Food For Thought

Salt, school lunches and the intersection of food, wellness and public policy.

Does Grandma Have an Eating Disorder?

Older anorexics and bulimics are on the rise

Eating disorders like anorexia nervosa and bulimia are on the rise among middle age and senior women. Like their younger counterparts, the older eating disordered female is seeking control, suffering from body dissatisfaction, struggling with low self-esteem or trying to cope with a stressful life event. Some have a history of disordered eating, but many develop disordered eating well after 60, even 70 years of age. In a culture obsessed with youth, thinness and dieting, some mature women have turned to extreme measures to keep their figures trim.

 In the 1950s, images of curvy Marilyn Monroe and Jane Russell were the epitome of the ideal woman. The 1960s gave us Twiggy and the emaciated model. Today’s 60 plus women were in their youthful prime during the dieting decades of the 1960s and 1970s. Virginia Slims cigarettes, Tab cola, Ayds weight loss candies and the advent of Jazzercise ushered in the decade of the Flashdance, aerobic-class, legwarmer-wearing 1980s. These cultural messages of thinness and fitness shaped the dieting behaviors of scores of women who are now eligible for AARP or Medicare. For some older women with eating disorders, the desire to fit the cultural norm of thinness has resulted in decades of chronic dieting, meal skipping and extreme weight loss measures.  For others, a stressful later-in-life event has them seeking control.

Disordered eating, regardless of age, revolves around stressors and the desire to regain control; and in the case of anorexia, a desire for thinness. Perfection, low self-esteem and emotional inhibition are often personality traits, Midlife and older women with disordered eating may have a history of eating issues that went into “remission” only to reemerge in older age. Others have suffered with long-term eating disorder symptoms without treatment. Recent reports indicate that newly diagnosed “tardive” anorexics, or those with first onset after adolescence, are on the rise because of smoldering body dissatisfaction, aging and stressful life events.

Regardless of age, stressors are a trigger for disordered eating. Stressors change with age. For the younger anorexic or bulimic, the transition from teen to young adult may be the challenge. For older women, the stressor may be a significant life event like the death of a spouse, parent or close friend or divorce, empty-nest, retirement and menopause. Such events throw some into an emotional tailspin, causing them to rely on old coping mechanisms, like diet restriction, to control anxiety.

Not all seniors with poor appetite have an eating disorder. Other causes, like medications, disease, depression, poor dentition and other issues should be ruled out. However, like younger eating disorder sufferers, the older anorexic or bulimic exhibits a telltale pattern of behaviors that should raise red flags for healthcare providers:

Recently I was asked to interview a patient with signs of anorexia nervosa. Expecting to see a teenager or college student, imagine my surprise when I was greeted by a salt and pepper haired slip of a woman with a sassy attitude. Darcy (not her real name) was a 66 -year old widow living in an “active retirement community.” She ended up in the hospital after a fainting spell on the golf course. Forever active and appearance conscious, Darcy always tried to maintain a fit figure. This, she admitted, became more difficult after birthing 3 children and menopause. But, the “extra padding” she developed didn’t seem to bother her loving husband of 40 years. As I probed further about Darcy’s weight and eating habits, she mentioned the passing of her husband. The suddenness of his death was “depressing and stressful.” As a result, she stopped eating and dropped 50 pounds. People, especially women, who hadn’t seen her in awhile began complimenting her on her “fabulous figure.” When she would mention that the weight loss was due to the death of her beloved, she was often met with “you look great” or “you certainly are handling the stress well.” * The flattering comments fueled her desire to continue to look “fabulous” so she continued dieting. When I asked her about her figure, Darcy said, “I still have a chubby belly and I could lose more around my thighs.” This, coming from a woman who at the time 5 feet 5 inches and 90 pounds, set off alarm bells. Upon further interviews, it was clear that Darcy met the criteria for anorexia. She did not have a history of an eating disorder, but like some anorexics of a similar age, her spiral downward was triggered by a stressful life event coupled with the positive and welcome attention she craved and received in response to her “new figure.”

Older anorexics run a higher risk of serious bone fractures, heart rhythm issues and infection.  Mature women with bulimia, especially those who abuse laxatives are at higher risk of for heart issues and gastrointestinal problems.

Treatment non-traditional eating disorder patients like Darcy is very similar to that of younger patients. Nutritional, medical and psychological care, along with careful attention to the unique aspects of older adulthood are components of a comprehensive care plan. If you or someone you know is suffering from an eating disorder, please go to www.ANRED.com for more information.

AFTERWORD:

*What I found especially disturbing and thought provoking were the comments Darcy’s friends made regarding her figure. They didn’t seem to care that her thinness was the result of a death, they were more focused on the result. This is not the first time I’ve heard similar musings. Several RD colleagues have told me of similar experiences. One in particular stands out: A woman, diagnosed with cancer, dropped several pounds. Friends commented saying, “you look great, how did you lose the weight?” When the patient told them, one said, “I wish I’d get cancer.” She wasn’t joking. Comments such as these illustrate, that for some, the deeply ingrained desire to be thin at all cost is almost, if not, pathological. What does this say about society’s value of thinness vs. health?

This column is dedicated to S, who passed away in her late 30s as the result of a long battle with anorexia and bulimia.

Selected References:

Lapid MI et al. Eating disorders in the elderly. Int Psychogeriatr. 2010; 22(4):523-536.

Mangweth-Matzek B. et al. Never too old for eating disorders or body dissatisfaction: a community study of elderly women. Int J Eat Disord. 2006; 39: (7)583-586.

Photo: from Fashion Crimes, November 2009 by Logan Salter and Ian Pool

 

Martina M. Cartwright, Ph.D., R.D., is an adjunct professor of Nutritional Sciences at the University of Arizona and an independent biomedical consultant.

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