UNC student moves beyond eating disorder, finds body confidence

By Molly Brice

Adjusting her headset, Joanna Kuang assesses the crowd in the studio, recognizing her regular attendees and noticing new faces. 

Kuang, a junior majoring in psychology at UNC-Chapel Hill and an aspiring psychiatrist, teaches weekly Pilates classes at Rams Head Recreation Center. On Sundays, she teaches her Pop Pilates class, a more cardio-intensive and lively version of traditional Pilates. 

Kuang’s thick black hair is tied neatly in a ponytail. The studio’s hardwood floor is covered by yoga mats with only small spaces peeking out between each participant. Even from the back of the studio, participants notice her contoured arms and toned legs.  

“The first few times was absolute terror,” Kuang said. “I felt like I was drowning.” That old but familiar trace of fear sits heavily in her stomach when she teaches a new section of choreography. 

Throughout the class, attendees watch Kuang closely to mimic her actions. Their inescapable glances follow Kuang with every subtle movement — any way she turns, she sees the reflection of their eyes in the studio’s mirrors.

Seven years earlier, Kuang would have shuddered at the idea of putting herself on display.

The slippery slope

During her freshman year at Horace Mann School in New York, Kuang slowly developed an eating disorder — joining the 2% of American females diagnosed with anorexia nervosa in their lifetime.

Like most high school freshmen, Kuang took biology. The teacher assigned a calorie counting lab that required students to track their food intake over a week. 

“No one came out of that lab understanding anything new about nutrition,” Kuang said. “All they knew was that they were eating too many calories.” 

“At first, I wanted to see how low I could get it and then it just sort of spiraled from there,” Kuang said. Like many people that suffer from anorexia, Kuang’s experience began with a quiet voice encouraging her to lose a couple of pounds, run a little more and eat a bit less.

“I’ve always been very hard on myself,” Kuang said. “When I want something, I go for it.”  Kuang’s internal drive has consistently motivated her to go the extra mile or two or three.

“Look at her Google calendar,” said Reeves Moseley, a junior who has been elected UNC-CH’s next student body president. “She is the epitome of a workhorse.”

In addition to managing Moseley’s campaign, Kuang has several other commitments: a part-time internship at the AHB Center for Behavioral Health and Wellness, a position on UNC Student Government’s mental health committee and a role as a research assistant with the department of psychology and neuroscience

“She works her butt off and never does anything halfway,” Sally Hammer, Kuang’s coworker at UNC-CH’s Student Recreation Center, said. 

Unfortunately, the same drive that has allowed Kuang to succeed in so many ways also detrimentally led to her eating disorder. 

“It’s a very slippery slope and all of a sudden you can’t stop,” Kuang said. 

Eating disorders develop gradually: skipping meals with friends, hiding food in napkins, lying about how much or how little one is eating, even diluting liquids to reduce calories.

Kuang learned to mix her milk with water, a tactic that allowed her to follow her mom’s rule of one glass of milk per day without the added calories. After experimenting, she found the appropriate ratio of water that kept the milk’s distinctive white color. 

Kuang worked through lunches in the library to avoid the questioning look of friends. She was happier alone where she could control what she was eating.

“Of course, this was reinforced because I would get compliments,” Kuang said, explaining how concerned friends also commended her slender figure and six-pack.

Journey toward recovery

This self-esteem high came to a crashing halt when Kuang’s body began to show physical signs of its malnourishment.

“My body just started to shut down,” Kuang said.  

Her hair, brittle from protein depletion, fell out. Her skin, callous from deficient vitamin intake, dried. Usually an exuberant person, Kuang felt her energy drain and her mood sadden. Sprains wouldn’t heal. No matter the temperature, Kuang felt a lingering cold in her bones that she couldn’t shake. 

At the end of her freshman year, Kuang was diagnosed with anorexia. As her friends traveled — eating whatever, whenever and however they pleased — Kuang’s parents monitored and prepared every one of her meals. 

“I was on a weight regaining journey,” Kuang said. As the rest of her family ate a bagel with cream cheese and eggs, Kuang ate two bagels, double the serving of eggs, a piece of fruit and an extra glass of milk poured by her mother. After a year of restricted eating, Kuang felt physically pained by this new diet. 

Eating disorder treatment is a long, arduous process of unlearning thought patterns and breaking detrimental habits. Eating and food is often only half the battle. 

“I couldn’t do anything that might resemble calorie burning,” Kuang said, “because they knew I would take it to an extreme.” 

Doctors advised Kuang to limit physical activity to the bare minimum. She could no longer run. She couldn’t even walk around the block. 

Behind closed doors, Kuang broke these rules. She retreated to her bedroom, locking the door, the doctor’s orders, her parents and the world out. Before falling asleep, Kuang would climb on her bed and start doing the math in her head, counting the number of crunches she’d need to do to compensate for the day’s calories. 

“Of course it did nothing, but it was psychologically soothing,” Kuang said.

Moving beyond

When Kuang started college at UNC-CH, she was in a  relapse prevention phase. This stage, as defined by the National Eating Disorders Association, is associated with the continued treatment of an eating disorder, which can be a chronic condition. 

Kuang wants to eat everything in sight some days, while on others, the sight, smell or even thought of food may feel overwhelming. “I don’t know if I’ll ever have an average relationship with food,” Kuang admitted.

At first, Kuang felt uncomfortable by the idea of a room full of people assessing her body’s movements during her Pop Pilates classes. Now, she embraces it.

“I think it’s been very healthy for my body image because I’m having to put myself and my body on display for people,” she said.

Panting internally, Kuang harnesses the adrenaline coursing through her muscles to push through the final workout. Kuang’s participants come to her class for the workout, but also her authenticity and ability to connect with her peers.

“One thing I really like about Jo is she’ll say when something hurts or is hard,” Jordan Killenberg, a UNC-CH sophomore and Pop Pilates attendee, said. “It really feels like she is taking the class with us.” 

Winding down, Kuang cues a slower song and starts to lead the stretches. To close her classes, she praises her attendees’ efforts, reminding them to feel grateful for their bodies’ hard work. 

Smiling, she looks out at their sweaty, reddened faces. “They’re looking to me for guidance,” Kuang said. “Being able to celebrate what my body is capable of doing is much more important than feeling self-conscious.” 

Edited by Rachel Crumpler and Maddie Fetsko


Empowering moms-to-be: doulas push for the best pregnancies possible

By Molly Sprecher

In movies, pregnancy is a supportive pep talk from the partner, a tough-love nurse and kindly doctor chanting, “one more push,” a first cry and ensuing happy montage. Off-screen: stretch marks map stomachs, afterbirths seep, nipples crack, limbs swell, distended stomachs cramp, hair thins, postpartum hits.

“I think there is a movement now for women to reclaim their bodies and their birth experiences,” Spencer Tackett, a junior at UNC-Chapel Hill seeking her doula certification, said. “And a large part of that is having a doula to help a patient advocate for themselves and calm them down when they are in a stressful and vulnerable position, or help women give birth with fewer medical interventions.”

What is a doula?

It’s hard to define what a doula is. Doulas aren’t medical professionals. Yet they are more than just emotional support humans who hold hands in the hospital. They are trained, largely through DONA, Doulas of North America, to support their clients throughout their pregnancy. Doulas offer physical, emotional, mental and educational support. . They answer questions and offer tips. In a time of emotional and physical vulnerability, doulas stand up for clients who cannot stand up for themselves — sometimes literally, seeing them balancing on the medicine ball, deep-breathing in the bed, pacing the floor with one hand dragging their IV.

Robin Rennells has been practicing as a birth doula for 11 years. She attended her first birth at the Women’s Birth and Wellness Center in Chapel Hill. She’s stood at the side of a woman, whose husband was out of town, getting a cesarean section. She’s scheduled her own family around being able to help grow others. She’s delivered all four of one woman’s children and been the doula for women who have struggled with infertility for years. She’s watched women mouth, “I did it,” through their tears and sweat. She’s left her home for a labor not knowing if she will be gone a few hours or a few days.

Doctors come in and out of the room, but Rennells stays, answering questions, holding hands, empowering clients and watching their confidence and courage grow. She’s emotionally and physically exhausted, but she keeps coming back.

“It’s like coaching someone through a marathon,” Rennells said. “Watching a miracle take place, believing in someone more than they believe in themselves, seeing a couple at their worst and best and seeing God answer many prayers.”

Why be a doula?

Joelle Schantz’s first birth lasted an hour and a half, and she stood in the corner watching her mentor coax the mother through. She’d thought she might cry. She didn’t.

Schantz completed her training to become a volunteer doula through the UNC-CH Birth Partners program. She’d first heard of doulas in a sociology class. She spent the rest of the day with friends joking that they would never have children.

“There’s this fear around birth for a lot of girls or women,” Schantz said. “Even though I was taking this reproductive sociology class, I think I still had that fear of it and thought that it wasn’t my cup of tea to be in the position to help someone. But the more you learn about something, the less fear is involved.”

Schantz has stood alone by the side of a teenage girl giving birth with no one to help her. She’s watched a father lean over the side of the tub holding his pregnant wife with pictures of their toddler. She’s hoped Spanish-speaking clients would understand her presence when they can’t understand her. She’s moved women into different positions, massaging pressure points and lowering them to the birth ball to facilitate shorter labors. She’s directed fathers away from televisions, reassured frantic women that the beeping on the electronic fetal monitor is normal and talked to people she’s only just met throughout the night. She’s wished she could be in 20 places at once, a doula for everyone who needs but can’t afford one.

Who needs a doula?

“There’s a huge disparity between maternal morbidity and mortality outcomes by racial divide, by income divide,” Schantz said. “The people who need doulas don’t have access to doulas. Everyone should be able to have a doula.”

Black, American Indian and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention.

“Doulas are expensive and not everyone can afford them,” Schantz said. “The people who have doulas are typically high-income, educated, typically white women.”

Women with insurance still pay an average of $3,400 in hospital fees during pregnancy, according to a survey by Childbirth Connection, a program run by the National Partnership for Women and Families. Without insurance, prices range from $30,000 for vaginal delivery to $50,000 for a cesarean section. Many women who would benefit from having an additional support system cannot afford to hire a $1,200 doula. Although doctors help ensure the physical well-being of the mother and child, clinical settings limit women’s ability to take control of their pregnancy.

“Women in society often aren’t as assertive, and that’s just because of social norms that are put on them,” Schantz said. “And when you’re in labor, especially in a hospital setting, those norms are perpetuated. And when you’re in pain and confused and don’t know what’s going on, giving a person the space to speak and making sure a person knows their options is a huge part.”

How does it feel to be a doula?

Fariha Rahman and Spencer Tackett are both students at UNC-CH. Rahman has seen five births. Tackett has seen none. All the same, both are beginning their journeys as doulas.

“The first time I was a doula, it was a 12-hour shift, and by the end of it, I was exhausted,” Rahman said. “When I went into the client’s room, within an hour or so, I was holding one of her legs, and next thing you know, the baby’s born.”

Rahman doesn’t know what to feel each time she sees a birth. They’re all different. She laughs with new mothers cradling their child. She tenses with mothers who’ve been told something’s gone wrong.

Tackett studies high-risk births, medical paternalism and the struggles of black motherhood in secret during her Celtic studies class. She sets notifications on her phone for doula trainings and checks her Facebook messages for information on the new UNC-CH Doula Project. While filling her schedule with classes on cesarean sections and social work, she worries that not having had a child herself will limit her ability to help clients.

“It would mean everything to experience a birth with a family,” Tackett said, “The birth of a child is one of the most memorable moments in a person’s life, and knowing that a family trusted me enough to have me present for that moment, and trust me enough to advocate for their wishes, would be really special for me as well.”

Rahman’s favorite part of the job is interacting with the mothers, watching their faces transform from screams to smiles and sharing the intimacy she’s been allowed into. She sees bodies contort and triumph over impossible pain.

“I’m Humbled,” Rahman said. “Honored and humbled.”

Edited by Maddie Fetsko