The Danger of an Eating Disorder at Midlife

While eating disorders typically affect younger women, they can persist into, reoccur or even begin later in life.

Unfortunately, eating disorders are a serious health issue for women at midlife.

An eating disorder can affect every cell, tissue and organ in the body and can lead to irreversible physical damage and even death. They can wreak medical havoc at any age, but the complications for older adults can be particularly perilous. Your body is older, less resilient and more vulnerable to the brutal punishment that accompanies extremes in eating behaviors and exercise.

The following is a list of some of the physical and medical dangers associated with disordered eating problems.

Anorexia Nervosa

Anorexia's cycle of self-starvation denies your body the essential nutrients it needs to function normally. The body is then forced to slow down all of its processes to conserve energy, leading to serious medical consequences.

• Abnormally slow heart rate and low blood pressure. This means that your heart muscle is changing. The risk for heart failure rises as your heart rate and blood pressure levels sink to lower and lower levels.
• Reduction of bone density (osteopenia), which results in fragile bones.
• Muscle loss and weakness.
• Severe dehydration, which can lead to kidney failure.
• Fainting, fatigue and overall weakness.
• Dry skin and hair, with loss of hair.
• Growth of a downy layer of hair called lanugo all over your body, including the face (your body's response to being cold much of the time).
• Body chemistry disturbances resulting in the potential for life-threatening arrythmias or seizures.

Bulimia Nervosa

The recurrent binge-and-purge cycles that characterize bulimia can affect your entire digestive system, leading to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.

• Electrolyte imbalances, dehydration and loss of potassium, sodium and chloride as a result of purging behaviors, can lead to life-threatening arrythmias or seizures and possibly heart failure and death.
• Potential for gastric rupture during periods of binging (a rare occurrence).
• Inflammation and possible rupture of the esophagus from frequent vomiting.
• Tooth decay and staining from stomach acids released during frequent vomiting.
• Chronic irregular bowel movements and constipation as a result of laxative abuse.
• Peptic ulcers and pancreatitis.
• Laxative abuse bowel disorder.

Binge Eating Disorder

Binge eating disorder often results in many of the same health risks associated with extreme obesity, particularly the risk of heart disease and stroke.

• High blood pressure.
• High cholesterol levels.
• Heart disease as a result of elevated triglyceride levels.
• Type II diabetes.
• Gall bladder disease. 
• Accelerated vascular disease.

For an exhaustive alphabetized list of medical dangers associated with eating disorders, visit the Eating Disorders Referral and Information Center.

Complex Factors Lead to Eating Disorders

Eating disorders are a challenging and disturbing multifaceted problem with biological, psychological and cultural roots. Understanding their complexity is essential for recovery.

While many people think of an eating disorder as an unhealthy quest for "the perfect body," they really have little to do with vanity and weight. According to mental health experts, eating disorders are complex psychological illnesses in which people try to control life's conflicts and stresses by controlling food. The food, weight, and body image issues are merely surface symptoms of more deeply rooted problems that are often difficult to identify.

People who develop eating disorders typically live in a state of perpetual emotional turmoil. They want to be in control but feel they are not. They tie their anxieties, self-doubt and feelings of failure or inadequacy to the way they look. They become preoccupied, even obsessed, with food and weight. These and other factors, which vary from person to person, can lead to extreme and often dangerous behaviors including self-starvation, bingeing, purging and compulsive exercise.

While no one is really sure what causes eating disorders, many experts believe that they develop over time and involve a combination of biological, psychological, socio-cultural and other factors.

Biological factors

• There may be a genetic predisposition in some families for eating and other compulsive disorders.
• When eating disorders appear to run in families, female relatives are most often affected.
• Scientists are investigating possible links between disordered eating and biochemical changes associated with psychiatric disorders that are common among people with eating disorders.
• Research has indicated that, in some people with eating disorders, there is an imbalance of certain chemicals in the brain. Such an imbalance may precede the onset of the disorder but starvation itself can create brain chemical changes.

Psychological factors

• Low self-esteem.
• Feelings of lack of control in life.
• Feelings of inadequacy.
• Depression, anger or anxiety.
• Major life events (i.e., loss of a family member or friend, moving, schools or jobs)
• Accumulation of stress without adequate strategies to cope.
• Stress and fear of the responsibilities associated with jobs, parenting or caring for an aging relative.

Socio-cultural factors

• Portrayal of men's and women's body shapes in the media and other elements of popular culture that are not representative of "real" men and women.
• Cultural and peer pressure to achieve the "perfect body" and stay in shape.
• Valuing of people based on outward appearance, not their inner qualities.
• Mixed messages about health and fast food; confusion about good nutrition and healthy eating.
• Occupations that put emphasis on a certain body shape and size.
• Pressure to achieve and succeed.

Other factors

• Belief that love is dependent on high achievement.
• Poor communication between family members.
• Difficulty expressing emotions and feelings.
• Troubled personal or family relationships.
• Sexual or physical abuse.
• History of teasing or bullying based on weight or shape.
• Ineffective coping strategies.
• "Modeling." Young girls, in particular, model behaviors on people they admire, like their mothers, popular peers, fashion models and musicians and actors.

Available Treatments for Eating Disorders

Even for women at middle age – and perhaps especially for women at middle age – there are good treatments available. However, the complexity of the problem requires a multifaceted approach to treatment – an approach that stresses nutritional issues as well as thoughts and feelings.

Eating disorders tend to be long-term medical problems. While it's difficult for relatives and friends to figure out ways to help, denying or ignoring the problem can have far more serious consequences. Don't expect an eating disorder to go away by itself. Seek immediate help from a qualified professional. You should have no problem getting referral to an eating disorders specialist from your family physician, a social worker or a mental health agency in your area.

Eating disorders are most successfully treated when diagnosed early and when the individual is committed to change. Often, a complete physical examination is necessary to determine if there is immediate medical danger and to rule out other illnesses. There are several different types of treatment available. Many experts believe that a combination of therapies yields the best result.

They include:

• Individual, group and/or family psychotherapy.
• Cognitive and behavioral therapy.
• Motivational therapy.
• Nutritional counseling/therapy.
• Medications.

If Emergencies Arise

Call 911 immediately if someone with an eating disorder:

• Complains of chest pains.
• Experiences dizziness or passes out.
• Vomits blood or passes blood in the urine or a bowel movement.
• Is suicidal or talks about dying.

Tips for Dealing with an Eating Disorder in a Family Member or Friend

• Be aware of the long-term nature of the illness and muster your patience.
• Don't blame yourself or anyone else (including the patient) for the eating disorder.
• The person with the eating disorder is responsible for behavior that affects others.
• Don't urge, watch or monitor eating, and don't discuss food intake or weight. Your involvement with eating can create opportunities for manipulation.
• Don't monitor the behavior of a person with eating disorders, even if you're invited to do so.
• Avoid turning mealtimes into a battleground. Minimize discussion about food issues.
• Be willing to negotiate on activities involving food.
• Do everything you can to encourage initiative, independence and autonomy.
• Don't use put-downs or comparisons with others who are more "successful."
• Don't neglect your family or others who are important in your life. Focusing on the person with the eating disorder can perpetuate the illness and destroy relationships.
• Don't play therapist. Let a professional handle it.
• Your obligation is to help the person get into treatment. Getting well is his/her job.
• Don't be afraid to support a recommendation for residential treatment or hospitalization.
• Seek help for yourself. Join a family support group or get individual therapy to help you through this difficult time.

This article reprinted with permission from Second Opinion, a public television health program hosted by Dr. Peter Salgo and produced by WXXI (Rochester, N.Y.),  West 175 and the University of Rochester Medical Center.

By Second Opinion