When Jessica Watts and Holly Hurt were at their worst, they were beyond skinny, but they still thought they were fat.
Jessica ate five foods, ones that were "safe." Holly kept a weight journal. The 5-foot, 2-inch teenager wanted to weigh 98 pounds. As her weight shrank, her goal did too, first to 95, then 94. "Then I didn't have a goal," Holly said recently. "I just wanted to lose more."
Holly, a senior at Boyle County High School, and Jessica, a junior at Lincoln County High School, are recovering from anorexia. They've formed a group called Eating Disorders End Now, or EDEN. They've created a Web site and a Facebook page. They are applying for non-profit status and raising money to buy T-shirts and wristbands.
They want the group to offer support to others who suffer from eating disorders and let them know that there is hope for recovery and that their worth is not measured by their weight.
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They want everyone else to understand that recovery isn't as simple as just eating, that they aren't vain and that they didn't want an eating disorder.
"It's like getting cancer," Holly said. "You don't choose it."
Jessica's eating disorder started when she entered high school. Her weight dropped from 120 pounds to "the high 80s," she said.
Jessica hid what was going on, said her mother, Tanya Watts. Jessica wore baggy clothes. Tanya thought her daughter was going through a growth spurt. She didn't notice the skipped meals.
"She would tell me she was eating her lunch at school, but she was really coming home and feeding it to the dog," Tanya Watts said.
In retrospect, she could have seen it: Her daughter was thin, pale and tired easily. Her hair was falling out. She didn't sleep well at night. She was "just kind of lifeless," Tanya said.
By the time a person with anorexia reaches the point Jessica had, it's physically difficult to eat, said Dr. Hatim Omar, a specialist in adolescent medicine at the University of Kentucky, who runs a clinic at Kentucky Children's Hospital for teens with eating disorders. Jessica and Holly are patients there.
Because they've been eating so little, their stomachs have shrunk, making it hard to eat more than a few mouthfuls at a time.
Constipation is a common problem. Their bowel muscles have weakened, and their starved bodies want to extract every bit of nutrition they can.
When he first sees new patients, Omar's goal is to gain their trust, stabilize their weight and turn their focus to their health. Every organ in the body is affected by anorexia, Omar said.
He wants his patients to be stable for six to 12 months. It can take that long for parents to realize their child has a disease, that the refusal to eat isn't just a mood or an attitude. "It's not as simple as just eat," Omar said.
Recovery can take one to three years.
"When you're seeing yourself as an elephant for two years, it's really hard to change," Omar said.
About 75 percent of anorexics recover with treatment, but there is always the danger of relapse.
Eating disorders are mental illnesses. Doctors don't know what causes them. Genetics and environment play a role. Stress, from school, abuse, sports or family issues, might contribute.
With anorexia, sufferers see themselves as fat even when they are deathly thin. They restrict their diets to the point of starvation. Some anorexics exercise excessively, burning more calories than they eat. Some binge and then throw up the food they consumed.
Those who suffer from the disease tend to have elaborate eating rituals, Omar said. They eat a little of this, a little of that and mix things up on their plate. When others begin to notice, they avoid situations that involve food.
The disease is more common in women than men. It often begins during adolescence. The younger a person is when it starts, the longer it goes untreated, the harder it is for the patient to recover, Omar said.
Jessica and Holly met in November, through Omar, and began e-mailing, talking on the phone and meeting for lunch. They got the idea for EDEN in January and have worked fast to put it together.
The Web site tells each girl's personal story. It gives suggestions for books to read on eating disorders and asks for prayers for themselves and others who are struggling. It doesn't contain any numbers — weights or clothing sizes.
Numbers are a trigger for both of them, they explained. Neither Jessica nor Holly knows how much she weighs. They stand backward on the scale at the doctor's office.
"If I see what I weigh, I'll want to lose," Jessica said. "I'll think I was too fat."
Jessica is petite and has shoulder-length curly hair. She is slender. Holly is taller and has long brown hair that frames her face. She too is slender, but she still struggles with what the mirror shows her.
Jessica and Holly still have bad days when they think they are fat. They can't watch The Biggest Loser, weight-loss commercials or listen to other people talk about dieting.
Holidays are hard. There's so much food and the pressure to always eat more.
Holly can't eat anything fried or breaded. Jessica can't stand grease. If a plate has too much food on it, it "freaks" her out. Going to a buffet, once a family tradition for Jessica, is also off-limits: There's just too much food.
But they have hope for the future. Holly wants to be a writer. Jessica wants to go to medical school and someday work with adolescents, like Omar does. They both want to learn to eat without counting calories, without worrying that they could be fat.
"I want to be able to go to buffets," Jessica said, "and be able to sit down with Mom and Dad and not have them worry about what I'm eating."