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Go backMiddle-Aged Women and Eating Disorders

Awareness is vital for breast cancer survivors and their supporters

When you realize that on any given day, nearly 40 percent of American women are on a diet, it’s easy to understand that our obsession with weight is profound – and profoundly disturbing. It’s a sad fact that 80% of girls are worried about being fat by the time they are 10. It’s no wonder then, that eating disorders (ED), long thought to be the domain of teenage girls, are becoming more and more prevalent among women in their 40s, 50s – even 60s.

According to Holly Grishkat, Ph.D., regional assistant vice president and director of The Renfrew Center in Radnor, PA (an ED treatment center), between 2001 to 2010, the rate of EDs among the middle-aged increased by 42%. And until recently, this population was flying way under the ED community’s radar.

Studies shed some light on both the problem and the triggers

Loss of any kind appears to be a huge trigger. Mid-life issues like divorce, dying parents, children moving out and job-related stress can often be the beginning of problems. At the heart of most eating disorders is a need to control. When their lives seem to be spinning into chaos, many women find their only sense of control comes from what they eat (or don’t eat).

For women, middle age brings other unique emotional and physical issues as well. Today’s woman is faced with an increased fear of aging and societal pressures to change her body in an effort to appear more youthful.

As psychiatrist Anne E. Becker, director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital and president of the Academy for Eating Disorders recently outlined for the Harvard Women’s Health Watch: physical changes in midlife may cause or reignite eating disorders.

According to Becker, “As our society values youth and as baby-boomers reinvent what it means to be middle-aged, there are growing social forces that can undermine older women's self-esteem and potentially lead to body dissatisfaction. For example, if you think the surface of your skin or the contours of your body aren't supposed to match your chronological age. That, combined with health concerns about obesity, can make people feel bad about their bodies and, in turn, could result in eating strategies that undermine well-being.”

An Australian study published in 2008 was one of the first to reveal a rise in eating disorders in older adults, particularly with binge eating and food restriction. The study found that in adults between 55 and 64, binge eating increased from 1.7% in 1995 to 7.4% in 2005, and strict dieting or fasting increased from zero percent in 1995 to 9.7% in 2005.

Another study found further emotional complications fueling this problem because so many women in their 50s, 60s and 70s still tied how they feel about themselves with their physical appearance. An alarming 45% of the women indicated that their self-esteem depended on their shape and weight. The same study revealed that more than 60% of these women had either “moderate” or “low” satisfaction with their shape and weight.

A more recent study highlighted in USA Today in June of last year further examined this trend. This first-of-a-kind study looked at older women, discovering that 62% of those surveyed say their weight or shape has a negative impact on their lives.

The study, originally published in the International Journal of Eating Disorders, showed 13% of women ages 50 and older struggle with the problem — some for the first time in their lives. The researchers surveyed 1,849 women online from across the U.S. in an attempt to find out how older women feel about their bodies and to estimate the prevalence of eating disorders. Since there are 53 million women in the USA older than age 50, this is an important population to monitor and understand.

What they discovered when attempting to show how what we weigh can have a negative impact on our lives, was that a stunning 79% said their weight or shape affected their self-image. Forty-one percent of the women surveyed confessed to checking their body daily, and 36% spent at least half of their time in the last five years dieting. These sorts of behaviors and attitudes are known to put women at higher risk for full-blown eating disorders.

The study also discovered that having a higher BMI (body mass index) was associated with more disordered eating, increased body dissatisfaction, dieting behaviors, preoccupation with food and a drive for thinness. This is not surprising, since women are constantly bombarded by messages to look perfect. The underlying problem is that perfection is an unobtainable goal. Although the popularity of aging celebrities who appear forever young and thin like Sharon Stone, Susan Saradon, Jane Fonda, Michelle Pfeiffer, and Christie Brinkley may be an inspiration for women on the one hand, they also serve to make many feel that, since we don’t look like them, we aren’t normal.

Author (and educator) Cynthia M. Bulik, Ph.D. (The Woman in the Mirror: How to Stop Confusing What You Look Like with Who You Are) does provide a shred of hope by pointing out that sometimes there appears to be a stage of “enlightenment.” When this occurs, says Bulik, "They're not concerned about how they look in the mirror and they get past that number on the scale. They are concerned with healthy eating, getting enough exercise and being happy. We need to get more women headed in that direction."

Eating disorders in middle age present unique and dangerous problems

As menopause approaches, metabolism slows and estrogen production drops, causing shifts in fat distribution that can lead to a thicker middle, even for women who are eating healthily and exercising regularly. Most women gain eight to 10 pounds during the transition through menopause, which may very well aggravate any predispositions for an eating disorder.

NBC’s Chief Medical Correspondent, Dr. Nancy Synderman, discussed this phenomenon recently, pointing out that the medical complications of eating disorders get more severe over time, and as they interface with the aging body, clinicians who treat this population have more to worry about.

Although of great concern, today’s middle-aged anorexics and bulimics may for the most part be individuals with histories of eating problems, rather than new cases. Many who face eating disorders in midlife have confronted them in the past. In fact, it is estimated that more than 90% of middle-aged women who are anorexic developed the disorder when they were younger.

"It’s rare, not impossible, but rare, for a woman 50 or beyond to develop an eating disorder for the first time," said Dr. Margo Maine, clinical psychologist and co-author of The Body Myth: Adult Women and the Pressure to Be Perfect. "Most in their 50s and 60s are women who had eating disorders when they were younger."

This doesn't mean a middle-aged woman’s experiences with eating disorders are the same as when she was young. Older adults may be ashamed to admit that they have these disorders. And this can be, literally, a dying shame.

It’s a well-known fact that eating disorders often have serious side effects, including osteoporosis, heart problems and gastrointestinal issues. Sarah Parker, director of anxiety and eating disorders at the Reeds Treatment Center in New York told ABC News damage to the body resulting from an eating disorder can be grave. "There can be significant damage to the heart and heart muscles," said Parker. "In really severe cases, the heart can stop functioning. Fat stores in the brain can become depleted and affect cognitive and neurological functioning. It can also result in osteoporosis and organ failure."

Another health professional expounded on this problem in an interview with Life Goes Strong, an online site for the middle aged. Dr. Emmett Bishop, MD, FAED, CEDS, founding partner and medical director of adult services at the Eating Recovery Center, discussed some specific health issues that middle-agers with EDs may face.

According to Bishop, “Older individuals have much less resilience when it comes to physical damage from eating disorders. A lot of things can go wrong with vital organs, bone density can be impacted, dental health can suffer, and as tissues become less elastic, I've seen people aspirate from purging. A whole host of medical issues can arise as people abuse their bodies over time. Eating disorders are the deadliest mental illnesses and premature death is very common. Older women also face somber statistics when it comes to EDs and death. Senior women comprise 78% of all deaths caused by anorexia, and the average age that women die from the disease is 69.”

Breast cancer survivor discusses her eating disorder

During a recent CNN interview, Diane Butrym talked candidly about her ED. The 50-something microbiologist (and mother of two) has been struggling with bulimia for the past decade. Her problem began in 2002. In March of that year she was diagnosed with breast cancer. Then in October, after completing her treatment, she was struck by a car in a crosswalk on her way home from work. Butrym sustained multiple ankle and knee injuries requiring surgery.

As a result of her injuries, and because she was unable to relieve stress and stay slim with exercise, Butrym began sharply restricting her calorie intake so she wouldn't gain weight. It wasn’t long before she was binging and purging. She recalls that the cycle began to feel addictive by providing her with both pleasure and a way to ease her stress.

Butrym sought treatment in 2003. Although she initially recovered, her life stresses multiplied. She failed to receive workers' compensation for her accident injuries, and she wound up losing her job in a hospital lab. It wasn’t long before she started purging again, and she has cycled out of inpatient and outpatient treatment facilities ever since.

When interviewed, Butrym was in recovery, and going back to school to study public health. "I'm excited about having a new career and having a new life," she says. "That's what recovery and therapy is all about, realizing and seeing that you're more important than that number on the scale, or the number of wrinkles you have. You have more to give people than that superficial life."

Sorting through mixed messages for clarity and health

Middle aged breast cancer survivors may feel they are faced with a perplexing dilemma, since science continues to indicate that obesity is directly tied to many forms of cancer. For women trying to avoid breast cancer, or prevent a recurrence, being overweight can not only cause them to have negative body images, but perhaps even worse, feel pressed to get the weight off quickly and keep it off.

Many women who have chemotherapy for breast cancer have reported an average weight gain of 5 to 8 pounds over a year. Some have reported gaining as much as 25 pounds.

There are many factors contributing to this weight gain. One reason could be premature menopause brought on by chemotherapy. As mentioned previously, menopause is often the culprit in middle-aged spread.

Another reason for weight gain during breast cancer treatment is the use of corticosteroids to help alleviate the nausea that often occurs with chemotherapy. These types of drugs can cause an increase in your appetite. In addition, they can cause a redistribution of muscle mass from the extremities into the abdominal area as fat. The usual result is a fullness of the neck or face and a big belly. Another side effect of steroid medications is loss of muscle mass. That loss of muscle also makes weight gain more apparent.

Hormone therapy can also lead to added weight, and since this therapy decreases the amount of estrogen and progesterone, it tends to cause an increase in body fat mass. At the same time, there's a decrease in muscle mass and a change in the way food is metabolized.

Many women taking tamoxifen have felt the drug was responsible for their weight gain. So far, though, thousands of women have been studied and have shown no relationship between this hormone and additional weight.

As we have discussed many times on this site, the only safe, tried and true method for losing weight and staying healthy is to be sure to eat a balanced diet filled with healthy fruits, vegetables, and proteins – and to make every effort to become more active. Rather than restricting calories to extreme degrees or purging ourselves of food, we would be much wiser to purge ourselves of the urge to lose weight in unhealthy ways.

If you, or someone you know, is struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237. You can also visit their website: ( www.nationaleatingdisorders.org )


February, 2013