Photo by Jerry Avanaim.

By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

As a top fashion model, Carre Otis made her living on looking thin and beautiful. But now she is sharing the ugly truth about the weight-loss strategies she subjected herself to and the dire health consequences that resulted.

"I had been on this insane diet for almost 17 years to maintain the weight that was demanded of me when I was modeling," Otis says. "My diet was really starvation. I am not naturally that thin so I had to go through everything from using drugs to diet pills to laxatives to fasting. Those were my main ways of controlling my weight."

But these strategies ultimately backfired four years ago.

"I had my first seizure and I had to go in for heart surgery," says Otis, who at 5'10 occasionally weighed as little as 100 pounds. "My doctor felt that the main contributing factor was so many years of malnutrition, especially during my formative years even before I got into modeling."

"The starvation weakened my heart," Otis adds. "Many women who have anorexia put their hearts in a compromised situation - it not unusual for women with anorexia to suffer heart attacks. I had also taken something called ipecac -- which is a syrup that makes you throw up - I took it when I was young as my way to control my eating.  It's been shown to bore holes in the heart. As a result I needed a minimally-invasive procedure that cauterized three holes in my heart - had it been a few years earlier they would have had to open my chest."

Because of her experience, Otis is passionate about helping other people with eating disorders like anorexia nervosa (AN) -- an eating disorder characterized by self-starvation and excessive weight loss.

As part of her "personal crusade," Otis is helping promote National Eating Disorders Awareness week - February 23 - March 2.  She also urges people to watch Perfect Illusions: Eating Disorders and the Family which was sponsored by the National Eating Disorders Association and will premiere nationally on PBS Monday, February 24.

Out of control

According to the NEDA, conservative estimates indicate that after puberty, 5-10 million American girls and women and 1 million boys and men are struggling with eating disorders.

 But the number of those struggling with food is likely much greater as there is a whole spectrum of disordered eating that is considered borderline or sub-clinical.

 "It's fair to make the case that a substantial minority of people - 40-50% -- have struggled one way or another with many of the symptoms even though they may not have the formal disorder," says Douglas Bunnell, PhD and president-elect of the NEDA. "'Eating disorder not otherwise specified' is an actual diagnosis - most people seeking treatment for eating disorders fit in this latter category."

According to Bunnell, the number one risk factor is dieting. "For some people it clearly fires up a self-perpetuating loop where they continue to restrict their intake and continue to diet."

Other risk factors include:

• Puberty
• Perfectionism or obsessional characteristics
• Female gender
• Other psychiatric vulnerabilities
• History of trauma - including sexual or physical abuse

Otis was clearly at risk and her career choice was a prescription for disaster.

"The pressure was if I didn't get into that dress size someone else would, someone else would get the job," Otis explains. "I had dropped out of school and was a runaway so I didn't have family to fall back on if I didn't work. I didn't have a lot of other options of making money other than modeling."

"But I can't blame it all on modeling," Otis adds. "Anorexia was there for me before I got into modeling but because of the arena and the demands the disease really got out of control for me. It's like being an alcoholic and going and being a bartender."

Bunnell says eating disorders involve "a complex interaction between some sort of inherited vulnerability and an environment that pushes people towards body loathing."

Anorexia generally occurs between the ages of 15-35, with onset typically in the teen years. Because AN has the highest mortality of any psychiatric illness -- approximately 5-20% of patients die -- recognizing its symptoms is vitally important.

For purposes of diagnosis, symptoms of AN must persist for three months and include:

• Refusal to maintain body weight at or above a minimally normal weight.
• Intense fear of weight gain or being "fat" and/or extreme concern with body weight
• Feeling "fat" or overweight despite dramatic weight loss.
• Loss of menstrual periods in girls and women post-puberty.

Healing mind and body

"Treatment is complicated," reports Bunnell, who is also director of the Renfew Center of Connecticut. "It often takes a long time - sometimes up to six to eight years.  It often takes several attempts at treatment. What we know increasingly clearly over the last several years is that people who get adequate and specialized care get better."

Otis says at times treatment was very difficult.

"Part of treatment for drugs and alcohol is you abstain from these but with eating disorders you can't abstain from food so the treatment is longer than drugs and alcohol," says Otis. "You have to find a balance with food in your life - you can't take out food. It can be absolutely terrifying."

Treatment for eating disorders involves a variety of approaches, including:

• Individual psychotherapy
• Family therapy
• Cognitive behavioral therapy
• Group psychotherapy
• Nutritional therapy
• Psychopharmacology

"For most any individual treatment is going to entail a combination of many of these," Bunnell reports. "This multi-disciplinary, coordinated treatment should be the standard of care."

"What has worked for me is therapy in conjunction with nutritionist who specializes in eating disorders that I see every two weeks," Otis says. 

But the harsh reality in the US is that only a minority of people get adequate care. This is often due to lack of awareness, stigma and inadequate insurance coverage.

"It is critically important that people recognize that eating disorders are very serious illnesses - not trendy lifestyle choices," Bunnell says. "They can be chronic and disabling and ripple through families and relationships. They require adequate, specialized treatment."

Otis aims to stop the problem before it starts.

"We have to get to kids younger," Otis urges. "Hopefully the kind of educational programs we're creating with NEDA can be installed in the school system. We have to educate people that the images they see are airbrushed and doctored."

"If you could see a before and after photo, you'd be amazed," Otis says. "Most of us don't look that way. We come in many different shapes and sizes and we need to support each other and our differences. Our beauty is in our differences."

To reach the NEDA, click here.

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 2/27/2003  -  John Morgan & Stephen A. Shoop, M.D.