Anorexia nervosa is a serious disorder that occurs in about 1 in 200 women in developed countries, usually starting in adolescence. More than 90% of cases occur in women. Persons with anorexia nervosa have low body weight and distorted body image, and often deny that they are dangerously underweight. Because malnutrition and being severely underweight have serious medical consequences, it is important for persons with anorexia nervosa to receive treatment for their illness. The relapse rate for individuals who have anorexia is high even after successful weight gain, which means that long-term treatment is necessary. The death rate from anorexia nervosa is among the highest of any mental illness and is about 10 times the death rate for young women without anorexia.The June 14, 2006, issue of JAMA includes an article reporting that the drug fluoxetine was not helpful in preventing relapse after initial weight gain in patients with anorexia nervosa.