A 22-year-old Miss Malta hopeful, Edera Fenech, opened up to the Times of Malta recently about how she was diagnosed with anorexia just over a year ago and told that it would kill her within a year.   But the Mosta beauty decided to fight the disorder and found that participating in beauty pageants gave her the motivation to do so.

The young woman has even acquired the confidence to speak out about her eating disorder. In recent weeks she has shared her progress on social media, saying she wanted to use her Miss Malta platform to help others. “I’m standing here to be an inspiration and the voice to help others with the same disorder since we need more awareness,” she wrote.

It all started when she was spending four to five hours at the gym and eating very little   ̶   “maybe a can of tuna, or nothing at all”.   Posting photos of herself when she was in hospital and her hair fell out, Ms Fenech described how the disorder gives sufferers a distorted view of their own body image.   

She told the Times of Malta that there are too many misconceptions surrounding anorexia, particularly the belief that the disorder affects women only or that is an issue of vanity. “It makes me feel disappointed and frustrated at the same time. Everyone can get this kind of disorder and it’s not a matter of attention but a matter of self-awareness,” she explained.

The young woman described how she struggled to recover.  She found that putting on weight again was harder than she thought.  But she fought on. “Pageantry empowered me. It gave me the courage to take up space and cement myself in society,” Edera said, adding that the most important thing pageants have taught her is to be a leader.

Now she is urging anyone struggling with eating disorders to seek help as early as possible and reach out to Dar Kenn għal Saħħtek   ̶   the Centre for the Treatment of Obesity and Eating Disorders.  “If it wasn’t for them, I’d have never been able to get over it,” she said.

70 million

Taken together, eating disorders affect up to eight percent of the population world-wide.  They mostly develop in adolescence and young adulthood. Several of the disorders   ̶   especially anorexia nervosa and bulimia nervosa   ̶   are more common in women, but they can all occur at any age and affect any gender.

The disorders often co-occur with other psychiatric disorders, most commonly mood and anxiety disorders, obsessive-compulsive disorder, and alcohol and substance use disorders.  Evidence suggests that genes and heritability play a part in why some people are at higher risk for an eating disorder, but these disorders can also afflict those with no family history of the condition.

For some people, a preoccupation with food becomes a way to gain control over one aspect of their lives. Although it may start out as simply eating a bit more or less than usual, the behaviour can spiral out of control and take over the person’s life. Eating disorders are a serious medical problem that can have long-term health consequences if left untreated.

Having a social life can be difficult for people with an eating disorder. When people develop eating disorders, they can become more distant and start to spend more time alone. This can make their harmful thoughts or low self-esteem worse. Socialising often involves eating with others, often in public places and this can be difficult. When people are ill, they are often unable to spend time with their friends and take part in social activities.

As eating disorders develop, people become more isolated, withdrawn and avoid social situations. Looking back, people who have been affected by one or other of the disorders feel that they have ‘missed out’ on social life or been ‘held back’, sometimes for years. Becoming isolated was often linked to low self-esteem, anxiety, and obsessive thoughts. Some said that, for them, becoming isolated was a direct cause of depression, rather than because of their eating disorder.

The prevalence of eating disorders around the world has been rising and is now thought to affect some 70 million people globally.  Between 2000 and 2018, their prevalence more than doubled worldwide and a recent systematic review reports that during the period 1999-2022 the global overall proportion of children and adolescents with disordered eating was 22.4%.  One person dies as a direct consequence of an eating disorder every 52 minutes.

A European Parliament Report estimated that 20 million people suffer from eating disorders in Europe with a cost of about €1 trillion per year (financial costs of about €249 billion plus burden of disease costs of about €763 billion). The financial costs of eating disorders were similar and the burden of disease costs higher than those of anxiety and depression.

Annabel Cuff, Anton Grech, Andrew Azzopardi, and Darleen Zerafa of the University of Malta examined the prevalence of eating disorders in Malta last year, and found that 5.5% (2.25% males, 3.25% females) of some 400 subjects aged 10-16 had one of the disorders.  The findings indicated that males were catching up with females in eating disorder diagnoses.

Despite treatment advances, mortality rates of anorexia nervosa and bulimia nervosa remain very high: those who have received inpatient treatment for anorexia nervosa still have a more than five times increased mortality risk. Mortality risks for bulimia nervosa, and for anorexia nervosa treated outside the hospital, are lower but still about twice those of controls.

In people with an eating disorder, quality of life is reduced, yearly healthcare costs are 48% higher than in the general population, the presence of mental health comorbidity is associated with 48% lower yearly earnings, the number of offspring is reduced, and risks for adverse pregnancy and neonatal outcomes are increased.

Lauren Gatt and seven other researchers of The George Institute for Global Health, University of Sydney, found that over 40% of participants in a study spent greater than 10% of their household income on disorder-related costs   ̶    a level of expenditure that has been defined as ‘catastrophic’ in other studies.  In comparison, in other chronic disease populations in Australia, only 12% and 5% of the study population spent greater than 10% and 20% of their income respectively on illness-related costs.

Hope Virgo’s story of hope

Treatment for eating disorders has improved considerably over the years and has come to include psychological, behavioural, nutritional and other medical complications. The latter can include consequences of malnutrition or of purging behaviours including, heart and gastrointestinal problems as well as other potentially fatal conditions.

Unfortunately, ambivalence towards treatment, denial of a problem with eating and weight, or anxiety about changing eating patterns is still not uncommon. With proper medical care, however, those with eating disorders can resume healthy eating habits, and recover their emotional and psychological health.

One woman who has written her story is Hope Virgo.  In November 2007, at the age of 17, Virgo was admitted to hospital because her BMI had dropped far enough that the doctors considered her life was in danger. Six months before that, she had started treatment with child and adolescent mental health services for her eating disorder, which, to her mind, was when the problems started.

Since the age of 13, she had been rigidly controlling her calorie intake and exercising obsessively. She once ran a half-marathon having eaten nothing for four days. She avoided her meals at school by giving away her food, and those at home in the melee of being one of five children.

In her book Stand Tall, Little Girl, Virgo describes her harrowing and dangerous descent into anorexia.  Today she is the personification of triumph or optimism. “In the media, you see the same stories, the same distressed, emaciated person; you hear of people dying,” Virgo says. “We need to hear those stories, but at the same time, I really believe that a full recovery is possible. I think we lose sight of that glimmer of hope.”

In her book, she gives the figures to back this up: 40% of people who have had an eating disorder never think about it again; 15% are unable to fight it off and are stuck in it; and 45% of people find a way to live with it, using coping mechanisms. Virgo’s pioneering work has an overarching purpose: to say, in her words and through her actions, that recovery is possible. It’s a rescue mission launched from regular life into a world of crisis – in which no one is seen as irrecoverable.

Stand Tall, Little Girl shows why fighting one’s demons and one’s own mind is one of the hardest things that anyone can do.  Nonetheless, Virgo did it.  Her will to survive was such that she did her A-levels at hospital and was discharged in time to go to the University of Birmingham to study sociology.

It was an unbelievable trial, since she emerged from hospital entirely institutionalised, with very rigid rules around both the substance and timing of all meals and snacks. If she broke these rules there was the spectre of relapse. But if one takes up the fight and doesn’t give up, there is light at the end of the tunnel.

One has to admire people like Edera Fenech and Hope Virgo. They are beacons for hope for many others who suffer in silence.

Dar Kenn għal Saħħtek are at Triq Dar il-Kaptan, Mtarfa, and can be reached on 21453690.  The professionals there have helped several thousand people over the years. If there are victims or relatives of victims who need to start a healing journey, they can also contact Eating Disorders Support Malta.

Main photos: Photographs shared by Edera Fnech with the Times of Malta, showing her struggle with the disorder, showing her in hospital and her hair that fell out due to the illness.