On paper, Meg Sexton was thriving. 

The recent college graduate was working in event planning and fund-raising by day, and taking classes for her Ph.D. in higher education and leadership by night. She trained for marathons — regularly running over 80 miles a week — and nurtured a relationship with her now-husband, too.

But on the inside, she was starving. Diagnosed with anorexia nervosa around age 23 in 2008, Sexton ate so little and exercised so much, a woman’s hand could fit around her bicep. She lost bone density, her period and her hair in “gobs.” She even, she later learned, had developed an arrhythmia. 

And yet, it took two years after her diagnosis — and a blackout during a marathon — for Sexton to commit to professional inpatient care. “My mind told me, ‘I’m not that sick — look what I’m doing!” she told The Post.  

For Sexton, and many others with what some might call “high-functioning anorexia,” fuel came not from food, but from the adrenaline of depriving herself of it. 

“It was almost manic,” said the now-mom-of-five in Ohio, where she’s teaching, consulting and finishing her doctorate degree. “I could go for two weeks and be completely restricting and I would almost feel this high.”

Experts say Sexton’s experience is common among people with anorexia nervosa, which generally involves eating so little that you’re significantly below an appropriate weight for your age, sex and physical health.

People with the condition also have an extreme fear of weight gain or fatness, and usually find their self-worth is almost entirely tied up in their body’s shape or weight. 

But unlike many other life-threatening conditions, people with anorexia can often appear to excel in work and life. Indeed, high performance is often both a feature and a bug of the disorder itself — feeding both the restrictive behavior and the perception that nothing is wrong. 

“I think ‘high-functioning’ really is a myth: It’s more high-masking,” said Erin Parks, Ph.D., chief clinical officer and co-founder of the eating disorder treatment platform Equip. “Maintaining a job, the high grades, the busy social life — it doesn’t mean that the illness is mild. And in fact, anorexia really thrives on perfectionism.”

Indeed, research shows anorexia tends to target people with type A personalities, who can then make eating as little as possible one more hard thing to be “the best” at. 

That’s part of why Jamal Essayli, Ph.D., associate professor of pediatrics and of psychiatry and behavioral health at Penn State College of Medicine, enjoys working with people who fall into that category: They’re nothing if not driven. 

“Someone who’s ‘successful’ at extreme restriction and losing weight and maintaining a low body weight — that’s very difficult to do,” he said. “So often, those sort of high-standard, persistent perfectionist qualities emerge in those individuals, or are risk factors for developing anorexia, but can also be the reason why they’re excelling in other areas of their life.” 

Staying alive  

Anorexia is the least common eating disorder, thought to affect 0.5% to 3% of women (and fewer men).

But it’s also the most deadly — not just of eating disorders, but of all psychiatric illnesses. Some research shows about 5% of patients die within four years of diagnosis since the body’s essential organs cannot run on fumes for a very long time. Suicide is common among the population, too. 

“Your heart rate drops, blood pressure drops, body temperature drops, digestion slows down, reproductive hormones power down, the body starts pulling from muscles and bone to keep going — these are the physiological things that happen with semi-starvation,” Essayli said.

Parks likens it to a factory owner responding to an electricity outage by laying off underperforming staff and shutting down some machines. The body, likewise, dials back nonessential functions and directs its limited energy toward maintaining the heart and brain. 

“So while it looks like everything’s just ticking along as usual, in reality, the body is just trying to prioritize what it needs to do to stay alive,” Parks said.

At the same time, malnutrition can take a toll on patients’ logic, blinding them to the dire reality they’re in.

Some brain imaging research shows people with anorexia can have reductions in gray matter (which supports things like thinking and information processing) and white matter (which sends signals to different parts of the nervous system). If the former is a computer, the latter is its cables, according to the Cleveland Clinic.  

“The lack of nutrients physically alters the brain, including the prefrontal cortex; areas responsible for self-awareness and decision making,” Parks said. “So it becomes biologically difficult for the person to grasp how truly ill they are.”

What’s more, 80% to 90% of the brain space people with anorexia do have left is consumed with thoughts of food and their bodies, Parks said. As the classic Minnesota Starvation Experiment showed, avoiding food is a recipe for obsessing over it. 

“As animals, as humans, it just makes sense,” Essayli said. “It’s a survival mechanism: The less food you’re getting, your brain’s going to be more focused on food.”

That was the case for Heather, a 24-year-old environmental consultant in South Carolina who developed anorexia in college. On the outside, she got good grades, traveled abroad and maintained a romantic relationship. She even looked “healthy,” never becoming medically underweight, a subtype called “atypical anorexia.” 

But on the inside, Heather restricted and ruminated over food. “I don’t think anyone noticed I was thinking about food all the time — like any minute I was awake,” she said. Her dreams and social media feeds were culinary minefields, too.

It wasn’t until she underwent a year or so of virtual treatment beginning her senior year that Heather settled into a healthier headspace. She practiced facing fears like drinking nondiet sodas and learned to put energy into other areas of her life. 

Today, the newlywed said her mind is filled with thoughts of “work, relationships, hobbies, goals – things I want to do in my life besides shrinking.” 

‘The clock runs out’ 

People with anorexia can only fool themselves and others for so long. Whether it’s an organ shutdown, a loved one demanding they get care or — a best case scenario — their own realization that there’s a better way to live, “the clock runs out for everybody,” Parks said.

Not that a five-alarm bell needs to sound before people seek help. Treatments including those offered in hospitals and inpatient centers, as well as different types of psychotherapy and nutrition counseling, can help people recover. 

And the earlier the condition is caught, the better the prognosis. Much like a substance-use disorder, “you do not need to hit rock bottom,” Parks said, “especially because so much of the physical damage [of an eating disorder] is irreversible.” 

Lillian learned that the hard way. Diagnosed with anorexia around age 21 after years of restriction, she remained in denial. She’d gotten straight As in college and even opened her own daycare business in the Chicago area — a long-term dream. So what, part of her thought, if she had unusual habits around food? 

“For the longest time, I just refused any sort of treatment, didn’t want to do therapy. It was just like, ‘This is how I live; this is how I’m gonna always live,’” Lillian said. 

But in 2024 at age 24, she finally committed to going “all in” on recovery thanks to encouragement from her now-wife and her own desire to be mentally well enough to foster a child. She sought virtual treatment and leaned on her partner to plan and prepare meals for them both. 

By that point, though, Lillian had hormonal abnormalities, low bone density and urinary incontinence, which some research says may be another complication of denying basic bodily urges. She’s still in pelvic floor physical therapy for the issue today. 

Early in an eating disorder, “you don’t think that there’s going to be all these ugly medical complications, and then they happen, and at that point you’re already so sick that you just don’t even care about your quality of life,” Lillian, who now has a four-month old foster baby, said. 

“Now that I’ve recovered, I’m like, ‘Wow, that’s crazy that I did this to myself,’” she added. “I have to live with the consequences, and I hate that other people haven’t realized that yet.”