Kellie is happy for us to use her first name and to call her middle-aged would
be just fine, she says cheerfully, because that’s what she is. She is less
forthcoming when you ask about her weight. She doesn’t weigh herself any
more, she says, though she probably weighs a bit more than she’d like to.
She’s healthy, which is great because three years ago, at 5ft 8in, her broad
muscular frame was down to seven stone.
That’s thin, I say. What did you eat? “You don’t,” she replies. “You drink
warm water and really cold water because that helps your metabolism. I
pretty much lived on sunflower seeds because that was protein to keep me
going at work. Maybe a slice of fat-free deli turkey. You do your best not
to eat anything at all.”
What seemed to make Kellie unusual as an anorexic patient, and the reason she
is talking about it, is that when she first became ill she was 43. Not 15 or
18 as you might expect, not a teenager worrying about boyfriends and exams
and why she didn’t look like Lindsay Lohan, but a mature woman with a
husband, two sons, a dog and a job in insurance. It is only since she was
treated at the Park Nicollet Health Services Eating Disorders Institute
(EDI) in Minneapolis that doctors have started to notice that Kellie is not
unusual, because they are now seeing a significant number of anorexic
patients who are over 40, some by a couple of decades.
“The increase in mature anorexic patients has been phenomenal,” says the EDI’s
medical director, Dr Joel Jahraus. “Three or four years ago they made up 13
per cent of our patients. Now they’re up to 38 per cent but we haven’t
recognised the phenomenon until the last year.” The EDI’s oldest patient was
68.
Eating disorder clinics elsewhere in America have also noted an increase in
the number of mature anorexic patients, and in Britain there is anecdotal
evidence that more mature patients are seeking treatment, skewing the notion
that anorexia affects only young women, and the medical fact that the
average age of onset is 15 to 16. The EDI is responding with a new $32
million eating disorders facility that will open in 2009, enabling its
specialists to treat mature and young patients separately.
The question then is why significant numbers of mature women are seeking
treatment for anorexia. Were they around before, unnoticed by doctors? Are
they women who became ill as teenagers when anorexia was first widely
discussed in the 1970s, and who have now reached middle age? The experience
of Kellie, newly ill at the age of 43, suggests that these theories don’t
work for all patients. Or do these women, like teenage girls, become
obsessed with their body image because popular culture tells us that if we
want to be attractive and popular and successful we must be thin? Today’s
middle-aged women are, after all, the first of their generation to have been
confronted by unnaturally thin role models throughout their adult life.
Jahraus points out that there isn’t much research to go on, but the existing
body of knowledge about anorexia does enable him to come up with some
informed speculation. The first point is simply that there is now greater
awareness of eating disorders than ever before, both within the medical
profession and among the general public. This means that anorexic women are
more likely to be identified and, as stigma associated with anorexia
declines, more will seek treatment.
“Shame and guilt is an inherent part of an individual’s eating disorder and to
overcome that we’d have to see a major change in society’s way of looking at
anorexia,” says Jahraus. “That is starting to happen — Spain has outlawed
models who are under BMI (body mass index) 18 which impressed us here. But
at the same time society continues to tell us that to be happy you have to
have the perfect body. Baby boomers have grown up with the idea that you’ve
got to look good, and the expectation of an attractive woman has evolved
from thin to outright emaciation. People think, ‘I don’t like how I look. I
want to lose weight because I’m not meeting society’s expectations’.
“We see two types of mature patients, those who have had an eating disorder
for many years, and those who are coming for treatment for the first time.
They say, ‘Gee, I wanted to be healthy so I got into an exercise regime’.
Then they find themselves ratcheting down the types of food they eat so that
only two or three things are safe. Compulsive exercise is a big part of this
— striving to be thin and using exercise to get rid of calories.”
Or, as Dr Alex Yellowlees, medical director of Glasgow’s Priory Hospital, puts
it succinctly: “Society’s idealisation of thinness is a crazy myth, a belief
system society buys into. It is extremely unhealthy and affects women of all
ages.”
If male doctors have a sound understanding of the mindset of anorexic women,
perhaps it takes a woman to emote on the body image pressures that
perpetually confront us. Susan Ringwood is chief executive of Beat (Beating
Eating Disorders, formerly the Eating Disorders Association), Britain’s
biggest eating disorders charity, and she too is aware that increasing
numbers of mature women are seeking help for anorexia. Might the unnaturally
thin middle-aged protagonists of Desperate Housewives have an unhelpful
effect on middle-aged women, I ask. This is Ringwood’s response.
“It’s one of those awful backlash things. Until recently older women weren’t
visible, they disappeared off the pages of magazines, they had no
aspirational model held up to them. Now there are women like Sharon Stone
and Madonna in their forties and women compare themselves to them and find
themselves wanting. We do know that there are some people who are
particularly vulnerable to feeling that because they are so driven to be
perfect.
“Then, because older women are presented in unrealistic ways, they feel
they’ve failed. Yes, it’s being shown that you can be beautiful in middle
age but it’s an airbrushed and slightly odd look. What you get in response
is an almost desperate attempt to hold on to youthful attributes, either
through not eating or over-exercising.”
For any anorexic patient, and this includes older women, their illness is
triggered by a genetic component and one or more socio-cultural components.
The genetic component relates to personality type — anorexic patients are
typically perfectionists, high achievers and have a strong need to control,
combined with low self-esteem — but this is not sufficient to trigger
anorexia on its own.
“With teenagers, the socio-cultural factor comes from problems with
adolescence and peer pressure. They’re striving to look the best, to have
the best boyfriend,” Jahraus says. “With older women we see a high divorce
rate and women are out there trying to look good, trying to find a partner,
and I think that has done something to influence these numbers of older
anorexic women we are seeing.”
Of the mature women I spoke to who have been treated for anorexia, none wished
to be identified, and some preferred not to be quoted. With some their sense
of shame was palpable, and they were frightened that people who knew them
might recognise them and then know that they were anorexic. It might seem
logical that if you are tall and weigh six stone, your friends have probably
worked this out, but it is common for chronic sufferers to become isolated
not just from other people, but from their thought processes too.
The word they all used repeatedly was “control”. They felt that when they
encountered problems, anorexia was a way of demonstrating a sense of control
and gave them a sense that they were good at something. They recognised that
society puts women under ridiculous pressure to be unhealthily thin, and
this had contributed to the onset of their illness, but once it was
entrenched their motivation to restict their eating came from their need to
maintain control in the midst of a chaotic or failing life, rather than a
desire to look like Teri Hatcher.
At the National Centre for Eating Disorders in Surrey, Deanne Jade, a
psychologist, suggests that the American announcement of increased numbers
of mature patients is “cute”. These patients were identified in 1979 as
anorexia tardive (late onset), she points out, using the term coined by the
late Peter Dally, a psychiatrist who pioneered effective drug-free treatment
for anorexic patients. Certainly there are medical case histories of such
patients on the internet, some in their seventies, but the onset of their
anorexia seems to be related to loss, commonly divorce or bereavement. What
we are seeing now seems to be more diverse.
Kellie believes that her anorexia was a response to feeling simultaneously
under pressure as a working mother and as the child of sick parents. “I
always believe that nothing will faze me, don’t let anything show,” she
says. “But it’s got to come out somewhere. I had self-esteem issues —
there’s such a huge focus on how you look. So you think, if I can look like
Posh Spice my problems will go away.
“It’s about what you can control, and I couldn’t control all the things that
were going on in my life, but I could control what I ate and maybe if I
looked like Teri Hatcher or whoever I would be happy and people would like
me.”
Kellie sought help when her sons started to stare at her and ask what was
wrong. She is now well but still feels huge, she says, even though she
isn’t. “It’s a battle. When something difficult happens I think right away,
I’m not going to eat tomorrow. Then you think, how is that going to help?
It’s so hard to break the habit of trying to deal with everything by not
eating. My body image will probably never be OK again.”
Where to find help
Beat Helpline 0845 6341414: e-mail help@b-eat.co.uk:
b-eat.co.uk
Anorexia & Bulimia Care 01462 423351: e-mail help@anorexiabulimiacare.co.uk:
anorexiabulimiacare.co.uk
National Centre for Eating Disorders 0845 3673383
I agree with Julia that the theory that women develop eating disorders mainly because of media images is somewhat glib. I have struggled with an eating disorder my entire life, and the earliest I remember having disordered thoughts is 4 years old. The first time I went on a diet, I was 8. That seems a little young to be mainly motivated by media. Media images don't help, obviously, but an eating disorder is like a virus - it cannot take root in a healthy system. (In this case, a healthy self-esteem.) As for older women, my mother is in her 60s and has had anorexia as long as I can remember. I suspect many older women are like her - they didn't develop the disorder recently; there is just more public awareness of it now. But many doctors still think that only young women get it, and miss the warning signs in older women.
Amina, I think one thing you need to remember is that an eating disorder is a serious mental illness. Of course it doesn't make sense. It sounds crazy because it is.
Lisa Bauch, Minneapolis, USA
I am so glad to have found your article . I really have been noticing as of lately that everywhere I look around me al I see is really skinny women in their 30's and 40's. I honestly see women in size 0 jeans looking thinner than their daughters. I am sure it is more common in some geographical locations than others. I am in Southeaster Pennsylvania, and I can definitely say women are getting very thin here..and as for myself at 40, I am striving for that size 0 also. Seems to be lots of competition around here. But , yes, the issue is control...our lives are suposed to be so perfect, so why not make our bodies perfect, the one thing we can have control over. Women of our generation , I believe, place extraordinary expectations on themselves
Nicole Thompson, Schwenksville, Pennsylvania
Mid 40s, Midwest USA
As a psychologist I feel this article is pointing out a very important trend in how eating disorders may occur across the lifespan. Likewise, Park Nicollet's Eating Disorders Institute seems to be at the cutting-edge of this trend--taking a much needed and proactive approach to recognizing treatment-specific needs of individuals in mid-life and beyond who struggle with these concerns. Thanks for a great article.
Robin , St. Louis Park, USA
I think a very important thing to understand about eating disorder patients is that they all suffer from low self esteem. The images of Hollywood affect your way of thinking - You see these women making tons of money and getting all sorts of attention and "love" and you start to believe that if you somehow could look like them, then people will love and respect you, too. It is a false sense of security in your thinking. If you didn't have that low esteem, you could not be tricked into believing this way. I suffered from both anorexia and bulimia for years and finally recieved in and outpatient treatment from the Eating Disorder Institute and I have been in recovery for some time now, but it always haunts you. It never completely goes away. But now that my self esteem is "normal" I am able to fight off those thoughts that tell me I should be thinner if I am to be loved. It takes years of treatment to successfully beat this often fatal battle.
Recovered in her 30's, Minneapolis, MN,
i believe that the consistent reference in the media of women likening themselves to famous women and striving to be like them as being a 'cause' of their eating disorder is a tad patronising and glib. It is a complex issue and people are individuals. If only it WAS as simple as that. I grew up avoiding girl's/ women's magazines - i think I had an inbuilt sense of distrust towards them in general and so was never affected by media, yet I went through an intense period in my late teens and through my 20's of obsession over food and body image. My reason was an assault at age 15/16 by a male and concluded unconsciously that to look feminine spelled danger - hence the desire to lose my curves and be 'safe'. If I had had more support around me then I wouldn't have suffered for so long and got over it more quickly. I did get over it (just) with homeopathy and studying complementary health myself and at age 40 I try to simply be kinder to myself. My heart goes out to sufferers........
jayne, clitheroe, lancashire
I just don't understand this mindset. How does not eating help with anything? If I did that, I'd be falling over from weakness and low blood sugar and I'd seeing fairies and twinkly lights. I don't know anyone else who could manage a working day, a family and other activities without at least one good meal a day in them. This whole anorexia thing does not make sense. I don't understand how people do it and not get fired or neglect their responsibilities. Maybe this is insensitive, but if someone can explain how not to eat and yet do everything one's supposed to do as a responsible adult, I'd really like to know.
Amina, Washington, USA
Actually, "nice" means accurate.
Amina, Washington, USA
'Too old to be skinny' - yet another article about anorexia. which I know is a distructive and life threatening disease.
I am rather puzzled as, in my daily life, I never come across overly skinny people.
On the contrary, every time I go to the supermarket or walking in the city all I see many hugely obese people waddling about.
Ten to twenty years ago you encountered such people in the USA but rarely in this country. I lived overseas for many years so am not sure when Brits began to pile on the weight.
Margaret Greene, Bath, N.E. Somerset
Having suffered from anorexia for 5 years (and now on the long, hard road to recovery) I would disagree that the raw images of emaciated celebrity's can trigger eating disorders. Admittedly, they contribute to developing the illness but low self esteem is the underlying root cause for someone who turns to food and weight as a daily coping mechanism
Now 21, I have endured 3 in-patient hosptial admissions battling the demons which literally nearly starved me to death. During these rehabilitation experiences, I met many older women who also suffered from anorexia and I don't recall any of them striving to surpass the thinnness of Victoria Beckham, or similarly unattractive frames. Their problems stemmed from a deep-seated insecurity about themselves (socially as well as physically) and the various relationships in their lives.
Anorexia requires enormous amounts of time, energy and self loathing: it's unrealistic to blame society's misconception of beauty for individual cases of anorexia
Julia Leonard, Malvern, WORCS, UK
I do not know whether there is an increase in the number of older women with anorexia but I do know that that is what caused the death of my grandmother in the 1960s when she was in her 60s.
It may be significant that when I recently told my sister-in-law, a very experienced GP, she doubted me and said that older people did not have anorexia.
I come across various middle-aged contemporaries whom I suspect of having the condition to a greater or lesser extent although it is not mentioned. They remind me strongly of girls whom I knew in my university days in whom it had been diagnosed.
Jane Halliday, Stockport, Cheshire.
THis does not surprise me.Working as a Beat volunteer and running an eating disorder support group as well as in my day to day mental health work I meet women and men of all shapes and sizes who are unhappy. Eating disorders and disordered eating is classless and has no age limits.Eating disorders affect all races and both men and women in a very serious way.Men sadly are less likely to come forward as are those from diverse ethnic backgrounds because of ftigma.. They hide in the gym or in their work or within the family
.
There is good treatment available and the sooner people come and ask for help the sooner they obviate very serious physical and mental health risks. Anorexia is not fashionable it has the highest mortality rate of any other mental illness and is an unplesant cruel illness if left untreated.Bulimia has risks as well. With good help recovery is achievable.
Fenella, London, UK
"Too old to be skinney" I am 41, 5"8' and 175lbs. and have noticed the trend for women my age and older to be bone thin as we may have been naturally as a young teenager. I wish women could recognize thier own individual beauty which changes as we age. We morph into something else that is still beautiful, different but beautiful in it's own right. I say to all women, don't let yourself be brainwashed by what someone else tells you that beautiful is. Use the mind God gave you to make those determinations yourself. It's hard to go against the grain but sometimes it is so much smarter and healthier and dignified.
Teresa Maxson, Columbus, Ohio
"At the National Centre for Eating Disorders in Surrey, Deanne Jade, a psychologist, suggests that the American announcement of increased numbers of mature patients is “cuteâ€. These patients were identified in 1979 as anorexia tardive (late onset), she points out, using the term coined by the late Peter Dally, a psychiatrist who pioneered effective drug-free treatment for anorexic patients."
I don't understand her comment - the issue is that there is an increased number. I guess she was just being "cute."
Reggie, Boston, MA
Have you seen how many programes there are on weight issues. At least 10 a day !! ls there any wonder why women are obsessed with their appearance? The world stresses too much on the outer appearance but not the inner person. Thankfully God does not judge us that way. l do think that we eat far too much for our own good. Most Western women are too overweight to even walk properly so they should eat sensibly. You need one good meal a day, not 3. Dairy is the worst thing any human being can consumed. The dairy industry refuse to admit that it is detrimental to one's health to consume milk. Cow's milk or any other animal for that matter is bad and should never be drunk. Babies should be breastfed until wean than say goodbye to milk forever. One of the main culprit for cancer to spread is COW'S MILK. Not only does it contains lactose but all the anitbiotic and heaven knows what else that goes into the milk including blood and pus!!! Eat your vegies and nuts for calcium.
Virginia, Brisbane, Australia
As a woman in her early forties who has successfully hidden & battled an eating disoder for well over twenty years and counting, I 'm of the oinion that it is your mind set and not your age that keeps you in thrall to this beast.
I reconise the need for 'control' and wake up knowing that even in a 'good' week the deisire to eat or not eat abnormally is something that has & will always be with me at 20 years & at 40plus & beyond.....
I admire Kellie for being braver than me in seeking help & acknowledging that there is no miracle cure.
40something, London,
Another issue is the attitude of gym instructors and other people who should be giving people a balanced perspective. My gym trainer told me off for having Splenda, the artificial sweetner, in my coffee and told me off for "all the cake you eat" as I had eaten a half piece of cake at a friend's birthday party. He also told me off for eating late in the evening, after I got home from the gym! He reduced me to tears as he had wanted me to lose 1 and a half stone in 3 months AT LEAST! Luckily I decided to ignore him and have happily lost half a stone in 2 months but if I had taken his comments to heart I would not be eating after lunchtime 3 days a week and would have lost weight, but would probably also feel ill and depressed and go on a junk food binge.
When people like him in positions of responsibility give such a distorted view of food to people it is no wonder that they feel that have failed and have to punish themselves to do better.
Helen, Basingstoke, UK
When I was young, I went to the Broadway first run of "the Sound of Music". We had seats in about row 6 of the stalls. Mary Martin ( Larry Hagman's mum!) was cast as Maria because she had the spunky qualities needed for the part. But up close she didn't look 18 as the script said: she looked about 75!
My mother explained that at a certain age ( around 40) a woman makes a choice of either face of figure and eats/diets accordingly. She always enjoyed her food and was tounge in cheek about "I'll diet tomorrow!". Years and years later, I had a bout of stomach upsets and i could sense the control over some aspect of my busy life I could exercise if I so chose. I also recognised that this was a road to nowhere, so I started eating normally again and never have regretted it. I hate exercise: it bores me stupid! I walk a lot, ride a horse and swim. All individual persuits where my mistakes are my own. I used to enjy line dancing, but that's out of fashion now!
Also: "cute "means accurate.
Carlyle Braden, Croydon, U.K