We live in a very curious word where emaciated bodies are no longer a true indicator of poverty.

Every morning thousands of women, both adolescent and adult, will wake up and allow the scale to determine whether they will have a good day or a bad day. The number that stares them in the face controls not only their eating patterns but the way they relate to their families, their co-workers and their friends. It used to be considered a disorder predominately affecting young women in upper middle class families. In the 80′s things changed, suddenly eating disorders appeared across all socioeconomic levels, the majority of the victims showed symptom onsets usually between ages 11 and 18.

A few months ago The New York Times published an article online entitled When Eating Disorders Strike in Midlife . According to the story, recent studies are suggesting that there has been a dramatic increase in the number of women over 30 that are struggling with symptoms of Anorexia, Bulimia and Bulimarexia (alternating between symptoms of starvation and binging/purging). In order to control their weight, these women are abusing laxatives, exercising excessively, purging (vomiting), and decreasing their caloric intake to dramatic levels.
The director of The Eating Disorders Clinic of The University of North Carolina in Chapel Hill, Cynthia Bulik, noted that 50% of her inpatients were middle-aged. Another clinic, The Remunda Ranch Treatment Program , a Christian treatment program in Wickenburg, AZ, disclosed that since the 1990′s they have had a 400% increase in admissions of patients over age 40.

When I read this article I was quite fascinated. I have worked with eating disorder’s clients since 1994, the majority of them in their late teens or very early 20′s. After reading the statistics in the article I began to wonder what would causes a disorder that had been considered to be predominately an Adolescent Issue to suddenly begin appearing in Mature Women? Could something be occurring in society to encourage adult women to become obsessed with their bodies, dieting, the number on the scale, and their dress size?

One reason for the increase in older female patient could be that some women had actually been anorexic or bulimic since they were teens, they had just never been diagnosed. They had been secretly fighting and hiding the symptoms of their eating disorder for their entire lives and only after being confronted or in some cases “discovered”, perhaps by a close family member, life partner or spouse, doctor or dentist (teeth problems are common after years of forced vomiting) they decided that the disease that they had utilized to gain control of their lives was actually in control of them.
Another possibility is that some women with no history of body imagine distortion developed symptoms later in life due to a dramatic life crisis such as a divorce, death or illness of someone close, or a change in life circumstances. In this time of economic insecurity, could the stress of losing a job, a dramatic decrease in family income, loss of or our home through foreclosure cause enough stress that a woman may take out their feelings on their bodies?

Is it possible that as adults, women are feeling as much pressure as adolescents to look a certain way – to strive for physical perfection and eternal youth? The encouraged role models from TV or Movies are often young, beautiful, thin women. It was suggested that the emergence of the incredibly thin British model, Twiggy, in the 60′s had a direct connection to a dramatic rise in the number of cases of anorexia. For those of you that don’t remember Twiggy, she was 5’6″ amd 97 pounds, her picture graced the cover of Vogue and Seventeen .

The intense societal values placed upon physical appearance still give women of all ages pause. Society, with the help of mass media, Hollywood, fashion magazines and television has defined “fat” as either a cosmetic or a medical problem. Women are bombarded with mixed messages: we are all supposed to pig out on a Big Mac, fries and a shake, enjoy “Miller Time” with our friends, go to Starbucks for a Venti Caramel Macchiato with extra whipped cream, but look like the girls in the Diet Pepsi commercials! Eating has become synonymous with having fun and socializing but being overweight has become synonymous with being lazy and unhealthy. And if working out at 24 hour fitness doesn’t take care of your problem, you can always head off to the local plastic surgeon to have yourself lifted and “liposucked” until you are back to your 22-year-old self.

Now don’t get me wrong, I consider myself to be a feminist therapist – therefore I believe that whatever you want to do to your body (such as breast augmentation, lipo, tummy tucks, etc) is ok by me, as long as you aren’t hurting yourself or becoming addicted to seeking perfection via the knife. I have had many friends who have had augmentation, lipo, and face lifts. If that makes you happy – go for it. But do it because you want to feel better about yourself, not because society is giving you meta messages that the way you look now is bad or wrong.

I have counseled many women about loving their body through different stages of life , but the reaction is often the same. They want to be a women that is young, thin, and without the lines of life for as long as they can afford it. They are afraid that their spouses will lose interest in them sexually if their body changes. Some worry about the fact that women age differently than men. Interestingly, out society often turns a blind eye at men that carry an extra 20 pounds.

It is very easy to understand the difficulties women experience after they have had a few babies, gone through menopause, and are dealing with a combination of lack of time to work out and a decrease in metabolism that often occurs with menopause. The sum of these can quickly equal a higher number on the scale. They begin dieting and as they lose weight they get a lot of positive attention from friends and family members. Suddenly, as they get close to their goal weight, some women develop what I call the “floating 5 pound syndrome.”

“If I look this good at 125 pounds…imagine how I will look at 120 pounds!” When they reach 120, suddenly their goal weight shifts to 115…and so on. When women lose weight, especially quickly, they often do not see the changes reflected in the mirror, even though their clothes become loose or they purchase smaller sizes. Their mind tells them that they still look the same. So, they continue to lose weight, being unaware that their mind is playing a wicked trick on them. The image in the mirror is a distorted reflection.

So, why are middle-aged women developing eating disorders? I am not entirely sure – I believe it is a combination of many of the issues I have addressed. Decrease in self-esteem, stress, fear of change are all factors perhaps. Eating Disorders are about control. In this economic time, we don’t have control over a lot of things.
Do you have middle-aged friends that may have become caught up in a weight loss obsession? Why do you think they have suddenly focused on their body? What suggestions do you have for women having “fat days?” What works for you?
I’m not sure what the answer is to many of these questions…but I think a dialogue is a good place to start.
Until next time…Dr Karen