Food for Thought

Rady Children's helps teen overcome eating disorder

By Jeanne Bellezzo

Anna's eating disorder began in sixth grade when classmates teased her about her muscular athlete's body.

For as long as she can remember, Anna Rocco has strived to be the best.

“I pushed myself to be the best soccer player, the best volleyball player,” says Anna. “Making a mistake on the soccer field or getting a low A instead of a high A was unacceptable.” Anything less than perfection, she says, created extreme anxiety.

What Anna calls the “perfect storm” — perfectionism, anxiety and athletics — took its toll in sixth grade. When classmates teased her about her muscular athlete’s body, she became determined to lose weight. Though she started with small changes – swapping white bread for whole grains, cutting back on sweets and counting calories – she quickly began to obsess. She constantly calculated calories,worked out excessively and drastically cut back on food; instead of eating a whole sandwich, she ate half, and then only a quarter. Her weight dropped quickly.

“I never stopped eating completely, so I convinced myself I didn’t have a problem,” Anna says. But within a month, she was considered underweight. While her parents were initially supportive of her healthier approach to eating, they soon realized something was very wrong. Her mother, Erika, took Anna to a pediatrician, who suspected an eating disorder. She sent Anna to a dietitian, who sent the 12-year-old home with a meal plan outlining exactly what to eat.

“I couldn’t follow it,” Anna recalls. “When I looked at the meal, I would get upset and anxious. I just saw numbers.”

Within weeks, Anna’s heart rate and blood pressure plummeted, and she was having digestive problems. She was admitted to an Orange County hospital, officially diagnosed with an eating disorder and prepped for a feeding tube. She vividly remembers being unable to eat a banana, despite the fact that her body was shutting down from starvation.

“I was completely taken over by my disorder,” she says.

Anna was transferred to a residential treatment center and not allowed to see her family. She was discharged after a few months, but she was far from well.

“We really were rookies,” recalls Erika. “We didn’t know who the right people were to contact.”

Over the next few years, Anna was in and out of treatment at various centers. In late 2011, after yet another relapse, Anna’s heart rate and blood pressure were severely unstable. Because of her unstable vital signs and potential irregular heartbeat, she was admitted to the Medical Behavioral Unit at Rady Children’s Hospital-San Diego, the only child and adolescent medical/behavioral inpatient unit in San Diego.

The Right Place

From the start at Rady Children’s, Anna felt she was in the right place. “It was really amazing that the doctors and nurses were able to take so much time with me even with all the other patients they were caring for.”

Anna’s doctor was Karen Loper, M.D., an adolescent medicine specialist and associate clinical professor of pediatrics at UC San Diego. “Eating disorders are very, very powerful. They will color the way patients view almost every aspect of their life,” Dr. Loper explains. “So we have to be very firm with the rules and the structure of our program, but also caring and compassionate to let them know we do understand how hard it is for them to overcome their really powerful impulses and compulsions and these horrible thoughts that make them feel awful about themselves all the time. We do everything we can to be positive and praise even very small progress.”

Once Anna was stable enough to get out of bed, she began to attend the UC San Diego Adolescent Day Treatment Program for Eating Disorders. Using a wheelchair because her heart was so weak, Anna attended the intensive program during the day and returned  to her hospital room at night.

Between the outpatient program and the inpatient care, she finally began to make real progress.

“I felt someone really cared, not just as a professional but as a person,” Anna says. “When I could not finish a meal they would take time to motivate me in the right way.”

After two months of intensive treatment, Anna was released. “It was the first time since sixth grade that I was not overtaken by my disorder,” she recalls. She has been in recovery for more than three years and attends the University of Nevada, Reno, where she is now a junior majoring in public health. Anna says she is also working toward a minor in substance abuse. "I plan to further my eduation after graduation by going to P.A. school and receiving a specialization in Neurology. One day I hope to study eating disorders and addiction in the brain."

Since her recovery, Anna has shared a passion for breaking mental health stigma. She has worked through her sorority to develop programs promoting healthy body image awareness and maintains strong ties with the hospital. "My relationship with Rady Children's continues to stay strong. I love helping the hospital that played a huge role in who I have become today. In the future, I hope to work at Rady Children's and be a part of their mission to make families feel that their child is one of their own."

The biology of eating disorders

Eating disorders can be deadly; more than 10 percent of people with anorexia will eventually die from them. Developing a better understanding and approach to treatment of these complex disorders is vital. Fortunately, tools such as brain imaging and genetics provide a greater understanding of the behaviors that drive them.

“Biology may be responsible for the transmission of certain genetic traits that make some people more susceptible to eating disorders,” says Walter H. Kaye, M.D., director of the Eating Disorders Programs at Rady Children’s Hospital-San Diego and UC San Diego and a UC San Diego professor of psychiatry. 

“Traits such as anxiety, obsessiveness, perfectionism, and being very achievement-oriented are often seen in these individuals long before they become anorexic or bulimic.”

Anxiety, especially, appears to play a powerful role. While most people who go without eating for a long period respond to food with pleasure, people with anorexia seem to have an opposite response: food makes them anxious, and eating makes them uncomfortable. Brain imaging shows that the pleasurable response to food is lacking.

Though researchers don’t yet fully understand the biology behind this, Dr. Kaye explains, it is helping them develop more constructive strategies for dealing with the temperament that goes along with anorexia. For example, instead of blaming the family for contributing to the disorder, a better approach is to involve the family in understanding the disease and learning positive approaches to encourage eating.

Originally published in U-T San Diego, October 2013