'At four I decided I was fat'

Author Marya Hornbacher knows all about the pain of being acutely weight conscious from an early age.

At four she decided she was fat. Driven by a desire to be thin, she was bulimic at nine and anorexic at the age of 15.

Ms Hornbacher's obsession with her weight continued into her late teens - at 18 she weighed a mere 3st 7lb. Four years ago the 27-year-old wrote her autobiography, Wasted, which chronicled her eating disorders from childhood to adult life.

Describing the pressures that drew her into a 15-year cycle of self-abuse, she said: "In our culture, thinness is associated with self-control and discipline - perfect people. There is a fear that one cannot participate as an effective human being without looking a certain way. That's something you see in almost everyone with an eating disorder - it [starvation] is plan B. If I fail I'll always be able to say I'm thin, as if that is success." It is eight years since the American author stopped starving herself and, by her own admission, the long-term effects of extreme dieting are clear.

"The chemical pathways in the brain are permanently altered after a certain period of malnutrition, exacerbating or possibly causing my manic depression. My teeth are rotten, my heart is three-quarters of the size of a normal heart because of muscle erosion, and it has a murmur. I can't have children and my ability to deal with simple issues is impaired because I missed so much of my life."