Never in my professional life as a dietitian have I seen such a silent, sad, suffering disease as that of anorexia nervosa. This is truly an all-consuming mental and emotional disease that not only consumes the person who it attacks but also everyone he or she comes into contact with.

The problem with anorexia nervosa is that it is not a loud disease, it is not an acute disease, one which brings you into the hospital quickly like appendicitis might, nor is it necessarily immediately obvious that someone has this disease. It is he exact opposite of obesity, and it too can be a killer.

I currently have a patient at the hospital, she is 5'1" and she entered weighing a miniscule 55 pounds, or approximately 52-53% of her Ideal Body Weight.

She is 20 years old.

What you don't see when you walk into her room is a happy go-lucky girl, what you won't see is a smile, what you won't see is color or joy.

No, what you will see when you walk into her room is a girl who says she is 20 years old yet appears as though she is 100. Her eyes look far larger than should be "humanly" allowed, eyes that stare at you longingly and fearfully.

As the dietitian, to her I am both the devil and best friend.

I am the one person in the hospital who can sympathize with her desire to know how many calories are in various foods, how much fat, and how much salt. I am the one person who understands how to put a meal plan together, and for that I am her best friend.

Yet, I am also the devil, because to her I represent everything she does not want. She knows I can recommend to doctors that she be forced to eat at least 300 calories per meal for a grand total of 900 calories a day, or that if she can't, then I can devise a plan to feed her through an IV the calories she so desperately needs before her body decides to end its life completely.

What she sees when she looks in a mirror is a "fat" girl, someone who if she eats is not perfect, is not loveable, and is a failure. She sees someone who needs to lose ALL weight. I have never seen anyone so afraid of a calorie, of a grape, of life-providing water.

What I have is a girl before me, refusing to drink even 1 cup of water, because she knows if she does and steps on the scale, she'll have "gained" weight.

While most of us could eat or drink 50 calories, about the equivalent of 1/2 cup of milk, 1/2 cup of grapes, or 1/2 cup of applesauce in a matter of seconds, could take her all day, a full 12-24 hours to eat or drink.

Now, I understand I have just described the worst of the worst of anorexic behavior, yet, it's a downward spiral.

Silent Sad Suffering.

This disease typically begins during purberty when a girl normally puts on a significant amount of weight because of hormonal surges and of course well, puberty. This is scary and if someone does not understand what is going on can become extremely devastating, what with the harsh words other kids and teenagers say.

So, to feel better, a boy or girl may decide to lose weight and begin to cut back on foods, food groups, or exercise a little more. For parents, it is hard to decipher normal teenage behavior from behaviors that slowly become more dangerous. Also, as a parent, what role should you have in determining what or how much your child is eating? These are difficult questions.

But, it is so devastatingly sad to walk into a room with a girl who is on the brink of death and cannot cognitively see that, all she can focus on is the number on the scale, the size of her wrists, the circumference of her thighs, and the image she sees in the mirror.

What happens when the number gets too low? Silent Sad Suffering, and eventually death.

Author's Bio: 

Dana Ellis, MPH, RD grew up in Clearwater, FL with an avid interest in healthy living and exercise thanks to a mother and father who taught her the importance of healthy living. Dana danced from the age of 3 all through college. Dana attended Cornell University in Ithaca, NY in 2003 earning her bachelor’s degree in Human Biology, Health, and Society, and Nutritional Sciences. She fell so in love with nutrition and how what you eat affects your health that she decided to pursue a career in nutrition. Dana completed her dietetic internship at Emory University in Atlanta, GA and moved to Los Angeles already a Registered Dietitian. Soon thereafter, she obtained a position as a clinical dietitian at UCLA Medical Center and has been working there almost four years transitioning from the general medicine floor to being the cardiac/heart transplant dietitian. Within a year of moving to Los Angeles, Dana realized how much she missed school, went back, and obtained her Masters in Public Health here at UCLA while working. Dana has had the opportunity to do public speaking at law firms, in the School of Public Health as a guest lecturer, and for staff at the Medical Center.