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For picky eaters, there can be no food substitutions. Illustration by Dori Hartley

Eric Ostendorf, left, at age 10, pre-anorexia; Ostendorf, center, at age 15 with full-blown anorexia; Ostendorf at age 17, a recovered anorexic. Courtesy of Becky Ostendorf

Every day, for the first four months of his sophomore year in high school, Eric Ostendorf ate an apple for lunch.

That's it. One apple. And sometimes he didn't even make it to the core.

The summer before, Ostendorf's pediatrician discovered an alarmingly low heart rate during a routine physical and sent the Kentucky teen straight to the hospital. At 15, he was at serious risk for a heart attack.

Ostendorf, now a 17-year-old high school senior, had been starving himself for months while engaging in obsessive-compulsive exercise regimens, he tells ParentDish in a phone interview.

After spending a week in the hospital with feeding tubes down his throat, Ostendorf was released on doctor's orders that his parents closely monitor his eating and with a strict embargo on exercise. However, as many anorexics have proved, there are ways around such restrictions.

"I would wake up a few minutes early, run the shower and then pump out about a hundred push-ups, do some crunches and then get in the shower, get dressed, come downstairs, hide the food (by tossing it down the back of his big sweatshirt when no one was looking), then flush it (down the toilet) when I was going up to brush my teeth," Ostendorf tells ParentDish. "And then I'd pump out some more push-ups."

Unlike anorexic girls his age who focus on whittling their waists to unattainably small sizes, Ostendorf says his focus was on building muscle mass.

"You rarely hear from guys about clothes size. The majority of guys I've treated with anorexia say to me, with a straight face, 'I will gain as much weight as you want me to gain, as long as it's muscle,' " Dr. Ted Weltzein, medical director of eating disorder services at Rogers Memorial Hospital in Wisconsin (where Ostendorf would eventually spend 100 days for inpatient treatment), tells ParentDish in a phone interview.

When he got to school, Ostendorf says, he would ask his teacher if he could use the restroom and then he would "crank out 45 chin-ups on the bar of the bathroom stalls."

He did that every class period, every day, for four months straight. He'd often miss his ride home at the end of the day because he was busy walking laps around the halls with his heavy backpack and doing chin-ups in the boys' bathroom. When he got home and found his mother helping his younger brother with homework, he'd sneak off to do push-ups, crunches, squats and calf raises. Ostendorf wanted biceps that bulged and abs he could bounce quarters off.

His mother, Becky Ostendorf, arranged to have the vice principal casually walk by his table in the cafeteria and discreetly peer into his lunch bag, which he was required to leave open on the table.

It was always empty, save for the remainder of his apple. Yet, his mother packed him a full lunch and neither she nor the principal knew he never ate it.

"I would stop at my locker to get my lunch like I was supposed to, and then I would make a beeline for the bathroom and, if no one was in there, I'd flush (the food) down the toilet. ... All I would have left is an apple because you can't flush an apple down the toilet," he tells ParentDish.

Ostendorf's parents decided to appear on a "Dr. Phil" episode titled "Body Obsessed Boys," which aired Jan. 8, 2009. Becky Ostendorf tells ParentDish in a phone interview that their health insurance had run out, "so I very selfishly said, 'We're doing this show because maybe we'll get some help that's paid for.' I hate to admit that, but that was the point I was at."

"Dr. Phil called me an enabler on national TV," she says. "(Eric's eating disorder) totally consumed our lives day in and day out. It was like nothing else mattered."

Weltzein also appeared on the show and offered Ostendorf a full evaluation and treatment at the eating disorder facility at Rogers, known for its rare all-male unit.

According to the National Eating Disorders Association (NEDA), about 10 percent of people with eating disorders are male. However, they are less likely to seek treatment because of the perception that they are "women's diseases."

"Our uniqueness," Weltzein says, "is that the males are with the males, not with the females. The staff is used to working with the males, which is different. (There's) a lot more 'Guitar Hero' on the male floor."

Ostendorf's birthday was on the 70th day of his 100 days in treatment at Rogers. He shared this journal entry, which was part of the treatment process, from that day: