Older women seek help for eating disorders
The federal government does not provide eating disorder statistics, but experts say in recent years more women have been seeking help for eating disorders such as anorexia and bulimia in their 30s, 40s 50s and older. For example, in 2003 the Park Nicollet Health Services’ Eating Disorders Institute in Minneapolis treated 43 patients age 38 or older, about 9 percent of patients; however, in the first six months of 2007 the facility has treated nearly 500 patients over 38, about 35 percent of the total. “Those numbers are staggering,” said Carol Tapen, director of operations at the institute.
The Renfrew Center in Philadelphia reports that 20 percent of its patients in 2005 were 30 or older. These women tend to fall into three categories, says Holly Grishkat, director of Renfrew’s outpatient programs. Some have had an active eating disorder for years. Others have been in remission but the disorder resurfaced when triggered by a new stress in life, such as a divorce or loss. Still others, a smaller group, developed the eating disorder later in life. As a result of these increases some treatment centers are creating special programs for more mature patients. (Forliti A. Disorders hit more than just the young. AP: Minneapolis 7/23/2007.)
Early treatment critical in bulimia
In a follow-up study of 44 bulimic patients after an average of 9 years from diagnosis and treatment in a Louisiana university research clinic, about two-thirds were recovered. When treated during the first few years of illness, the probability of recovery was above 80 percent. But when diagnosis was delayed 15 years or more after onnset, the probability of recovery fell below 20 percent. Duration of bulimia nervosa was the only factor that predicted whether outcome was successful. The particpants estimated that they had spent an average of $25,164 for their psychiatric and medical treatment. The not-recovered patients had spent about $45,095, compared with $14,091 for those who recovered. The researchers conclude that early intervention is critical to recovery. (Reas DL, Williamson DA, Martin CK, et al. Duration of illness predicts outcome for bulimia nervosa: a long-term follow-up study. Int J Eat Disord 2000;27:428-434)
Disturbed eating for toddlers
When do eating disturbances begin? Perhaps very early, even soon after birth, according to a study that followed a community sample of 216 newborns and their parents in the San Francisco Bay area from birth to 5 years. Mothers completed eating and body image scales, and each year answered questions related to their child’s eating. Over the 5-year period the mother’s reports indicated that 10 percent of the children showed inhibited eating, 18 percent secretive eating, 34 percent overeating, and 10 percent overeating-induced vomiting. Most had few episodes and only exhibited one behavior at a time. Risk increased annually through age 5, and did not differ by sex.
Secretive eating by the child was related to mother’s body dissatisfaction, disinhibition, and bulimic symptoms, as well as parental weight — suggesting that perhaps a mother with secretive eating may model this for her child. Overeating was linked to maternal restraint and drive for thinness, perhaps suggesting that a mother’s dieting and idealization of thinness may promote the child eating less than wanted, followed by overeating. Overall, a mother’s body dissatisfaction, internalization of the thin ideal, dieting, bulimic symptoms, and maternal and paternal body mass predicted eating disturbances for the child. (Healthy Weight Journal 2000:14:3:34 / Stice E, Agras WS, Hammer LD. Risk factors for the emergence of childhood eating disturbances: a five-year prospective study. Int J Eat Disord 1999;26:375-387)
Former smokers more rigid binge eaters
Research has shown differences between smokers and nonsmokers for eating disorder patients. Studies find that (1) smokers exhibit a general worsening of the eating disorder profile in both anorexia and bulimia nervosa; (2) smoking is more common among individuals who binge eat than who have anorexia nervosa; (3) smoking is associated with increased likelihood of bingeing and vomiting, and greater maturity fears; and (4) female eating disorder patients who smoke report higher levels of body dissatisfaction, drive for thinness, and interoceptive awareness than nonsmoking patients.
A recent study extends many of these differences to former smokers; such differences tend to persist even though they have successfully quit smoking many years before. The study of 91 obese women with clinical binge eating disorder, with 53 classified as never smokers and 38 as former smokers (an average 15- year interval since smoking cessation), found that the former smokers were more likely to endorse specific symptoms of eating pathology – to have rigid dieting strategies, higher levels of dietary restraint, and avoidance of eating. The researchers suggest that binge eating may have replaced smoking as an insufficient coping strategy. The two groups did not differ in age, body mass index, or in frequency of objective and subjective bulimic episodes during the past three months.
The findings indicate that treatment-seeking obese persons with binge eating problems and a smoking history may represent a subset of patients who may benefit from special treatment to address rigid and pathological patterns, say the researchers. They call for further research to investigate whether smokers and nonsmokers respond differently to standard treatment for BED. (White MA, Grilo CM. Symptom severity in obese women with binge eating disorder as a function of smoking history. Int J Eat Disord 2007;40:77-81.)
Fluid restriction in anorexia
Anorexic patients often drink copiously so as to feel full or resist consuming calories. But others restrict fluids for weight control, although this is not often documented. In a study of seven fluid-restricting patients with very low hydration, researchers at the University of Sydney, in Australia, said once fluid restriction had begun it progressed rapidly, with patients refusing to drink anything with a few days. None voluntarily reported this fluid restriction, and all denied the symptoms of dehydration. In all cases, food restriction was severe prior to fluid restriction. In treatment, fluid intake was recom mended before food intake.
Two common reasons these patients gave for restricting fluid was that it made them feel bloated and they believe even water contains some calories, through its impurities. Restricting fluids give dieting-disordered patients a strong sense of control, the researcher report. They suggest that some anorexia patients may restrict food and fluid proportionately, citing animal studies that show when subjects are deprived of food, less water is consumed. Similarly, when the lab animals are deprived of water, less food is eaten. (Healthy Weight Journal 2000:14:3:34 / Lowinger K, Griffiths RA, Beumont PJV, et al. Fluid restriction in anorexia nervosa: a neglected symptom or new phenomenon? Int J Eat Disord 1999;26:392-296)
Anorexia marks steady increase
A long-term trend of rising rates of anorexia nervosa is documented in a Rochester, Minn. study. During a period of 55 years, from 1935 to 1989, 193 female and 15 male community residents met the criteria for a first diagnosis of anorexia nervosa. The youngest was 10; the oldest, 57. Highest rates were between 1980 and 1984. In the next 5 years rates dropped slightly; however, the researchers say this was merely a short-term fluctuation and the overall trend has since continued upward. In the most vulnerable group, 15- to 24-year-old females, anorexia rose steadily throughout the 55 years.
Overall, the incidence was 8.3 per 100,000 person-years. Estimated increase is 1.03 per 100,000 person-years for every calendar year. Some studies have failed to show an increase in eating disorders, but most are small and use incomplete data. The Rochester researchers use data which can be meaningfully integrated, since this area has long been a major medical center in which most residents are diagnosed locally. (Lucas AR, Crowson CS, O’Fallon WM, Melton LJ. The ups and downs of anorexia nervosa. Int J Eat Disord 1999;26:397-405)
Eating disorders in female athletes
College female athletes participating in judged sports are at a higher risk for eating disorders than women in refereed sports, according to a Louisiana State University study of 131 female students. The researchers looked at three groups: women in judged sports such as diving, cheerleading, and gymnastics; women in refereed sports such as tennis, basketball, volleyball, and track; and nonathletic women. They administered nine tests related to body image and eating disorders, including interviews and body measurements. Although the number diagnosed with eating disorders was too small for significant differences, the researchers found 13.5 percent of women in the judged sports had clinical eating disorders, compared with 3 percent in the refereed sports, and 3 percent of the nonathletic women. (Mean body mass index was about 22, and did not differ among the three groups.) The researchers conclude that being in a refereed sport may be protective against the female athlete triad. (Zucker NL, Womble LG, Williamson DA, et al. Protective factors for eating disorder in female college athletes. Eat Disorders 1999;7:207-218)
Meatless diets put athletes at risk
Menstrual abnormalities and the female athlete triad are linked to the meatless diets that are common among female athletes, warns an article in The Physician and Sportsmedicine. One study cited reported menstrual irregularities in 26.5 percent of vegetarian women, compared with 4.9 percent in nonvegetarian women. Another compared 9 regularly menstruating runners with 8 amenorrheic runners and found 44 percent of the menstruating runners ate red meat, while none of the amenorrheic runners did. Still another study showed that, of 13 amenorrheic runners, 12 were vegetarians, and 8 had eating disorders. Only 3 of the 19 menstruating runners were vegetraians, and none had eating disorders.
The review shoed that even though intake of iron and calories was the same, female runners who ate a modified vegetarian diet (less than 100 grams of red meat per week) had significantly lower iron levels than those who regularly ate red meat. One study showed that female runners who did not eat meant, chicken, or fish had protein levels below the recommended minimum for encurance athletes.
Although it is theoretically possible to compete athletically on a meatless diet, the researchers emphasize thtere is risk. They recommend that female athletes who call themselves vegetarians be screened for disordered eating and amenorrhea, and if either is found, for osteoporosis. The American College of Sports Medicine recently published a position statement on the female athlete triad. (Loosli AR, Ruud JS. Meatless diets in female athletes: A red flag. The Physician and Sportsmedicine. 1998;26:45-48,55)
Dieting behaviors in college students
Of 84 college females tested with the Eating Attitudes Test (EAT-40), 18 percent indicated high eating concerns and were consuming 415 fewer calories than subjects with normal eating concerns and 629 fewer calories than subjects with very low eating concerns. They were also eating less fat. Of the total, 80 percent had dieted to lose weight and 32 percent had dieted 6 or more times. Currently dieting were 46 percent of these women students even though 82 percent of the dieters were within the recommended body mass index range of 19 to 25. On average they wanted to lose 11.5 pounds. (Pereyra L, et al. Eating attitudes, dietary intake, and dieting behaviors in college females. J Am Diet Assoc 1997;97(S):9:A-48)
Disordered eating on campus
In a sample of 1,226 university students, faculty, and staff in North Carolina, 23 percent of women and 8 percent of men tested above 20 points on the Eating Attitude Test (modified, approved version), indicating disordered eating patterns. When asked if terrified about being overweight, 80 percent of women and 20 percent of men reported being terrified.
One third (85 percent women, 15 percent men) reported being preocuupied with the desire to be thinner. Half thought about burning calories when exercising (65 percent women; 35 percent men). Over one third were preoccupied with the thought of having fat on their bodies (73 percent women; 27 percent men). Over one-third ate diet foods (83 percent women; 17 percent men). Nearly one third dieted (84 percent women; 16 percent men). Eleven percent had the impulse to vomit after meals, and 7 percent said they vomited after meals (98 percent women, 2 percent men). Hartung concludes that this study shows that males are more conscious of their appearance, body fat content, and self-control around food than previously believed. It supports the need for continued nutrition education and psychological support on college campuses for both sexes. (Hartung L. Disordered eating patterns in relation to gender in the college environment. J Am Diet Assoc 1997; 97:9 (Suppl):A-60)