Formerly known as the fashion model’s disease, anorexia and eating disorders are still taboo subjects in society. EVARIST and GILLIAN BARTOLO speak to Juan Ameen about their experience during their daughter’s illness.

Mrs Bartolo explained that it all started in the summer before her daughter started sixth form

“One night her boyfriend brought her home because she had fainted and we found out that she had not been eating enough. We told her off and said that she must start eating normally again and for the moment it passed,” she said.

Between first and second year sixth form, Louisa started going to the gym – excessively, added Mr Bartolo – and was very careful about what she ate.

Mrs Bartolo said that, during that summer, Louisa started working as a waitress and kept complaining all the time about feeling tired.

“I found this very strange – especially since I had worked as a waitress myself and could not understand how she was always feeling so exhausted,” she said.

“In September, we discovered that Louisa was lactose intolerant. Soon after she told us that she would throw up whenever she ate pasta – we automatically assumed that she was celiac,” she added.

However, after they received the results of the tests from their local GP, they discovered that Louisa was not celiac.

Soon after, said Mrs Bartolo, her sister told them that Louisa had confided in her and told her that she was afraid of eating.

“It was at this point that the alarm bells started ringing. We took her to a psychologist but she was not very happy with him and we soon stopped attending sessions,” she said.

Mr Bartolo pointed out that it was a very difficult period – especially because there are no support structures in Malta, neither for the victim nor for the parents.

“When you look up information on the Internet, you find a lot of conflicting advice but nothing really helpful when dealing with your own specific case,” he said.

In December, Louisa had exams but her parents had not realised that she had lost a lot of weight and was pretending to eat more than she actually was.

To make matters worse, two weeks before her exams Louisa went down with a stomach bug and could not eat solids for two weeks.

“She is a perfectionist – she was studying really hard for her exams because she wanted to do well,” said Mrs Bartolo.

However, on the first day of exams, Mrs Bartolo received a phone call from the school asking her to pick Louisa up because she was unwell.

“I panicked when I received the phone call – and so did she. She started panicking because she wanted to do well in her exams,” she said.

At that time, Louisa’s weight was very low – just under 43 kgs and she started going to a psychiatrist.

However, said Mr Bartolo, he took a very hard approach to the situation, telling her that she had to eat larger-than-average portions, for example.

He explained that it was a very difficult situation to deal with because they both wanted Louisa to solve the problem herself but still wanted to help.

“She was very suspicious of everything and everyone – especially what we put in the food. She used to have pea soup for lunch every day to which we added lentils to have more substance. However, she caught us out once and hit the roof,” he said.

She felt that it was a breach of trust and became even more secretive, he added.

Mrs Bartolo said that she had become touchy with very big mood swings.

“She also became very secretive – she moved to another room,” her father explained. “Louisa was also very weak and spent a lot of time asleep in her room. We were so worried that we would go up to check if she was still breathing,” he said.

The whole situation created a lot of pressure on the family.

“We felt extremely frustrated and guilty – we felt responsible, that we had to do something and we were angry seeing her potential waste away,” he said.

Both parents were guilt-stricken because they felt that they had contributed towards her sickness.

“We were both conscious about our weight and I had lost a lot of weight – too much actually and had developed a slight obsession myself” said Mr Bartolo.

He confessed he also felt guilty that he was not present at certain moments of their life as he should have been due to his political commitments.

Mrs Bartolo also felt guilty because she had once suffered from depression and was afraid that she had passed it on to Louisa.

“We felt that we had both failed as parents – we went through a lot of heartache and did a lot of soul searching,” said Mr Bartolo.

However, he added, the positive side of it all is that it brought the family together and taught them to discuss their feelings and communicate more.

The family started giving more importance to food and eating together more often.

Another person who contributed greatly to Louisa’s healing process was gastroenterologist Mario Vassallo.

“She was having a lot of stomach problems because she was not eating and we took her to Dr Vassallo. She liked him a lot – he was very gentle with her and she trusted him,” said Mrs Bartolo.

In fact, Louisa felt more comfortable with him than she had with a lot of other professionals.

Before her A-levels, Louisa knew that she had to build up her energy again so she agreed to have lunch with her mother at school.

“I would pick her up after I finished work at around 12.30 and have lunch together. We had already established what we were going to have for lunch and at least Louisa was eating regularly,” she said.

However, once her A-levels were done, she started not eating again.

“It was very difficult at home – she wanted to leave and we had huge arguments over this. Louisa wanted to study abroad and I agreed – but she wanted to take a gap year before,” said Mr Bartolo.

The turning point in Louisa’s illness was an opportunity for a four-month work experience in Tunisia.

“She wanted to go but we were worried about it. When Dr Vassallo found out that she was going he expressed alarmed as he did not want her to lose more weight,” said Mr Bartolo.

When Louisa arrived home she broke down – crying and screaming. “She said that she refused to get better – that she had nothing to look forward to. She accused me of acting like a politician with her: building up her hopes and then letting her down,” he said.

“I told her that it was up to her to get better or not,” he said.

That afternoon, a friend of Mrs Bartolo, who had passed through a similar situation with her own daughter Emma, asked Louisa if she would like to speak to Emma as she was in Malta for a week.

“It was a great leap forward – she listened and understood what Louisa was going through. However, when Tunisia was mentioned, she agreed that Louisa should not go and suggested she go and stay with her in Glasgow instead. Louisa was thrilled.

It was thanks to Elaine Dutton and Maria Ellul, a psychologist and nutritionist respectively, that her parents gave her the go ahead. The agreement was made on the condition that Louisa would return to Malta after a month for them to monitor her weight.

Her real struggle to recover started in Glasgow

Another incentive to reclaim her health came when she was called for an interview with the university of her dreams. “Two weeks before the interview, Louisa was sick with a stomach bug and could not eat – again.”

Worried, Louisa e-mailed Dr Vassallo on an almost daily basis, and he suggested ways she could build up some energy without eating. For two weeks Louisa drank energy drinks and sugary fruit juices and gradually built up some strength.

Mr Bartolo pointed out that a holistic approach is needed to tackle the problem at its roots – something that is not available in Malta.

“Unfortunately you go to various professionals who only focus on one aspect of the problem. Actually, you need a team of professionals who give holistic treatment,” he said.

Both parents said GPs need to be more aware of the problem and become more informed.

“These in turn will refer the family to a team of professionals who will tackle the various problems involved – and this should be free to all,” said Mrs Bartolo.

Following her experience, Louisa, in collaboration with the Health Promotion Department, is launching Taste Freedom, a campaign promoting better understanding, prevention and effective treatment for the eating disorders anorexia and bulimia on Friday.

For more information about the campaign visit www.tastefreedom.org.