Lauren Greenfield's 'Thin'

Brittany, a subject in the film

Photographer Lauren Greenfield, known for documenting cultural attitudes about women and their bodies, followed four women with eating disorders at Renfrew, a residential treatment facility in Florida. Her documentary, 'Thin,' chronicles their stories and will premiere on HBO on November 14, 2006 at 9PM ET. Here, we caught up to the filmmaker to ask her about the project and to share what she learned about this devastating illness.

Q: What inspired you to make this film?
LG: The idea grew out of my last book, 'Girl Culture.' I spent five years photographing women across America and their "body projects" -- how they use their bodies to express themselves with everything from fashion to sex to eating disorders. I was really struck by some of the women I met with eating disorders and wanted to delve into their stories and explore this [illness] -- the most pathological of body projects. It was a story that I couldn't tell well as I wanted to in photographs, but I could tell in a film.

Q: What was the most surprising thing you learned in making the documentary?
LG: One thing that really shocked me was that the experts say it takes about four to seven years to recover from an eating disorder. Yet, the average insurance policy pays for three weeks of treatment. That's a huge disconnect. And you see in the film, that three of the women have crises related to insurance. That kind of stress took away from the quality of treatment because they were so worried about whether or not they could continue. Some of them would be on the phone begging their insurance carriers for just one more day of treatment. It's hard to make progress in treatment when you feel you can't stay the course.

Q: In making the film, did you come to any conclusions about the causes of eating disorders?
LG: Each woman had her own story and I didn't want the viewer to come away with a straight causal relationship. Every woman has different triggers -- one subject talked about the pressures on women in the South, for another it was issues with her mother. There are lots of stories of abuse, trauma and divorce. And one woman told me, "Nothing like abuse ever happened to me, I just wanted to be thin."

I think it's a complex mix of genetics, family dynamics, personal history and personality. It has nothing to do with mainstream concerns and media pressure. I certainly think our social values play a role, but I don't think that's what's triggering a full-blown eating disorder.

Q: Our country is heavier than ever, yet eating disorders are also on the rise. How do you make sense of that?
LG: There are lots of contradictions: As a culture we're obsessed with food and thinness. Eat but don't eat. In Renfrew, they are treating women who are anorexic and also women who are binge eaters. Different women have different eating disorders -- some are skeletal and some are heavy. But both disorders are coping mechanisms using food to numb intolerable pain.

Q: What did you think about the culture of the treatment facility? There was a lot of competition there.
LG:The institution was almost a character in the film. Renfrew has the feel of a college dorm. It looks like one and functioned much like one. Eating disorder culture and behavior is very contagious, so in that environment, the disorder is magnified exponentially and there's competition and alliances. The ethos at Renfrew is all about community and I was interested in how that concept worked both for and against these women. I think I captured that in the film.

Q: Some of the women in the film don't fare so well at the end. Did you come away thinking that it is possible to recover from an eating disorder?
LG: I came away thinking that it's a tenacious illness. Care at a facility like Renfrew can cost $1,500 a day, and experts say it takes four to seven years to recover, so it's very difficult to get really good treatment for as long as a woman needs it. I hear 50 to 80 percent get better [with treatment].

It's disheartening for women and for the families [of these women] because you would think that by going to a treatment center, that they'd come out fixed. But these women will continue to struggle for a long time. And sometimes they require multiple hospitalizations.

But even with a relapse, these women can come out further along and stronger than they would have if they hadn't gone to Renfrew at all -- because at least they get some tools to [help] cope. Of course getting help early is a big key to success. Teenagers who get treatment tend to find recovery more often. Once you've been doing this for 10 and 20 years, it's hard to imagine your life any other way. But I believe there's hope for recovery and you have to hold onto that hope and be motivated.

Q: All of the women we see in the treatment center are white. What does this say about eating disorders and women of color?
LG: Traditionally, there's been a stereotype that this illness only affects white, middle-class women. I don't know if that was ever true or if it was just because of who was getting treatment. There's not great research on the issue, but I know I saw poor women, mothers, older women, Latinas and women from other countries.
I actually went back to Renfrew to do a photography book of 'Thin' because I felt like there were stories of diversity that weren't in the film. The subjects in the film are amazing but not necessarily representative of the broad spectrum of women with eating disorders. In the book, I cover women with this illness from their teens to their fifties -- and some are Puerto Rican and African American women.

Q: What do you want people to take away from your film?
LG: It's hard to meet someone who doesn't have a personal connection to this illness. I wanted people to really understand what it's like to have an eating disorder. The media covers it often, but there's a lot of misinformation. So, there's a sense -- even for people with eating disorders -- that no one really knows what it's like, not even the people closest to them. The women who have this illness are smart, articulate, successful in many ways. And yet, they're in this kind of insane prison that's really hard to understand -- but it is a mental illness that women and I think all women have a reference for. I want to get the film out to widest audience possible to raise awareness about the illness.

Photographer Lauren Greenfield is the author of Girl Culture. 'Thin' is her first film and is also a book.