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Healthy Bodies

Eating disorders exact toll on adults, too

By Helyn Trickey
Special to CNN
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(CNN) -- Pushing a grocery cart loaded down with cereals, sandwich fixings and sweet treats up and down the aisles of her local store is one of Cindy's great joys.

"I'm checking out new items and buying things that aren't on the list," the 38-year-old mother and wife from New Jersey said with a laugh. Cindy has asked that her last name be withheld for reasons of privacy.

"I go to the grocery store, and I'm having a spiritual experience on Aisle 5."

But grocery shopping has not always been such an exuberant experience for Cindy. She suffered for years from anorexia nervosa, an eating disorder in which a person severely limits the amount of food he or she eats in fear of weight gain or a distorted body image. Anorexic people can be severely underweight.

Years earlier, a trip to the grocery store would have meant darting up aisles to gather the handful of food that barely sustained her: toast, popcorn, raw vegetables and yogurt.

"In different sections of my life I could tell you exactly what I was eating because I had the same thing every day for years," she said. "When you have anorexia you can never get low enough. If you're 93 pounds, then you're trying to get to 91. You are working so hard to never get to your goal."

But Cindy, a mother to two school-age children and owner of a home-based business, is not quite the face that many people associate with an eating disorder.

She's not the angst-ridden teenager so often portrayed in media messages and after-school TV specials that highlight the dangerous symptoms of the mental disorders.

Instead, she is part of what some health officials call a growing trend of women in midlife seeking help for their eating disorders, which can include anorexia, bulimia (binging and purging food) or compulsive exercise.

"Eating disorders predominantly occur in the pubescent years, the teenage years," said Dr. Katherine Halmi, director of the eating disorder program at NewYork-Presbyterian Hospital in White Plains, New York.

"But we are definitely seeing an increase in women over the age of 30 and 35 seeking treatment," Halmi said.

In her experience, the trend began in the mid-1990s and continues to climb today.

In 1988, 4.2 percent of the women admitted to her clinic with eating disorders were in their 40s.

Halmi estimated that today 10 to 12 percent of the patients seeking treatment at her clinic are adult women.

Baby boomers' desire to remain young could be one reason for the jump in adult-onset eating disorders, according to the Anorexia Nervosa and Related Eating Disorders group. The people of the baby boom generation have been inundated throughout their lives with pop-culture and lifestyle references to the importance of image. Think the sexy "Desperate Housewives" or age-defying movie stars such as Susan Sarandon and Demi Moore.

The disorder also may be spurred early on by worries over weight and image, but it may be sustained or recur during midlife over anxiety, stress or anger, according to the Mayo Clinic.

And there is strong evidence to also suggest a genetic link, Halmi said.

Cindy first began exhibiting symptoms when she was 11 or 12 years old, she said.

The pre-teen gleaned unhealthy eating habits from watching her mother struggle with an eating disorder that influenced the entire family.

"We would all sit down to dinner, and we'd have a salad or some chicken and an entire head of broccoli," Cindy said. "I don't ever remember eating rice or a baked potato with butter or any kind of carb before I met my husband."

That was when she was in her early 20s, Cindy said.

Cindy's wake-up call came from a candid, difficult confrontation with her husband.

"I was very depressed and angry and agitated, and we'd already had our daughter and we were talking about having another baby when he looked at me and said, 'You look like you've been in a concentration camp. There's no way I will have another child with you unless you get well.'

"I think that unless you have someone in your life who is going to call you on it, it's hard to break that cycle on your own," she said.

Treating older patients

In the past three decades, the number of females wrestling with an eating disorder in the United States has doubled to at least 5 million, according to the U.S. Department of Health and Human Services. The non-profit National Eating Disorders Association estimates an even higher number -- as many as 10 million women and 1 million men.

Even more Americans -- 25 million, according to the eating disorders association -- struggle with binge eating. The disorder is characterized by out-of-control eating sessions in which large quantities of food are eaten in a matter of several hours. Cases of bulimia tripled between 1988 and 1993 in women ages 10 to 39.

There is little national data available about eating disorders among midlife adults. However, doctors, treatment centers and groups such as NewYork-Presbyterian Hospital have recorded evidence of an upswing.

The Renfrew Center -- an eating disorder treatment center with offices in Florida and Philadelphia, Pennsylvania, where Cindy sought help -- reports a nearly 70 percent surge in admittance rates between 2001 and 2003 for women over the age of 35. In 2003 almost a quarter of patients there were 35 or older.

"I think we've seen the number of [adult] patients coming in for treatment now, in part, because it is more acceptable," said Dr. Holly Grishkat, the Renfrew Center site director for outpatient programs in Philadelphia. "The message is out there that it is OK to get the help you need."

"[Eating disorders are] not an easy disease to treat," she said, "and it's usually something people struggle with over and over. It can be a lifetime fight -- obsessively thinking about food ... weighing themselves 30 times a day."

And while more adult sufferers may be knocking on the doors of treatment centers, the decision to ask for help means confronting feelings of failure and anger.

"The symptoms the women in midlife are showing are similar to the young sufferers," Grishkat said. "What is different are the circumstances surrounding the eating disorder. By midlife, you are treating a person who [sometimes] has had the disease for 20 years."

Anorexia has one of the highest death rates of any mental health illness, and it is one of the hardest to treat, according to Halmi.

While youths in treatment have an 80 percent chance of overcoming their eating disorders, adults in treatment have only a 25 percent chance of getting well, she said.

These numbers illustrate the importance of getting adolescents into treatment at the first sign of trouble. Parents should be concerned and seek a medical evaluation for their child if he or she is losing weight, becoming isolated from peers or exercising compulsively, Halmi said.

"Once a person is over the age of 18, the dynamics of anorexia and bulimia change. The illness becomes a protective device for them. ... They are terrified to give it up," she says.

Not only is the disease part of an entrenched thought process in the older sufferers, but their bodies have taken a beating, too. Heart disease, osteoporosis and dental problems are just a few of the long-term complications.

Older patients do not necessarily fit in with traditional treatment programs that have, for the most part, focused on younger women and teenagers.

"They need a space to talk about their age-specific issues. Things like divorce and [aging]," Grishkat said. "They really respond to family intervention and grief and loss groups because it is a reflection of where they are in their lives."

The whole family

Family therapy is mandatory at the Renfrew Center, and it is just that kind of open dialogue that might have made a real difference in the lives of Daniel Becker and his mother, Carol, he said.

"I think there was this message that if we upset mom, we would make her sick. ... It wasn't OK for us to talk about it. It was the most obvious thing going on and we couldn't talk about it," said Becker, author of the book "This Mean Disease: Growing up in the Shadow of My Mother's Anorexia Nervosa."

Carol Becker suffered with anorexia for nearly 30 years before dying in 1992 of anorexia-related heart failure. The disease took a ravishing toll on the entire family.

"I think there was a time when we [the Becker family] kept hoping that things would get better. ... We each sort of gave up at different times," he said. "The hardest thing for any family member of someone who struggles with anorexia is ... you're angry at them for their behavior and then you feel sorry for them when you realize that they're sick. There's this constant cycle of anger and guilt."

It's just this cycle that Cindy hopes to break in her own family.

She continues to watch her mother and an older sister struggle with eating disorders. But Cindy said she is determined that her children, especially her young daughter, will not inherit her unhealthy eating behaviors.

"When you are eating something different from everyone else at the table, your kids notice," she said "They may not say something about it, but they notice."

"My children don't know what I've been through," Cindy said. "But one day they may and, hopefully, they'll see that I faced something really big."


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