Lindsey Purkett's bright eyes and engaging smile mask her secret.
She has struggled daily with food for more than a decade, and is losing a battle that has crippled her socially, harmed her physically and given rise to occasional suicidal thoughts.
When she stands, her 85-pound frame shows the toll of anorexia nervosa, a mental disorder in which sufferers refuse to eat regular meals. Of disorders, it is the most deadly, and quite hard to cure.
When doctors asked Purkett if she was afraid to die, she shrugged off the scare tactics.
"I told them, "No, I'm not,'" she says. "It's better not to suffer."
Purkett, 26, has drifted in and out of hospitals and mental care without success. She has no health insurance. She's too weak to work.
A few months ago, she finally became homeless, bouncing between shelters and homes of family and friends.
In late December, as she was spending the last of her cash on a room at the Pueblo Marriott, desk manager Dane Cornell intervened. He took Purkett home to his mother, Mary Cornell, an advertising executive who since has provided Purkett with a place to stay in Pueblo.
Cornell quickly found that Purkett was barely eating, nibbling on tiny meals of chocolate and coffee.
So she enlisted the help of a family friend, Victor Reyes, a district court judge in Pueblo. Reyes scoured the region, and then the nation, in search of treatment a specialized eating-disorder program that would take Purkett despite her lack of insurance.
After reeling off an exhaustive list of great-sounding programs in Colorado and around the country, Reyes still has had no luck finding one that offers assistance to the poor.
"It's so frustrating," Reyes says. "Here I am, a judge, and even I haven't been able to help her."
A deadly problem
When asked if glossy magazines with images of svelte models are behind the distorted mirror image that makes her seem fat, Purkett says she doesn't know. She says eating makes her feel "bloated."
"It feels better not to eat," she says.
Without treatment, Purkett could die.
Her chances of dying are 23 times higher than someone without her disorder, says Dr. Kenneth Weiner, medical director of the prominent Eating Disorder Center of Denver.
That's because people with eating disorders are more likely to have depression, which can lead to suicide. Also, the physical weakening of the body means heart problems and electrolyte imbalances are more probable.
The condition, which may be inherited, is treatable, according to Weiner. Citing research, he says about 80 percent of patients recover. However, that is in a timeframe of seven to 10 years of treatment.
Dr. Ellen Rome, head of adolescent medicine at the Cleveland Clinic Foundation in Ohio and an expert in eating disorders, likens treatment to an "exorcism."
"You are helping the person suffering from the disorder gain their personality back," Rome says.
Purkett is probably "chronically adapted to starvation, similar to living through the Holocaust or other period of starvation," she adds.
Treatment usually involves intense work with a physician specializing in eating disorders, a dietitian, a therapist and, often, a family therapist.
A costly solution
Weiner's center, which charges $900 per day for partial hospitalization, $450 a day for outpatient treatment and $15 for 15 minutes with a dietitian, doesn't accept uninsured clients.
"My hope is, one day, we will find the funds to assist indigent people with care," he says.
Reyes took Purkett to a social services office to help her enroll in Medicaid, the cooperative federal/state insurance program for the poor. But she couldn't qualify at this time.
Even if she did obtain Medicaid, in Colorado there are few clinics that specialize in eating disorders, and even fewer that will take Medicaid, says Toni Saiber, executive director of the Eating Disorder Foundation in Denver.
The foundation's volunteers field a range of calls from people seeking help with eating disorders, the majority coming from uninsured, underinsured or Medicaid clients.
"The heartbreaking thing is that I can't help them," says Saiber. "There's just nowhere to send them."
Even people with insurance face problems accessing care. Insurance companies typically cover markedly fewer services for psychiatric issues than physical ailments.
"It's almost like you have to be on your deathbed before insurance will kick in," Saiber says, adding that most insurers cover only a handful of visits and not the long-term treatment needed to cure eating disorders.
It's an issue for many people in need of psychiatric treatment.
In response, a committee at the state Capitol earlier this week passed Senate Bill 36, sponsored by Sen. Moe Keller, D-Wheat Ridge. The bill expands the list of mandatory mental disorders that insurers must cover to include eating disorders, among several others.
The idea is preventative care, says Weiner, who testified Monday in support of the bill. Untreated or under-treated mental conditions, he says, may exacerbate physical problems down the road, such as heart problems stemming from untreated anorexia.
"It's better not to be penny-wise and pound-foolish," Weiner says.
Nationally, the Eating Disorders Coalition is working with Sen. Patrick Kennedy, D-R.I., on similar "mental-health parity" legislation.
Sam Menaged, president and founder of Philadelphia's Renfrew Center, the country's first residential eating-disorder treatment facility, and a former president of the Eating Disorders Coalition, says change is needed.
"There's a stigma associated with mental health in this country, and as a result it has gotten short shrift," he says.
But the legislation won't help people like Purkett, Weiner concedes.
So Cornell and Reyes are left hoping for a miracle.
Purkett, who was a cheerleader at South High School in Pueblo, spent several years at Colorado State University-Pueblo studying psychology, but quit. She's also worked retail jobs. She left one in part because she was embarrassed to be seen in public.
Now her life is on hold again. For a month at Cornell's house she avoided food. Then, recently, she began having peanut butter and jelly for breakfast.
Cornell is measuring success in such small breakthroughs. She knows Purkett will need lots of help to become self-sufficient.
"It's "Don't look up the whole staircase,'" Cornell says. "Just take one step at a time.'"
Purkett harbors doubts. It's hard, she says, to believe her life could be any different.
"I can't control it," she says of her anorexia. "I can't fix it."
Eating disorder discussions
Led by Courtney Martin, Palmer High School graduate and author of the upcoming Perfect Girls, Starving Daughters: The Frightening New Normalcy of Hating Your Body
Monday, Feb. 26: Film and Q&A, 4 p.m. at Colorado College's Slocum Commons, 130 E. Cache la Poudre St.; Author reading and Q&A, 7 p.m. at Loomis Lounge, 1104 N. Cascade Ave.
Free; visit coloradocollege.edu or call 389-6607 for more.