Fashion magazines show thin young models. An after-school special shows a teen girl suffering with bulimia. We perceive eating disorders as diseases of the young.
It’s a false perception, according to new research from UNC-Chapel Hill. The authors surveyed the disordered eating behaviors of 1,849 women aged 50 and older. They found disordered eating does not discriminate based on age.
“We just haven’t bothered to ask how Grandma feels about her body,” says Cynthia Bulik, director of the UNC Eating Disorders Program, who led the study. Bulik is also the author of “The Woman in the Mirror,” a practical guide to help women suffering from body image issues. The work was published in the International Journal of Eating Disorders.
“The thought is that older women replace body concerns with health concerns. But it turns out those body concerns don’t go away,” says Bulik. “It’s double trouble.”
Older women are no small group either. Women over 50 comprise about 17 percent of the U.S. population, more than 50 million people.
None of this surprises Eve Cribbs, a licensed clinical social worker.
“The bulk of who I see are between about 35 and 60,” she said. Cribbs, based in Raleigh, exclusively counsels people with eating disorders.
The survey measured disordered eating, which is an umbrella term for all the symptoms of eating disorders.
In other words, disordered eating refers to specific behaviors, but an eating disorder is a diagnosed disease. Eating disorders include anorexia, bulimia and binge eating.
Someone who engages in disordered eating does not necessarily have an eating disorder, though the likelihood is stronger as symptoms pile up. Further, disordered eating can still have major health consequences, regardless of whether a person has an outright eating disorder.
The symptoms surveyed included binge eating, obsessive weight checking and low body mass index (BMI), which is the number the National Institutes of Health uses to define under/overweight individuals. Another symptom, purging, includes vomiting, laxative use, and excessive exercise.
Some figures were startling. Eight percent of women reported purging – without binging – in the past five years. “Even women in their 70s reporting purging,” said Bulik.
Of the women surveyed, 3.5 percent reported binge eating at least once a week, a figure comparable with numbers from other age groups.
Cribbs sees the stories beneath the statistics every day.
“Some patients started out disordered as adolescents, and have intermittent returns to these behaviors. Some patients are former bulimics, who still binge eat with no compensatory purging,” Cribb said.
Psychologically, body image plays a large role. Sixty-two percent had frequent concerns about their shape, a few times a week or more. Four out of five indicated their body image played the most important role in their self-perception. A full 71 percent were trying to lose weight.
The study also busted the notion that eating-disordered people are thin. A larger BMI was correlated with a higher likelihood of disordered eating. Bulik thinks this result might be painting a grim picture of yo-yo dieting and its consequences.
“Sometimes, it’s an attempt to outrun aging, as menopause can change the body,” Cribbs says. Bulik also wants to do this study in men, another group often ignored with respect to eating disorders.
“Guys are really having trouble, too,” she said.
Link to health issues
Health issues linked to disordered eating are numerous, such as gastrointestinal and heart problems. Tooth decay can arise from purging by vomiting because stomach acid erodes tooth enamel. Osteoporosis is a concern for all women, and disordered eating can make it worse.
With older patients, health care providers may be blind to issues associated with the young, such as disordered eating.
Doctors use glucose screening for pre-diabetic testing. When a patient is diagnosed as pre-diabetic, they are often given a lecture, she said. This lecture often includes a prescription of weight loss.
“But if there is any compulsivity about weight loss, they can really easily become reactive,” Cribbs said. “They may lose the weight quickly, unhealthily, only to regain it. They feel at fault. Avoid the doctor. It also messes with the metabolic condition (of diabetes).”
“Health care providers have to keep these issues on the radar screen,” Bulik said. “Bodies aren’t as resilient as they age. (Disordered eating) can take an even bigger toll on health than it does in young people.”