It started with trips to the gym a couple of times a week. Not because she wanted to lose a few pounds—she’d always been a normal weight despite having an ultra-thin mother and a father who was quite heavy—but simply because she wanted to stay healthy.
Then the Potomac woman started exercising more often and for longer periods each time. Meanwhile, she tightened up her diet, living on bananas, sushi and rice cakes with peanut butter.
“That was all I would eat, and in small quantities,” says Robin, who, like several women in this story, prefers not to use her real name.
She liked the results she saw in the mirror. And exercising helped manage the stress she felt as she entered a new phase in her life.
“When my children started needing me less, I started feeling somewhat purposeless and out of control,” says the 47-year-old mother of two. “My eating and exercise habits were the only things I could control. It’s something that really snowballed.”
She started weighing herself obsessively. In 2007, she dropped down to 92 pounds on her 5-foot-2-inch frame, and her periods stopped, a sign of malnourishment. “I didn’t think there was anything wrong with me, because I had lots of energy and felt great,” she says. “I just didn’t like the feeling of chewing food or having food inside me. For the longest time, I would sit at the dinner table with my kids and not eat. I just liked the empty feeling.”
Robin didn’t know it at the time, but she’d spiraled into anorexia.
Once considered the purview of teenagers and college students, eating disorders—including anorexia nervosa, bulimia and binge eating—are on the rise among adult women. An estimated 24 million people in the United States have an eating disorder, with 85 percent to 90 percent of them women, according to the National Association of Anorexia Nervosa and Associated Disorders.
It isn’t known how many are over 30, but “there are definitely more adults with eating disorders than there used to be,” says Laura Ratner, a psychotherapist in Chevy Chase who specializes in the treatment of eating disorders.
In the last decade, the Philadelphia-based Renfrew Center, the country’s largest network of eating disorder treatment facilities, has seen a 42 percent increase in people 35 and older entering its residential program. And at the University of North Carolina Eating Disorders Program, nearly half of the women treated are over 35.
“You can spot some of these women because they’re a lot thinner than they were in their wedding photos, even after having children,” says Faye Berger Mitchell, a nutritionist specializing in eating disorders in Bethesda.
But even the statistics don’t fully reflect the scope of the problem: Only 34 percent of people with anorexia, 43 percent of those with bulimia and 44 percent of those with a binge-eating disorder seek and receive treatment, according to the National Institute of Mental Health (NIMH) in Bethesda. Those figures are particularly disturbing, experts say, given that these disorders can have deadly consequences.
People with anorexia are 18 times more likely than their peers to die prematurely, according to the NIMH. (In 1983, singer Karen Carpenter died of complications from anorexia at the age of 32.) “With malnutrition, every organ in the body is affected, including the heart, the kidneys, the liver and the brain,” says Dr. David Herzog, director of the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital in Boston and an endowed professor of psychiatry in the field of eating disorders at Harvard Medical School.
Osteoporosis and fertility problems can occur with poor nutrition and low body weight. Even after people resume eating normally, they can still suffer from problems with memory and attention, Herzog says. Alcohol abuse is often a companion problem, and suicide is a common cause of death among anorexics.
Meanwhile, bingeing and purging can cause electrolyte imbalances that may trigger heart arrhythmias. Exposure to stomach acid from repeated vomiting can erode tooth enamel, and in some cases the force of repeated vomiting can cause esophageal rupture.
“I had one woman in her 40s who was bulimic, and one day she felt like something was stuck in her throat,” says psychotherapist Page Morris, director of The Renfrew Center of Maryland, which opened in downtown Bethesda in 2009. “She went to the hospital and had an MRI. It turned out the sphincter at the bottom of her esophagus was shredded, and the doctor told her that if she made herself vomit one more time, her esophagus would rupture and she would likely bleed to death.”
It was a wake-up call for the woman, who finally approached her recovery in earnest.