Anais Garcia, 21, anxiously stares at the menu of a Bob Evans restaurant in Baltimore. Her dark brown eyes gravitate toward the Fit and Healthy section, which lists calories per meal. She takes a long time figuring out what to order and decides to go with her “safe meal,” a small stack of pancakes, with no butter, reduced-calorie syrup, a small bowl of fruit on the side and a cup of black coffee.

“Restaurants are like battle zones for me, literal war zones,” she says.

A ballerina who contended with anorexia nervosa for years, Garcia, who is 5-foot-11/2 tall, has reached 105 pounds, a safer weight than the 79 pounds of a year ago. In her gray turtleneck sweater and casual black leggings, her extreme thinness remains apparent. “For the past five years, I’ve done nothing but hate and try to disown my body,” she says.

Ballet celebrates the body — and thinness. Despite demands for change from dancers who have experienced problems and from psychologists specializing in eating disorders, the stereotype that a dancer must be elegant and lean persists. Ballerinas become vulnerable to self-consciousness about their bodies, and they face increased risk of anorexia, bulimia nervosa and other eating disorders.

Generally, someone who develops an eating disorder has a predisposition, with several factors at play. For ballerinas, “it is of course the ballet culture,” which is competitive and demanding, says Linda Hamilton, a New York psychologist who has worked with ballerinas with eating disorders. But “you might also have a personality predisposition,” she says. “A perfectionist personality can make the dancer intolerant of any physical changes.”

Sometimes, “the disorders start early, as young as 12,” she says, because the curves that come with puberty don’t fit the ballet look.

“One out of two dancers suffer from an eating disorder,” Hamilton says. “It’s still an ongoing problem and it needs to be addressed, because once ballerinas develop an eating disorder, it’s hard to recover.”

Born in Columbia, Maryland, Garcia was brought up by her mother after her parents divorced and started dancing when she was 3. By middle school, intent on pursuing a professional ballet career, she was dancing four to eight hours a day. “It just became an obsession,” she says.

She became a professional at 19. She danced for two years across the United States, performing in Miami, in Washington for the Washington Ballet and in New York for Dance Theatre of Harlem.

“It got really serious very fast,” Garcia says.

No one in her family ever ridiculed her for her size, she says, attributing her eating disorder to the competitive nature of ballet itself.

At 13, living in Baltimore, she was determined to enter the Baltimore School for the Arts (BSA), a respected public high school with an outstanding reputation in ballet. She was rejected, she says, not because of her dancing but because the faculty decided she needed more muscle tone.

“I remember that when she didn’t get in, it was her mother who contacted me and we spoke about her weak muscle tone,” says Norma Pera, the dance department head. “We are looking for a body that is physically fit enough to aerobically do the work.”

Garcia auditioned again and was admitted at 14, as a sophomore. Teachers, she said, repeatedly said she was “too soft” and encouraged her to have more “muscle tone” — terms she took as code for “fat.”

When she won the lead role of Clara in “The Nutcracker,” in her senior year of high school, she felt that reinforced the idea that “being skinnier was better.” She began using laxatives, purging, skipping meals and overexercising, to lose still more weight.

She understood she was ill and “that my sickness was only going to get worse and that anorexia had taken everything that once made me happy, and just made it a living hell,” she says.

But her desire to become a professional was more powerful than her sickness.

Pera says that she and the other teachers had no indication that Garcia was going through a severe eating disorder.

Garcia had graduated from BSA in spring 2015. She decided to start company auditions a year later, after dropping out from her first semester at Towson University in Baltimore, where she was majoring in dance performance.

“Pursuing companies full time meant I had to watch what I was eating,” she says, calling it probably the worst decision she had made because “I was eating a granola bar and a coffee per day.”

Garcia checked into the Renfrew Center of Philadelphia in August 2017 for treatment of her eating disorder, a decision that followed what she calls the “hell semester.”

Garcia’s final audition came later that month. She had an opportunity to audition with Dance Theatre of Harlem in New York.

“I told my mom, ‘I have to go, this will be it!’ ” But as she was going upstairs, she recognized for the first time that she had body dysmorphia — a body image disorder that causes people to constantly worry about their appearance.

Garcia entered the intensive inpatient program at Renfrew.

During the three-week program, doctors diagnosed her with anorexia, anxiety, depression and post-traumatic stress disorder.

After she completed the inpatient and partial hospitalization program at Renfrew, she transferred to its intensive outpatient program, which allowed her to move home to Baltimore.

Garcia no longer pursues a professional career in ballet, but she is dancing as a hobby. She is on a new career path, majoring in exercise science at Towson.

She plans to go into a physical therapy school afterward.

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