The Truth About Life
After Eating Disorders

Essays, Articles, & Nonfiction Works
by Aimee Liu

These treatment facilities offer specialized programs for eating disorders, including men and women over age 21.
Discover the many ways others are using their voices, talents, and passions to turn suffering into creativity and hope.
Links to websites and organizations that provide information and referrals.
References cited in GAINING
How do anorexia and bulimia impact life AFTER recovery? GAINING is one of the first books about eating disorders to connect the latest scientific insights to the personal truth of life before, during, and especially after anorexia and bulimia.
"I've read countless books about eating disorders, but I've never seen one like this. Combining the professional wisdom of leading experts with personal experiences from women and men all over the globe, this book fills a gap on the recovery bookshelf. Anyone who has been touched by an eating disorder needs to read this."—Jenni Schaefer, author of Life without Ed
America's first memoir of anorexia, and one of the earliest books about eating disorders, originally published in 1979


ACCESS to healthcare!

August 24, 2009

Where has the summer gone? I’m afraid a good part of it seems to have been consumed by the craziness that's swamping President Obama’s healthcare reform efforts. While I can’t pretend to understand all of the issues involved, I know enough to be distressed by the insurance-orchestrated efforts to block even civil discussion about the way forward. And anyone else with a history of eating disorders should be, too.

Why? Because the current system allows insurance companies to act as gatekeepers to health care, and they will use every excuse they can find, including a history of eating disorders or related ailments, to block access. That’s before we even get near the question of coverage specifics within an insurance plan – and as I’ve noted in previous blogs, few if any insurance policies cover the length of treatment that is actually needed to establish recovery from a serious eating disorder.

Here is what the President’s initiative is trying to do:
• Reduce costs — Rising health care costs are crushing the budgets of governments, businesses, individuals, and families, and they must be brought under control
• Guarantee choice — Every American must have the freedom to choose their plan and doctor – including the choice of a public insurance option
• Ensure quality care for all — All Americans must have quality and affordable health care

All excellent goals, but for me, the priority is access. Let me share my specifics to show you why I’m exercised, and why I think you should be, too. Back in 1989, as a result of the punishment my body had endured during my eating/exercise disorder, I had surgery for a condition called avascular necrosis, which is a fancy name for dead bone in one ankle. The surgery was not wholly successful, but twenty years later I can walk and swim and have required no further operations. Otherwise I am in excellent health, with no risk factors for any other diseases. My medical needs amount to about two office visits per year. Nevertheless, my ankle qualifies as a pre-existing condition that makes me practically uninsurable as a self-employed person. I’ve been rejected by more than three insurance carriers after torturous application procedures. The coverage I have, through a group plan with the Authors Guild, is both minimal and prohibitively expensive. No vision, no dental, no chiropractors, etc. And the cost is $25,000 for my coverage alone. Assuming my doctor charges $100 per visit, that means the carrier is making a $24,800 profit on me every year. No wonder the insurance industry is opposed to reform!

Fortunately, my husband enjoys superb and affordable access to healthcare through the Government-run system of Medicare. But the premium I am forced to pay is an outrage. If I were single, I can assure you I would have no healthcare, since I could never afford this coverage on my writing income alone.

Make no mistake, this is an issue that affects all of us, regardless of our stage of health or recovery. Even if you have coverage now through your school or employer, the current system will make it difficult for you to retain coverage after you graduate or if you should lose or leave your job.

So please visit
to contact your elected representatives and urge them to demand ACCESS to health care for all. The debate on the details will doubtless continue through the fall, but let’s get together and show our support for the process and our agreement on the need for change.
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Anorexia's Red Herring

Too-skinny models may be a factor in spawning eating disorders, but they're just one of many.
By Aimee Liu

Published in the Los
Angeles Times,
September 22, 2006

THIS WEEK in Madrid, heroin chic was prohibited. For the first time, the organizers of a major international fashion show recognized that by showcasing emaciated models, the fashion industry promotes eating disorders. Under pressure from the Madrid government, medical associations and women's advocacy groups, the Assn. of Fashion Designers of Spain finally rejected morbidly thin models.

When selecting models for this year's Madrid fashion week, which ends today, the designers set a minimum body mass ratio (calculated on the basis of height and weight). Their required ratio was 18 — meaning a minimum of 119 pounds for a 5-foot, 8-inch woman. The bar was by no means high. For ordinary mortals, a ratio of 18.5 qualifies as underweight. Even so, five of the 68 auditioning models flunked.

To understand why they flunked, we need to look beyond the fashion industry to the true causes of eating disorders. These include genetic predisposition, temperament, family dynamics and personal trauma. I know; modeling fueled but did not cause my own adolescent eating disorder nearly 40 years ago.

Twiggy was my generation's Kate Moss. I fixated on her at age 13, and by the time I started modeling one year later, I'd dropped 30 pounds. Being skinny became my identity. At 5 feet, 7 inches, I didn't weigh more than 100 pounds again until I was 21.

My anorexia ultimately destroyed my career.

Models were — and still are — paid to make fashions look good, and that meant fitting sample wardrobes. Reigning teen cover girls Shelley Hack and Colleen Corby understood this. In dressing room lunches between shoots, I'd watch them wolf down tuna salad sandwiches while I pretended not to be hungry. They were lucky, I told myself, they could get away with eating. I began to lose jobs when I became so thin that stylists couldn't even pin dresses on me to look right. Still, I felt I couldn't eat.

Like many anorexic models, I was drawn to the fashion world because it reinforced my anorexia. I would be willing to bet that most, if not all, of the runway models disqualified in Madrid fit the same pattern — as do many emaciated gymnasts and ice skaters.

Three years ago, I began interviewing medical researchers as well as middle-age women and men with histories of anorexia and bulimia. I wanted to find out what we know now that we didn't know in the 1970s, when I quit my self-imposed hunger strike. I learned that researchers now are discovering genetic links between eating disorders, depression and obsessive-compulsive disorder. Genes also shape the temperaments of people who are prone to anorexia and bulimia, although the mechanisms for this are still poorly understood.

A landmark 2003 British study found that certain innate childhood traits, such as perfectionism, inflexibility and cautiousness, each increase an individual's risk for anorexia by a factor of seven. Someone like me, possessing all five traits measured in the study, is 35 times more likely to develop an eating disorder than a daredevil who happily wears mismatched socks.

Further, eating disorders are triggered not by pictures of Kate Moss but by sudden or cumulative experiences of intolerable emotion, such as shame or fear. Puberty unleashes a natural tidal wave of these emotions. Adolescence also happens to be the age when rates of sexual abuse soar, academic and social pressures intensify and parents become a source of embarrassment rather than solace. It makes sense that this is prime time for eating disorders. Obsession with weight offers a distraction. Extreme weight loss signals distress.

It also makes sense that rates of anorexia and bulimia spike in middle age, when many women again face emotional turmoil. Women over 30 now make up a full third of residential patients at the Renfrew Center, a Philadelphia treatment facility specializing in eating disorders. Divorce, grief, the empty nest — all can trigger illness if the individual possesses a genetic predisposition.

The onset of eating disorders is like the firing of a gun. Genetics form the gun. Cultural influences such as the fashion industry and familial attitudes about weight then load it. And intense emotional distress pulls the trigger.

Healthier figures on international catwalks may help to disarm the gun. However, of the more than 40 women I interviewed, only a handful had ever paid any attention to fashion. When they started starving, they were asking for help, not admiration. Those models who failed the test in Madrid need treatment, not rebuke.

Copyright 2006 Los Angeles Times