Q: In the NOVA program, sufferers mentioned being encouraged in their behavior by material addressing eating disorders (The Karen Carpenter Story, a book on bulimia, etc.). That being the case, how is it possible to do preventative work? I'm an educator and would love to create a program that could stop the disorder from occurring in the first place. Is the mere mention too contagious to discuss until after onset? Do you have any suggestions? Thank you for your time.

Melanie from New York

Johnson: Melanie, the issue of prevention in the area of eating disorders is indeed complicated. The principle complication is that the illness is essentially embraced and even glamorized in our culture. We do not face quite the same issues in our prevention work with drugs, alcohol, sex, smoking, etc. We have tried to focus our efforts more on preventing dieting and accomplishing self-esteem through other means than manipulating one's size and shape. We try to be careful to not suggest methods of weight control like vomiting, laxatives, diuretics, etc. There are some very good prevention materials that have been developed that artfully navigate these thorny issues. I would recommend that you visit the Eating Disorders Awareness and Prevention and the Harvard Eating Disorder Center Web sites (see Help/Resources) for more information about prevention materials that are available.

Q: My concern involves eating disorders among men. It would seem that recent proliferation of skinny, flat-abs men in the media (especially in fashion/fragrance advertising) would be having a negative effect on mens' health overall or at least their perceptions of themselves (much like society has been doing to women for over a century now).

I know increased exposure to this has affected my opinion of myself, which manifests itself in other forms, including social phobia all stemming from this need to be perfect. I am at a point where I don't let people get close to me and avoid social situations because I always feel like I am "on" and people are looking and criticizing all my flaws. This has also negatively affected any potential romantic relationship I could have because I feel that no one would want to date someone with my body type. And that sex with someone of my physique is anything but beautiful. I am a 23-year-old, 5'9", 145-lb. white male.

I guess my question is what is the status of eating disorders among men? Has there been an increase? If so, why? Is anything being done to address this? Or am I the only guy that feels this way about myself? The show on NOVA was very well done, it's just hard for me to relate because I'm male, though the causes may be similar to some extent.

Peter from New York

Johnson: Peter, eating disorders among males is receiving increasing attention. You're right, the cultural emphasis on thinness, fitness, and perfect bodies has caught up with men. We are seeing an increased request for help for eating- and body-related problems from men. In a sad way it is a powerful comment on how much the sociocultural emphasis on thinness contributes to the onset of these illnesses.

Interestingly, the biopsychosocial issues driving the illness are about the same for men as for women. Likewise, all of the same recommendations for treatment hold for men as for women. Often, it is harder for men to ask for help because the illness is so highly identified with women. There are two new books about eating disorders and men that are quite good: The Adonis Complex : The Secret Crisis of Male Body Obsession, by Harrison G. Pope Jr. M.D., Katharine A. Phillips M.D., and Roberto Olivardia Ph.D.; and Making Weight: Men's Conflicts with Food, Weight, Shape & Appearance, by Arnold Andersen, Leigh Cohn, and Thomas Holbrook (see One Man's Battle). Both books can be obtained from Gürze Books, www.bulimia.com, 800-756-7533.

Q: A lot of my friends lately have been noticing some of my tendencies and habits of anorexia and are concerned about it. I'm starting to worry too. I didn't think it was very serious. I am 13 years old. I am 5'4" and weigh 102 pounds. I wish to lose weight. Recently I have been doing certain things that seem to be characteristic of eating disorders, but I'm confused about which disorder I have—anorexia nervosa or bulimia nervosa. Some of my habits and tendencies include: Trying to lose ten pounds, only eating one meal (or less) a day, hating it when my friends watch me eat, trying to throw up, stepping on a scale after I eat anything—the list goes on. I'm confused because sometimes I binge too. I know that bingeing is part of bulimia, but I have so many other habits of anorexia that I don't know what it is that I'm dealing with. What I'm looking for is some information on my condition and some treatment possibilities. If you could please help me, I would really appreciate it. Thank you.

Katherine from Minnesota

Johnson: Katherine, you are showing all of the signs of someone who is struggling with an eating disorder. Don't worry about which of the categories you fit in. The most important thing is that you immediately ask for help. First, let your parents or some other adult that you trust know the things you are doing. Second, allow yourself to visit with a professional that is familiar with eating disorders and the issues that girls your age face. I am so glad that you took this opportunity to let us know that you are having trouble. But you have to take the harder step now and let someone know who can directly help you. The thoughts and behaviors you describe will only get worse. It will be much easier to help you now.

Q: I want you to understand that writing this letter to you is a big step for me. I am an 18-year-old ballet dancer who suffers from bulimia. I do not overeat and then purge, but I throw up most of what I eat. In the past six months I have dropped 20 pounds. I was never heavy, but now I am happy with my weight for a ballet dancer, which is 110 pounds at 5'7". I do want to stop; I'm very ashamed of what I do and want to get help. I do this in secret, nobody knows at all. My question is: How can I go back to eating healthily, without gaining weight? I know my metabolism is probably messed up somewhat. Can you advise me on what foods to start eating so that I don't gain weight back? That is my ultimate fear. Thank you. I hope for a response soon because in a few days I will be going home for Christmas break to be with my family and won't know how to deal with all the holiday food.

Laurie from Oklahoma

Johnson: Laurie, your question raises several very important issues. Many people who have eating disorders use purging behaviors such as self-induced vomiting, but do not overeat or binge eat. The symptoms you describe are very familiar to us, and we can usually be quite helpful. I would strongly recommend that you consult with a professional who has had substantial experience with treating eating disorders.

You are living in a world that makes recovery very difficult. Recovery for ballerinas, models, athletes, and entertainers is usually more difficult because one's identity and/or livelihood is tied to these roles and being thin is usually one of the criteria for success. For folks who are naturally thin this is not a problem. If you are not naturally the size and shape that is being idealized, then one can begin to resort to more and more desperate measures to look the way you think you have to in order to continue in the field. Many, many talented young women have unwittingly ruined or compromised their abilities by trying to make themselves a size and shape that is not normal for them. Many young women drive their weight down and perform more poorly over the course of time. They may experience some initial performance enhancement, but the semi-starvation, purging, excessive exercise, etc. eventually harms more than it helps. Please seek expert professional help before your skills begin to deteriorate.