Eating Disorders

Eating Disorders

You Can Stop the Obsession

Chances are you've known someone with an eating disorder. Maybe she was a high school classmate, the one who became so thin that her clothes just hung on her bones.

Maybe she's the neighbor down the hall, the one who runs five miles every morning no matter what, then appears every night at the gym to ride the exercise bike, swim or work the Stair Master--whatever it takes to get in two workout hours a day.

Maybe she's your housemate, the one who binges quietly in the kitchen late at night--after she's been out to dinner with friends. She tries to hide the pizza boxes, cookie bags and ice cream wrappers, and she vomits in the alley behind the house.

Maybe she's you.

There are three major types of eating disorders--anorexia, bulimia and binge eating disorder--and they can threaten a woman's life.

Ninety to 95 percent of people who have anorexia or bulimia are women. Among those who have binge eating disorder, the majority are also women. Many suffer in silence, so it's hard to determine how many have the problem, but some experts put the figure at seven million women.

Women may be more susceptible to eating disorders than men are because of society's emphasis on thinness, experts say. And other factors--including family history and low self-esteem--may also play a role.

When It Happens after 30

While eating disorders occur most frequently in teenagers, adults suffer as well. Women over 30 who have an eating disorder fall into three categories, says Vivian Meehan, R.N., D.Sc., founder and president of the National Association of Anorexia Nervosa and Associated Disorders (ANAD), based in Highland Park, Illinois. Some develop the problem after 30, some have a recurrence of a disorder they had as teens, and others have battled eating disorders for several years.

Life's upheavals may summon an eating disorder, says Dr. Meehan, especially events that cause a sense of loss, like divorce or the death of a loved one. A woman may try to make up for the loss of control in other areas of her life by controlling her relationship with food, she says.

Sometimes it takes women in the over-30 age group longer to get help, says Dr. Meehan. "We can sometimes intercept the behavior in teenagers because their families are there to support them in the treatment. Their parents decide to put them in a program, to get them into therapy and to participate in family therapy," she observes. But no one can force an adult into treatment, she says.

The Binge Eater's Battle

The most common eating disorder in women over 30 is binge eating disorder, says Susan Yanovski, M.D., who specializes in eating disorders at the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland. People with binge eating disorder overeat but do not vomit, take laxatives or exercise excessively to purge their bodies of food as people with bulimia do.

Binge eating disorder is found in about 2 to 3 percent of adults, and experts say 60 percent of those who have the disorder are women. Binge eating is said by experts to be a problem for 23 to 46 percent of obese women who seek treatment for weight reduction.

Women who binge eat tons of food, and they do it regularly. "If you chow down at Thanksgiving dinner, that's not a binge," says Dr. Yanovski. "That's not definitely a larger amount than most people would eat under the same circumstances." But if you sit down with the family and eat dinner, then eat a pint of ice cream, a whole bag of cookies and four doughnuts and feel out of control during the episode, that's a binge, she says.

It's important to place a binge in context, says Dr. Yanovski. If you starve yourself through the day, then eat half a cake, that's not necessarily unusual, given that you didn't eat anything all day, she says. "Almost all women have a time when they eat large amounts," she says, but that doesn't mean they have binge eating disorder.

To constitute a true binge eating disorder, such mega-eating must occur at least two days a week for six months, says Dr. Yanovski, and must be accompanied by a feeling of not being able to control what or how much you're eating.

What's going through a woman's mind when she binges? According to Dr. Yanovski, she feels out of control and distressed. Some typical thoughts are "I don't know why I'm eating this," "I really wish I weren't eating this" and "I should really stop now." She feels guilty, depressed or disgusted with herself after the binge.

The binge eater's habits include eating rapidly, chowing down until she feels uncomfortably full and eating alone because of embarrassment over how much she's consuming.

Many women won't go out with friends because they want to stay home and binge. They hide food from their husbands and children, and they eat at night and bury the remains in the trash, says Dr. Yanovski.

Overcome by the Urge to Purge

Bulimia involves bingeing and then trying to get the food out of the body or the calories burned as quickly as possible. Many people with bulimia vomit and take diuretics and laxatives to purge the food. Others exercise excessively or fast for 24 hours or more. Bulimia is the diagnosis when a woman has indulged in this kind of behavior at least two times a week for three months, says Dr. Yanovski.

Bulimia affects from 2 to 3 percent of young women, and women with bulimia outnumber men by ten to one.

While many women with bulimia often appear healthy and are at a normal weight, they have a morbid fear of becoming fat. They often plan their binges, feeling both anxious and excited beforehand and then guilty and disgusted with their behavior afterward, according to Dr. Yanovksi.

Those with bulimia feel shame and often go to great lengths to conceal their habits. Bulimia over a long period of time can severely damage a woman's teeth because of the stomach acids in vomit or cause death from heart arrhythmia or congestive heart failure, which can be triggered by electrolyte imbalances. Women with bulimia may also die from breathing in their own vomit.

When Thinness Is Everything

Like women with bulimia, those with anorexia have an overwhelming fear of gaining weight. Even when they are underweight, they believe they are fat.

Although anorexia nervosa is the least common eating disorder, affecting less than 1 percent of adolescent and young adult women, it has the most serious health consequences. Ninety-five percent of people with anorexia are female.

The woman with anorexia pursues a thinner body by limiting her food intake severely, Dr. Meehan says. She eats so little that her body loses a lot of weight very quickly. Substantial weight loss is often the first sign of the disease.

While many dieters count calories and limit their food intake, women with anorexia carry this behavior to the extreme. They often cut out all carbohydrates and fatty foods. They may be obsessed with calorie counting and become ritualistic about food, allowing themselves to eat only so many pieces of a certain type of food at a certain time.

These women can be very secretive as well, allowing themselves to eat only when they are in a closet or bathroom, where no one will see them.

A diagnosis of anorexia can come when a woman engages in such behavior and is 15 percent below her ideal weight. In extreme cases, people with anorexia have fallen to 60 percent below their ideal weight.

While some women who have anorexia just restrict their eating, others also have episodes of binge eating and purging in addition to food restrictions. The substantial weight loss that occurs can disrupt hormone production, and all women with anorexia develop amenorrhea, or loss of their periods. The lack of estrogen can harm bone health and place women with anorexia at increased risk for osteoporosis. Also, changes in the heart, including decreased heart size, can lead to cardiac complications, a leading cause of death in those with anorexia.

Why Women Are at Risk

Our culture's emphasis on a woman's thinness is a major factor in the development of eating disorders and a big reason why women experience them more than men do, researchers say.

"Women are shown the same TV commercials asking them to eat all the same high-fat foods as men. However, women are then shown magazine covers with impossibly shaped women who are both thin and have breasts. This sends messages to women that 'Yes, you should enjoy yourself, yes, you should be eating all these high-fat foods, but you have to end up looking like these models who are at about 80 percent of their ideal body weight,' " says Dr. Yanovski.

In a study of over 60,000 people conducted by the Centers for Disease Control and Prevention in Atlanta, women were more likely than men to consider themselves overweight: 38 percent of adult women reported that they were trying to lose weight, compared with 24 percent of adult men.

The weight-loss message comes across loud and clear every day. A 1992 study found that ten of the most-read women's magazines contained over ten times more ads and articles promoting weight loss than men's magazines did.

In fact, dieting often precedes a woman's bout with anorexia or bulimia, says Dr. Yanovski. With binge eating disorder, the scenario is a little different. "Over half of women with binge eating disorder report that they began binge eating before they ever started dieting," says Dr. Yanovski.

The Relationship to Emotions

Women with low self-esteem may be at increased risk for anorexia, experts say. These women tend to have a poor body image, place extreme importance on their figure and weight and view thinness as central to self-worth.

Depression has also been associated with eating disorders; an estimated 40 to 80 percent of those with the disorder have a history of depression. Depression's connection to bulimia and binge eating disorder is especially strong, but it's not clear whether depression causes those two disorders or vice versa, says Dr. Yanovski. "What we can say very clearly is that bad feelings seem to trigger binge episodes in many people," she says. She cites anger, sadness, boredom and fatigue as feelings that might kick off a binge. In addition to depression, obsessive-compulsive behavior and other psychological disturbances have been observed in individuals with eating disorders.

Having a dysfunctional family is thought to increase a woman's risk for eating disorders, researchers say. People with anorexia, for instance, may come from families that are overprotective, rigid or poor at solving conflicts or have poor boundaries defining the relationships of its members.

A study done at Yale University determined that mothers of girls with eating disorders were less satisfied with family cohesiveness than were mothers whose daughters didn't have such disorders. The study also found that mothers of daughters with eating disorders were more likely to have the disorders themselves than were mothers whose daughters didn't have eating disorders.

Beating the Odds

Women can take steps to protect themselves from falling into the eating disorder trap. Here are some suggestions.

Reject the cultural ideal. Women are bombarded with images of a body ideal that is unrealistic, experts say. Realize it and don't compare yourself to it or try to achieve it, says Dr. Eckstein. "Begin accepting your body the way it is," Dr. Eckstein says. "Sometimes I give people an exercise to do in the shower: Scrub their bodies and tell every single part of their body, 'I love you, I want to take care of you now,' " she says. And remember this: Most women who feel they need to lose five to ten pounds probably don't need to, says Dr. Eckstein.

Aim for a healthy weight. If you plan to lose weight, talk with your doctor, pick a realistic goal--and stop when you reach it. "If your goal weight keeps getting lower and lower," that may be a sign of trouble, says Dr. Yanovski. Another is when you find yourself telling others that you weigh more than you really do, says Dr. Yanovski.

Talk about your diet. If you are going on a diet, be public about it, says Alice Lindeman, R.D., Ph.D., associate professor of applied health science at Indiana University in Bloomington, who studies eating disorders. Tell people how much weight you plan to lose; if you lose more they'll know and point it out, she says. Similarly, if you have a friend who is dieting, speak up if you think she's going too far.

Don't fear a gain. If you get very upset if your weight goes up a little and are only content when your weight goes down, that's a clue that you might have an eating disorder. "Anorexics get very upset if their weight goes up. Regardless of what it goes up from, a half-pound is like a catastrophe," says Dr. Simko. So take it easy on yourself and realize that weight fluctuations are normal.

Don't skip meals. Skipping a meal will only make you hungrier and more likely to overeat when you finally are around food, says Dr. Yanovski.

Know your triggers. Alcohol can be a powerful trigger, so if you find you binge every time you drink, avoid alcohol, says Dr. Yanovski. Or if buffets set you off, do your best to steer clear of them, she says. "If you are one who binges every time your husband is out of town because you're bored, plan ahead to spend time with friends," she says.

Vary your routine. Nip any compulsiveness about eating in the bud, says Dr. Lindeman. For example, thinking things like "I will eat 25 peas" means you might be moving into the danger zone by being ritualistic about food and insisting on the same routine every day. Other examples of this kind of thinking include "I only go down this aisle of the grocery store," "I only buy this cereal," "I eat right at noon."

Eat with others. Make yourself share your eating time with others, so you can eat normally and at a regular pace, says Dr. Lindeman.

Take assertiveness training. Anything that strengthens your sense of being an individual, with your own rights and needs, can help, Dr. Eckstein says. Ask your at your local library about assertiveness training classes in your area.

Tell someone. If you're having a problem with food, tell a friend, family member, doctor or co-worker with whom you can talk openly and easily. Women find telling someone is often a relief and the first step toward healing, says Dr. Eckstein. A support group can also help. Ask your doctor or hospital for help in finding one.

Keep track of your periods. If you've been dieting to lose weight and have noticed a change in your menstrual periods, see your doctor. Weight loss severe enough to cause amenorrhea may be a sign of anorexia, and many women with bulimia have irregular periods.