“I just want to be thin. If it takes dying to get there, so be it” Polly (30 years old)

It is not every disease that has its own tattoo, but persons with anorexia nervosa and bulimia nervosa who belong to the American National Eating Disorder Association, often tattoo themselves with a pair of ribbons, red denoting anorexia and purple recovery. Ana and Mia – for anorexia and bulimia – affect some five million women and girls in America and, increasingly, worldwide. Approximately one in seven dies of the disease. Although the disease is overwhelmingly female and middle class, it cuts across the entire demographic and affects men and boys as well. At the root of the condition are the contradictory body images that society increasingly sells to girls and women – of razor-thin models living happy, sexy, successful lives. Think of Paris Hilton and Victoria Beckham (but not for too long). Hardly a week goes by before another model dies of an eating disorder related heart attack or organ failure, most recently Carla Sobrado Casalle and Ana Carolina Reston, both young Brazilian models. With omnipresent imagery and celebrity hype shaping female images, many women and girls seek to attain the ultimate thin, Size Zero, even if it kills them.

Lauren Greenfield has explored aspects of social roles, peer pressure, and eating disorders among young women and girls in two previous books, Fast Forward (1999) and Girl Culture (2002), yet her latest effort, Thin, goes much further in examining the culture of body images and the ramifications when it gets out of hand. The Thin project, a traditional book with interviews and images by Greenfield and a TV documentary for HBO, the Home Box Office network, directed by her, examined the lives of young women and girls at the Renfrew Center, an inpatient facility in Boca Raton, Florida, with a day rate of $1,500, for people with eating disorders.

Greenfield, a member of the VII Photography Agency, worked with HBO for over two years to develop the project and spent 10 weeks shooting some 200 hours of tape with a small camera crew over a six-month period. Her team was granted unprecedented access to staff and patients who consented to being filmed and interviewed. She followed up the story for more than 18 months, after the film was finished, to do further still images and to conduct interviews for the book. The stories track the lives of four patients in particular, Polly (30), Alisa (30), Brittany (15), and Shelley (25), as well as various others who flesh out a range of ages, socio-economic levels, and personal histories among the patients. The two halves of Thin illustrate the different modalities and structures of books and movies. Whereas the book may be followed linearly or at random and provides more opportunity for patients’ backstories – many of which feature sexual abuse as a child – the film concentrates as much on the actual group dynamics of being at Renfrew, as a patient, as staff, and as visiting family. The group dynamics play out most vividly among the four or so young women and during their general “community meetings” with the entire group of patients and staff. This is very dramatic stuff with girls struggling to eat, vomiting, sneaking cigarettes, ragging on staff, undergoing searches, engaging in middle-school level power games with one another, and suffering complete emotional meltdowns. The women also discuss their eating disorders and their perceptions of themselves in relation to their ideal image.

The movie version brings the Schrödinger’s Cat principle into the equation: does observing the experiment change the result. This principle is also vital to photojournalism. How does documenting something, especially with a camera or a film crew, affect what is going on? What is being staged for the camera is a question all journalists are confronted with on a daily basis. Similarly, the theatrics of patient interactions sometimes seem like some hammy student production. The camera, like the pen, also seeks out dramatic characters with interesting stories. The book may more freely include stories of the more mundane patients, but film and television demand action and drama. Greenfield argues that the girls and women at Renfrew were more preoccupied with their daily life and death struggles to be concerned with playing for the camera.

This version also reveals details less visible in the book. We see how the women talk, their mannerisms, and their body language. Camera angles play a role as well as images shot from sitting on the floor level bring a different perspective and subtle judgments to otherwise straight interviews. Similarly the omnipresence of pharmaceutical advertisements in the calendars, wall clocks, mouse pads, and refrigerator magnets points to the role the industry plays in medical facilities where psycho-active drugs are a way of life (and death). Other images point out to problems in the American way of life. Some of the staff at Renfrew are overweight if not obese. How that affects patients with severe body image problems is open to question. Likewise, when the patients are introduced to “normal” food and eating experiences it is inevitably at some fast food restaurant with its calorie laden nachos and French fries.

Thin is a powerful glimpse into the world of eating disorders and attempts to control them. Greenfield records the stories of several patients as they struggle to regain their health at Renfrew Center. The women confront their personal histories with anorexia and bulimia at a completely personal level. The film is up-close and personal, almost too personal. Thin is, as the PR people at Renfrew and Greenfield state, but a snapshot of what goes on both at the Center and in the lives of these women in the film and with people with eating disorders in general. That said, Thin makes for compelling watching. The book and film are accompanied by a website,, which provides backstories, deleted scenes, resource guides, and an ongoing series of blogs and forums where women in the film and others post commentaries in an ongoing give and take.

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