When Mia Walter's 10-year-old daughter decided to quit gymnastics, the Nashville mom was almost relieved.
A talented gymnast, Sheila had been moving steadily up the ranks of competition since she was 4 years old, but the effort was grueling: By fourth grade, she was practicing 14 to 16 hours a week, she nursed frequent injuries, and her ankles and knees constantly hurt.
"It just wasn't fun for her anymore," says Walter. Tiny when she quit gymnastics, Sheila began to fill out a bit once she dropped the rigorous practice routine. Walter liked the change in her daughter: "It was just a pound or two at most -- it wasn't really noticeable -- but she looked healthier."
But that pound or two began to bother Sheila. "I'd been around all these older girls at the gym who were always saying things like 'Oh, I'm so fat,' and I started to worry that once I quit gymnastics, I would get fat, too," Sheila, now 13, remembers.
Over the next six months, worry gradually turned into obsession as she cut out sweets and chips, then dairy and meat and finally everything but salad.
"If I put something in front of her that she thought would make her fat, you'd see the fear in her eyes. She'd force herself to take a bite or two, and then she couldn't eat any more. I tried being nice, and I tried being firm, but there was just no way to make her eat," says Walter.
Sheila also began to exercise obsessively. After meals, she would go up to her room to do crunches and jumping jacks for two hours straight. She couldn't watch TV without doing push-ups or running on the treadmill at the same time.
In the beginning, Walter never suspected that her fourth-grader might be developing an eating disorder. "She was only 10," she says. "If she'd been 13, I would have worried, but I didn't think it could happen to a 10 year old."
In fact, the physical changes in Sheila came so gradually that neither Walter nor Sheila's pediatrician noticed them at first. At her well-child checkup in July, Sheila's weight was still within the normal range for her growth pattern, and she showed the early signs of puberty -- breast buds, a slight widening of the hips -- that a doctor would expect to see in a girl her age.
Walter mentioned her concern about the change in Sheila's eating habits, so the pediatrician explained the importance of eating from all the food groups, including fats, and Sheila said she understood.
By the end of August, there was no mistaking that something was terribly wrong. Normally a "happy, social, easy-going girl," according to her mom, Sheila became withdrawn, anxious and depressed. She complained of being cold all the time, despite the hot Nashville summer, and kept bundled up in sweatpants and baggy jackets.
When Sheila put on a swimsuit for the first time in weeks, Walker was shocked: "She looked like a death-camp survivor, all bones. I asked her, 'Sheila, do you realize how much weight you've lost?' But she said she still felt fat. So I took a picture of her and showed it to her and asked, 'Is this too skinny?' And she said, 'Yes.' She could tell that the girl in the picture was too skinny, but when she looked in the mirror, she felt fat."
A rush trip to the doctor revealed that Sheila had lost 17 pounds -- almost a quarter of her body weight -- in the six weeks since her well-child visit. Her body temperature was only 94 degrees, her heart rate was low and she was severely dehydrated.
Immediately, the pediatrician hospitalized Sheila, and Walter tried to arrange for her to see a child psychiatrist. "I pulled every string I could think of to get her in, but the only one in the area who was taking new patients had a three-month waiting list," she says. "I was hysterical. I remember calling the psychiatrist's office and saying, 'Please, we can't wait. My child will be dead in three months.'"