The first photos most people saw of Josh McCullum showed the 97-pound teenager in a Maine hospital room, where he spent two weeks after his arrival home from a fall study abroad trip to Egypt.
His host family, Coptic Christians who fast 200 days of the year as religious tradition, had starved him, McCullum told the Associated Press. His parents said that their son was no longer the boy they sent on the program and that they would consider filing a lawsuit against AFS USA, the nonprofit study abroad program that arranged McCullum's trip.
Doctors said the teen's health had deteriorated so much that he was at risk of suffering a heart attack when he returned in January.
But AFS also has photos of McCullum, and they show him celebrating with other students during the abroad experience. Some even show a smiling McCullum — who claimed that his starvation at one point was so dire that he resorted to stealing food — eating at parties.
"This situation is unique," Margaret Crotty, director of AFS Intercultural programs, told "Good Morning America." "It's not the norm." Crotty also insisted that student safety is always the organization's first priority. AFS USA, founded 60 years ago, organizes abroad programs in 40 countries.
The father of McCullum's host family, Shaker Hanna, told the AP that the teen under their care was extremely well-fed throughout his stay. The Coptic Christian family, which, by religious rite, is also vegetarian, offered McCullum fish and meat, Hanna said.
"The truth is, the boy we hosted for nearly six months was eating for an hour and a half at every meal. The amount of food he ate at each meal was equal to six people," said Hanna, who has two sons and a daughter studying in the United States in separate AFS exchanges.
McCullum acknowledges that his friends told him to leave Hanna's family, but the teen said that he wanted to stick it out, in part because the neighborhood where he would have to move was in a reputedly dangerous section of Alexandria. He did not complain to his parents, who now claim that AFS provided false assurances that their son was in excellent health.
McCullum is one of thousands of American students who travel overseas for high school and college exchange programs to learn about a foreign culture through immersion.
His story quickly circulated through college study abroad offices and overseas study programs Thursday, leading coordinators to speculate what went wrong and offer tips to ensure other students going overseas remained safe and healthy.
About 223,500 American students traveled abroad in 2007, though only 1 percent chose to study, like McCullum, in the Middle East, according to the Institute of International Education.
"The vast majority of students abroad do not have difficulties that rise to the serious level," said Brian Whalen, president and CEO of the Forum on Education Abroad at Dickinson University. "Part of studying abroad is rising to the challenges of living in a different culture. Most students meet the challenges and rise to them."
Students, Whalen said, should be properly trained to handle emergencies and know whom to contact if something goes wrong.
American students enrolled in foreign universities typically do it one of three ways. They study through a program sponsored by an American college, go through a study abroad program that coordinates American students' classes and accommodations with a foreign school, or simply enroll in the foreign school on their own.
In most programs students are given a safety lecture at the beginning of the program, and local contacts in case of emergency, said Sonja Thorsvik, the study abroad coordinator at Loyola Marymount University in Los Angeles. The university is home to the Center for Global Education, which operates a clearinghouse for information on how to study abroad safely.
There are a handful of rules any student going abroad should know, Thorsvik said.
Students often have a difficult time adjusting to foreign surroundings in their first weeks overseas, Thorsvik said. When choosing a program, students and parents should make sure there is a network in place to help kids negotiate problems with their host families and to determine whether they are just slow acclimating to a foreign country or if there is a real problem.
McCullum said he was not fed breakfast, took to school for lunch a sandwich of cucumbers and cheese, and had a small dinner of beans vegetables and sometimes fish.
He said he sometimes bought food, and once tried stealing it from a supermarket, but was caught.
"To me it seems like this was a personal choice," Thorsvik said. "Students are not prohibited from going outside to take their meals. Students usually eat one or two meals a day with their host families, but can still go out and eat. If everyone fasted for as much and as long as he did, the entire community would be malnourished."
McCullum's father has speculated that the boy took to fasting because he was manipulated by the family and had developed Stockholm syndrome, a disorder in which people under duress sympathize with their captors, the AP reported.
Thorsvik offered an alternative reason why the boy starved. Sometimes, she said, students so wholly throw themselves into the culture in an attempt to "go native," but go too far.
"It is very rare for a student to go to Egypt," he added. "He would have to be very independent. Sometimes those personality types attempt to fully immerse themselves in the culture. They want to experience things so much that they do harm to themselves."