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I just started a rotation on the adolescent wards, and about half of our patients have eating disorders. They are all girls, and they range in age from 12 to 17 years old.

Every day, they have group therapy meetings in the recreation room at about noon. They file by our work area in flannel pants and pony tails, wearing shirts from cross-country teams and field hockey teams and basketball teams, slapping their slippers on the floor. They are all somewhere between 60 and 80% of their ideal body weight for height.

As they walk by, I think to myself, "Man, they are so pretty." And I am not proud.

At first, I thought, it can't just be me. Something has to be reponsible for making these women want to be thin, and it's probably the same thing that's squeezed my feminist brain into finding pointy chins and saucer eyes attractive. Right?

Well, not really. During a group session with our patients the other day, I began to understand that although societal norms might initiate dieting and body image problems in people with eating disorders, it's compulsion and control that make them continue in the long term. After the thighs are gone and the belly is flat, it's about seeing the scale needle continue to move downward; demonstrating how much control you really have; putting one over on your stupid parents; proving yourself a winner at something. Yes, the girls in our program do think they're fat--but that's not where it ends.

Where does it end? As one girl said, "There is no lower limit that would make me happy."

Yes, women in all forms of graphic media have gotten thinner, on average, over the last 100 years. But it's hard to demonstrate unequivocally that eating disorders have become more prevalent over that time. (See citations 6-17 in this paper.) One could (and I do) conclude that there's a disease process at work in these patients that we do not provoke or mitigate with culture.

By these calculations, I'm the only one in the doctor-patient relationship whose viewpoint is much influenced by the thinness of the ladies in the magazines.