This is a season of gustatory excess, when families gather at ample tables, offices hold lavish parties, and people eat and drink till they are beyond sated. Not everyone, though. There is a grimmer corner of America. It is populated by men and, more commonly, women who shun food not because they are too poor to afford it, but because they are too troubled to desire it.
The country’s obesity epidemic deservedly draws constant attention, but many have a diametrically opposite problem: They are obsessively, and perilously, thin. Some experts estimate that 30 million Americans are plagued at some point in their lives by disorders like anorexia nervosa, binge-eating and bulimia. About one-third of them are men, belying broadly held assumptions that this is almost exclusively a female concern. Many are blacks, Latinos and Asians, countering another routine belief that this is a whites-only issue.
Some get better, and stay that way. Others cycle through periods of recovery and relapse. And some, roughly a third of them, remain chronically ill or die. The National Eating Disorders Association describes anorexia as having “the highest mortality rate of any psychiatric illness.”
Retro Report, a series of video documentaries exploring the continued impact of major news stories of the past, examines how public understanding of this issue has evolved since the startling death of the singer Karen Carpenter in 1983. Her illness, anorexia, had long been familiar to medical professionals. An English doctor, William Gull, gave it its name in the 1870s, but the condition had been recognized for centuries. A few women proclaimed saints by the Roman Catholic Church are believed to have been anorexic.
Although the problem was always hiding in plain sight, Ms. Carpenter’s death at 32 made everyone see it clearly. She and her brother, Richard, were the hugely popular Carpenters duo, their records selling in the tens of millions with 1970s hits like “Close to You,” “We’ve Only Just Begun” and “Rainy Days and Mondays.”
The demons that plagued Ms. Carpenter led to extreme dieting. As is typical with anorexics, no amount of weight loss was enough for her. Fans at her live performances were shocked by what they saw. The 145 pounds once on her 5-foot-4-inch frame had dropped to 91 pounds in 1975. By September 1982, she was down to 77 pounds. That was when she was admitted to Lenox Hill Hospital in Manhattan with a critically low potassium level. “Her face was all eyes,” a friend later recalled.
Doctors and nurses helped her put on weight, but irreparable damage had been done. Ms. Carpenter went into fatal cardiac arrest on Feb. 4, 1983.
Since then, public awareness of eating disorders has come more sharply into focus, in part because celebrities began to reveal their struggles. To name but a few, their ranks have included Jane Fonda, Lady Gaga, Kelly Clarkson, Calista Flockhart, Fiona Apple and Paula Abdul. When Amy Winehouse died in 2011 at 27, the cause was said to be drug and alcohol abuse. But her brother has said that her system might have better withstood the chemical onslaught were it not compromised by frequent bouts of bulimia.
Those in the grip of a disorder like anorexia do not always command the sympathy of others. A frequent reaction is finger-wagging that boils down to: Snap out of it. Just eat, for goodness sake.
Life, though, is rarely that simple for someone in torment — someone like Ayanna Bates, 20, who lives in Queens and works with Project Heal, a nonprofit that helps people with eating disorders pay for treatment. Typically, eating disorders take hold in adolescence, and Ms. Bates was no exception. When anxieties overwhelmed her at 13, she began to push food away. “Starving was used to hurt myself,” she told Retro Report, but “it was also used for control.”
“It was an exciting feeling because I felt, like, at the time that was the only thing I was good at,” she said. “So it gave me a sense of empowerment.”
Health professionals now understand that the disorder is not so much a willful refusal to eat as a complex interlacing of psychological, biological and environmental issues. “There’s been increasing understanding over the last several decades that this is a serious psychiatric illness,” said Dr. Evelyn Attia, director of the Center for Eating Disorders at NewYork-Presbyterian Hospital. “This is a brain-based disorder.”
Some people are believed to be genetically predisposed to the malady. Some react to childhood traumas and other triggers. And then there is a “social environmental” component, said Jillian Lampert, chief strategy officer for the Minnesota-based Emily Program, which treats eating disorders. Society’s imperative “tells us to be thin and beautiful and attractive and strong and muscular and all that other stuff,” Dr. Lampert said.
Look no further than the Miss America pageant. In July, The Atlantic magazine cited the body mass indexes of women who won this most famous beauty contest going back nearly a century. The index measures a person’s weight in relation to his or her height. An index that exceeds 25 qualifies as overweight; above 30 is obese. Dipping below 18.5 is considered underweight.
Studies showed that the typical index for Miss Americas in the 1920s was 22, which is what it would be for a woman who is 5 feet 6 inches tall and weighs 136 pounds. By the 2000s, pageant winners were down to 16.9, equivalent to that 5-foot-6 woman reduced to 105 pounds.
In the main, Dr. Lampert said, no single factor explains an eating disorder. Genetics, trauma, visions of beauty — “it’s usually the confluence of them,” she said.
Western countries are where the problems have tended to lie, but as eating habits change across the globe, other societies are experiencing similar issues. In the United States, access to treatment is far from uniform. Some states recognize anorexia and bulimia as mental health concerns; others do not. Some insurance companies provide coverage, others not. At the federal level, the help that may be provided could depend on the fate of the besieged Affordable Care Act.
Even now, decades after Karen Carpenter’s death, some people cannot grasp an anorexic’s agony. Carrie Arnold studied the issue in her 2012 book, “Decoding Anorexia: How Breakthroughs in Science Offer Hope for Eating Disorders.” She herself has struggled with anorexia. Her skin at one point turned a grayish yellow, she said. Her hair fell out. Clothes slipped off her shrunken frame. “And yet, at the same time,” she said, “I’d get questions from people asking me, you know, ‘How did you do it?’
“Like they were asking me for diet tips even as, you know, my heart was giving out.”
The video with this article is part of a documentary series presented by The New York Times. The video project was started with a grant from Christopher Buck. Retro Report, led by Kyra Darnton, is a nonprofit video news organization that aims to provide a thoughtful counterweight to today’s 24/7 news cycle. Previous episodes are at nytimes.com/retroreport. To suggest ideas for future reports, email firstname.lastname@example.org.