Deb Bettinger, guides a group of students through steps at the Lawrence Arts Center, 940 N.H., getting them loose for dance class. Bettinger says she takes care to ensure that her students don't become preoccupied with body image, which can trigger self-esteem issues or eating disorders in impressionable youths.

She can remember watching ballerinas as a little girl and wishing for the same lean athletic body. She can pinpoint specific moments in her life when people made comments about her weight.

But Baker University student Haley Gilbert says her seven-year struggle with eating disorders is about much more than food and body weight.

“Sometimes it’s not what society dictates as much as what is in your environment and also your personality type and your thought process as a person,” Gilbert says. “It’s things you are born with that you really can’t escape. I’ve been hard on myself my whole life, and so it’s something that has naturally occurred.”

Gilbert is concerned by the misconception that eating disorders are only about weight and food.

“It’s just a part of the process. It’s part of the disease,” she says. “At first it might be about the weight, thinking, ‘My problems will be solved by how low my body weight gets.’ You go lower and lower and feel like you are accomplishing something. For whatever reason it can become a coping mechanism.

“The number one thing that people don’t understand is that you don’t have to be 80 pounds and you don’t have to look like a concentration camp victim to have an eating disorder. It’s the behavior.”

In recent months, the Council of Fashion Designers of America has issued regulations to try and thwart such situations. Responding to recent eating disorder-related deaths and intending to prevent harm to impressionable young girls, the council has begun teaching models about nutrition and upping age limits for participation. Some are strongly pushing a ban on models who do not meet a certain body mass index.

Dangerous disorders

Ed Bloch, co-owner and director of the Life Enrichment Center, 5200 Bob Billings Parkway, is a licensed clinical social worker who has specialized in treating eating disorders for 17 years. He says an attitude shift is needed when it comes to asking people to gain or lose weight in a radical manner.

“With the modeling regulations, it gives a misconception that a person only has anorexia or bulimia if their body mass index is 18 or lower. You can use the numbers, but the behavior is already in place,” Bloch said. “All you do is save them from going deeper into it. There needs to be an awareness that someone gets there by an internal process. That person cannot stop losing weight. If the culture said that all people who were above weight were beautiful, people with anorexia wouldn’t suddenly stop eating.”

In fact, anorexia nervosa and bulimia are defined as mental disorders. The Diagnostic and Statistical Manual of Mental Disorders bases the diagnosis of anorexia nervosa on a failure to maintain nutrition and often a “severe loss of body weight.” Bulimia is often diagnosed based on binge eating and purging cycles intended to prevent weight gain.

Frequently the two disorders intermingle and, due to the typical hidden nature of the behaviors, are difficult to diagnose. Both, however, often lead to additional physical complications, including heart disease; organ, hormone, and bone damage; and death. Death rates for eating disorders are some of the highest for any mental illness, with some studies reporting 20 percent of diagnosed cases having fatal results.

High-risk discipline

Despite the strong emotional components of eating disorders, Bloch says it remains especially important for coaches and instructors in body-focused activities to be aware of the signals they send.

“Any time you have a kid in athletics or in any performance, (you) need to be careful in relation to food and weight,” Bloch says.

Candi Baker, dance program director at the Lawrence Arts Center, 940 N.H., says she tries to be alert for signs of eating disorders in those who attend the center’s classes.

“The industry has become much more aware of the dangers of dancers being too thin,” Baker says. “I think it’s not an issue here because we welcome anyone and everyone, and we encourage all body types. We’ve had dancers that don’t have traditional body types who have been wonderful dancers.”

Still, both Baker and ballet program coordinator Deborah Bettinger say they don’t ignore the prevalence and possibility of eating disorders.

“I don’t make an issue of their weight, which is a common thing in dance,” Bettinger says. “Dance has those traditions and those pressures. You wear a leotard and tights and stand in front of the mirror the whole time. I can see how the environment would foster weight consciousness.

“In ballet they are athletes, and there are different body types out there. To contaminate with bad ideas certainly isn’t appropriate for me. They need to feel good.”

Both Baker and Bettinger say if a concern were to arise, they would talk to the student with as much care as possible.

Talking openly

Bloch says common ways of talking to people with eating disorders – saying things like “Just eat” – are not helpful. “You are shaming them,” he says.

“You have to be careful about the things you say,” Bloch says. “Some things you say can trigger them. But you are not going to be able to be perfect if an individual has an eating disorder – other than going mute.

“Have an open dialogue, saying, ‘What do you need from me?’ Check in with the individual. Ask them what you could be doing differently. Don’t be afraid to ask those questions. Ask them to be open about when you make mistakes.”

Gilbert says having an eating disorder, whether one wants to get better or not, can be isolating. However, attempts by others to be supportive are appreciated.

“It’s frustrating, it’s aggravating, and it’s lonely because you feel like people don’t understand,” Gilbert says. “It’s really important to be genuine and honest. Be someone to listen. Even if you feel like you’ll never understand it, being willing to listen and validate their feelings can really help.”