I overlooked numerous warning signs.
Occasionally, my daughter (I’ll refer to her as Olivia) simply wasn’t hungry. That was fine—fewer meals I had to deal with preparing. (Cooking is definitely not my favorite thing.)
She chose to prepare her own lunches for school instead of eating what the cafeteria offered. That was okay by me. I did notice her special breakfast burritos looked smaller over time, but I brushed it off.
Her interest in cooking and baking increased, and she started making meals for her sister and me while barely eating what she prepared. I didn’t think much of that either. And since she loved cooking, I didn’t question her obsession with food shows on television.
She was also getting quite into exercise—Pilates, running, that sort of thing. If I didn’t see where this was heading, I can only say it’s tough to notice warning signs when you’re not actively looking for them. As obvious as they seem now, they weren’t at the time.
Olivia appeared nearly perfect—bright, funny, considerate, with great grades and lots of friends, involved in both cheer and swim teams. Beautiful, tall, graceful, with flowing red hair and a charming gap-toothed smile. It was remarkable, especially considering our family was recovering from a huge trauma: the loss of Olivia’s dad, my husband, from a particularly aggressive type of brain cancer.
In the months following Bill’s death in the summer of 2022, I thought Olivia and her sister might have escaped unscathed from the ordeal. They seemed to be coping well. But my daughter’s eating disorder was the first red flag indicating that wasn’t the case. Olivia has allowed me to share her story. She has seen and approved this account.
Despite earlier signals, it took our annual holiday trip to my in-laws’ ranch for me to realize there was an issue. Olivia’s refusal to indulge in the festive meals was hard to ignore. While she wasn’t completely abstaining from food—well, that would be a later development—she was certainly eating very little. The moment that stands out the most was our dinner at a local pizzeria known for its circular fries, dubbed “spuds.” Olivia didn’t touch a single spud. Not even a bite.
A day or so after returning home to Los Angeles, Olivia wanted to run with me. When she put on her leggings and tank top, she looked alarmingly thin. At my in-laws’ home, we’d all been bundled in winter clothes, so this was my first glimpse of her in tighter-fitting apparel after what turned out to be rapid weight loss. I can clearly picture her: legs so skinny that her leggings danced around them, shoulder blades jutting out, her frail arms moving awkwardly as she pushed herself forward before collapsing in exhaustion.
Recalling my feelings during that moment is painful. Instead of concentrating on helping my daughter, I was consumed with shame about being seen with her. My once vibrant child had become a frail ghost, hunched on the roadside, her condition so unmistakable that anyone who noticed us could easily judge me as a negligent mother—or so I thought. I was fixated on what others might think rather than on Olivia’s distress. It’s a memory I wish I could erase.
That afternoon, I took Olivia to her pediatrician. Interestingly, it was January 7, 2025, the same day wildfires raged through Los Angeles. While our house was spared, the panicked atmosphere cast a surreal shadow over our own crisis.
The doctor took one look at Olivia and instructed me to head straight to the ER. She had gone from merely thin to dangerously underweight in just weeks. I was stunned. I would have been even more alarmed if I had known that, at only 12 years old, Olivia would spend the next nine months away from home—returning briefly only to fall back into old patterns. In retrospect, I consider myself lucky; she did eventually come home for good, when so many other children don’t.
This is the account of an illness that took so much from my daughter and our family, and the struggles she endured to reclaim her life. Olivia is now back at school and on the recovery path, but I still feel the lurking presence of her eating disorder, a constant threat trying to draw her back in. Each time she asks about calorie counts or declines a meal outside her structured diet, every mention of her feeling “fat”—which happens frequently—I can sense her illness nearby, like a predator waiting to spring.
For much of the past year, Olivia battled a severe form of anorexia, unable to grasp reality, fixated on losing weight she didn’t need to lose. She transitioned between various hospitals and treatment programs, hitting rock bottom in a Texas hospital where she had to be fed through a tube. By the time she was ready to confront her disorder, she’d missed so much of her childhood: birthday celebrations, school dances, family outings—all overshadowed by the relentless demands of her illness. Moreover, it pushed my parenting skills to the brink—a test that I’m still grappling with.
While this story centers on Olivia, it’s not hers alone. Eating disorders are more common—and deadlier—than I realized before Olivia’s diagnosis, and they’ve surged in numbers since the COVID-19 pandemic. Exact figures are elusive, because the government doesn’t track eating disorders like other medical conditions, which shows how little they are taken seriously as a public health issue. However, a prior study found that around 9 percent of Americans, or approximately 30 million, will experience an eating disorder in their lifetime, including about 2 million children and teens who will encounter this before they turn 20.
The pandemic created a perfect storm: isolation for kids led to excessive social media use and increased anxiety. Children’s hospitals noted a surge in emergency room visits for eating disorders during the early days of the pandemic, with those statistics failing to revert to pre-pandemic levels. Consequently, the crisis around eating disorders has only worsened, threatening more young lives.
Eating disorders rank among the highest for mortality rates among mental illnesses, with studies indicating that about 5 percent of patients die within four years after diagnosis. Anorexia is particularly perilous, carrying risks of organ failure, heart complications, and suicide.
Anyone can develop an eating disorder, and of course, there’s no single cause. Family history, mental health issues like trauma and anxiety, and the influence of social media can all contribute, with images promoting thinness often glorified. Eating disorders can seem like a false sense of control in chaotic environments, even though succumbing to one actually means losing control—similar to addiction. Olivia’s struggle, I ultimately realized, served as a coping mechanism in the wake of her father’s passing. It provided an outlet for her distress while leading her to chase after the unrealistic goal of achieving a thinner appearance.
After leaving the doctor’s office that January afternoon, Olivia and I spent tense hours at the UCLA emergency room, where they specialize in acute eating disorder treatment. She was admitted that night, and soon I felt way out of my depth as medical staff began discussing “meal plans,” “refeeding,” and “supplements,” terms that were completely foreign to me at that point—a clear indication of my naivete. I assumed Olivia would recover at the hospital and return home quickly, but it would take me some time to realize we were only at the start of a long and treacherous journey. It became evident that Olivia wouldn’t be home again anytime soon.
Our daily routines there revolved around Olivia’s meals. Their approach was “food as medicine,” necessitating she consume around 4,000 calories a day, split between three meals and three snacks. When it was time to eat, they presented her meals with a half-hour countdown. If she didn’t finish in that time—and she typically didn’t—she had to supplement her meal with a protein drink to complete her caloric intake. When the mealtime ended, a nurse would assess what remained on her tray, and regardless of how little was left—even a small amount of ketchup—they would ask Olivia which flavor of the supplement she wanted. The nurses were trained to remain neutral, avoiding any comments about her food intake, and I admired their consistency. Even if she had eaten nothing, they just picked up her tray and in a calm tone, asked if she preferred strawberry, chocolate, or vanilla. Olivia would usually opt for strawberry. Afterward, she had another 15 minutes to finish it, with the looming threat that failing to do so would lead to immediate tube feeding. Olivia was so fearful of that consequence that she always finished her supplement.
Every morning at 6, Olivia was weighed. They had her use the restroom first and would only weigh her in a hospital gown. The scale’s numbers were kept hidden, so she never knew her weight. Mirrors were not allowed in her space; a bathroom mirror was covered with paper mats that would repeatedly unstick. She wasn’t permitted to enter the bathroom except for showers; most of the time, she used a bedside commode that nursing staff monitored to keep track of her output.
Once she was strong enough, Olivia began to take short showers and go for brief walks. Initially, those walks were confined to the unit, but eventually, she was allowed outside to stroll in a courtyard filled with trees, grass, and paths, though it also had its share of rats. At all times, she was attached to a heart rate monitor via electrodes on her chest and had to carry a bulky device that resembled a shoebox. I sometimes offered to carry it, but since it was connected to her by a short cord, I had to stay close, making sure it didn’t pull at her. More often than not, she’d yank it back, insisting on carrying it herself.
During these walks, Olivia seldom encountered other eating disorder patients. When I was nearby, I glimpsed other disturbingly frail individuals in hospital gowns, but they rarely crossed paths. It seemed like the opportunities for them to compare each other were painstakingly avoided.
At the hospital, a unique contraption acted as Olivia’s constant companion—a peculiar device that resembled a talking robot. This “telesitter” was a rolling, missile-like design outfitted with audio and visual equipment that allowed the staff to monitor her at all times.
“No exercising, please, Olivia!” the telesitter would announce if she moved her legs too much. She was permitted no formal exercise aside from her walks, and the device had strict criteria for what counted as exercise. Sometimes I sensed Olivia attempting to sneak in extra movements, though at times, she might have been simply fidgeting unconsciously.
After several weeks, Olivia’s hospital stay was approaching its end, and her treatment team encouraged transitioning her to a “residential” program, a home where she could reside with other teens suffering from eating disorders. I was still clinging to the hope she could come home instead, so I sought a final discussion with the head of her program. This doctor was both highly qualified and somewhat intimidating; she was the go-to person for pressing questions. No doubt to avoid crowds, she appeared at Olivia’s bedside spontaneously, much like a magical figure, often when I wasn’t around. Nevertheless, I sought her out for clarity about what would happen if Olivia didn’t go to residential and what her chances were of ending back in the hospital instead.
“One hundred percent” was her immediate answer.
That sealed the deal, and I informed Olivia she’d be moving to residential directly from the hospital. She burst into tears and fell to the floor, a pale figure in a flimsy hospital gown, tethered by wires to a heart rate monitor and to me.
“Please, Mommy, don’t make me go; I don’t want to go!” She wailed, but I had to be firm, and Olivia demanded I leave her room.
If there’s a villain in this tale, it’s the insurance company. I was troubled to learn that our insurer, more than anyone else, dictated when Olivia’s hospitalization would end, as they would stop coverage once it was deemed no longer medically necessary. Doctors were supposed to decide that, yet they faced constant scrutiny from the insurer, which second-guessed their decisions. Over time, I became increasingly aware of just how influential the insurer was in every aspect of Olivia’s care, and this was deeply concerning. Since determining treatment duration seemed highly subjective, it felt unsettling that insurance representatives who had never met Olivia made key decisions about her care. Most of the time, I was satisfied with the outcomes, but I gradually understood that this was largely due to Olivia’s healthcare providers tirelessly advocating for her with the insurer.
Treating eating disorders presents numerous challenges. It’s a mental illness centered on bodily issues, so effective treatment must address both aspects, leading to many complexities. Patients often don’t recognize the severity of their condition, insisting they are fine, that they don’t meet the criteria for a true eating disorder, and that they are taking up spaces needed by those who are “really sick.” Olivia expressed frustration with parting from her eating disorder, which had long given her a sense of control amidst chaos. For months, she candidly voiced her reluctance to recover, associating it with gaining weight. Once she even told a therapist she’d prefer death to being fat. There isn’t a universal method for prompting recovery; however, group, family, and individual therapies, along with education on nutrition and the health risks posed by eating disorders, can be helpful. Sometimes, it just takes time, as patients slowly contemplate what they want their lives to look like. This was Olivia’s experience; eventually, she just wanted to escape the confines of hospital rooms and treatment centers.
“It’s a tough illness, and we lack effective treatments,” remarked Melissa Freizinger, a psychologist at Harvard Medical School, highlighting anorexia. “So much about it remains elusive, despite my extensive experience working in this field.”
When it came time for Olivia to leave the hospital and head to her new residential program, both of us were fraught with anxiety. Olivia had gained enough weight that she no longer appeared ill, though she was still about ten to fifteen pounds shy of her “target weight,” determined by the hospital’s guidelines. (Honestly, I never quite grasped how they calculated that number, especially since it varied between facilities.) One of her main worries about the new program was being the “fattest one there.” This concern was voiced repeatedly, even after I attempted to explain how misguided it was.
We drove along congested freeways from UCLA to the outskirts of San Fernando Valley, expecting the unexpected. What we arrived at was a large, upscale home that, from the outside, looked like a typical single-family house, albeit with multiple cars parked outside. The yard was spacious, adorned with beautiful California oak trees, and had rumors swirling about wealthy neighbors.
Inside were half a dozen other girls aged 12 to 17, all struggling with various eating disorders, mostly from similar socioeconomic and racial backgrounds (white, privileged). Though not all teen treatment centers cater exclusively to girls, many do, and this one was among them. As we walked in, Olivia encountered the other clients, who greeted her warmly. She would spend nearly four months at this establishment, where she forged a few close friendships and, I think, found a sense of belonging—though I remain doubtful about the program’s actual benefits. Many of the other girls were older and viewed as “cool” by Olivia; I worried that it could romanticize having an eating disorder. They spent much of their time lounging in the communal space (which they termed the “milieu,” a word I found odd in this context), listening to music and crafting friendship bracelets. I was frequently called upon to provide more supplies. It often felt more like summer camp than a treatment facility. At one point, Olivia expressed a desire for new underwear, noting how cute the other girls’ styles were, which felt like a wake-up call. Eventually, I pulled her out a week early after a confusing incident in which she fell and hit her head; no one seemed particularly concerned, and while it ended up being fine, my disenchantment with the whole program grew. After all, she had already spent a significant amount of time there, and I felt she was ready to return home.
Olivia relapsed in a flash—it was shocking. She later confessed she had actually meant to relapse. The first day back, she ate a bit, but the following day, she consumed less, and by the third day, it was nothing at all—not even water. I had to rush her to the ER. I discovered she had been secretly exercising at night. One day, I found her journal open on the floor with a list titled “Exercises for getting skinny,” detailing various ab workouts. That was a low point for me. I had held so much hope for her return, determined to devote my time to ensuring she was eating properly, but it was naive. We went through the cycle of hospitalization, residential treatment, and return home several more times before I truly lost faith in my ability to keep Olivia safe and healthy here. I wanted so desperately for her to be home; I wanted that more than anything, yet it was unattainable until she was ready to improve, and she still wasn’t. I had no idea when that moment might come, or if it would at all. It was becoming increasingly difficult to believe that Olivia would ever find her way to recovery.
Living with anorexia is akin to battling a drug addiction, with thinness as the addiction. Left to her own devices, Olivia would strive to starve herself by any means, including deception. I genuinely believe she might have starved herself to death if given the chance—thankfully, that wasn’t the case (though once she turns 18, it could become a reality, which terrifies me). When she didn’t want to eat, my options felt almost non-existent. She would just sit there, resolutely closing her lips.
This occurred even when I’d prepared an elaborate meal, which was quite a feat for me. I remember being thrilled upon Olivia’s return from her first residential program, eager to make her a “harvest bowl” recommended by the facility. It required baked butternut squash, sausages, goat cheese, and other ingredients. I had to enlist help from a friend experienced in cooking. Yet, when I presented the harvest bowl, Olivia merely sat there, refusing to eat. I was heartbroken, but there was nothing I could do.
At one point, I threatened to toss Olivia’s iPad into the pool if she didn’t eat. Strangely, I can’t recall the outcome, though I doubt I actually went through with it. My only success in getting her to eat when she didn’t want to was when she desperately wanted a haircut. I told her she had to eat a specific meal first, and she complied. I then tried incentivizing her with a promise of a manicure, but that fell flat. At another juncture, I drafted a contract for us to sign wherein she pledged to try hard to eat, and I agreed to give up my own habit of nicotine pills. Sadly, we both ignored that agreement.
About six months in, it grew increasingly difficult to maintain hope. I found myself instructing others to hang on to hope, thinking that if they did, I had to, too. Then things worsened.
Staff from Olivia’s current residential facility reached out, stating she wasn’t eating and recommended transferring her to a program where they used feeding tubes (which her current center didn’t). The alternative was yet another trip to the ER. I can’t recall my exact reasoning, but I thought it wise to try something different. The nearest residential program with feeding tubes and an available bed was in Houston, so off we went.
Even though it was May or June, Texas was oppressively hot and humid. We found ourselves navigating a colossal airport that felt five times larger than LAX, and Olivia was utterly drained from the travel. I got her to the new residence. Like the others, it was in a spacious home in the suburbs, and everyone seemed friendly enough. Still, Olivia felt completely out of place—she had never been to the South, and it left her miserable. I returned to Los Angeles.
A couple of days later, I received a distressing call from the Houston facility informing me that Olivia was on a “food strike” and they needed to provide her a feeding tube. I consented to this. Shortly thereafter, they called again to say Olivia had refused to accept it.
My reaction was pure disbelief. It hadn’t occurred to me that refusing the feeding tube was an option. If that were the case, why had she been transported to Houston? I was baffled and never understood if the L.A. staff who recommended the move knew she could refuse such treatment. The mystery deepened when I realized Olivia was aware of this possibility. Even amidst a desperate situation, I felt a tiny sense of pride in her resolve. I wasn’t sure I, at 13, would have had the courage to push back against adults in the same way, though it could just as easily have been her disorder influencing her decisions.
Reflecting on Olivia’s condition, I remember her as a joyful baby, a charming toddler, and a sweet young girl. It struck me that she was still that kind-hearted girl, albeit one who believed she’d prefer death over gaining weight and who needed to survive with a feeding tube in Houston.
I learned later that the vast majority of residential facilities won’t administer feeding tubes against a patient’s will; that remains largely a hospital prerogative. Olivia had to return to a hospital, after some frustrating indecision over which one she should attend. The residential staff eventually sent her away, not in an ambulance, but in a car driven by a young staff member who spent the ride gossiping with her boyfriend on speakerphone, while Olivia sat in silence in the passenger seat.
Meanwhile, I regrouped and made my way back to Houston, again trudging through the enormous airport into the sweltering heat. By the time I reached the hospital, Olivia was deteriorating. She hadn’t eaten in two or three days and urgently needed nutrients. Given the purpose of her hospital visit was to get a feeding tube, I assumed that would happen straightaway, but I didn’t account for the frustrating reality of a hospital lacking expertise in eating disorder cases. One doctor knew what needed to be done, while another insisted she first try a few bites of a peanut butter and jelly sandwich. They thought maybe she’d rekindle her appetite. Thankfully, that ridiculous idea was swiftly abandoned once the knowledgeable doctor intervened, but it took what felt like an eternity. I realized how fortunate we had been at UCLA, where every staff member was thoroughly trained to deal with eating disorder patients. I never witnessed anyone there mistakenly discussing weight or exhibiting a basic misunderstanding of how to treat such illnesses; that wasn’t the case in Houston.
When the moment finally came for Olivia to receive her feeding tube, she appeared ready and surprisingly accepting. She had feared feeding tubes for so long, yet at this point, she seemed almost eager for one—perhaps because she recognized she was nearing a critical point and sensed relief in having the decision taken out of her hands. She didn’t resist at all.
I have little recollection of the feeding tube being inserted. Maybe I shut my eyes or looked away to avoid witnessing it, or maybe I’ve simply blocked that out. However, the sight of her with the tube down her nose is forever etched in my mind. It was a skinny yellow tube, positioned at the edge of her right nostril and taped behind her ear. She sat up in that hospital bed, so far from home, with that tube marking her pale skin, and I knew we had reached a low point, a pivotal moment of despair. I thought back to when she was a happy infant, a sweet little girl—and even now, she remained that sweet girl, but now she’d rather die than gain weight and had to rely on a feeding tube in a Houston hospital. And I began to wonder, would she ever get better? Was this going to be her reality, shifting between hospitals and treatment centers, longing for a normal life? In that moment, feelings of despair washed over me, amplifying my sense of helplessness as a parent—no matter how deeply I love her. Her eating disorder had such a tight grip that nothing else seemed to matter, and I feared it might never let her go.
Not long after getting the feeding tube, Olivia wanted to focus on eating or drinking supplements because she desperately wanted it out. It was uncomfortable. She thought it was wrongly inserted due to pain in certain areas along her esophagus. Medical staff would frequently wheel in an X-ray machine to check for complications. It always seemed to require readjustment or retaping, causing her discomfort. After a day or two of consuming supplements, we pushed to have the tube removed, but that became a drawn-out process. I got so frustrated that at one point, I vowed to pull it out myself. Olivia developed a low fever at night, though we weren’t quite sure of the cause, making the situation feel bleak. My focus shifted to figuring out how to return her to UCLA, and after several more days, we finally got the tube out and left with a sense of relief.
Returning to UCLA felt like coming home. Houston had been our lowest point. Olivia would face another relapse, and surprisingly, she had also contracted COVID for the first time, which accounted for the fever (thanks, Texas!). However, a few weeks later, she enrolled in a different UCLA program that was superior to previous residentials, and within that context, something shifted. Her mindset transitioned from clinging to her illness as a necessary security blanket to embracing the desire to recover, along with eagerness to re-engage with the world.
That doesn’t mean all is perfectly resolved. She’s been back since early September and remains acutely aware of her calorie intake. Our kitchen is now filled with nutritional guides to ensure I prepare balanced meals that meet specific caloric goals—and not a calorie more. Dining out at restaurants without calorie information is stressful, although it’s becoming easier. I drive to her middle school every day at noon so she can have lunch with me in the car; otherwise, I can’t be sure she’s eating enough. But despite everything, she’s home and she’s eating. That’s a significant improvement: she’s eating, and she’s home.
Having spent nine months away, Olivia underwent noticeable changes. While I wasn’t keeping track, she became a teenager—not just chronologically, as she turned 13. Now, the teenage Olivia dons makeup, swears frequently, and spends her time excitedly chatting on the phone with her new best friend from residential treatment. She’s always had a strong spirit, but now carries a confidence she previously lacked. If you didn’t know her, you might not recognize that, beneath it all, she’s still grappling deeply with insecurities and vulnerabilities, even as she remains sweet. She’s also obtained a nose piercing (despite my disapproval, although she’d deny it) and has two life-size Justin Bieber cutouts—one constantly on the verge of toppling over.
This precarious cardboard Bieber has turned into an unfortunate metaphor for Olivia’s fragile mental stability. I worry that any disruption could send her spiraling back into sadness, where she might once again retreat to her eating disorder for comfort. I’m hopeful that it won’t happen; she’s resilient, determined, and equipped with valuable coping skills from therapy. Yet, just like I hold my breath when navigating around that unstable cardboard figure, I’m perpetually bracing for potential falls in Olivia’s journey—hoping they never come.
I’ve taken away a few lessons from living with my daughter’s anorexia: avoid commenting on how anyone looks; just call food food, without labeling it as “good” or “bad.” Body dysmorphia is very real, though it took me a while to grasp. It’s challenging to accept that your daughter can appear so thin to the point of translucence, yet still see herself differently in the mirror. But she truly does.
The hardest—yet most crucial—lessons were about my role as a parent. I can and must support Olivia, encourage her, and show her love. Leading by example is vital, as are fostering positive family meal habits. Yet, I can’t force Olivia to follow through or promote healing; that decision must come from her. It’s critical she knows I’ll always be here for her. I hope she understands that. I think she does. Just to be sure, I intend to tell her once more right now.
