Dying to be thin: The reality of eating disorders

There was a time in her life when Katie Mills dreamed of food — literally. At the height of her battle with anorexia nervosa the former model would dream of food and wake up starving. Every night. Every morning. “I remember waking up having dreams about food because I was that hungry,” she recalls. Ms Mills is one of an estimated one million Australians to suffer from an eating disorder. But unlike other common and potentially fatal diseases such as cancer and stroke, eating disorders are, for many, a hidden and misunderstood condition. Revelations that Jaimi Kenny, the daughter of former Olympian Lisa Curry and champion Ironman Grant Kenny, had struggled with an eating disorder before her sudden death this month shocked a public who had only ever seen a smiling, apparently happy woman photographed beside her famous parents. Similarly, former England cricket captain Andrew “Freddie” Flintoff’s admission that he still struggles with bulimia made headlines because he defies the stereotype. That is despite statistics that suggest one in three people with an eating disorder is a man. “I probably should get help,” Flintoff told a BBC documentary airing in the UK tomorrow. “I know it’s a problem and I know it needs addressing.” The world got an insight into the crippling craving to be thin when anorexia movie To The Bone was released in 2017. Actress Lily Collins played the persecuted lead character Ellen, who was able to wrap her thumb and finger around her brittle bicep. And she shocked friends, family and fans with the lengths she went to to get the look. “I personally knew that this was something I needed to do to tell this story,” Collins, who struggled with eating disorders herself, said at the time. “I wanted to be able to best exert my experiences on (Ellen) by going to the lengths I felt comfortable going to as an actor.” With eating disorder concerns rising since the start of the coronavirus pandemic — support services say calls are up about 40 per cent — The Sunday Times asked Ms Mills to walk through a day in her life at the height of her eating disorder to highlight the daily triggers that modern life throws up and how she has learned to deal with them. Now healthy and happy at 28, six years after her disease reached its peak, Ms Mills also had advice to offer not just to sufferers but to friends and family about how to make it through to the other side. “My day would start and I remember waking up having dreams about food because I was that hungry,” she said. “I was so hungry that the first thing I did was eat my breakfast — I always had breakfast. (But) before I got out of bed I would check my hip bones to check there was no fat on them. “Then I’d make breakfast but it had to be weighed and measured, and if I got it under what I usually do I’d be happy with myself. It could not be one gram over. “It was extremely strict, it was the same breakfast every day: oats and cut-up strawberries on top, and measured almond milk but I only had almond milk because my dietician forced me. “I would walk after breakfast but first there’d usually be a panic attack because I needed to go faster than yesterday and I didn’t know how I was going to have the energy. “I had an app that measured how far I walked and how fast I walked and I’d base it off that, but I usually did have a set walk which would just increase every day. “So after that I’d come home and do sit-ups and squats. “I had to do a set amount. Obviously.” At the time, Ms Mills was working in Perth as a model. While on the inside she was sick and suffering, perversely, she found “the skinnier I got the more work I got”. And with that work came compliments about how great she looked. However, at the peak of her sickness Ms Mills was often too sick to work and would spend her days at home or distracting herself with cleaning or trips to the beach or the supermarket. “Between (my walk) and lunchtime it was really cleaning or, if I had work, modelling or going to the beach or anything but I would not sit, I would distract myself,” she said. Sometimes that distraction would include catching up with friends. But it did not happen often, both because of the stress involved if the catch-up involved eating or drinking, and because the disease had robbed Ms Mills of her personality and she could barely manage conversation. “(If we were going out) I’d have to check the menu to make sure there was something I could eat, and even then it was usually just too hard, it was not worth the panic attack that came before and after,” she said. “I felt like I couldn’t socialise. I didn’t have the brain power to have the conversations, so that was another thing.” Social media was another potential distraction for the then-22-year-old, but it could prove to be a major trigger. Even the most casual user of social media will be familiar with the ubiquity of skinny, semi-clad women online. Instagram, in particular, is the natural habitat for influencers flogging “skinny tea” or wannabe influencers showing off their thigh gaps. US studies have suggested a link between Instagram use and both heightened body image concerns and orthorexia nervosa — a form of disordered eating that manifests as an obsession with healthy eating. Because Ms Mills worked as a model, she felt obliged to follow models and modelling agencies on social media to keep up to date with trends and contacts. As a result, she was constantly exposed to unrealistic images to which she felt she must aspire every time she picked up her phone. “Being in the industry that I was, I really wanted to get work so I’d follow modelling agencies and stuff like tha,t and that’s how I knew what I had to be and the size I had to be,” she said. “I don’t know if that’s healthy for anyone but especially when you’re ... it’s very difficult when you’re not naturally built that way.” Lunch meant another meal to be navigated. “I tried to get out of the house to buy my lunch,” Ms Mills said. “I’d try to get something as low-calorie as possible, so whether it would be salad or a five-packet of sushi or those rice paper rolls that had nutritional information on the side. “Even if I was cooking, I could do the maths in my head (to work out the calories). If I wasn’t working, the afternoon was a tough time so I’d usually go shopping to the grocery store to distract myself. “I’d try to distract myself but then I’d get to the point where I’d get in the pool and swim laps, and it got more every day.” At the time Ms Mills was living with her mother, who was naturally worried about her daughter. Her mother’s presence meant a healthy meal at dinner could be guaranteed, but Ms Mills would have only a small serving of what was on offer, despite feeling ravenous enough to eat the whole thing. In hindsight, she can see how well-meaning comments, whether from her mother or friends in whom she had confided about her disease, could be triggering. “I think the worst one was when I was trying to get better and they would say, ‘You look so much healthier, you look so much better’, because to me that was just saying, ‘You’ve put on weight’, which is someone’s biggest fear when they’ve got an eating disorder,” she said. “I think that’s what makes it so hard to recover from an eating disorder. It’s not like drug addiction or cancer because you’re so scared of the thing that makes you better.” Many 22-year-olds might want to spend their nights out partying with friends, especially those working in the supposedly glamorous world of modelling. But not Ms Mills, who was constantly battling exhaustion and anxiety that made it tough to leave the house for long. “It (going out) wasn’t part of my life,” she said. “I couldn’t. I was just so anxious so if there was a chance I would have to consume food or drink, I wouldn’t go or I’d go for a little while and I’d come home. “My nights were very similar. I had to have my routine at night-time and I was exhausted by that stage. I’d lost my personality as well.” It took time, the help of psychologists, doctors and a stint at The Hollywood Clinic, a mental health facility that specialises in eating disorders and anxiety, for Ms Mills to make it out the other side. From the vantage point of 2020, she can see how very abnormal a “normal” day for her must have looked to an outsider. And while she is “well on the road to recovery”, even now it is possible for old habits to reappear. In the early days of the pandemic, when WA supermarkets were being stripped of their basics, she had to fight the urge to give in to them. “I had to push back against it,” she said. “When the whole ‘Get your brown rice and stock up on your staples’ was a thing, I remember getting excited and thinking this could be an excuse to restrict. But you can’t go wrong in recovery if you just keep eating — that’s the only way you get through it. You just have to constantly make that choice, to eat the food no matter how anxious it makes you feel.” Ms Mills is also distanced enough from her disease to feel frustrated at the way in which the modern world promotes diet culture, from how friends are encouraged to talk to one another about food and their bodies, to the way some members of the medical profession rely on stereotypes — like the doctor who told her she was not skinny enough to be sick. “You’re bombarded with messages of diet culture: this is what you should be eating, this is the way you’ll look if you eat this amount, and this is what happy looks like, when you’re aware that happy doesn’t have a look,” she said. “You start to notice it more and more. I get angry, still, and I think everyone who knows me knows how much I hate diets. I used to work in a hair salon where there was always talk about diets ... it’s the way women speak to each other. “Eating disorders don’t discriminate. It doesn’t matter your age, gender or weight. “I want to emphasise the weight bit: it doesn’t matter what that BMI says, you’re sick enough to get help. “If you get a doctor who says you’re not sick enough, find a new doctor.” Eating disorder statistics in Australia have been on the rise for years, with the number of eating disorder hospital admissions in WA alone up 165 per cent between 2010 and 2018. The coronavirus pandemic has exacerbated the problem, with eating disorder helplines in Australia reporting a 40 per cent increase in calls for assistance or advice since the start of the pandemic. In the US, the numbers have been more like 70-80 per cent, according to the National Eating Disorders Association. According to Australia’s Butterfly Foundation, a national support service for eating disorders, that is down to a number of factors. Specific pandemic triggers can include a disruption to food shopping routine and food availability and isolation that shuts people off from their support services. The closure of gyms, which could disrupt exercise routines, and difficulty or delays accessing medical professionals during lockdowns could also amplify symptoms being experienced by sufferers. The stress and trauma that has come with the pandemic could see people who have never been diagnosed with an eating disorder experience symptoms for the first time. These days, Ms Mills is studying dietetics and mentoring others living with eating disorders in the hope her experience can help people in similar situations make it through to the other side as she has done. “The diet industry ... make their money off the fact that they don’t work,” she said. “So I think there’s a lot that people are fed and they just don’t realise they’re maybe not unhealthy, they might have weight on them but they’re not unhealthy. “It (my illness) made me realise who I am and who I want to help.”