Back on her feet

Katie Emminger resumed playing soccer for Perry Hall this season after battling an eating disorder.

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From the beginning, Perry Hall soccer player Katie Emminger said she didn't know anything was wrong.

Despite the weight loss, skipped meals and lower stamina, it never occurred to her that she was suffering from an eating disorder.

Her grandmother died in January 2004, only months after her aunt died. And her parents were going through a separation that spring. With so much turmoil surrounding her, Emminger thought the gloomy feelings she was having were natural.

"All of that happened at once, so it was tough to deal with," Emminger said. "I didn't think anything was wrong, but people on my club soccer team mentioned something to my parents."

Emminger was suffering from anorexia nervosa, an eating disorder that typically involves self-starvation and considerable weight loss. The condition caused her to be hospitalized and miss last year's soccer season.

The recovery process and the road back to the soccer pitch was long and arduous, but Emminger came back strong this season, culminating with her scoring the winning goal in the Baltimore County championship game against Sparrows Point.

In contrast to her healthy appearance now, Emminger looked frail last year, and she wasn't eating during lunch breaks or at the dinner table after school. Her parents began to sense that their daughter's weight loss - she had gone from 128 pounds to 112 - was indicative of a more serious problem and that she needed help.

"We had noticed the eating pattern had changed, but [girls with eating disorders] are very good at hiding it," Emminger's father, Jim, said. "They will tell you they ate at a friend's house, or they ate before you got home. I guess it is just a slow process of learning and noticing that she is really starting to look skinny. Then you have other people asking, `Is Katie feeling OK?' "

After she returned from a trip to Ocean City in August 2004, Emminger's parents made an appointment for her at the Center for Eating Disorders, which was formerly at St. Joseph Medical Center in Towson but is now at Sheppard Pratt.

Dr. Angela Guarda, assistant professor of psychiatry and behavioral sciences at Johns Hopkins Hospital and director of its eating and weight disorders center, said between 0.5 percent to 1 percent of adolescent girls suffer from anorexia nervosa. The disorder also occurs in males, but is 10-fold less common in boys. She said researchers still do not know why there is a gender difference, but it is likely that hormonal changes related to puberty are a factor.

"The age of onset for anorexia coincides with puberty," Guarda said. "Usually, girls develop this within a few years of puberty and very rarely develop this before any pubertal changes. And it is also rarely developed at age 30 or 40. Usually, the onset is early teens to early 20s."

Guarda said there was a recent study in Norway that found female athletes are three times more likely to suffer from an eating disorder than non-athletes. She said sports in which there is an advantage to be thin, such as track and field, gymnastics, ballet and ice skating, usually have a higher rate of developing an eating disorder.

However, she said it is not unusual to see eating disorders among soccer players because it has become such a popular sport for female adolescents.

"Some coaches sometimes favor thinner athletes, perhaps in a subliminal way, but not all coaches," Guarda said. "There is a message - at least one the kids absorb - that it is better to be thin."

At her initial visit to the Center for Eating Disorders, Emminger was given one week to gain back some weight -- even 1 or 2 pounds -- and if she was unsuccessful, the doctors were not going to let her play soccer because her heart rate had grown too weak to be on the field.

"It was scary because I didn't think anything was wrong," she said. "But when I figured it out, I just wanted to get better. I know what I have to do to get better."

When Emminger was not able to gain the necessary weight after her first visit, she was admitted to the hospital. She remained there for a little more than a month, eating three core meals set out for her each day and taking three weight supplements to regain her strength.

While the physical rehabilitation was helpful, Emminger said she was helped most by the cognitive therapy sessions. She also began to realize that if she did not get better, she would never be able to return to her first true love: soccer.

She was already going to miss the 2004 season because of the illness.

"I knew that if I didn't get better, then I wouldn't be able to play soccer," Emminger said. "I really needed soccer. I still struggle sometimes, but I realize that I have to get better to have a normal life."

Her teammates at Perry Hall and coach Brad Kressman were supportive throughout her recovery. Kressman encouraged Emminger to get better and promised that her spot on the team would be there when she was healthy enough to return.

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