At 18, Lada considered herself “slightly overweight”. She left her home in Hlinsko in eastern Bohemia and went to London and returned a few months later weighing 35 kilograms.
Jana used to binge and purge four to five times a day. Her bulimia made her gain weight. After she went to the hospital for dehydration, a common effect of the disorder, she became anorexic and lost about 15 kilograms in two months.
Stories like these have become increasingly common in the Czech Republic, which has the world’s 15th-highest prevalence of eating disorders and the second-highest in eastern Europe, according to a study by Health Behaviour in School-aged Children (HBSC), an international organisation that conducts social surveys. The growth rate is especially surprising in countries that have only recently begun researching, diagnosing and treating people struggling with them.
Tip of the iceberg
“Doctors haven’t been thinking about eating disorders here,” said Tomáš Rektor, a psychiatrist and psychotherapist for Terapie.info, a publicly funded centre in Prague. The HBSC survey represents an important mark of this problem. One estimate states that 3% of the Czech population suffers from eating disorders. At 5%, the US has the highest percentage, according to the European Council on Eating Disorders. Rektor and other experts believe the Czech number lowballs the problem. “Most women who have an eating disorder either think they don’t have an eating disorder or are never diagnosed for one,” he said. “Diagnostics in other countries may be better, which would make their numbers higher than here. It is really unknown specifically how many people actually have an eating disorder.”
Expert Hana Papežová agrees that statistics only measure “the tip of the iceberg”. “[The studies] are really very complicated to be representative of the whole population,” she said.
Hazel Mycroft, a psychologist at Prague’s Lotus Counselling Service, said the impact of globalisation and western influences may have transformed the concept of beauty in the former eastern bloc. “There is no doubt there is more pressure on young people to conform to the ‘thin ideal’,” she said. “Thinness in the western world has been culturally synonymous with success and moral perfection. … Fatness represents laziness, lack of discipline, unwillingness to conform.”
A combination of therapies
For Lada, who had lost so much weight in the UK, the positive responses she got for her slimmer physique made it difficult to take note of her problem. “I have always been overweight, not really fat, but overweight,” she said. “My adolescence was badly affected by that. I went on many diets, but no luck. I came home [from London], and I became ‘the queen of the social life in Hlinsko’. After so many years, I was beautiful.” This fuelled her desire to get even thinner. “I stopped eating normally …” she said. “My friends were gone because I cared about nothing else but my figure. I had no social life whatsoever. I just behaved in very odd way, exercising all the time, eating half an apple a day.”
It took family intervention, which Rektor and Papežová say is the most important factor in recovery, to overcome her anorexia.
“There was this moment when my whole family started to talk to me that there was something wrong, and I always trusted my family a lot and also I knew there were things that I did that no one else did,” Lada said. “I decided for the psychiatric hospital first, but it didn’t help me much. But there was one doctor, and she sent me to this psychologist who used hypnosis and breathing methods. I spent three years there, and I started to put on weight. Then I started to stop thinking about food all the time. Then, I realized it was all over: I was myself again.”
Lada represents a rare success story among victims of eating disorders. Rektor said the majority of his patients go to him for therapy but don’t finish their treatment, which often includes psychotherapy as well as antidepressant and antipsychotic drugs.
Jana struggled with anorexia and bulimia as a teenager and into her 20. “It had gotten out of control. Even I realized that,” she said. “My parents and I decided to admit me to the hospital. At the time, I was very upset because I didn’t really want to get better, but I did it for my parents.” She underwent several months of daily individual and family therapy. While she knows she has come a long way and feels healthy, she sees a therapist weekly and still faces a difficult recovery. “What’s hard is looking at myself gaining weight and knowing that it’s all right,” she said. “I have to tell myself all the time I am not fat, but it’s so hard to convince myself.”
Rektor agrees with the idea that western influence may have contributed to the growing numbers, but also blames the rapid social development after 1989. “During communism, everyone worked eight hours a day, which meant people had eight hours a day to spend with their families,” he said. “Now, both parents work; children are left at school or with nannies.” He doesn’t think communism made families happier, but “the aims and goals were geared towards family then and are geared towards work now”. Rektor acknowledges the western influence, saying “we want to be like you – we want to wear the same clothes as you, we want to be as thin as you, we want to have the quality of life that you do”. Still, he believes this influence has diminished in the past 15 or 20 years.
Lada and Papežová say the Czech Republic is not as obsessed with thinness and body image as other countries. Still, Lada says young women face pressure here. “For young girls there is this black and white vision of the problem,” she said. “Either you are slim and beautiful and then successful in life or you are fat and ugly and consequently a failure.”
Doctors have asked the modelling industry to ban underweight models in the Czech Republic, Aktuálně.cz reported in March. Italy instituted such a policy in 2006. This spring the Academy for Eating Disorders (AED) met in Prague to discuss measures the country could take to prevent the problem from growing. The AED, for example, recommends that girls younger than 16 should not be allowed to model because “their underdeveloped adolescent bodies have been setting ill trends for ‘ultrathinness’ in the past decades”, according to the article. The doctors also suggested that models be required to present a certificate from their doctors stating that they are not underweight. The doctors believe this will promote a more positive and realistic image of women.
As information on eating disorders becomes more available, experts hope to find ways of prevention and treatment, but that could take a while. “Until society changes the dominant discourse which associates thinness and weight loss as universally good, then I think we will continue to have a problem with eating disorders,” Lotus Counselling Service’s Mycroft said.
Rektor agrees. “Eating disorder patients know that they are too fat, and their family and doctors know that they are too thin,” he said. “It means that this person has to change their entire perception of themselves, their values and how they view family.”
Jana still struggles with her image of her body and of eating. “Sometimes, I still see myself as fat, and my confidence is not there,” she said. “I can’t eat out with my friends or go to parties because I feel so uncomfortable. But I hope that this will change for me. It’s getting easier.”
Lada said that while she considers herself recovered, she didn’t have an easy time of it. “Since [I recovered], I have been overweight, but I don’t care any more,” she said. “I don’t think about it at all. I concentrate on my family, my house, my work, and I am a happy person. Sounds a bit like a fairytale, but the healing process wasn’t a fairytale at all, believe me.”