Providence Umwali had her dream set on modelling career. She was obsessed about modelling. By the age of 18, she had become so fixated that while at school, she would spare time practicing on how to perfect her sashay on the catwalk.

A year ago, the 22-year-old fashion dealer from Gisozi was on the verge of obtaining a job from a modeling agency. Through a series of assessments and competitions, Umwali was left out ostensibly because her hip and body size were not ‘waspy’ enough to pass for a model’s.

In started her date with anorexia nervosa, an eating disorder where individuals fear gaining weight.

Although she was still a student, Umwali, was not about to give up one her dream. She would do anything to fit in; her physical exercises intensified.

She could work out almost three times a day while feeding the stomach on water alone. The focus was to lose weight day-by-day.

"I lost up to three kilogrammes in the first week and was happy with myself, I was determined to lose more until I reached that ‘perfect size,’” she says.

"Everything that could help me lose weight, I did. Once in a while I would take lemon and gins because I was told it would be the fastest way to lose weight.”

From 56 to 35 kilogrammes, the rate at which her flesh was wasting away was alarming, but Umwali would take not notice; only her targets mattered.

"I would exercise several times through the night,” she says.

Umwali was depressed, lacked appetite, and always ate minute portions of food in isolation.

Sarah Mukadayisenga was in bewildered by her friend’s peculiar changes; the immense weight loss, extreme thinning, and complaints over headache, thinning hairlines and breasts sagging on the chest.

"She used to eat strict portions of fruits and leafy vegetables,” Mukadayisenga reminisces.

"All I wanted was to look my best, I wanted to fit in each and every single dress for the contract that I set my eyes on,” Umwali explains.

Sadly the isolated eating disorder could not provide that opportunity.

Since the main diagnosis of the disease relies on clinical signs, severe body changes and complications, the effect was spotted after some damage had been done.

"Her proportions of food worried me most and she always got concerned about fitting in each and every single cloth she admired from the stores,” Mukadayisenga says.

Umwali’s isolation would not stand alone without causing depression, her lips looked dry and serious muscle wasting was evident.

Slightly similar to the common signs of malnutrition, her skin became pale and hair looked silky.

That is when she found herself at Score Clinic in Nyarugenge District, Kigali.

"I complained about feeling very tired and doctors told me that I was hypoglycemic. I was scared when I laid eyes on the medical report, my condition was label’ed ‘severe,’” Umwali recalls.

Her weight loss had dropped, BMI (basal metabolic index) was 16 and other clinical symptoms triggered nutritionists to advise on diet adjustment.

Her blood volume was also found to be low and she complained of severe headache.

"I was advised to improve my eating habits and exercise only once a day. But this did not seem any easier for me. Although I tried to implement it, it took me a while to revive the normal eating patterns,” she says.

"The recovery therapy required me to regain weight up to 65 kilogrammes, which demanded a lot of eating and balancing the nutrients.”

Today, Umwali looks fresh after recovering from the eating disorder.

What experts say about anorexia nervosa

Dr Charles Mudenge, a psychiatrist at University Teaching Hospital of Kigali, says, social attitudes that promote thin body are the biggest contributors of anorexia nervosa.

"Individuals in this category have fear of gaining weight and would do anything to maintain their looks, especially those who participate in the pageants,” Mudenge says.

Alexia Mupende, a model, says it is important to maintain one’s looks while in the modeling business, but this does not have to come with a serious change in diet.

For Mupende, doing simple exercises and eating healthy is enough to keep the body in shape.

"Having a balanced diet to provide the right nutrients and the correct proportions of food is important in this profession. When I do that, I rarely put a lot of concern on gaining weight,” Mupende says.

Although a lot of scientific research associates genes, hormones and family background as causative factors for anorexia nervosa, many risk factors have been found culpable in causing the condition.

"Worrying about, or paying more attention to, weight and shape, having an anxiety disorder as a child, having a negative self-image and eating problems during infancy contribute to the condition,” says Alex Mucumbitsi, the head of nutrition at the Ministry of Health.

Management of anorexia

The biggest challenge in treating anorexia nervosa is helping the person recognise that they are ill.

Most people with anorexia deny that they have an eating disorder. People often enter treatment only when their condition is severe.

The treatment seeks to restore normal body weight and eating habits. Since weight is the biggest problem, individuals can be helped to gain some weight through increased social activity, reducing physical activity, and using schedules for eating.