giving up sweets. No more Oreos and Chips-Ahoy after dinner, a staple at her house. No more Little Debbie fudge-like brownies. No more Skittles.
Over the next five months, she dropped a few pounds and sprouted several inches. She was 5-foot-2 and 108 pounds. She celebrated her 12th birthday last spring by buying a bright flowered tankini. Everyone said she looked great.
That's when the trouble began, she recalled. "I figured, 'Why not lose some more weight and look even better?' "
She basically starved herself the rest of the summer until, last fall, she was hospitalized. Her heart muscle was so weak it could have stopped at any time.
This girl, who asked to be called Allison, was among nearly 20 kids ages 8 to 12 admitted to Hasbro Children's Hospital last year with life-threatening conditions caused by eating disorders. And those are just the ones who got sick enough to wind up in the hospital.
The numbers underscore a disturbing trend: Kids are developing eating disorders at increasingly younger ages.
THE NATIONAL EATING DISORDERS ASSOCIATION,
in Seattle, can provide no clear statistics on the number of girls under age 12 who suffer from eating disorders. "There still tends to be a lot of secretiveness, and not everyone seeks help," notes Holly Hoff, a project director for the association.
But NEDA surveys have found:
51 percent of all girls ages 9 and 10 say they feel better about themselves if they're on a diet.
46 percent of all 9- to 11-year-old girls say they are "sometimes or very often" on diets.
82 percent of these girls say that their families are "sometimes or very often" on diets.
That, Hoff said, "highlights the very critical role that parents play" as role models for their kids about weight. "When mom talks about not wanting to wear a bathing suit, or just being on the latest crash diet, kids pick up on that."
She said these messages are going out to even the youngest children. Surveys show that 42 percent of girls in grades 1 to 3 say they want to be thinner.
Hoff, who uses puppet shows to teach young children the dangers of dieting, said, "What's amazing to me is hearing first graders ask me, 'What is better, Slim Fast or Weight Watchers?' "
She said, "I had one darling tiny little girl who raised her hand and said, 'I don't want to wear blue jeans because they make my ankles look too fat.' "
TRADITIONALLY, HOFF SAID,
teens have been most at risk for developing eating disorders -- especially during "times of major physical and emotional life changes," such as puberty and heading off to college.
But today, girls are going through puberty at a much younger age, says Jennifer Aspel, a Providence psychologist who specializes in the treatment of eating disorders. And typical teenage concerns about body image and dieting are also affecting these much younger girls.
Add the influence of pop culture that promotes the wafer-thin body look, the media barrage about dieting and weight issues, and an increase in societal pressures for kids of all ages, Aspel said.
No wonder she's now seeing middle and elementary school kids with significant eating disorders -- at younger ages than ever before.
These children face even greater medical risks than older girls with similar disorders, said Dr. Suzanne Riggs, director of adolescent medicine at Rhode Island Hospital and Hasbro Children's Hospital, who heads the team of specialists that treats these kids when their dieting becomes deadly. Because they're still growing, even a small weight loss can quickly and dramatically affect their health.
It strips their bodies of good fat as well as bad, affecting everything from menstruation and bone density to the brain's ability to function, Riggs said. They lose so much muscle that even their hearts are at risk.
Consider Allison's case: Most 12-year-olds have a normal resting heart rate of at least 60 beats per minute. Allison's was barely 50 when her mom brought her to Hasbro Children's Hospital for a checkup last fall.
Riggs immediately admitted Allison to the hospital's intensive care unit. Riggs told Allison's mom: "If we let her go home, her heart could stop tonight."
Her mom burst into tears.
"I couldn't believe what they were telling me," her mom recalled. "How could it have gotten this bad, this fast? . . . I was just sobbing -- sobbing and shaking. I couldn't believe this was happening."
ALLISON'S MOM HAD BEEN WORRYING
for months about her daughter's diet. First, her daughter had given up sweets. Then fat. She refused peanut butter sandwiches. She ate salads without dressing. She'd pick at dry toast or sandwiches with a single slice of turkey -- no mayo. She swapped cereal for Carnation Instant Breakfast, and she toyed with dinner with her family. Soon, she barely ate anything.
Allison had also become obsessed with exercise, her mom said. Right after dinner, she'd race outside to the trampoline and start jumping furiously. Or, she'd suddenly drop to the floor and grind out 50 or 60 sit-ups.
"At first," he mom said, "I thought [her diet] was great. I thought, 'It's good you want to be healthy.' "
But then she watched her daughter shrink, dropping from a misses' size 5 pant to a girls' 14 -- a size she hadn't worn in more than three years.
Her mom tried to force her to eat, but worried about pushing too far. "Do I make her eat, or do I not make her eat? What's the best thing to do? I don't know. And no one could tell me."
It all came to a head when Allison traveled to Florida with her grandmother last August, and she began shivering uncontrollably in the 80-degree heat. Her mom knew something was desperately wrong. She met her daughter at the airport and called her pediatrician on her cell phone during the drive home.
Allison was mad. "There's nothing wrong with me. I'm fine!" she insisted.
But the pediatrician figured Allison now weighed about 95 pounds, and he agreed it was time to see a specialist. He gave Allison's mom the names and numbers of a variety of specialists in Boston and Providence.
She felt clueless. "What did I know about eating disorders? I'm feeling totally isolated, abandoned, and I didn't know where to turn."
Finally, she learned of Dr. Riggs and her program at Rhode Island Hospital. It took five weeks to get an appointment.
Her mom recalls: "I cried every night for five weeks."
ALLISON WAS EXPERIENCING
what experts say are the classic signs of an eating disorder:
She had a sudden, drastic change in her diet. She was obsessed with weight and body image. She insisted on checking food labels for fat grams and calories, and refused to eat entire categories of food. She exercised excessively. She was losing fat and muscle as well as energy. She couldn't concentrate in school.
She says her friends in her public middle school didn't say much about her weight loss. Most of them thought she was just naturally skinny.
But in some schools, weight loss becomes a competition of sorts -- especially among certain groups of girls who tend to be ambitious, overachievers who aim to please adults, Riggs said.
This attitude can be fueled by some mothers -- and fathers -- who focus too much on body image -- theirs or their daughter's, Riggs says.
These moms are constantly dieting, and going to the gym, and even having cosmetic surgery. Often they encourage their daughters to do the same.
Some schools can also inadvertently foster eating disorders, Riggs said. She recalls one all-girls school that assigns parts for the annual school show based on body size. They have some costumes for thin girls and some for heavy girls, so they essentially hand out parts based on a child's weight.
At another all-girls school, the so-called "anorexics table" in the lunchroom is where the girls who don't want to eat lunch sit during the lunch period, one parent said.
But the problem isn't confined to girls schools, Riggs was quick to add. It's also found in co-ed schools, and it crosses socio-economic and racial borders.
Some coaches foster eating disorders by encouraging athletes, especially those in competitive sports and dance classes, to diet to "make weight" or "look good" for the judges, Riggs said.
In fact, she said, an increasing number of boys are suffering from eating disorders -- either because of sports or parental and peer pressure to have flat abdomens and look good in tight-fitting pants.
ALL THIS IS JUST
plain wrong, says Riggs and other experts.
"It's tough to change the cultural mindset," says Steve Emmett, founder and executive director of the Anorexia and Bulimia Association of Rhode Island. "We need to teach people it's what's inside that counts."
Kids -- and their parents -- need to accept that they're going to put on weight as they approach puberty.
Some girls will put on 20 to 50 pounds in a year, says Hoff, of the National Eating Disorders Association. Some kids fill out before adding inches in height. Others gain inches, then fill out. But they need to know that their bodies will even out over time.
Riggs thinks no child should be encouraged to lose weight -- especially not those who are approaching or entering puberty. They need that weight to grow the way their bodies are meant to grow.
And some kids have to face genetic facts: They're born with certain body types, and that's out of their control.
"Some kids are predispositioned to be one weight or another," said Dr. David Herzog, a professor at Harvard School of Medicine and president of the Harvard Eating Disorders Center at Massachusetts General Hospital. "Their bodies are built differently."'
"All kids go through rough spots, heavy/slim," Riggs said. But ultimately, "what weight and shape you have is not a personal choice."
So parents and others have to preach, and practice, healthy lifestyles -- from healthy diets to staying active -- as role models for their kids, Aspel said.
"We need to find better ways of identifying beauty or attractiveness in ourselves," Herzog said. "Weight is one, but humor, optimism, athleticism, all contribute to our attractiveness as people." And we need to emphasize that to our kids, he said.
IF A CHILD IS LOSING WEIGHT,
parents should contact a doctor, Riggs said. Not all weight loss is caused by eating disorders. Some are a result of other medical problems. But in general, she and others said, the only time a child should be placed on a weight-loss diet is when a pediatrician -- not weight-conscious parents -- decide that it's a medical concern.
"It's when the behaviors become extreme, when the preoccupation [with weight] becomes extreme, that's when we begin to get concerned," Aspel said.
Even then, pediatricians need to be more attuned to how they address weight issues -- and the risks weight loss can pose, Riggs and others said.
She cited the case of one young man, recently admitted to the hospital after his weight dropped from 210 pounds to 110 in 8 months and his heart rate was a meager 19 beats per minute. She called the boy's doctor, who said he'd been monitoring the boy's weight loss. The doctor said the boy's heart rate had been "in the 30s" for the past several weeks and perhaps months.
Riggs shook her head at the thought. This boy could have died.
And he was under a doctor's care.
SOME, SUCH AS EMMETT,
say more needs to be done to make society more accepting of the fact that people come in all sizes and shapes so kids don't feel the pressure to look like a supermodel.
Parents also need to talk to their kids about weight issues and take the focus off losing weight as a way to look good.
Beauty is more than skin deep.
"When kids 9, 10, 11 years old are talking about [how] they hate themselves, they hate their bodies, they're too fat . . . It should be taken seriously," Aspel said. "There should be some discussion. At the same time, a parent's initial instinct is, 'If my child's unhappy with how they're looking, let's change it.' "
But consider non-diet approaches, she suggested. Look at ways the entire family can change their diets and physical habits.
Indeed, Riggs said, parents need to take control of meals. It's their job to choose the foods, prepare the meals and insist the kids eat. The bottom line, she said, is "food is the medicine and you have to eat it all."
Others compare food to the fuel needed for a car to run. Kids need to understand the importance of this.
And schools need to do more to educate children, as young as kindergartners, about the perils of diets and eating disorders, Riggs said. But they've resisted, often because they don't have the time or money to expend on the curriculum.
SO SOME PARENTS GROUPS
have stepped up to bat.
Brenda Abramovich, chairwoman of the Parent Action Committee of seven independent schools in Rhode Island, has been busy compiling a program on eating disorders that will be hosted by the Lincoln School in Providence and is open to the public.
One of the students at Lincoln's elementary school was recently hospitalized for severe medical complications stemming from an eating disorder, and many of the parents there are understandably concerned, Abramovich said. "They're equally surprised and frightened it could happen this young."
But the issue affects a variety of students and families, not just at Lincoln, which is why she wanted an open forum to increase awareness of the fact that an increasing number of young girls are suffering from eating disorders.
She arranged for Herzog, of Harvard, to be the keynote speaker. Riggs and Aspel will also serve on the panel, to answer questions and provide advice.
The forum, to be held at Lincoln School on Feb. 20 at 7 p.m., is free.
Meanwhile, Aspel said, if parents suspect their child has an eating disorder, they need to talk to their kids and get them help.
"Denial is a very strong factor," Aspel said. "You don't want to believe your child has a major problem such as that."
But sometimes, you have to face facts.
THIS IS THE KIND OF ADVICE
Allison's mom wishes she'd had last summer. Allison's weight loss and dieting was affecting the entire family. Her parents argued over what was normal and what wasn't, and how best to get Allison to eat. Her father would say, "This is ridiculous. I can't believe you're causing this family this kind of grief." Her brothers yelled at her for making their mother cry.
Allison, like many kids with eating disorders, felt out of control.
But the one thing she could still control was what she had to eat.
Allison, like most kids with eating disorders, come from what would be described as "good" families, Riggs said. But their families often get sucked into the whirlpool of concern and frustration with the disorder.
"It's a kind of power within your family," Riggs said. " . . . Everyone focuses on the kid's eating." Ultimately, she said, "it's a cry for help."
Allison's mom said she was relieved when she finally got an appointment with Riggs last fall.
She figured they'd meet with Riggs and her daughter would get a physical, and then they'd arrange for nutrition counseling, personal counseling for Allison -- maybe for the whole family -- to help her get back on track.
She told Allison they'd take the day off school, head to the doctor's office in the morning, then hit the Providence Place mall to go shopping and have lunch -- a much-needed girls' day out.
She was stunned to hear Riggs say that Allison needed to be hospitalized that day or risk dying at home that night.
"I felt like I got shot with a gun," her mom said.
On the flip side, she said, she wanted to hug Riggs. "I could just feel the sense of relief come over my body . . . It was like, 'Thank God.' "
ALLISON SAYS SHE INITIALLY THOUGHT
it would be cool to spend a couple of days in the hospital, since she'd get to skip school.
But it wasn't fun for long.
She was confined to her bed, hooked up to a cardiac monitor. She was told she had to eat, or she'd be force-fed through a tube in her nose. She wasn't allowed to use the bathroom, unless someone was there to monitor her. And the only people allowed to visit were her parents and her brothers, from 2 to 4 and 6 to 8 p.m.
She spent eight days in the hospital, then eight more days in "partial" care. Allison jokingly calls it "daycare."
Her mom dropped her off at the hospital at 7:30, so she could be monitored while she ate breakfast, lunch and two snacks. She'd also get weighed and see medical specialists and tutors. Then, her mom would pick her up around 4 p.m. for dinner and to sleep at home for the night.
Allison's mom says the hospital staff was great, as were the teachers and other officials at her child's suburban middle school.
In fact, two of Allison's teachers and an assistant principal confided that their own daughters were struggling with eating disorders.
She says she's heard that 1 in 100 kids has an eating disorder, whether or not it's diagnosed. "You don't know how prevalent this is," she said.
Now that Allison is home, she's still regularly meeting with Riggs to monitor her progress. But instead of meeting with Aspel each week, she now meets every other week.
ALLISON IS NOW DOING GREAT,
her mom says. But she's still got a long way to go. She's had a peanut butter sandwich or two, and she's had a couple of Skittles as well.
But she needs to become more flexible about what she eats, and she needs to consume 3,000 calories a day to allow her body to grow naturally.
Allison, now a slim, pretty 12-year-old with long brown hair and a mouth full of braces, says she's open with her friends about what happened. "I told them I wasn't eating enough. I had an eating disorder, and my heart rate got so low I was hospitalized."
So she sits here now, in the sunroom of her suburban home, munching graham crackers and pudding, on the road to recovery.
But there's no quick fix to eating disorders, Riggs noted. "It's important that people not think of this as like strep throat -- take amoxicyllin and it's over. This illness is chronic. [It requires] long-time treatment."
For more information regarding eating disorders, check the Web sites for the National Eating Disorders Association, www.nationaleatingdisorders.org, or the Harvard Eating Disorders Center at Massachusetts General Hospital at www.hedc.org.
