While anorexia and bulimia in midlife are indeed on the rise, there is also a parallel increase in older women with another kind of serious eating problem: binge eating disorder. Women with binge eating disorder binge without purging. Hence, they tend to be overweight or obese. Binge eating disorder is not the same thing as obesity, which can arise from simple overeating - grazing continually, without regard to hunger. Rather, people with binge eating disorder regularly consume a glut of calories in one sitting, feeling unable to stop.
These women often do not know that they have a clinical problem, and they are falling below the radar of physicians. When most people think of an eating disorder, they envision anorexia and bulimia. A middle-aged woman thinks: I'm not emaciated. I'm not throwing up. I'm not a teenager. Therefore, I can't have an eating disorder. So she does not seek treatment.
Even a woman who senses that she has a problem may refuse to get help. To explain why, eating disorders researchers surveyed the attitudes and behaviors of 125 women aged 50 to 65 years old. The women were of all weights and sizes, but none were undergoing treatment for an eating disorder. The study found that the heavier a participant, the more she strived to be thin, the greater her body dissatisfaction, and the more she tended toward disordered eating.
The simplistic societal myth is that overweight people are lazy and lack willpower. In fact, most Americans believe that personal choice, rather than genetic predisposition or marketing by food companies, is the main reason that people are overweight. But this midlife study, while involving an admittedly small sample of average middle-aged females, defies such thinking. The results show that the heaviest midlifers are the most body-obsessed; they feel self-loathing and so are driven to starve. Increasingly pressured, they are channeling their feelings of shame into body abuse, leading to an outcrop of eating disorders that develop in midlife. And when they need help, shame deters many of these women from seeking treatment.
Right now experts are estimating that binge eating disorder afflicts roughly 3 percent of Americans. But that is likely to be a gross underestimate. James Hudson, at McLean Hospital in Massachusetts, says that this disorder is rising even faster than anorexia and bulimia. Further, Hudson notes, women with binge eating disorder are asking for treatment much later in life. Thus, the women who binge exclusively have been hiding their problem for a long time, or they are simply getting sick for the first time, later in life.
One explanation that may account for binge eating in older women may be that this disorder simply might take more years to develop than anorexia or bulimia. Specialists such as José Appolinario, at the Instituto Estadual de Diabetes e Endocrinologia in Rio de Janeiro, Brazil, are finding that the anatomy of the binge in binge eating disorder is different - less severe - than that in bulimia. Appolinario recalls the case of a woman with bulimia nervosa whose binges were extreme: every day, she would take all the leftovers in her refrigerator, put them in a pot with water, and prepare a "stew." She would eat it all and throw it up afterward.
Binge eating disorder is generally not so extreme. A woman who binge eats but does not purge might consume three large meals in a day, for example. After the third, she steals away into the kitchen and quickly eats the remains of the cake. The critical difference is that she is not vomiting or dieting between these binges. Thus, her body may more slowly develop the kind of craving necessary to launch a full-blown disorder.
The genesis of this disorder, in part, is food deprivation. Researchers have shown that both purging and radical dieting can start bingeing in the first place. The body, when faced with intense hunger, believes it is in a state of famine. It does everything in its power to procure food. The body has an arsenal of biological signals that push up appetite until hunger becomes an all-consuming craving. If a woman has been dieting hard, her body will not let her continue indefinitely (except in cases of anorexia where a woman wields enormous resolve not to indulge her ravenous appetite). And the moment she lets her food-restricting guard down, her body will almost force her to overeat, mercilessly and without pause.
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