You Don't Have to Be Young (or a Woman) to Have an Eating Disorder

Until recently, eating disorders have been primarily associated with adolescent girls who don't eat enough-or eat far too much.

Now: The landscape of these disorders has changed. More and more women and men in their 40s, 50s, 60s and beyond are struggling with these sometimes life-threatening conditions.

Most of the 11 million Americans—10 million women and one million men—who struggle with an eating disorder, such as anorexia nervosa, bulimia nervosa or binge-eating disorder (a condition that's only recently been recognized by health professionals), are under age 30.

However, in the last 10 years, there has been a substantial increase in the number of women over age 30 who seek treatment for an eating disorder. There are no up-to-date data to tell us whether eating disorders are increasing in men, but clinical experience suggests that they are.

What Is An Eating Disorder?

Scientists aren't sure exactly what causes an eating disorder, but research shows that genetics play a role. People who have a first-degree relative, such as a parent or sibling, with an eating disorder are generally at greater risk themselves. When this genetic predisposition is combined with certain psychological and emotional triggers, an eating disorder may result.

Older adults battling an eating disorder fall into three categories—those who have struggled their entire lives...those who struggled as adolescents, recovered to some degree, then relapsed.. and those who have recently developed the problem for the first time. Eating disorders can be divided into the following categories…

Anorexia nervosa is characterized by low weight (typically less than 85% of normal weight for one's age and height), fear of weight gain, denial of illness and distorted body image-typically, thinking you are overweight when you are not. Anorexia nervosa can lead to a number of complications, such as hair loss, osteoporosis, electrolyte imbalances, cardiac problems and organ failure.
Bulimia nervosa occurs in people at all weights and is marked by binge eating—uncontrolled consumption of unusually large amounts of food-accompanied by purging that seeks to "undo" the binge in the form of vomiting, unnecessary use of laxatives or excessive exercise. Bulimia causes many of the same health consequences as anorexia.
Binge-eating disorder (BED) is similar to bulimia but without the purging. BED differs from simple overeating in that sufferers feel a loss of control over what they eat. The condition can lead not only to obesity but also to problems such as insomnia and body aches.

Aren’t I Too Old For This?

Older women and men) face a number of situations that can trigger an eating disorder…

Hormonal changes. At menopause, most women are unprepared for the physical changes, including a hormonally driven redistribution of fat from other parts of the body to the abdomen. This can result in extreme weight-loss strategies to try to retain a youthful body. Hormonal changes also can lead to mood swings and sleep disturbances that often trigger cravings and increase appetite, setting the stage for binge eating. In men, decreases in testosterone and age-related changes in their bodies can trigger eating disorders.
Divorce. Following a breakup, women may seek a new mate and want to appear as physically attractive as possible. This can prompt some women to take extreme measures to lose weight. If a man's wife initiates the divorce, he can feel lost and abandoned and turn to food for comfort.
Empty-nest syndrome. A mother who has spent many years attending to her children can experience a sense of loneliness, uselessness and boredom when they leave home. This is a classic set-up for binge eating-often seen as a desperate attempt to find a sense of "fullness" in the pantry.
Depression. Older Women and men must contend with the deaths of friends and other life events that can trigger depression. Reduced appetite is a common symptom of depression and can lead to anorexia in some cases.
Overdoing fitness regimens. Anorexia can develop in people who are overly zealous in diet and fitness regimens. Their good intentions can quickly cross the line from healthful to obsessive.

How To Get Help

One of the challenges of treating older adults is that, unlike a teenager, a 60-year-old woman or man cannot be compelled to enter treatment. It's crucial that women or men who experience thoughts and behaviors that characterize eating disorders (such as distorted body image, irrational fears of being overweight and an inability to control bingeing) realize that it may not be just a passing phase, and the earlier they seek help, the better.

In the case of anorexia, inpatient treatment is often necessary. With anorexia, the brain is unable to function properly because of malnutrition (decision-making can be impaired and brain shrinkage may occur). About 10% of patients with anorexia die from medical complications of starvation, such as heart failure, or suicide.

Insurance companies often cover inpatient treatment for anorexia but tend to deny coverage for inpatient treatment of bulimia and BED.

For anyone struggling with bulimia or BED…

Find the right professional. The most effective treatment includes a therapist (a psychiatrist, psychologist, social worker or other experienced health professional with a background in treating eating disorders. To find a practitioner in your area, consult the National Eating Disorders Association, www.national eatingdisorders.org...or the Binge Eating Disorder Association, www.bedaonline.com. A registered dietitian should be consulted to offer advice on proper nutrition and healthful eating habits.

Also, be sure that the symptoms-mental and physical—are discussed with the patient's primary care physician. This is important to ensure that the doctor takes the patient's eating disorder into account when offering medical advice.

Caution: Some doctors are not educated about the growing prevalence of eating disorders among older patients. If you believe that you or a loved one has symptoms of one of these conditions but your doctor doesn't agree, get help from a therapist on your own and seek a second medical opinion.

Start therapy. Cognitive behavioral therapy, a form of psychotherapy that teaches patients how to understand their own patterns of thinking and behavior, is the most effective treatment for eating disorders. With the help of a therapist, you will explore why you starve yourself and when you're more likely to binge so you can work to change these habits.
Consider medication. The only FDA-approved medication for eating disorders is the antidepressant fluoxetine (Prozac), which is approved for the treatment of bulimia. This drug can decrease the frequency of binge eating and purging but does not offer a permanent solution.

If you suspect that a loved one may have an eating disorder: Have a conversation that begins with a loving message such as "I care about you, and I care about your health. And I worry about how much you seem to be struggling with your eating."

Try to persuade your loved one to at least undergo a professional evaluation (with a dietitian or psychologist or psychiatrist) and to then think through the options. Point out that it's always better to have information and an expert's opinions than to make decisions in a vacuum.