SouthFlorida.com | City Link Magazine

On a Thursday morning in March, about 20 women sit in a recreation room at The Renfrew Center in Coconut Creek, passing around a basket of stones engraved with inspirational words such as hope, balance and change. At this meeting, known as "community," each newcomer draws a stone that has a special meaning for her and begins to talk about food, sometimes through a flood of tears. The group includes students, mothers, athletes, businesswomen, a valedictorian and even a ballet dancer. All have at least one thing in common: an eating disorder has ravaged their bodies as well as their minds.

Kranthi Pushpala has attended many of these meetings since checking into the center this past December. The 24-year-old from Houston has been battling bulimia for 11 years.

"A big part of recovery is being able to tell your story," says Pushpala, who, during community, encourages the other women in the group to talk about their disorders. "Now that I look back on my life, I was in a vegetative state. I didn't know how people could eat and be OK with it. I [would have been] happy to make it to 35 or 40 [years old]. I was just waiting to have a heart attack."

Pushpala's eating disorder developed after her parents reunited following a 10-year separation. "My dad came back, and he was an alcoholic, in and out of rehab. I thought about food all the time. I couldn't even go to a movie without wanting to leave so I could engage in symptoms," she admits, using Renfrew-speak for "purge."

To the outside world, Pushpala seemed to have everything going for her. She was pursuing a master's degree in accounting at the University of Texas at Austin and even spent three months studying in London. "I traveled, but it was miserable. Half the time, I couldn't even get out of bed because I wasn't eating," she says.

Pushpala based all major life decisions around her eating disorder. "I went into accounting because it was stable and I thought, 'If I get really sick, I can always get another job,' " she admits. "Even when I got into relationships with men, I'd think, 'If I get sick, can he support me?' It was always about someone taking care of me."

In another traumatic twist, her uncle was murdered three months before she checked into Renfrew. "I went into a deep depression," she says. "But I knew I had to change."

Pushpala is one of 10 million American women struggling with an eating disorder. While it may be tempting to stereotype these women as people who simply don't want to eat, the root of their problems often isn't food.

"Depression, anxiety and post-traumatic stress disorder are often linked with eating disorders," says Dr. Heather Maio, a group leader at Renfrew. "A large percentage of the women have had some form of physical, sexual or emotional abuse. Many of them also struggle with substance-abuse issues."

Disorders such as anorexia and bulimia have been making headlines since the passing of pop singer Karen Carpenter in 1983. But they have drawn renewed attention in recent months following the deaths of three models.

On Aug. 2, 2006, during Fashion Week in Uruguay, Luisel Ramos walked a runway for the last time. The 22-year-old, 5-foot-9-inch, 98-pound model suffered heart failure caused by anorexia nervosa and collapsed near her dressing room. Ramos was reportedly surviving on a daily menu of Diet Coke and lettuce. Three months later, a 21-year-old, 88-pound model named Ana Carolina Reston died of anorexia-related kidney failure the night before a photo shoot. Her strict diet of apples and tomatoes was no longer enough to sustain her 5-foot-7 frame. Then, on Feb. 13, Ramos' 18-year-old sister Eliana, who was also a model, died of a malnutrition-related heart attack.

In response to these deaths, both Milan and Spain banned any model whose body mass index is less than 18 from participating in fashion-related events. For example, a 6-foot-tall model with a BMI of 18 would weigh 133 pounds. The rest of the world, however, continues to obsess over superskinny starlets such as Nicole Richie and Mischa Barton, whose drawn faces and emaciated bodies grace magazine covers worldwide. This is unlikely to change anytime soon.

"Every shape is beautiful, and it is hard to feel that way when you look at the celebrities and models in the magazines every day," says Karelle Levy, the Miami designer behind the women's clothing line Krelwear. "The body mass index is a great way to keep the models in check with their health. I work with extremely thin models sometimes, and that even reads in the photos, which is not really an attractive thing."

Cece Feinberg, whose public relations firm has organized countless fashion shows in Miami, points out the fine line between fantasy and reality in the fashion world. "My thought is that magazines are to some extent for entertainment purposes," she says. "Few people can afford all the clothing and jewelry shown in a fashion spread, so why should people think they need to attain that body image? The girls are meant to be mannequins, fantasy figures."

As the prevalence of eating disorders continues to rise, more people seek treatment at facilities like The Renfrew Center, which also has locations in New York, New Jersey, Pennsylvania and Connecticut and specializes in treating patients with anorexia, bulimia and binge-eating disorders. Last year, it became the setting of the HBO documentary Thin. While the film focuses on patients' rule-breaking behaviors -- such as swapping prescription drugs and sneaking out of the center to get tattoos -- it neglects to portray Renfrew's stated mission, which is to help patients recover from their afflictions and live a normal life.

The grounds of Renfrew look like a private-college campus. Patients dress in Ugg boots, Juicy Couture tracksuits and sweatshirts that bear the names of their home states, including Kentucky, Michigan and Massachusetts. Each patient carries a binder with a clear-plastic front pocket that typically displays family photos and other reminders of life beyond her eating disorder.

Throughout Renfrew's manicured halls, patient artwork decorates the walls with affirmative messages such as, "I'm worth loving" and "Beauty is everywhere." Some of the handwriting is so tiny it's barely legible, as if the person who wrote it wants to literally disappear.

In one hallway, women line up to receive medication from a nurse behind a window. Some clutch stuffed animals, others sort through their Louis Vuitton and Coach bags. While several women wait for a simple vitamin pill, the majority of Renfrew's patients are on some type of medication for depression, anxiety, ADHD or bipolar disorder.

"Our treatment approach is highly relational," says Dr. Gayle Brooks, a psychologist and Renfrew's clinical director. "We help them to learn how to have connections with people rather than having the relationship be primarily with their eating disorder."

Renfrew has an intensive psychotherapy program. Patients meet with a therapist four times a week and attend nearly 50 groups a week. "They're also meeting individually with a nutritionist," Brooks adds. "We're very focused on life after Renfrew, as well. They often have control of symptoms [only] when everything is controlled around them."

The minimum stay at Renfrew is 30 days, but most patients stay five to six weeks. "We have some residents stay with us for several months," Brooks notes.

The age of Renfrew's patients averages 13 to 42, but women as old as 60 have stayed here. The center provides a range of care, from the highly structured residential treatment to intensive outpatient care, in which patients visit the center three nights a week to eat dinner and attend two groups. It currently accepts only women as residential inpatients.

"We have nutrition and cooking classes, so patients can learn how to prepare healthy meals," Brooks says. "We also have restaurant and supermarket excursions where women learn to make food choices."

While many women leave Renfrew fully recovered, about 25 percent relapse and return for additional treatment. "This is a progressive illness, and a person can come into treatment at a certain level of readiness to change," Brooks explains. "Sometimes, they come in not even knowing they have a problem. They may leave knowing they have a problem but not do anything about it. Then, they come back feeling like they want to work on it."

Brittany Doherty, a 19-year-old from Dallas, recently checked in to Renfrew for the first time, after six unsuccessful attempts at treatment at other facilities. "Before I came here, I was at Presbyterian Hospital in Dallas on the cardiac floor," Doherty says. "Renfrew saved my life."

Doherty's eating disorder developed when she was 13. "One of my good friends went into the hospital for anorexia," she recalls. "I didn't even know what it was, but when I found out, it made me look at myself and start worrying about my body more."

She started playing with her food and stopped eating carbohydrates. Two years later, she was hospitalized for malnutrition. "The first time I was hospitalized, Atkins was really huge. It was all over TV and magazines, and I wouldn't go near carbs. Carbs were just so scary. I was just eating vegetables and maybe an apple all day," Doherty says. "Then, fat was a bad word, so I would eat nothing with fat. Then, I realized it wasn't about the food. It was about how I'm feeling and how I take it out on the food."

All that dieting damaged her heart. She credits Renfrew's therapy and processing groups with giving her a real shot at recovery.

"Art therapy has been amazing. We write down whatever negative thoughts we're having on an index card, shred it and make art out of it," Doherty says. "In dance-movement therapy, you move how your body is telling you."

The center customizes menus to suit each patient's nutritional needs. "On a typical day, I have to have six proteins, three dairies, seven starches, two fruits and vegetables, and five fats," Doherty explains. "Then, I have snacks like a granola bar and cheese or cereal and milk."

Sloane Baby checked into Renfrew Oct. 13, 2006, for anorexia and overexercising. When the 18-year-old Auburn University volleyball player began feeling too weak to play, her family and coaches urged her to seek treatment at the center.

"Preseason was intense. We'd practice and play six days a week," Baby says. "On the seventh day, I wouldn't just rest. If I didn't go to the gym every day, I'd feel guilty."

Baby spent 104 days at Renfrew before her Jan. 24 release. "When I first got out of treatment, I used to read fitness magazines," she says. "Everything you read in the tabloids or women's magazines is how-to-lose-weight tips. Image is such a huge part of our culture. I can't escape it."

She currently lives in Clearwater and is working part-time at a coffee shop. "I'm now allowed to exercise three times a week, and I learned how to have flexibility in my workouts and food choices because I was so rigid," she says.

Like many patients before her, Baby placed a pair of shoes in the center's Healing Garden upon her exit to symbolize her path toward recovery. She is planning to attend a patient reunion in June.

Jaclyn Heyen is hoping to join her. Heyen was born and raised in a small Nebraska town. She came to Renfrew six years ago after restricting her food intake, overexercising and abusing laxatives. She was also a cutter, which often resulted in her being Baker Acted, that is, sent against her will to various psychiatric hospitals. The 5-foot-10-inch singer was surviving on one Snickers bar a day and exercising for eight hours straight.

"My parents dropped me off at Renfrew and didn't give me a plane ticket home," the 28-year-old says. "They basically disowned me over the phone."

Since last August, Heyen has been performing at Renfrew's weekly inspiration celebrations, during which patients express an aspect of their spiritual self by reading poetry, singing or dancing. "Each week, we have a different theme, like peace, gratitude or humility," dance-movement therapist Susan Kleinman says. "I help the women reconnect with their bodies to experience their feelings and how they move through life. We give form to our feelings through our actions."

Heyen is now studying music technology at Florida International University and working with Kleinman to inspire women with eating disorders to feel whole again. While she says her stay at Renfrew helped her overcome her disease, she still struggles with it. "I've had my eating disorder since I was 9," Heyen says. "I'm much better, but there are days I have to push myself to eat three meals."