Gritty, shows how warped the thought processes can get for someone with anorexia. No matter how little you weigh, it's always too much. Back in college I worked on the peds unit at a hospital and twice took care of teenage anorexic girls. They're a little scary because their mindset is so skewed. To you they look like a concentration camp survivor, but they see themselves as too fat. Lia's obsession about the caloric content of everything she puts in her mouth and maniacal exercise regimine seemed realistic. However, like other readers I found the constant strikethroughs in the text annoying.
Lia has been battling anorexia for years and has already been hospitalized twice. The story opens with the death of her former best friend. The knowledge that she ignored 33 phone calls from Cassie the weekend she died pushes Lia further down the spiral. Her parents had their own issues which play into the ensuing battles over her eating habits, where she should be living, what type of treatment she should be receiving, etc. She is a master manipulator (she jerry-rigs their scale to show her weight as more than it really is and sews coins into her robe to add extra weight) but her body can only take so much abuse before it gives out.