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The Enemy Within

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Dr. Ira Sacker, head of the Eating Disorders Clinic at Brookdale University Hospital and Medical Center in Brooklyn, learned early that eating could be fraught with emotional complications. "I came from a family where food was an issue," says Sacker, 57, author of 1987’s Dying to Be Thin. "My father and I would share coffee and cake, and the next day my mother would remark that I must have gained weight." As a child the Culver City, Calif., native — the son of Harry, who managed a plumbing-supplies company, and Lottie, a bookkeeper — developed a habit of overeating that stayed with him until his college years. "As I began to feel better about myself and found I had other passions, food no longer became an issue," he says. Now Sacker, who lives in Jericho, N.Y., with his wife, Marianne, 55, a video producer, uses his own experience to connect with others. "Much of what I’d experienced in my own life about perfectionism and control problems are a major part of what people with eating disorders are all about," he says. PEOPLE contributor Debbie Seaman talked to Sacker about the increasing incidence of anorexia and what he has learned in his 26 years of treating the disease.

Q: We think of anorexia as a disease of teenage girls. Is that true?
A: No. We’re dealing now with kids as young as 5 or 6. We’re also seeing anorexia in men dramatically increase. It used to be 20 to 1, female to male; now it’s 10 to 1. Males are becoming preoccupied with body image, with the concept of being buff. African-Americans, who 10 years ago were not preoccupied with the thin look, have begun to develop eating disorders.

Q: What causes anorexia?
A: No one is really sure. There are probably genetic precursors. We see it running through families. It can be triggered by the example of parents who are preoccupied by their own body images. It certainly is caused by nature as well as nurture.

Q: What are anorexia’s long-term effects?
A: They include bone loss, possible cardiac irregularities, kidney failure and sudden death. There’s also a link to infertility in women.

Q: How hard is it to recover from anorexia?
A: It’s very difficult to recover from any eating disorder. We use the word recovery; we never talk about a cure. The underlying eating-disorder mentality is always there. Weight gain is not in itself recovery-it is often the last thing that occurs as the eating disorder stabilizes. Recovery comes from beginning to understand oneself and beginning to accept that person.

Q: Are anorexia recovery rates improving?
A: Actually, relapse rates are getting worse. According to studies, up to two-thirds of recovering anorexics relapse on a regular basis.

Q: Why do anorexics relapse?
A: Medical care focuses on getting back into eating, allowing the person to reach an ideal weight. They look normal, but emotionally they’re not able to deal with the environment. People say, “You look so much better.” Well, “looking better” terrifies them because to them that means they look fat. A patient needs a transitional place, somewhere to go after leaving the hospital and before going home, where he or she can learn what is required to function in the environment outside.

Q: What should you do if you’re an anorexic and have relapsed?
A: One, you have to be aware your weight is dropping. Two, you have to want to get help. The key is in the relationship with the therapist. There has to be a team of therapist, physician and nutritionist, and they have to be on the same page.

Q: How long does recovery take?
A: I’ve treated some people for a year, and others for as long as 10 years. It depends on age, how long they’ve been ill, how invested in the illness they are-and how much they want to get better.

Q: Why is this such a difficult illness to beat?
A: We are in a media-motivated society. We focus on the illustration of body image as it is placed in front of us. The majority of adolescents I speak to look at size 2 as normal, when in fact the average adolescent is a size 10. There is a study which shows that young girls are more frightened of being fat than they are of nuclear holocaust or their parents dying. That’s scary.

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