When Diets Turn Deadly: Adult Eating Disorders
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When Diets Turn Deadly: Adult Eating Disorders

A shocking, little-known health crisis is afflicting more and more women in midlife -- serious eating disorders. Here's the surprising truth about who's at risk and how much is at stake.

A Slippery Slope

Becky Marsella had never been heavy, but in 1999, as her 40th birthday approached, she set out to get in better shape. She joined a gym and watched what she ate, adding more vegetables and cutting out red meat and bread. She started to walk around her suburban Lakeland, Florida, neighborhood, eventually upgrading to running. As she reached a slender but muscular 105 pounds on her 5-foot-5 frame, compliments from friends and coworkers started pouring in.

But this is no midlife makeover success story. Despite Becky's healthy new look, her quest for fitness had already taken a sinister turn. "The more I exercised and the more I watched what I ate, something just seemed to grab hold of me," she recalls.

Rey, her husband of 20 years, thought she looked fine before she started dieting. Now he watched in alarm as her exercise routines grew increasingly intense, her eating more restricted. Becky continued to lose weight, but when Rey tried to talk to her about how thin she was getting, her angry silences made it clear the subject was not open to discussion.

Although she had no prior history of eating disorders, Becky's dieting had spiraled into full-blown anorexia. Today, despite inpatient treatment and extensive therapy, this once-fit and confident woman remains a walking skeleton who for months has struggled unsuccessfully to get her weight back above the 70-pound mark.

Women at Risk

Becky Marsella is far from alone. Though long thought of as an ailment that affects teenage girls, anorexia is now overtaking more and more women in midlife. So are other food-related disorders, including bulimia and compulsive overeating.

Although there are no hard statistics on the age distribution of the estimated 5 to 10 million female Americans who suffer from some form of eating disorder, experts attest to a startling rise among midlife women. "We've seen a fourfold increase in the percentage of our 40-and-over patient population since we opened in 1990, and a threefold increase in women over 50," says Edward Cumella, PhD, director of research at Remuda Ranch, a treatment facility in Wickenburg, Arizona. "The number of teens in treatment nationwide has grown much more slowly."

In a culture where plastic surgery has become a spectator sport and weight loss is a $50-billion-a-year business, the growing prevalence of eating disorders among midlife women perhaps isn't surprising. "Everywhere women turn, they see messages about being thin and being young," says Holly Grishkat, site director at the Renfrew Center, in Philadelphia, the nation's largest eating disorders treatment facility. Midlife women are particularly vulnerable to these siren songs because, like teens, they are undergoing a cascade of physical, emotional, and social changes as they move from one stage of life to the next. One survey also found that 57 percent of middle-aged women are dissatisfied with their bodies -- three points higher than the rate for teenage girls -- and that almost 40 percent say they would willingly give up three or even five years of their life to achieve their ideal size. As a result, Grishkat expects the number of older women seeking treatment for eating disorders to continue to rise.

That means the number of women who suffer eating disorders' worst effects also will increase: The disease kills more people than any other form of mental illness. Between 5 to 20 percent of anorexics will die of heart arrhythmias, brain damage, and other effects of long-term starvation. Bulimia and compulsive overeating -- disorders that are even more common among midlife women -- can also often have severe and even fatal health consequences, from permanent intestinal damage to sudden heart stoppages. Indeed, Terri Schiavo's cardiac arrest was reportedly the result of a potassium deficiency due to her bulimia, which in turn caused severe brain damage that resulted in her spending 15 years in a vegetative state.

How can behaviors that are both dangerous and exceptionally unpleasant -- starving, vomiting, exercising to the point of collapse, overdosing on laxatives -- become so difficult to control? Douglas Bunnell, president of the National Eating Disorders Association, describes the effects of bulimia as in some ways similar to a chemical addiction. "People say that afterward they feel grounded, calm, numb," Bunnell reports. "One woman told me she usually feels like an overactive pinball machine, and bingeing and purging is like a giant reset button."

For Debra G., a 47-year-old homemaker in Smithtown, New York, an obsession with food was a secret salve for childhood wounds. Her father would demand that she eat every morsel on her plate, sometimes forcing the food down her throat until she threw up. He also mentally, physically, and sexually abused her. Chubby when she left home as a teenager, she went on a starvation diet right before she got married, at age 24. Afterward she continued to cut back on eating and pushed herself to exercise. Her weight sank to 88 pounds.

Although anorexia often impairs fertility, Debra became pregnant. That shocked her out of her pathology. "The doctor told me I was going to lose my baby unless I got some nourishment," she says. "I did what he said and gained 50 pounds."

Her first child was born in 1985, her second in 1989, and motherhood seemed to banish her problems with food. Then seven years ago she began to have disturbing dreams about her childhood. Although her father was long dead and she no longer had any contact with her mother, the anger and pain she thought she'd set aside bubbled again to the surface. So did her anorexia.

"I didn't want anything to do with food," she says. When she did eat, she would sneak off to the bathroom to purge. "I felt too full, too overwhelmed. I'd vomit and feel as though all my troubles had gone away."

But the bad feelings always came back, compounded by shame. She cooked elaborate meals for her family but ate less and less herself. She began downing laxatives and obsessively weighing herself, sometimes getting up every hour at night to stand on the scale. Her thick blond hair began to fall out. She purged as often as eight times a day.

Debra later learned that her then-adolescent kids sometimes overheard her purging but, not knowing what to do, kept silent. Her husband, an electrician, had no idea what Debra was doing to herself. "She did a really good job of hiding it," Mike says ruefully. "I was always totally in love, and her size never mattered to me."

Even if Mike had noticed, or if her children had spoken up, it's far from certain that Debra would have listened. Insistent, sometimes ferocious denial is typical of this form of mental illness. "Their eating disorder is the only thing they have that gives them a sense of self-esteem," explains Dr. Cumella of Remuda Ranch. "They're terrified of not being thin, and those emotions blow away any logical thinking." Family members are often bullied into silence, forced to watch impotently while their loved ones self-destruct.

Deadly Denial

That's the hell in which Becky Marsella's family has been trapped. As her anorexia worsened, Becky continued to cook hearty meals for her husband and daughter, while she lived on coffee and an occasional steamed vegetable, secretly priding herself on her willpower. If Rey protested, there were angry arguments.

Finally, in the winter of 2002 -- three years after her eating disorder emerged -- Becky's brothers and sister decided together to confront her, intervention style. "She was so angry that we were forcing her to deal with this," her daughter Rachel recalls. "She had a mouth full of venom and spit it at everybody."

Her brother threatened to have her confined in a mental hospital if she didn't seek help -- something the law would allow if they could prove her to be a danger to herself -- so Becky began seeing a therapist. But in secret her regimen became even more extreme. Becky would creep out in the middle of the night to go running. She would claim she'd already eaten, then live on nothing but coffee and a powdered protein drink.

"Anorexics often feel out of control, as if they don't have a voice," says Becky's therapist, Deborah Poor, author of Peace at Any Price: How to Overcome the Please Disease, a book about the underlying causes of eating disorders and other addictions. "The one thing they can control is that no one can make them eat."

By October 2003 Becky's weight had dropped below 60 pounds and she was hospitalized for severe malnutrition. Poor convinced her to go into treatment at a center in Tampa. But Becky hated treatment -- the probing questions, the lack of privacy -- and begged to come home after the first month. At first Rey -- as advised by Poor -- told his wife that if she left the facility he would not allow her back in their house. But her pleas continued.

"Every time I talked to her, she just sounded worse," Rey says. "It was costing us an arm and a leg, the last bit of credit I had left. She wasn't getting any better, so shortly before Christmas, she came home."

Since then Becky has lost the few pounds she gained while in and after treatment. Her arms are covered with bruises, and much of the hair on her head has fallen out, both symptoms of extreme starvation.

Rey feels more helpless than ever. "I want to believe she's going to be all right, but how can I?" he asks. "She still looks like something out of a concentration camp."

Breaking the Cycle

No one can say why some women are unable to overcome anorexia, even with intensive therapy and family support. But they are the exception -- an estimated two-thirds of all people with eating disorders do recover. Lynn Krauss,* 49, is a clinical director at an eating-disorders treatment facility in Mississippi. But only a decade ago she was in the grip of anorexia herself.

When Lynn left college after her first year to get married, she regarded staying trim as part of her duties as the wife of a fast-rising sales executive. After her two sons were born, keeping her weight below her "maximum" of 117 pounds (by medical standards the low end of normal for a 5-foot-4 woman) became more of a struggle. When playing tennis five days a week, running three miles a day, and spending two hours at the gym wasn't enough, she supplemented her punishing exercise schedule with laxatives, diuretics, and weight-loss pills. "I didn't care what I was doing to my body," she says now. "I just cared how it looked."

And when Lynn turned 40, she did look good. Her husband threw her a lavish birthday party and gave her a $21,000 watch. A week later, he announced that he was in love with someone else, adding, "Can we still be friends if we get divorced?"

Devastated, Lynn asked why he wanted to break up their family. His incredible answer was: "Because you've let yourself go."

Almost immediately thereafter, Lynn's husband was offered a new job in Arizona -- a major promotion. Fearing that the family-oriented company would rescind the offer if he left his wife and children, he ended the affair and called off the divorce. Meanwhile, Lynn decided that she'd get even thinner. Her compulsive dieting deteriorated into full-blown anorexia and her weight soon dropped below 100.

After the couple relocated, Lynn's unhappiness only deepened. "I continually prayed that my heart would stop," she recalls. What saved Lynn's life was an encounter with the wife of the pastor at her new church, a woman who, as it happened, had just taken a counseling course on eating disorders. Recognizing that Lynn was in serious trouble, she persuaded her to talk to a therapist who specialized in anorexia and relationship issues.

Therapy allowed Lynn to stop starving and start living again. It also helped her survive her husband's continued infidelities and their eventual divorce, return to college, and become a licensed therapist herself. "I no longer look in the mirror and hate myself," she says. "I thank my legs for getting me around. I thank my arms for lifting what I need to lift and hugging the people I love. I hope I'd feel that way if I weighed 400 pounds.

The Long Journey Back

For many older women, anorexia's reputation as a disease that afflicts only the young can make it harder to seek help. Stephanie M., 39, a Southern California stay-at-home mom, had seen her weight balloon to 280 pounds on her 5-foot-4 frame, due in part to medication she was taking to treat depression. When she dropped 35 pounds after being switched to another drug, she was inspired to lose more by eating less. Soon she was living on less than 700 calories a day, and vomiting up what little food she did consume. Her dramatic weight loss -- another 100 pounds in a matter of months -- and preoccupation with her size made her therapist suspicious, but Stephanie hesitated to tell him the truth and go into treatment. "I felt too old," she says. "I thought this was something that only happened to teenagers."

Once she entered a program in January 2004 she was uncomfortable being with a group of mostly younger women and clung to the idea that she didn't belong there. But after a few days she began to realize the full ugliness of what she'd been doing. Only then was she able to dig in to do the hard work of healing herself.

Debra G. also fought the idea of getting better. "I knew something was wrong with me," she says. "I'd feel dizzy and so sick I couldn't get out of bed. I was afraid. Yet every time I looked in the mirror, I was so fat!"

She saw a therapist but refused to consider inpatient treatment for almost a year. "My therapist said, "Do I have to call the ambulance when you drop dead on my floor?" I used to pray to God: Please help me. Let me know what to do."

In August 2003 Debra finally summoned the courage to tell her husband the truth and enter treatment at the Renfrew Center. "I'm so glad I did," she says. "I learned that I didn't have to live like that -- that there are other ways to cope."

Today Debra continues to work with her therapist and a nutritionist and is clinging tight to her recovery, despite occasional relapses into old behaviors. "The journey has a lot of baby steps," says Debra, who's now studying for the ministry. "I could go back to my secrets, to my shame, but I don't want to. I can use that energy for so many other things."

A year after leaving treatment, Stephanie is maintaining a stable weight of 130 pounds and taking her recovery one day at a time. "Treatment did me a world of good," she says. "I just wish more women who have this secret knew that there is help for them."

*Not her real name.

Originally published in Ladies' Home Journal, June 2005.