Dying Young
Bulimia robs Napa teen of promising life

By BROOKE E. BRYANT
and SARAH KRUPP
Napa Register

Andrea Smeltzer was a vibrant and promising young woman, an exemplary 'student with a passion for life that made an impression on everyone she knew.

But in June, the 19-year-old became a sobering statistic. A Napa resident for most of her life, Andrea spent a year living abroad in Spain and was fluent in the language by the time she graduated from Vintage High School in 1997.

At the prestigious Pitzer College, where she was an active presence on campus, she managed to complete her undergraduate degree in international studies by the end of her sophomore year. After college, she hoped to use her degree to work with humanitarian agencies like Amnesty International. "She experienced more in life than many people do. But I used to say to her, 'Please slow down, you'll have nothing left at 30. It'll all be done,'" recalled her mother, Doris Smeltzer. "Maybe she knew."

On June 16, after a thirteen-month struggle with bulimia, Andrea died in her sleep when an electrolyte imbalance caused her heart to fail.

The public's perception of eating disorders - once thought to be the domain of adolescent girls and supermodels - is changing, thanks to recent high-profile Incidents like the 1997 death of the San Francisco ballerina whose heart failure was linked with an eating disorder, and Princess Diana's often publicized struggle with bulimia.

For those who knew her, Andrea's death put yet another new face on the disease: that of a young, successful college woman with everything to live for.

Disorders not unique
Andrea's experience, although tragic, is not unique. It is estimated that as many as 25 percent of college-aged women deal with disordered eating habits of some kind, if not necessarily full-blown anorexia or bulimia, according to Carla Jackson, a health educator at Pitzer.

"It often develops in college because college is a big transition time: a lot of things are new, there are added responsibilities and expectations that people put on themselves," said Jackson. 'They control their eating to be able to control one aspect of their lives."

There is no way to pinpoint exactly what happened to trigger the eating disorder in Andrea. Most likely it was a complex combination of factors and circumstances that ultimately became overwhelming.

Both of her parents had struggled with life-threatening illnesses when she was younger, and the trauma made its mark on Andrea.

In college, she balanced her rigorous academic demands against a legion of other commitments on campus, from hosting tours to mentoring other students. At the same time, she was charting new territory in her personal life in a turbulent relationship with her first boyfriend.

Andrea's mother doesn't underestimate the role that unrealistic standards of beauty, inundating society through television, movie screens and fashion magazines, played in her daughter's illness.

Robin Lasser, who struggled successfully to overcome an eating disorder of her own, agrees. Lasser is a San Jose State University professor who recently collaborated on an exhibit called "Eating Disorders in a Disordered Culture" that drew nationwide attention to the issue.

"Our culture says that in addition to everything else, being intelligent, funny and athletic, women must also be perfect-looking. Of course the standards of beauty are impossible to achieve," said Lasser.

How to fight it
As awareness of the severity of the problem moves into the public's consciousness, a wealth of treatment programs and organizations have been established to combat eating disorders, many of them on college campuses.

Colleges, including the one that Andrea attended, often have health education outreach and counseling services specifically designed to target the issues surrounding eating disorders.

When Andrea developed an eating disorder in May of 1998, she did all the things that were supposed to save her life. She called her family the day after she threw up for the first time and told them what had happened. She sought professional help from both a nutritionist and a counselor, often for several sessions a week, and spent hours reading books and surfing the Internet to find out everything she could about the disease.

"Andrea knew eating disorders inside, outside, backwards, forwards," her mother said. "She could quote you line and verse. But knowledge does not equate with behavioral change. That is why just informing people is not enough. Just being educated is not enough. Because Andrea knew."

Despite the breadth of resources available to her, and her own commitment to healing, neither knowledge nor treatment was enough to save Andrea.

She is not alone. Although the majority of those who seek treatment do recover, 20 percent never experience any improvement at all, and between two and three percent eventually die from their condition, according to Anorexia Nervosa and Related Eating Disorders, Inc., an organization devoted to educating the public.

Statistics like these are precisely why many experts say that even comprehensive treatment programs aren't enough.

Consequently, many advocate prevention strategies that range from educating about body issues to attacking the social pressures that contribute to the development of eating disorders.

"Educators should introduce the topic in elementary school and middle school so that it is not such a shameful thing to discuss. Early intervention is essential so that the problem can be cured way before it becomes clinical," said Adriana Schoenberg, a nurse practitioner and member of the eating disorder team at the University of California at Berkeley Health Center. "Clinical people, especially pediatricians, should be trained to detect the symptoms."

While the benefits of programs that emphasize self-esteem building seem indisputable, some experts caution that educational programs that provide graphic details about the disease may backfire.

"Education is important, but not necessarily all the gory details like bingeing and purging," said Andrea James, a counselor for the Rader program, an eating disorder treatment center located in Los Angeles. "Kids could pick up dangerous tools and adopt them to cope with their problems."

Society's pressure
Even the most optimistic admit that one of the most significant contributors to the development of eating disorders - the social emphasis on unattainable standards of weight and beauty - isn't likely to disappear anytime soon.

That doesn't mean that people have to accept without question the messages that are fed to them through the ever-expanding outlets of the media, according to Holly Hoff, the program director at Eating Disorders Awareness & Prevention, Inc.

"Watch for messages that don't represent diversity of body shape or a healthy ideal of weight," suggested Hoff. "Challenge these messages by writing a letter, or just tearing up a magazine picture or talking back to your TV when they don't project a positive image."

Doris Smeltzer wants people to understand exactly why challenging these attitudes and messages, which are often deeply ingrained, is so important. Because someone who looks healthy and vital can die without warning. Because an electrolyte imbalance can happen in a matter of hours. Because getting help doesn't guarantee recovery.

Spreading the word
Andrea can no longer speak for herself, but her mother intends to make sure that her voice is still heard. Doris Smeltzer is organizing a collection of Andrea's prose and poetry for publication. She has spoken at two memorial services for Andrea, and plans to speak out about her daughter's struggle on college campuses and disordered eating conventions in the future.

Andrea intended to use her talents to touch the lives of others and make a difference in the world - lofty goals, but in light of everything she had already accomplished, perhaps not so far-fetched. If her story can help keep even one life from being extinguished by the disease, Doris Smeltzer Is convinced that it isn't too late to fulfill those ambitions.

"I think that my goal now in the new life that I have - because my life has been forever altered - is to spread her story," Andrea's mother says. "I want people to know that the best thing in the world to do is to prevent that first time so that It doesn't start, because curing an eating disorder is so incredibly difficult and complicated."