Tara Haakonson thought she was healthier than she'd ever been.
In her freshman year at the University of Minnesota Duluth, the St. Cloud-area native was doing all the right things. She worked out obsessively, and her diet was heavy on fruits and vegetables. She entirely eschewed processed foods and fast foods.
She started out with a goal of 1,200 calories per day, but that decreased to between 900 and 1,000, said Haakonson, now 24. "Now" is seven years later, and she knows that level is "not sustainable. It's not nearly enough to keep your body healthy."
At 5 feet 9 inches tall, Haakonson began her first year at UMD weighing 150 pounds, she said. She went home for summer break weighing 25 pounds less.
She thought she was healthy, she says now; in reality, she was sick. She didn't know it then and wouldn't have believed it, but she would be diagnosed later that summer with anorexia nervosa, an eating disorder.
Not just young females
She's not alone. At least 30 million Americans suffer from an eating disorder in their lifetimes, according to a 2007 study reported in the journal Biological Psychiatry. Although it is the third-most common chronic illness among adolescent females, it affects males and females, people of all ages, economic classes and ethnicities, according to the Eating Disorders Coalition.
Even young women and girls with eating disorders don't necessarily match the stereotype of ghostly thin, Barbie-doll wannabe, said Jillian Lampert, chief strategic officer for the Minnesota-based Emily Program, which treats people with eating disorders.
"Most people who suffer with eating disorders are normal weight or they live in larger bodies," said Lampert, who grew up in Hibbing. "And we would never know by looking at them that they're struggling with an eating disorder. So I think that's a big misconception. And it's promoted by the supermarket checkout tabloids. All the celebrities who are young and often white and female are in stories talking about an eating disorder. ... It's just not true."
Haakonson was young and white and female when her anorexia expressed itself. But it had nothing to do with body image, she says now. She sees it as a response to the culture shock when she left the safe, familiar environment of home and found herself dealing with the stress of trying to make new friends and coping with college-level studies.
"That kind of culminated in ... seeking control over all the chaos," she said.
She compensated by spending more and more time at the gym, choosing to work out instead of spending time with friends and refusing to be around certain kinds of food, Haakonson related.
By the end of the school year, she had gone from "an athletic frame to a more stark, bony and less muscular, atrophied body," she said.
At home, she bought a gym membership and insisted on preparing her own meals. She resisted going to family gatherings if they involved eating at certain places.
She started to experience what she now knows to be symptoms of her eating disorder, Haakonson said. It was summer, but she felt cold all the time. She'd park her car in the sun and sit inside with the windows rolled up. With the air conditioning on in her parents' house, she'd lie in bed at night under four blankets. Despite her workouts, she felt tired all the time. She took naps and had difficulty concentrating.
In August, when her mother insisted on taking her to the doctor, Haakonson thought she'd be vindicated, she said. When the doctor confirmed that she had anorexia, she was devastated.
"I was crying," Haakonson said. "I was literally, physically in shock."
Since she was about to return to UMD, a counselor recommended that she enroll at the Emily Project's Duluth office. She was placed in outpatient therapy and learned what was unhealthy about her habits. Haakonson managed to get her disorder under control, she said, but after her sophomore year in school, she didn't seek any additional help.
That led to a relapse during her junior year. In March 2014, her grandfather had died, she was renting her first house, and she was accepted into the University of Minnesota College of Pharmacy. Then her appendix was removed, and she experienced a period of nausea.
Feeling stressed, Haakonson resumed her dietary restrictions, she said, and started working out more than ever. Her weight dropped to 115 pounds.
She stayed in Duluth that summer and returned to the Emily Program. "This time ... I was mentally ready to commit to treatment," Haakonson said. "Before, I was kind of thrown into it. My parents were really the ones driving the appointment."
Haakonson was enrolled in intensive outpatient therapy, meaning three-hour sessions four times a week. For the first time, she was part of group sessions where she learned from other people with similar struggles.
She agreed to stay out of the gym and limit exercising to going for walks. She was encouraged to moderately eat foods that she once had banned from her life - an occasional soda, some Oreo cookies or a visit with friends to McDonald's.
Her visits to the Emily Program are down to once a month, she said. Now in her last year at the Duluth campus of the pharmacy college, she has a gym membership again but a changed mindset about using it. Her weight is a healthy 140 pounds. She has a different attitude about food.
"If I'm hungry, my body needs more nutrition and I should eat," Haakonson said. "If I'm not hungry, that's OK. I don't have to force myself to eat. (It's) just learning to listen to your body."
'Stop doing that'
Lampert's own eating disorder developed during her junior year in high school, she said, but she didn't get help until her freshman year at St. Thomas University.
In Hibbing, her family doctor was well-meaning, but didn't know how to help her.
"(He) suggested that I stop doing that," she related. "And I was thinking I would love to be done with this thing that torments me most of the time and is making me eat in this bizarre way and over-exercise and throw up and do all the other things I was doing. But I don't think I could just stop like magic."
Lampert remembers traveling to Europe with her parents when she was 20 to attend her older brother's wedding and stopping at a restaurant in Germany.
"I'm in a foreign country trying to eat, trying to be normal with this raging illness," she recalled. "And I ended up literally crying in the bathroom at the German restaurant, and ordering a plate of what turned out to be pickled carrots."
Data that she calls somewhat outdated suggest it typically takes seven years from onset of an eating disorder to recovery, Lampert said. That was true for her - she considers her eating disorder to have lasted from age 15 to age 22.
"That seven years I lost - I graduated from college on time, and I did all the stuff I was supposed to do," she said. "But ... it just robs so much of life. And people kind of keep going because they don't think there's a better option."
During that time, Lampert made the ironic choice to study to be a dietitian. It has served her well in her 13-year career with the Emily Program, where she works in program development, communications and leadership.
She has become well-versed on the science of eating disorders, which research show to be rooted in biology and genetics, she said.
Because of biological differences, people with eating disorders process their emotions differently than people who don't have them, Lampert said.
"They almost see in high def," she said. "Remember when we didn't have HDTV and then we got HDTV, we're like, wow! Everything's so much brighter and closer and sharper, and that's sort of how people with eating disorders think all the time. It's brighter, sharper, more stimuli."
There's no pharmaceutical treatment for eating disorders, Lampert said - at least not yet. Treatment involves talk therapy and training about food.
"It means helping people to bring structure to their eating," she said. "Whatever the eating disorder, whether it's under-eating or overeating, the structure of eating is not quite right when people are ill. So we bring in more structure and more regularity."
These days, Haakonson has structure in her habits. She is as likely to go for a walk to enjoy the weather or play basketball with friends as she is to work out alone at the gym, she said. A "monumental piece" for her was becoming less obsessive about counting calories.
But it's still part of her story.
"Being diagnosed changed me," Haakonson said. "It's always going to stick with me. I think that I probably will always have those thoughts, off and on. But I have a choice of what I do with those thoughts."
About the Emily Program
The Emily Program, a privately owned for-profit treatment program for people with eating disorders, was founded 25 years ago in St. Paul and opened an office in Duluth 10 years ago.
The Duluth office, at 26 E. Superior St., Suite 315, currently sees about 50 people a week, said Jillian Lampert, the program's chief strategic officer.
Most commercial insurers cover eating disorder treatment "pretty well," Lampert said, especially in Minnesota. Medicare and Medicaid cover hospital inpatient and one-on-one outpatient therapies, "but there's a lot in between that isn't covered."