The death of a model in Brazil – 21-year-old Ana Carolina Reston, whose weight had gone down to 39 kilos – appears to have marked a watershed in the fashion business – politicians, medical experts and fashion houses are now coming out against the skin-and-bones standards sought by models, a trend that has made anorexia an epidemic that afflicts thousands of young girls. The symptoms of anorexia nervosa are massive weight loss and an inability to maintain a normal weight. This is due to self-imposed starvation. Sufferers restrict their food intake because they are afraid of getting fat; they have a distorted perception of their body image and, although hungry and thin, still believe they are fat. There are two types – those who reduce their food consumption to a minimum, and those who binge and then purge by vomiting. «Anorexia is a very serious disease that often leads to malnutrition and even death,» said Giorgos Panotopoulos, a physician and dietician who is the director of the Hygeia Hospital’s Obesity, Metabolism and Nutrition Clinic. «Treating it calls for particular caution, persistence and knowledge, requiring the participation of two doctors – a dietitian and a psychiatrist. The dietitian essentially takes the place of the usually emotionally distant father and the psychiatrist is a substitute for the mother.» In 90 percent of cases, the patients are women aged 15-25, but there is a steady 10 percent who are men, something that is often overlooked. In fact, although rare, it affects men particularly severely. Usually the patient refuses to eat, skips meals and will not eat most kinds of foods, even if they are healthy. According to Panotopoulos, anorexics usually reject fats, starchy foods (pulses and grains) as well as red meat. As their weight falls drastically, body fat almost disappears, muscles atrophy, the skin dries out, the amount of body hair increases due to lack of protein, while blood pressure and the rate of the heartbeat drop. «Unfortunately, diagnosis is usually late, when weight loss is considerable – over 25 percent of the original – because the symptoms go unnoticed or are underestimated both by patients and their families. The first step toward treatment is acceptance by the patient herself that she has a problem and needs help. In about 30 percent of cases treatment is successful – that is, the patient achieves an acceptable weight, resumes menstruating and does not develop complications. Another 50 percent continue as they are; they do not die but do not live well; they suffer from premature osteoporosis, anemia, social and psychological problems, loss of menstrual cycle, loss of interest in sex and fatigue, which creates problems at work. The disease often becomes chronic and death occurs in 8-10 percent of cases after a period of 10-15 years.» This article appeared in the January 14 issue of K, Kathimerini’s color supplement.