Like most women, Kate Moore, at 41, had a lot of balls in the airshe was a married mother of two school-age boys and a nurse at a busy outpatient clinic in North Carolina. After recovering from a hysterectomy, Kate (which is not her real name) developed IBS-like symptoms on top of the stomach problems she already had because of her anxiety. Before she knew it, shed dropped 10 pounds. Once my doctor determined that nothing scary was going on health-wise, I figured I could keep going, she says. The compliments began pouring in; Kate was exhilarated when she got back to her college weight.
Then she was assigned a demanding new boss. My work became stressful and demoralizing, she says. Our schedules were hectic, and this just added to a chaotic family life. With her anxiety ramping up, I started feeling like a failure as a mom, wife, nurse, and housekeeper, she says.
At the same time, she found herself obsessed with shedding even more weight. I never felt beautiful or particularly thin, and I have always had poor body image, so this newfound attention due to my looks was addicting, she says. Losing weight was a way I could succeed at something and control the chaos.
Exercising excessively and limiting her calories to just 100 per sitting and 500 for the day, Kate began making excuses for why she barely ate. Id say, I ate before I got here; Im eating several small meals; My stomach is off, she says. She came to believe she could literally feel her flesh expanding with each bite of food, and she began to make herself throw up after eating.
Far from creating order, Kates stringent regimen put a strain on her marriage. She and her husband argued about her weight, which stressed out her children. My sons knew I wasnt eating and that their dad was beside himself with worry, she says. It broke my heart when they made me breakfast in bed complete with overflowing bowls of their favorite cereal, burned toast, and sloshing glasses of orange juice. Over a few months, she dropped from size 12 to size 4, which triggered heart palpitations, fatigue, bouts of hypoglycemia, and dizziness. It was fainting at work that finally drove Kate into treatment for her eating disorder, which involved five years of therapy and included a stint in a residential treatment facility and an intensive program with her husband before she finally recovered. Now 56, shes been at a healthy weight for a decade.
My sons knew I wasnt eating and that their dad was beside himself with worry.
Eating disorders are surprisingly common among women in midlife. A 2012 study in the International Journal of Eating Disorders estimates that 13% of American women 50 and older have eating disorder symptoms, slightly more than the percentage diagnosed with breast cancer. The Renfrew Center, a nationwide network of residential eating disorder treatment clinics, reports a 42% jump in women over 35 seeking treatment over the past decade. Research shows that though rates of anorexia plateau around age 26, rates of bulimia dont peak until around age 47, and rates of binge-eating disorder dont hit their highest level until the 70s.
The COVID-19 pandemic has made matters worse for patients of all ages. A new survey of people with eating disorders in the U.S. and the Netherlands shows a sharp increase in food restriction among people with anorexia and anxiety about finding foods consistent with prescribed meal plans. Those with bulimia and binge-eating disorder report increased bingeing.
The data suggests that only about 5% to 10% who develop an eating issue get it for the first time as adults. A portion of the women had it in adolescence, recovered or partially recovered, and then relapsed later in life, says Cynthia M. Bulik, Ph.D., founding director at the UNC Center of Excellence for Eating Disorders at the University of North Carolina at Chapel Hill. A portion have had persistent illness, never really recovering, and some seem to have had subthreshold conditions or hints of an eating disorder in adolescence, but never had it really crystallize into a full-blown diagnosable syndrome until midlife. These women may have been at a low, though not alarmingly low, weight; may have dieted on and off; may have engaged in compulsive exercise for years; or may have a history of binge-eating, but not at a frequency that would have brought it to the attention of a health care provider, she says.
Like their younger counterparts, older women can experience the primary eating disordersanorexia nervosa, the extreme restriction of food; bulimia nervosa, gorging and then purging through self-induced vomiting or laxatives; and binge-eating disorder, consuming huge quantities of food in a short time. But the lines between these diagnoses often get blurred in midlife. Many older patients started out with one set of symptoms, like restricting anorexia, but shifted into bulimia or binge-eating over time, says Margo Maine, Ph.D., a psychologist specializing in eating disorders at midlife and author of The Body Myth: Adult Women and the Pressure to Be Perfect. The most frequently seen eating disorder in adult women is otherwise specified feeding and eating disorder (OSFED), a combination of anorexic symptoms and bulimia, she says.
Another common way EDs can manifest in older women is as atypical anorexia. Women with this disorder restrict their eating for days on end. They have every marker of anorexia, except their weight doesnt drop to such a frightening threshold, says Maine. These women may have lost weight but were at a high weight to begin with, so their weight isnt dangerous based on their BMI, but for their body type, frame, or weight history, they can be in danger. Women with atypical anorexia may have dieted so severely, their metabolic rates have slowed to a crawl to defend their bodies against starvation.
Whether a woman is 15 or 50, an eating disorder is believed to be prompted by genetic factors that include personality traits such as sensitivity and perfectionism, which account for more than half the risk. Piling on environmental factors such as the cultural obsession with thinness and youthor a personal crisiscan make it even more likely to be set off. And menopause can bring hormonal shifts that, just as during puberty, spark depression and anxiety, raising the risk of disordered eating even further.
Also, physical changes that come with age may take a toll on a womans body image and confidence. For a variety of reasons, women normally gain about 1.5 pounds per year in their 40s and 50s, research shows. A 2013 Austrian study in the International Journal of Eating Disorders found that women in perimenopausethe roughly four- to eight-year window that typically falls in a womans 40swere more likely than either premenopausal or postmenopausal women to succumb to these disorders.
Meanwhile, women deal with unprecedented cultural pressure to stay trim and attractive. Unlike when there were fewer women in the workplace, says Maine, today most women are out in the world, and theyre being evaluated constantly, which includes what they look like. As more women have positions of power and visibility, the effects of aging are on full display. Looking youthfuland thincan seem critical to staying competitive on the job.
All of a sudden the number on the scale became the measurement for how I was doing.
Then, of course, there is life drama: Divorce, having children leave home, the need to care for aging parents, and other midlife challenges often occur alongside a surge in symptoms. It can happen whenever your identity is yanked out from under you, says Los Angelesbased author Aimee Liu, who suffered from anorexia in her teens and relapsed in her late 40s when her marriage was in trouble. All of a sudden the number on the scale became the measurement for how I was doing, says Liu, now 68, author of the memoirs Solitaire and Gaining: The Truth About Life After Eating Disorders. Fortunately, Lius therapist helped her connect the dots between her stress and returning symptoms, and she recovered relatively quickly.
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Eating disorders affect all the bodys organs and systems, from the heart to the hormones. Lack of proper nourishment lowers blood pressure, sometimes to dangerous levels, and estrogen, which can trigger bone loss. As the brain consumes up to a fifth of the bodys calories, simple thinking processes and concentration can suffer. Purging can lower the bodys electrolytes, leading to heart arrhythmias and even heart failure.
But older women with eating disorders may have even more problems: Loss of muscle can slow metabolic rate, and age-related cognitive impairment can manifest faster, says Maine. Digestive troubles like gastroesophageal reflux disease and irritable bowel syndrome are also common. As our organ systems age, they become less resilient, says Bulik. For example, vomiting and having stomach acid coming up the esophagus all the time, the body just doesnt bounce back. Not that it necessarily does when youre an adolescent, but its worse when youre an adult.
Lisabeth Kaeser, a peer pastoral counselor in Terrace Park, OH, battled anorexia in her youth and relapsed when she was 47 and her father was dying. She developed a heart arrhythmia, reflux, and gastroparesis, in which digestion slows and the stomach is slow to empty, as a result of her self-induced vomiting and extreme food restriction. Its uncomfortable. Ive experienced constipation, horrible bloating, and pain, she says.
Yet after five years of various types of therapy, shes stopped throwing up, put on a couple of pounds, and made peace with her body. Now 55, she refers to her body as not overweight, but weight restored. Its difficult at times, but I constantly remind myself that I have gained so much more in my life than weight, she says. She has become an eating disorder coach too: If Im strong enough to starve myself or make myself throw up, Im strong enough to live in a weight-restored body, she says.
For patients who are still struggling, however, dying from an eating disorder is a grim possibility. These diseases have the highest mortality rates of any psychiatric illness, yet research shows that only 27% of sufferers seek help. One barrier: embarrassment. Women will say, What am I doing in your office with anorexia? Sixteen-year-olds get this. Im 55, says Ann Kearney-Cooke, Ph.D., a psychologist at the Cincinnati Psychotherapy Institute. Just teaching them that research shows that up to 15% of midlife women have an eating disorder is reassuring. It helps them to know theyre not alone.
There are two FDA-approved medications for eating disordersfluoxetine (Prozac), to treat bulimia, and lisdexamfetamine (Vyvanse), for binge-eating disorder. Neither is going to be a cure by itself, says Michael Lutter, M.D., Ph.D., a psychiatrist who specializes in treating eating disorders in Plano, TX, but they are somewhat helpful. Therapy, ideally geared toward adult women, is the primary treatmentin a residential facility if a patient is very sick. Alison Smela, a former advertising executive in Glen Ellyn, IL, was treated at such a facility when earlier anorexia symptoms flared up after she got sober in her mid-40s. For three months, she received therapy and eating support within a program track specifically for women over 30. We had group sessions where we talked about marriage, work, and kids, she says. The younger patients were talking about boyfriends, parents, and first jobs.
Dee Shore, 56, a writer at a university in Raleigh, NC, briefly skirmished with dramatic weight loss in high school and then gained weight in college, but experienced a full-on relapse when she was 42, a few years after her father intentionally drowned himself during a hurricane. Her weight dropped dangerously low until she had to be hospitalized in a locked facility. She wound up being hospitalized four times in all. Then, with her husband, she entered a study for adults with anorexia at the University of North Carolina. It really made the difference for me, she says. Called UCAN (Uniting Couples in the Treatment of Anorexia Nervosa), the program recognizes that partners dont know what to do to help and fear that whatever they do will exacerbate the problem. Often they also need relationship work, because the eating disorder affects the whole family system, Maine says. The approach educates couples about the recovery process and teaches them effective communication skills so they can be on the same page about goals. That helps women feel theyre not in it alone.
Eating disorders are complicated, says Maine. Women cant just go in and sign up for six sessions of cognitive behavioral therapy. They really need to understand the role this eating disorder has played in their lives, why it emerged, and how they can live without it and start making very difficult changes to their behavior.
Yet women do get better, Maine says, and Lisabeth Kaeser is living proof. Today I eat to my hunger and enjoy spending time with friends over a glass of wine and good food without throwing up or restricting. And a good cup of coffee, which for me includes half-and-half, she says. Trust me when I say recovery is worth it.
This article originally appeared in the December 2020 issue of Prevention.
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