A Disorder Comes of Age


Marie Burkhead once savored seafood dinners at Red Lobster with her husband. She noshed on pizza and shared birthday cakes with her son. At 5-feet-7, she weighed a trim and healthy 120 pounds, sometimes edging up to 125. “My weight didn’t bother me,” she says. “I thought, ‘Oh, I’ll lose that extra 5 pounds someday.’”

Then, in 2004, she and her husband separated, and her 10-year-old son chose to live with his father. “I went from being a full-time mom to seeing my son only sporadically,” says Burkhead, of Perry Hall. “I had lost my main identity, and I wasn’t in control of my life. So I started to eat less and exercise more.”

She’d hike 2 1⁄2 hours a day, often trudging through the woods in Gunpowder Falls State Park. “It would take my mind off being by myself,” she remembers. Health food became her mantra. Fruits and veggies. Minimal calories. No cookies or other sweets. And the weight started dropping. 115, 110. When she reached 100 pounds, she wasn’t alarmed.

“I thought, ‘Wow, I got to 100.’”

Then she started losing energy, muscle mass and became too weak to even walk the trail. “I was battling to finish,” she says.

By 2009, she had dropped to 84 pounds. Exhausted and afraid, she checked herself into the Sheppard Pratt eating disorders program. She was 36 years old when she was diagnosed with anorexia nervosa.

“I wasn’t even healthy anymore,” says Burkhead. “I was trying to have some sort of control. I had lost my identity as a wife and a mother, and this disease came out. Look what I did to myself.”

In treatment centers here and around the country, cases of anorexia nervosa and other eating disorders long associated with young women and teens have been rising among people over age 35, according to recent studies and local experts.

“The stereotypes of the past are really breaking down now,” says Dr. Harry Brandt, director of The Center for Eating Disorders at Sheppard Pratt in Towson. “For a long while, attention has been focused on young people, but we’ve seen a fairly dramatic increase in people age 30 to 35, and even up into their 50s and 60s.”

At The Johns Hopkins Eating Disorders Program, which often treats long-term chronic cases, at least one-third of their patients are over age 35. “We don’t know if there are truly more cases of anorexia or whether they are getting to Hopkins more,” says Dr. Angela Guarda, associate professor and the program’s director. “But do we have more older patients? The answer is yes.”

A study published in the July issue of the International Journal of Eating Disorders shows that 13 percent of women ages 50 and older struggle with eating disorders—some for the first time.

The study noted that common maladaptive eating behaviors include purging, binge eating, excessive dieting and excessive exercising. In some cases, like Burkhead’s, first-time battles with anorexia or bulimia are the result.

“It’s very hard to get rid of. It’s hard,” says Burkhead, now 39 and still weighing in the low 90s. “It’s a mental disease. You are fighting with your mind all the time.”

When it comes to age trends in eating disorders, those in their 40s and 50s seem to be struggling like teenagers. What’s going on here?

People might be more aware of the disease via the Internet and media coverage, experts note. Or those diagnosed at younger ages are living longer because of advances in medicine.

Stressors like divorce can tip some women or men—who are already dieters—over the edge. And societal pressures to stay thin have evolved over the past decade as the population grays—or at least buys more hair dye.

“You have the Baby Boomer Generation, the Twiggy Generation, that is not as comfortable about aging,” says Brandt. “‘Fifty is the new 40, 60 is the new 50,’ that kind of thing.”

Central to the disease, in most cases, is body image. And Americans often don’t like what they see in the mirror. University of North Carolina researchers who led the study published in July showed that a whopping 79 percent of women surveyed online reported that their weight or shape affected their self-perception. And the majority of respondents age 50 and over said such weight issues had a negative effect on their lives.

The trend is spreading across the spectrum. Up to 24 million people of all ages and both genders in the U.S. suffer from an eating disorder (anorexia, bulimia and binge eating), according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD).

“Eating disorders affect anybody and everybody, it doesn’t matter their nationality, age, sex, religion or race,” says psychotherapist Sharon Peterson, founding director of the Eating Disorder Network of Maryland. “Too many people are falling through the cracks.”

Peterson says that 50 percent of her private patients struggle with eating disorders. “Either they had an eating disorder all along or one that was not recognized,” Peterson says. “Sometimes they’ve been in remission, but it begins to resurface; or they are going through this for the first time.”

Peterson notes that eating disorders might go undiagnosed by physicians or unrecognized by family members. Some cases are mild (occasional bingeing on food), others more severe (anorexia, or bulimia nervosa—also known as bingeing and purging). If left untreated, eating disorders can lead to health risks such as heart ailments, osteoporosis, depression—and death. Eating disorders have the highest mortality rate of any mental illness.

Although fewer men face eating disorders (about 1 in 10 treated for anorexia are male), more cases are surfacing, experts say. “There is a normal progression with weight, yet men will say they want to be the same weight they were when they got married,” says Brandt. Men can be prone to binge eating and yo-yo dieting.

Some of the triggers for adult eating disorders differ from those faced by teens, including life stressors such as children leaving home for college (or moving back home), marital problems such as a spouse’s infidelity, divorce, or loss of a loved one, aging parents, menopause, sexual dysfunction and illness or injury. A common factor, however, seems to be negative self-image and a need to regain control.

Once divorce hits, for example, people feel they’ve got to get back out there.

“America has a high divorce rate, and people age 45 or age 50 think they need to be thinner if they want to be attractive,” says Brandt. “Or they are not as mobile in their 50s—they’ve developed tendinitis or knee injuries and think, ‘I’m not burning enough calories, so I can’t eat.’ Or they’re adjusting to kids moving out, so there’s less focus on the kids. Obsessive behavior can set in as a way to control things.”

Burkhead knows all about that: “I’d make lists and plan my meals out ahead, and it really became obsessive.” She says she had no eating issues as a teen or in her 20s, though she struggled with anxiety. By her mid-30s, she was surfing websites for calorie-restricted diets. “I picked this up as my identity and it was something I was good at,” she says. “I could fool myself.”

Media messages and pop culture clearly contribute to Americans’ overall obsession with weight. “Tabloids are always showing stars who have lost a lot of weight or gained a lot of weight,” Peterson says. Among girls in fifth to 12th grades, nearly 70 percent report that magazine photos influence their idea of a perfect body shape, with nearly half saying they want to lose weight because of those images, according to ANAD. Yet the ideal body type portrayed in advertising is “possessed naturally by only 5 percent of American females,” studies note.

That same preoccupation, experts say, shifts from Seventeen magazine to Self, Vogue or Shape. Consider an emaciated Demi Moore, 50, on a recent cover of Harper’s Bazaar or 90210 alumna Jennie Garth on an October cover of People magazine: “40 Wow! ‘I just lost 30 Pounds.’”

Trying to look 17 is one thing. Yet, during the past few years, actresses or models remain hot commodities into their late 30s, 40s and even 50s. Consider these slim A-list celebs: Jennifer Aniston, 43; Halle Berry, 46; Julia Roberts, 45; Cameron Diaz, 40; Angelina Jolie, 37; Jennifer Lopez, 43; and the ever-youthful Andie MacDowell, 54. The upside of their career longevity might carry a downside for women who feel pressure to look forever young.

“So they see a Jennifer Aniston and think, ‘Look how thin she is and she’s in her 40s, and here I’m not as thin,’” says Brandt.

And while a host of women might simply feel a bit down on themselves, this Sisyphean search for perfection can create a “perfect storm” scenario for some whose personality traits make them prone to eating disorders.

“We are looking at Type-A personalities,” says Peterson. “Strong-willed, hypersensitive, perfectionist, with a tendency to see things as black and white, to be rigid in their thinking.” Other traits include competitiveness, high self-expectations, repetitive exercise routines, compulsiveness, drive and a tendency toward depression.

The Modern Mom might be especially at risk. Some women, including those who’ve set aside professional careers or juggle both work and home, become avid marathoners or attend serial spin classes at the gym. They obsessively eat only organic or raw foods.

In more extreme cases, such health consciousness can morph into a newly described form of anorexia known as orthorexia nervosa, or an obsession with eating only “healthy foods.” In those cases, a strict diet of raw vegetables with a dash of almonds could become another way to justify limited calorie intake.

That was the case for Burkhead, who says her desire was less to be thin than to be a “super healthy” person. “I can’t get my head around eating something ‘unhealthy.’ I haven’t been able to eat candy, cookies, cake, bad food, junk food,” says Burkhead, who was diagnosed with orthorexia. “I know it’s bad, but I started to feel superior doing these things. I could just watch people eat cake.”

Guarda and others compare eating disorders, especially anorexia, to alcoholism—in which a behavior, such as social drinking, can trigger problems for those genetically predisposed. “It’s like drinking at a cocktail party,” she notes. “Only a couple of people get trashed and can’t get home.”

A similar “can’t stop” switch might be flipped with eating disorders. “People start dieting, and it’s more rewarding to them than it is to others,” Guarda says. “If a physical illness or stress causes them to lose that initial weight, they can get stuck in this dieting and exercise behavior and it becomes increasingly driven.”

“We are not very accepting of ourselves as we get older. It’s a developmental step people aren’t willing to take,” says Brandt. “I’m 55 and I can empathize with the struggle. But people are dieting to go below the weight where the body wants to be—a normal, natural set point.”

He poses the dilemma. “Do you think a 50-year-old woman is supposed to weigh the same at age 50 as she did at age 20? She has had children and gone through other physical changes,” he says. “We need to engage this population to look at this as part of life.”

Brandt and others urge people to focus less on the scale and more on being healthy and balanced. Health risks for adults with chronic or late-onset eating disorders can prove especially deadly: including liver or kidney failure, severe osteoporosis, pancreatitis or irreversible heart damage. “The older you are, the more susceptible you are,” Guarda notes.

Yet that message of balance might prove increasingly difficult.

With more than one-third of Americans now obese, according to the Centers for Disease Control and Prevention, current public health efforts—including U.S. government anti-obesity campaigns—center on curbing calories in our diet. The message is laudable but also can fuel obsessive behaviors to control weight, experts say.

Authors of the University of North Carolina study recommend that health professionals screen for eating disorders: “Greater public health attention must be drawn toward effective strategies to achieve health rather than desperate and ultimately ineffective attempts at weight loss.”

As awareness grows about the issue, families and friends on the front lines also can become more aware of signs or symptoms, and then encourage loved ones to seek counseling or treatment.

Burkhead’s mother and ex-husband staged a quiet intervention, urging her to get counseling. At first she didn’t want to admit she had a problem. Eventually, after being diagnosed, she found effective counseling. Burkhead also joined a support group with ANAD and is buoyed by the friends she’s found there. She gives herself positive pep talks and taps other coping skills. Already facing pre-osteoporosis, Burkhead wants to increase her weight. Her tentative goal: Add 25-plus pounds to get back to her 120 mark.

“I can’t say I’m recovered or anything close to it, but I’m trying,” she says. “I want to be more flexible. Shake things up. I’d like to start dating again. To settle into a more normal life.
“I brought a cookie in my lunch today. And I haven’t had a cookie in a long while,” she adds. Then she laughs at herself. “But, still, it’s a cashew cookie. It’s not like it’s an Oreo.”


Contact the Eating Disorder Network of Maryland for facts about eating disorders, area treatment providers and support groups. 443-377-1266, http://www.ednmaryland.org

National Association of Anorexia Nervosa and Associated Disorders is a clearinghouse for information about eating disorders across the country. Helpline: 630-577-1330, http://www.anad.org

Left to right: Dr. Harry Brandt, director of The Center for Eating Disorders at Sheppard Pratt;  Dr. Angela Guarda, director of The Johns Hopkins Eating Disorders Program; and Sharon Peterson, founding director of the Eating Disorder Network of Maryland.

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