Antonia Caruso is in a good place these days, something she could not have imagined two years ago.

She is a 16-year-old junior at Scarborough High School, a cheerleader for the Red Storm, an honors student and a novice weight lifter who recently finished fifth in a body building competition.

She is also recovering from anorexia, an eating disorder that can be one of the most dangerous health threats to young women. At her nadir, the 5-foot-5 Caruso dropped to 92 pounds. Now she weighs 117.

“I’ve never felt more healthy, more alert in my life,” said Caruso. “I feel amazing. Working out makes you feel so good about yourself and it gives you so much confidence in yourself.”

Caruso lifts weights five days a week, alternating between the bench press, squats and dead lift, each workout lasting about an hour. She will also occasionally run, though she prefers to be in the gym. She sees a nutritionist.

“She wants to be healthy,” said Christine Haley, her mother. “She wants to feel good, she wants to look strong and feel strong.”

It wasn’t always that way.

Caruso began dieting when she was in the fifth grade. By the time she was a freshman, her diet had become severely restricted. “You just start to cut out these foods for an underlying issue that you don’t know about,” she said. “And then the more you cut out, you just cut out more and more and more until there is a long list of foods you won’t even touch. And then all of a sudden, you’re left with these little bits of calories and you’re afraid of everything else.

“I was terrified of food and it was an awful way to live.”

She was down to eating about 500 calories a day of raw vegetables. “Unless it was a piece of broccoli, I wasn’t eating it,” she said.

And her health began to suffer. She couldn’t walk without getting dizzy. Her speech became slurred. She had trouble understanding what other people were saying.

Her parents gave her an ultimatum: “We told her to either eat or go to the ER,” said her mother. “She chose the ER.”

She would eventually miss much of her freshman year. While she was able to complete much of her studies, her mother said she still has to make up one class before graduation.

It wasn’t just Caruso who was suffering, but also her parents and siblings. “It affects everyone in the family,” said Haley. “It’s comparable to someone who’s an alcoholic.”

Caruso’s pediatrician saw her and was the first to suggest it was an eating disorder. From there, her parents entered her in an outpatient eating disorder clinic at Mercy Hospital, where she was diagnosed with anorexia nervosa. According to the National Eating Disorder Association, anorexia affects between 0.5 percent and 1 percent of women in the United States. It is among the most common psychiatric diagnoses in young women. And it has one of the highest death rates of any mental health condition.

Dr. Kathleen Hart, the president of the Eating Disorders Association of Maine in Falmouth, said there are no concrete numbers on how many Mainers are affected by anorexia, but that “Maine pretty much mimics every other state. We have a high need for eating disorders treatment in Maine, especially in rural areas.”

Caruso entered the clinic on Oct. 29, 2013. The treatment included individual counseling, group therapy and eating. She didn’t go to school while she was in therapy.

“You ate every meal there, except dinner,” said Caruso. “And you had to finish every single thing on your plate. If there was anything there that wasn’t finished, it was placed in a supplemental drink. Being honest, the treatment was miserable. It’s one of the main things that keeps me on track, to never go back.”

But she did. Caruso was released from treatment in mid-December. On May 3, 2014, she was back.

Caruso says she is focused on living a healthy lifestyle and does not “want to get obsessed with how I look.”

Caruso says she is focused on living a healthy lifestyle and does not “want to get obsessed with how I look.”

She was in treatment until July 3, 2014. She has a monthly check-in, and has tried to resume a regular routine. In the fall of 2014, Caruso asked her mother if she could try out for cheering. Her mother initially hesitated – “The program recommended nothing for a year,” she said – then agreed. It provided a good social outlet for Caruso.

Then last February, wanting to become stronger for cheering, Caruso walked into the weight room at Scarborough High. Jeff Quirk, one of the Red Storm’s strength coaches, was there that day.

“I give her a huge amount of credit,” said Quirk. “She came into a gym filled with football boys. I gave her a couple of techniques and she showed up again and she showed up again and she showed up again.”

Soon she started training with Quirk, sometimes at World Gym in Portland, sometimes at the high school. Lifting weights was lifting her spirits and changing her life.

“I never imagined that I’d get so into it, but it’s literally my favorite thing to do now,” said Caruso. “Mentally and physically, it’s a huge part of my life. Mentally it’s such a stress reliever for me. Physically it’s helped me with my eating disorder.”

At the same time, she met with nutritionist Mike Foley. He told her if she wanted to “train like an athlete, she had to eat like an athlete.”

He has her on a diet of 2,800 calories a day, eating eight times a day. “My friends never see me not eating,” joked Caruso. The most important meal, said Foley, is breakfast. He has her eat a large protein-based meal within 20 minutes of waking.

“The whole thing with Toni was to get her to understand that food was crucial for her well being, that she was recovering,” said Foley. “I didn’t have to do too much. She was at a point where she just needed to listen.”

Still, her mother wasn’t so sure it was a good thing when Caruso told her she wanted to start weight training. “I was nervous because it was something else related to her body, something else related to her body image,” she said.

And eating disorder experts share that concern. Dr. Kathryn Zerbe, a professor of Psychiatry at the Oregon Health and Science University and author of several books on eating disorders, said weight training is typically not recognized as treatment for an eating disorder.

“There may be benefits to it if the individual has oversight by a physician who has training in eating disorders,” she wrote in an email. “There can be a sense of empowerment and motivation to have a healthy body. The downside that we don’t know when someone who has had an eating problem begins to weight lift, etc., is if they are over-exercising or trading one ‘addictive behavior’ for another.”

Caruso and her support circle is making sure that doesn’t happen. She has days off from training. Her mother monitors her diet and her workout schedule carefully. If she sees Caruso becoming too anxious over it, she steps in.

“I still look for the signs,” said Haley. “But I feel secure … She’s very content right now.”

Hart, who has been treating eating disorder patients for over 20 years, said it appears that the weight training has had a very positive effect on Caruso’s recovery.

“It sounds like it’s brought her some happiness and that she’s found a relationship with her body that is supporting her recovery,” she said.

Caruso gradually put on weight and is now, as Quirk put it, “117 pounds of ripped, dense, jacked muscle.”

He said she lifts 210 pounds in the squat, 205 in the deadlift and 100 in the bench press. “She has perfect mechanics,” said Quirk. “She’s spot on with everything.”

At some point, Caruso approached Michelle Brown, a former body builder, to teach her how to pose for body-building competitions. Brown’s daughter, Tiana, is also a cheerleader at Scarborough and sometimes trained with Caruso in the school gym. Michelle Brown had told her that she would coach her if Caruso ever wanted to pose.

“I wanted to see her strive and reach her goal,” said Brown, who didn’t know about Caruso’s anorexia until she told her two months before the competition. “I had to get her to learn what her body could do, how to get those muscles to pop. It’s not easy. People on stage make it look easy, but it’s not. It’s a challenge and it’s demanding on those muscles.”

Caruso did pretty well, placing fifth in the novice class and fifth in the open class of the figure portion of the body building competition. “She did a very good job for being so young,” said Brown. “A lot of people she went up against had that muscle maturity with them. I was thrilled.”

With such a busy cheering season coming up in the winter, she doesn’t plan on competing again for another year.

“Her mindset,” said Quirk, “is that she’s got fitness for life, not fitness for a show.”

As she completed a recent workout, Caruso said the competition was simply a byproduct of her training.

“For me, it’s just about leading a healthy life like this,” she said. “This is something I want to do the rest of my life.

“I don’t weight train for the competition because I don’t want to get obsessed with how I look.”