Jackie Evancho, 22, Reveals She Has Bones of an '80-Year-Old' Due to Anorexia-Caused Osteoporosis

After suffering from an eating disorder for seven years, Jackie Evancho is ready to make a change.

In the new issue of PEOPLE, the singer, 22, opens up about her battle with anorexia and how she's working to get healthy.

While she's struggled with disordered eating since she was a teenager, the America's Got Talent alum — who placed second in 2010, at just 10 years old — knew she needed help last year, after she was hospitalized following a January 2021 car accident that broke her back in two places.

"They were abnormal breaks, breaks that you see in 80-year-olds," Evancho explains. "That's how I learned that my eating problems created osteoporosis. So now I'm a 22-year-old with osteoporosis."

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But the bone-disease diagnosis didn't immediately compel Evancho to address her food issues.

"I had to eat [for my bones] to heal, and that really messed me up with my eating problems, because I was gaining weight to heal," she says. "Once I finally healed, my disorder said, 'OK, now you've got to be really hard on yourself to get all of that out of you . . . and then some.'"

Evancho eventually sought treatment last October at an inpatient facility. Her anorexia has been an ongoing health hurdle, just as her recovery continues to be a work in progress.

Evancho's battle with anorexia began at age 15. As she was going through puberty, "I noticed that I looked a little bigger to myself, so I asked my mom, 'Do I look fat?' And she was like, 'No, no, that's just baby fat,' " Evancho recalls. "So I decided that I was going to start to mildly diet and start working out regularly."

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At the time, Evancho "didn't see results" she wanted, so she began eating even less and working out more. "When I started to go days without eating, in my head I said, 'I know that this isn't normal,' " she says. "I felt exhausted, moody, tearful, but after a bit of time, I started to feel nothing."

Despite seeking outpatient treatment at age 17, Evancho continued to struggle — and when the COVID-19 crisis hit in 2020, her eating disorder was only exacerbated.

"The urge to restrict what I'm eating, on top of eating because I'm bored, and panic because I have this distorted view of myself in the mirror . . . it made everything really difficult," she says. "There weren't distractions during COVID."

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Today, Evancho is "still fully in the throes" of her ordeal, but, now, she wants to be healthy. She sees a nutritionist and therapist and undergoes eye movement desensitization and reprocessing (EMDR), a type of psychotherapy that she hopes will help her process past trauma and get her anorexia under control.

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"I'm still struggling, but I'm fighting, which is good because a year ago I was giving in to it completely, and that's so dark and painful," Evancho says. "I'm not healthy yet, but I have been able to implement healthy coping skills and better eating habits."

Music — and her career — have motivated the performer.

"Since I was a kid I've put so much blood, sweat and tears into my career, and to see that sort of fade away because of this demon in my head? No, I'm going to fight this now because you can't take this one thing from me," says Evancho, who in September will release her ninth LP, Carousel of Time, a Joni Mitchell covers album that includes remakes of "Both Sides Now" and "A Case of You," among other classics. (See below for a first listen of her "A Case of You" cover, which officially drops July 13.)

Evancho has also been working on original music, having recently returned from a songwriting trip to Nashville, where she found drawing on her experiences cathartic, she says: "It's opening old wounds, but painting with the blood; it wasn't healing, but it was making something beautiful out of something painful."

Adds Evancho: "There are still issues, but they are so much better," she says. "There are days where I feel helpless and hopeless, but I'm sick of living like this."