The Disordered Eating Epidemic

Find out the new generation of abnormal eaters (hint: it’s not your daughter’s).

by Shelley Levitt
Photograph: Photo: Levi Brown

If you assume that eating problems are primarily the province of the age group most likely to join a Justin Bieber fan club, you’re right—but what you may not know is that experts are reporting a surge of these illnesses among women several decades older. For instance, at the Renfrew Center, a group of 10 eating-disorder clinics nationwide, close to 20 percent of the women in both the outpatient and residential divisions are now part of the facility’s Thirty-Something and Beyond program. Similarly, a few years ago the eating-disorders program at the University of North Carolina at Chapel Hill typically treated at most two midlife patients at a time; today one in two patients is a woman 35 or older, says director Cynthia Bulik, PhD.

Only a minority of midlife women eligible for treatment have issues that would meet the very precise definition of an eating disorder found in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the psychiatric bible. Instead of anorexia or bulimia, such women are far more likely to suffer from what’s called disordered eating—diet patterns that disrupt a person’s life but are not as extreme, and usually not as dangerous, as diagnosed eating disorders. “These problems exist on a continuum,” says Bulik. “There isn’t a magic line that divides disordered eating from an eating disorder.”

People who suffer from disordered eating are often obsessed with their weight, but there are exceptions. Those with the malady called orthorexia shun foods like meat, carbs, dairy, anything with preservatives or artificial flavors and often nonorganic fruits and vegetables, in the name of improving their health. “It starts out with good intentions and becomes a joyless obsession that takes over people’s lives,” says Martina Cartwright, PhD, RD, a biomedical and nutrition consultant in Scottsdale, Arizona. And then there are the excessively picky eaters, who have an aversion to all but a very limited number of foods. Many picky eaters feel strongly about consistency and texture in the foods they consume. “Some can’t eat tomatoes because the seeds are a big discontinuity. Even a chicken-breast sandwich can raise alarms, because the thickness of the chicken varies,” says Nancy Zucker, PhD, director of the Duke Center for Eating Disorders in Durham, North Carolina.

Most experts believe that disordered eating seldom shows up for the first time in midlife. Even if a 35- or 45-year-old woman reports she has never suffered from these problems, “if you take a really good history, you’ll find they have had some kind of disordered eating in their past, like fad dieting or the need to meet a specific weight goal for ballet or sports,” says Holly Grishkat, PhD, a psychologist with Renfrew’s clinic in Radnor, Pennsylvania.

Midlife eating problems are increasing “exponentially,” says Kathryn Zerbe, MD, director of the Oregon Psychoanalytic Institute in Portland and the author of Integrated Treatment of Eating Disorders: Beyond the Body Betrayed. The question is, Why now? “In our mothers’ generation, there was acceptance that your body wasn’t going to look the same at 50 as it did at 25,” Zerbe says. “Today there’s not. For some women, an obsession with a rigid diet is a way of trying to skirt the issue of aging and mortality.” Kimberli McCallum, medical director of McCallum Place, a treatment center in St. Louis, agrees: “Eating disorders can be a maladaptive way to cling to what your body looked like 20 years ago.” But disordered eating can also become a way of dealing with a midlife search for meaning, says Edward Tyson, MD, an Austin, Texas, physician who specializes in eating disorders. That’s sometimes the case with orthorexia. “It can become almost like a religious cult,” Tyson says. “Maybe you can find all of life’s answers in the head of a lettuce that’s brought down on the back of a yak from the Himalayas by a Buddhist monk.”

Here, four women with disordered eating patterns tell their stories in their own words. Those using only first names prefer to remain anonymous.

The "Healthy" Eater

Brit, 40: St.Louis; associate professor of philosophy and psychology

I started seeing a psychologist in the fall of 2009 when my marriage was breaking up. I was experiencing anxiety and panic attacks. One day the heart palpitations were so intense, I went to the emergency room because I thought I was having a heart attack.

I wasn’t, of course, but I was losing weight, and a couple of months into my therapy, the psychologist asked about my eating habits. I described my meals—a handful of cranberries for breakfast and typically nothing else until about 9 pm, when I’d have a dinner of beans and raw vegetables—and told her I’ve always been focused on eating only very healthy food. She said, “I think you have an eating disorder,” and categorized it as orthorexia, a term I’d never heard before.

I think my therapist was struck not only by what I was eating but also by the amount of time I devote to thinking and reading about food. As a ­researcher—my area is perception—I have access to academic libraries, and I spend about four hours a day reading the latest studies on disease-preventing foods and the benefits of, say, extreme calorie-restricted diets. I shape my food intake to this research. Right now I’m eating about 1,200 calories a day, keeping protein very low and leaving vegetables and even garlic uncooked, because sometimes you get more vitamins if you eat them raw. I also adjust the kinds of spices and chile peppers I use according to the newest studies saying which have the most antioxidants.

My eating habits weren’t the biggest problem in my marriage, but they did cause friction. I’d spend most of the day reading studies about food, tracking down healthy ingredients at specialty shops, making my own spice mix from whole spices and finally putting it all together. My husband is a very good cook, but I’d watch him and say, “You can’t use that much oil” or “Don’t use coconut milk.” I’ll admit that I still preach at people sometimes. Recently I was at a luncheon with about 20 colleagues where the food was served family style. I wouldn’t pass the meat platters to anyone, and if someone placed a meat dish next to me, I’d say, “Could you remove that thing?”

I don’t live a very social life, and that has a lot to do with food. I don’t have people over to my house because they wouldn’t appreciate the food that I cook, and there’s no way I’m cooking food with ingredients I wouldn’t eat. And it would be nice to date more, but I turn down a lot of invitations. One guy invited me to a lunch at a neighboring university, but I knew the food would be premade. That would be an uncomfortable situation for me, so I said no.

I’ve come to recognize that my eating habits are a compulsive way of dealing with anxiety. There are a lot of things I can’t control, but what I eat is something I can control. Plus, when you are on a restricted-calorie diet, you’re slightly hungry all the time, and my brain associates that with pleasure. Feeling hungry feels better than experiencing anxiety, anger or depression.

I enjoy eating healthy food, but I’d like to be able to make more exceptions to my diet. It would be nice to eat fish now and then, especially something healthy like salmon, and cheese on occasion. I’d like to be able to go to someone’s home for dinner and eat a plate of pasta, even if it’s not whole wheat. But mostly I want to find a more direct way to deal with the issues that are causing my anxiety; then everything else will take care of itself.

The Finicky Eater

Heather Hill, 40: Raleigh, North Carolina; website developer

I’ve been a picky eater from the time I was weaned. At 40, I still eat the way a six-year-old does, excluding everything that doesn’t fit the narrow spectrum of what I like. For me, that’s french fries, bagels, macaroni and cheese, pasta with butter or marinara sauce, vegetarian pizza, corn, broccoli, apples and bananas. That’s it.

I’ve always thought my eating habits were weird and shameful. My mother was racked with guilt and felt it was all her fault. But I never thought I could change, until a few months ago. While doing some Web research to help my daughter—at five, she’s an even pickier eater than I am—I stumbled on an online support group for adult picky eaters (pickyeatingadults.com).

To say that this community has changed my life is an understatement. The support group has more than 1,000 members, and I couldn’t believe there were all these other people who have the same food issues I do. I cried when I read the postings. Now I’m working with a therapist at the Duke Center for Eating Disorders. I don’t know if I’ll ever be healed, but I already feel more accepted and normal.
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When I was a kid, being a picky eater got me a lot of extra attention from my parents, my teachers and the kids at school. It was almost cute: “Oh, Heather doesn’t eat this or that.” It set me apart. In high school, too. I was a cheerleader, and on the way back from football games the bus would stop at McDonald’s. The football players loved me because they got to fight over who I’d pass my Big Mac along to; I’d take their fries in return.

In my twenties, I started to become self-conscious. When I was dating someone new, I’d just say I was a vegetarian instead of explaining how limited my diet really was. Being pregnant with each of my three kids was very difficult. I really wanted to eat healthy and increase my protein, but I just couldn’t stomach eggs, chicken or even tofu. That was very frustrating for my husband, but it’s just the way my brain works. If I take a bite of something that’s not on my list of foods, an alarm goes off in my head—“Woo! Woo! Woo! Alert: There’s something foreign and inedible in your mouth”—and I have to get rid of it. That can happen even with the foods I love. If there’s something unusual about the texture of a french fry—say, it was made with a potato that was bruised, so it’s softer in some spots—that’s enough to make me feel as if I’m going to throw up.

Recently my daughter had a playdate with some other girls, and the mom made lunch for the mothers. She handed me a plate with salmon, rice and some kind of vegetable—nothing that I would eat—so I said I was fasting because I was having a medical procedure the next day. It was easier than watching her go through her cupboards to find foods I’d accept, only to have me say no to everything anyway.

In a perfect world, I would like to eat like a normal person. But realistically, I don’t see that happening, and I don’t really want to put myself through the stress of trying to like new foods and failing at it. What’s more important to me is having an answer to what this is all about.

The Doughnut Junkie

Barbara, 47:, Charlotte, North Carolina; interior designer

I grew up in a very affluent New Jersey family in which appearance was the most important thing. I wore a size 10 in high school, so I wasn’t obese, but my family berated me terribly about being fat. My brothers called me “whale” and “tub of lard,” and that was accepted by my parents. One brother made me drink four cups of tomato juice with apple-cider vinegar every day. He was a wrestler, and that was what he used to melt fat off his body. It didn’t work for me.

We had a family dinner every night at 6, and I wasn’t allowed any starches or dessert, only a little piece of meat and some salad. Of course, my parents said they were doing this for my own good. My life, they’d say, would be so much better if I were thin.

I got my driver’s license when I was 16, and that’s when my bingeing started. I’d drive to Dunkin’ Donuts, buy a dozen and eat them right there in the car. Then I went away to college, and I stopped bingeing cold turkey. Away from the pressures of my family, I didn’t feel the urge to stuff myself.

I didn’t binge again for a decade. Then, at 28, I was diagnosed with breast cancer. I went through a lumpectomy, radiation and chemotherapy, and my weight went from 140 to 125. When the treatment ended, I started putting weight back on, and my mom said to me, “Don’t you wish you could stay on that chemo forever? You sure did look good.” That triggered it. I went back to eating a dozen doughnuts in half an hour. Only the first one or two taste good, but once I start, I have to finish them all. Afterward I feel as if my body is going to explode, as if I have been drugged. I am numb to any emotion.

By then I was married with two daughters, and my husband discovered what I was doing. The shame of being caught was enough to make me stop, and I didn’t binge again for 15 years, even through my divorce. But this past year has been difficult: I lost a brother to cancer, my mother has been bedridden for months with a broken hip, and my business has been hit hard by the recession. Three months ago, I was with friends who wanted to stop for breakfast at Dunkin’ Donuts. I didn’t have the guts to say, “No, I can’t go in that place.” We went in, and I just ordered an egg sandwich, but the next morning at 7:30 I was back and bingeing again.

Now I’m bingeing two or three times a week. When I feel the urge, I find myself driving to the doughnut shop, even though I realize I will end up in physical pain and filled with self-disgust. I wish I could keep my car from going there, but I don’t have the ability to stop myself. It’s the definition of insanity.

My weight is up to 200 pounds, and I’m just waiting to hit rock bottom so I can stop bingeing again. That’s as much of a plan as I have right now.

The Dieting Champion

Rania Atalla, 44: Amman, Jordan and Washington, D.C.; writer

Five years ago, when I was working as the chief of staff to Queen Rania of Jordan, I found myself in Greece at a state luncheon for the queen and her husband, King Abdullah. I thought no one was noticing me as I moved my food around my plate, course after course. But when dessert was served, the chef came out, leaned over and whispered, “Madam, is everything all right with the food?” I wanted the earth to open up and swallow me.

By this time, it had been well over a decade since I’d actually eaten lunch. When I was invited to a luncheon, my day would be ruined; the world would become a totally dark place. So I’d either take notes throughout the meal or play with my food to hide the fact that I wasn’t eating. Obviously, it didn’t always work.

I’d held a series of fast-paced jobs in Washington and then in Jordan, and I’d become accustomed to running on adrenaline rather than food. Stopping to eat would just slow me down, so I often wouldn’t eat anything all day until I got home at 10 or 11 at night. I also had a list of prohibited foods that got longer and longer; I eliminated all carbohydrates, dairy and sugar in coffee. There’s a physiological and psychological high created by restricting food intake—a constant underlying buzz and a feeling of power that I enjoyed.

I became so compulsive about exercise, meanwhile, that after a 14-hour flight from Jordan to Washington, I’d go straight to the gym because I had missed that day’s workout. On weekends, I’d turn down invitations if I thought they’d interfere with my spending up to three hours at the gym. Excessive exercise was my form of purging, but as I entered my forties, I was having to work out longer and harder to keep my weight low, and I was developing sports injuries such as tendinitis in the back of my knee and a strained hamstring. Then, at my annual checkup last year, a bone-­density test showed that I had osteopenia, bone loss that can lead to osteoporosis. I learned later that this condition is often caused by eating disorders, because your body is not getting enough vitamins and minerals.

That was a wake-up call. I started seeing a therapist who specializes in eating issues. I recognized that while I don’t meet all the criteria for ­anorexia—I’m not missing periods, for one thing—my disordered eating was ruling my life. I also came to see that my unhealthy relationship with food was just a symptom of my pursuit of perfection in all areas of my life. I hadn’t earned the nickname “The Bulldozer” from my colleagues for nothing. I thought if I worked hard enough, I could produce the perfect report, the perfect body, the perfect me.

Today I consider myself someone in recovery who’s on the road to normalizing her eating habits. I hadn’t had breakfast in 20 years, but I’m starting to have Ensure and a bit of oatmeal in the morning. I still find it difficult to order in a restaurant, and I have bread and low-fat cheese for lunch because a cooked meal at midday triggers self-loathing. I’ve also been taking at least one day off from working out every week. I’m trying to learn to be more compassionate toward my body, and I think I have crossed a threshold.

Where to Get Help

National Eating Disorders Association

Academy for Eating Disorders

National Association of Anorexia Nervosa and Associated Disorders

The Duke Center for Eating Disorders

University of North Carolina Eating Dis­orders Program

Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital

Renfrew Center for Eating Disorders

Further reading

Crave: Why You Binge Eat and How to Stop by Cynthia Bulik, PhD

The Body Myth: Adult Women and the Pressure to Be Perfect by Margo Maine, PhD, and Joe Kelly

First Published Tue, 2010-08-31 12:38

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