Nothing has been remotely that successful for adults with anorexia, and there is no easy explanation as to why. One reason may be that adults have simply been sicker for longer, believes Angela Guarda, director of the Eating Disorders Program at Johns Hopkins University: “The longer you have anorexia, the more anorexia creates physiological changes in the body and the brain that then create a self-sustaining cycle. You do it today because you did it yesterday, no longer because you decided to go on the Atkins diet when you were 15 or because you broke up with a boyfriend and you decided to lose weight. It’s no longer about that.”