Diane, a soft-spoken woman from upstate New York, has had bulimia for nearly eight years. She’s been treated as an inpatient six times and an outpatient seven times—all with limited success.
But unlike the other patients, who are mostly in their teens and 20s, Diane is 50.
Eating disorders are increasingly common among older women, and eating disorder clinics have seen an influx of older patients. “My oldest client is a woman who is 74,” says Jeanne Rust, Ph.D., founder of Mirasol treatment clinic in Tucson, AZ.
While most of us might associate grandma with her gingerbread cookies and cushy lap, we’d be wrong to assume she no longer cares about her looks.
A survey of 475 women, ages 60-70, found that 90 percent felt moderately or very fat, though their average BMI was 25, right on the border between healthy and overweight. A full 60 percent felt dissatisfied with their bodies.
The Start of a Deadly Disease
For Diane, the onset of her bulimia was riddled with stress and change.
In 2002, Diane was diagnosed with breast cancer, launching a fight that ended “triumphantly” when she walked in a Susan G. Komen Race for the Cure.
A week later, a car struck Diane as she was leaving the hospital where she worked, leaving her seriously injured. “Overnight, I was just taken out of everything,” she says. “I went from being very productive to homebound.”
Faced with a court battle, limited mobility and an extended absence from work, Diane started restricting her eating. At first, she didn’t see the harm. “I just thought it was a way to maintain my weight,” she recalls.
Soon, her behavior grew much more concerning. Some days, she’d eat no more than a pack of mustard for lunch, and when she binged, she’d “eat anything I had in the house,” which could mean five slices of pizza and four bagels with cream cheese in a single sitting (that’s about 3,000 calories). Her life revolved around when she could binge and purge.
Slammed with so many stresses at once, Kimberly Pearson, M.D., a psychiatrist at Massachusetts General Hospital, says it’s no surprise that Diane used bulimia as a coping mechanism.
Psychologists use a stress-diathesis model to explain the onset of eating disorders, meaning that a genetic vulnerability combined with a stressful environment triggers the disease. “You can skate through with genes that predispose you if the environment is friendly,” says Pearson. But if life takes a turn for the worse, an eating disorder can rear its ugly head.
For some, the disease is a recurrence of an earlier struggle with weight issues, but for others, like Diane, it’s new.
Even then, the disease doesn’t come out of nowhere. “If one presents with an eating disorder in midlife, there is usually a history of some abnormal eating,” says Pearson. “To say that they have always had a healthy attitude toward eating and body image then suddenly develop an eating disorder later on would be extraordinarily rare.”
Shifting relationships in midlife—like divorce, empty nest syndrome or responsibility for aging parents—are common triggers for late-onset eating disorders. Add onto that the stress of dating in midlife and media images of vivacious, youthful older women (Demi Moore, anyone?) and you get a perfect storm. “Women in midlife are under a tremendous amount of stress,” says Rust.
By the time Diane returned to work, she’d lost quite a bit of weight and had difficulty concentrating. Tasks that used to be easy for her were suddenly enormously challenging and she had to take frequent breaks. She eventually lost her job.
At any age, the physical repercussions of an eating disorder are myriad, but the risks are even greater for older women. “The body is generally more vulnerable,” says Elizabeth Midlarsky, Ph.D., professor of clinical psychology at Columbia University Teachers College. “Organ systems have weakened or become diseased.”
“At a time in a woman’s life when she should already be concerned about her bones and heart, an eating disorder adds an extraordinarily excessive strain,” adds Pearson. “It’s one thing for a 20-year-old to be straining her heart like that, but to be 55 with a potential family history of cardiac issues is that much worse.”
Diane paints a vivid picture of just how devastating the medical complications can be.
After eight years of purging, Diane has suffered from gastric reflux and bleeding, osteopenia, esophageal ulcers and severe anemia. Once, her esophagus closed up because of muscle contractions (dysregulated by the purging) and doctors had to insert what Diane calls “a balloon thing” so that she could swallow food. She has found herself in the ER repeatedly for episodes of dehydration and fainting, and once broke her tailbone when she passed out in the garage. “Medically, it has really hindered me,” she says. On most days, she suffers intense fatigue and finds that she “can’t do a normal day’s worth of work without having to take a nap or lay down.”
The risks only worsen with age, when malnutrition can cause confusion about the real root of medical problems.
Midlarsky works with eating disordered patients over 65 (the oldest is in her 90s), and she finds that cause is often blurred with effect. “They can seem depressed or demented from not eating,” she says. “I say, get her fed and then let’s talk. Nutrition and hydration can have a lot to do with health problems in later life.”
The social consequences can be even harder to manage.
Out on disability since 2006, Diane deeply misses the hospital where she worked for 23 years and the co-workers who felt like family to her. “We basically grew up together,” she says. “We graduated, started jobs, got married, had kids, all in the same time frame. I cried a lot about that.”
Her family life has changed as well. She and her husband had a once-vibrant social life but now rarely leave the house, and family gatherings like Thanksgiving, or even a simple dinner out, can cause enormous stress. “I know my daughter is very angry,” she says.
When asked if Diane’s behavior could increase her daughter’s risk of an eating disorder, Lynn Grefe, CEO of the National Eating Disorders Association (NEDA) asserts that such beliefs are misguided. “Moms don’t cause eating disorders in their daughters,” she says. “The traits may be passed down, but if a mom has an eating disorder, that doesn’t mean her daughter will have one.”
Still, Pearson does say it’s a risk factor. “Whenever a mother is embedded in her own eating issues, it’s hard for a daughter to develop healthy body image in that context.” The best action a mom can take is to watch her daughter for signs of an eating disorder and catch it early.
For older women, the road to recovery is paved with obstacles.
Grefe says that, in her experience, older women tend to be more secretive about the disease. “They think it’s a young women’s disease, so they’re embarrassed,” she says. That can keep them from admitting the problem. “We work very hard to say there’s no embarrassment,” she adds. “These are illnesses. It’s nobody’s fault.”
Unfortunately, the general public rarely reinforces that view. “People with eating disorders get a lot of anger directed their way,” says Pearson. “Older women especially can draw contempt from people who say, ‘Aren’t you old enough to know better?’”
In fact, Diane has heard those words before. When she checked into her first treatment center, her fellow patients were half her age. “I remember one of the parents saying to me, ‘Aren’t you a little old to be going through this?’ I just felt really embarrassed, like I should have my stuff together by now.”
To make matters worse, doctors rarely screen for eating disorders in older women. “People don’t believe it,” says Midlarsky. “They think, ‘She’s skinny so she must be sick.’ Weight problems get lost in the shuffle.”
All four experts I interviewed cited a lack of screening as the number one barrier to treatment.
Diane first questioned her health when friends pointed out her weight loss. “One of my co-workers—a physician—said I looked like I came from a concentration camp. That really stuck with me,” she says. “You hear those comments and you think, maybe I’m not okay.”
What finally brought her to the doctor was not bulimia, but depression. Her oncologist recommended a therapist, who referred her to an eating disorder clinic.
As it turns out, that path is fairly common. “Women will stay in denial for years,” says Rust, “until they begin to have health consequences. Often, depression or anxiety will get them to the doctor.”
Once there, the doctor can intervene. NEDA is currently working with the American Medical Association to train physicians to detect eating disorders in women of all ages. According to Pearson, it’s just a matter of asking the questions.
Today, Diane is ready to turn her life around. She’s taking classes at a school of public health and would eventually like to become a health educator to spread awareness about eating disorders and, one day, influence policy.
She offers this advice to older women who suffer from eating disorders: “Find a way to get over the embarrassment because you deserve the same treatment anyone else is getting. It’s important to be your own advocate.”
If you believe that you or anyone you know may be suffering from an eating disorder, call the National Eating Disorders Association helpline at 1-800-931-2237.
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