ANOREXIA @40 THE ILL­NESS NO ONE TALKS ABOUT

Women aged 40+ who live with eat­ing dis­or­ders of­ten suf­fer in si­lence, too em­bar­rassed to ask for help. The re­sult is they fall through the cracks of care and end up stuck in a vi­cious cir­cle of ill­ness. Here’s why you need to speak up — for your­self or s

Best Health - - CONTENTS - By ANNA SHARRATT

LISA BOLTMAN IS 43 AND A MOM OF THREE BOYS. She’s a self-con­fessed per­fec­tion­ist and “peo­ple pleaser.” But she’s also sur­pris­ingly frank when it comes to her eat­ing dis­or­der, anorexia ner­vosa, which doc­tors have told her might kill her. At 5 foot 5, she cur­rently weighs “in the 90s” and can fit it into kids’ clothes.

“Peo­ple say ‘Get over it,’” says Boltman, but “it’s not a choice.”

Boltman had al­ways man­aged to keep her anorexia in check. Di­ag­nosed in her 20s when her weight fell to 81 pounds, she had re­ceived treat­ment for lax­a­tive abuse — a com­mon prac­tice among those with eat­ing dis­or­ders to lose weight — and kept her weight at 125 pounds dur­ing her 30s. Then in 2014, some­thing changed. “I was feel­ing un­com­fort­able in my skin — it’s this empty feel­ing.” She started tak­ing hun­dreds of lax­a­tives daily and over-

exercising. Her weight fell dra­mat­i­cally.

At a weight too low to qual­ify her for a pri­vate eat­ing dis­or­der clinic (some pro­grams re­quire a Body Mass In­dex [BMI] of 16 for ad­mis­sion), Boltman sought help at an eat­ing dis­or­der out­pa­tient pro­gram at a nearby hos­pi­tal. But she felt the pro­gram wasn’t a good fit since it wasn’t cus­tom­iz­a­ble (ev­ery pa­tient got the same meal plan) and she left af­ter just two days.

She now man­ages her dis­or­der with the sup­port of her fam­ily. She gets her­self and the kids out of the house to avoid ru­mi­nat­ing about her ill­ness. She works as an ad­min­is­tra­tive as­sis­tant to keep her­self busy. And she con­stantly forces her­self to eat. But she con­fesses that it’s dif­fi­cult, and doc­tors have told her she may die from a heart at­tack or kid­ney fail­ure if she con­tin­ues re­strict­ing food and abus­ing lax­a­tives.

She says there’s an in­ter­nal di­a­logue at ev­ery meal. “I have to say to my­self: ‘To­day is the day you’re go­ing to be nor­mal.’”

Boltman is one of 600,000 to 990,000 Cana­di­ans — 80 per­cent of them fe­male — who suf­fer from an eat­ing dis­or­der, pri­mar­ily anorexia ner­vosa, bu­limia ner­vosa or binge eat­ing dis­or­der, ac­cord­ing to the 2014 House of Com­mons Stand­ing Com­mit­tee on the Sta­tus of Women. (See page 45 for more about th­ese dis­or­ders). Ac­cord­ing to the com­mit­tee’s re­port, anorexia ner­vosa has the high­est over­all mor­tal­ity rate of any men­tal ill­ness, with 10 to 15 per­cent of in­di­vid­u­als with the ill­ness suc­cumb­ing to it; about five per­cent of bu­limia ner­vosa pa­tients die from the dis­ease. Com­bined, th­ese two dis­or­ders kill an es­ti­mated 1,000 to 1,500 Cana­di­ans per year, the re­port finds.

While th­ese eat­ing ail­ments are com­monly di­ag­nosed among women in their 20s, health-care ex­perts are now see­ing more women re­laps­ing with age and, sadly, fall­ing through the cracks of care.

“Over half of the peo­ple that we see are over 35,” says Deb­o­rah Ber­lin-Ro­ma­lis, ex­ec­u­tive di­rec­tor of Sheena’s Place, a sup­port cen­tre that pro­vides free ser­vices to peo­ple over 17 with eat­ing dis­or­ders, as well their fam­i­lies, care­givers and com­mu­ni­ties. She says women hit their 40s and they’re over­whelmed by ca­reers, chil­drea­r­ing, di­vorces or car­ing for el­derly or sick par­ents. With anorexia, symp­toms come roar­ing back — or yo-yo di­et­ing pre­cip­i­tates full-blown binge eat­ing. “It’s like a merry-go-round that you can’t get off of,” she says.

De­spite this, eat­ing dis­or­ders — par­tic­u­larly anorexia in women over 40 — are un­der-rep­re­sented in ED pro­grams and ser­vices. “Adults in midlife are not show­ing up to treat­ment,” says Les­lie McCal­lum, a PhD can­di­date at the Univer­sity of Toronto study­ing this group. As a re­sult, older women who re­lapse in mid­dle age of­ten get missed by fam­ily mem­bers and clin­i­cians — and they hide their ill­ness and suf­fer in si­lence. When they do visit a physi­cian, GPs at­tribute their anorexia symp­toms — weight loss, ab­dom­i­nal pain, changes in bowel habits, hair loss — to other med­i­cal con­di­tions.

McCal­lum says that it’s a com­plex is­sue. Women over 40 with eat­ing dis­or­ders are out there, but they hide it well — and deny­ing the sever­ity of the ill­ness is com­mon among peo­ple of all ages with eat­ing dis­or­ders. “It’s dif­fi­cult for older women to step for­ward and ask for help due to mis­con­cep­tions about eat­ing dis­or­ders be­ing a younger women’s ill­ness,” she adds. She says the se­crecy around th­ese ill­nesses is com­pounded in women in their 40s and older. “They think: ‘I should know better — I’m a ma­ture woman,’” she says. Plus, some en­joy the com­pli­ments a slim fig­ure can bring.

“Their lives are much more com­pli­cated,” says McCal­lum. “The stakes are so much higher. We re­ally need to pay at­ten­tion to this group.”

GET­TING TREAT­MENT

When an eat­ing dis­or­der such as anorexia or bu­limia resur­faces in mid­dle age, or a binge eat­ing dis­or­der is newly di­ag­nosed, the first step is ad­dress­ing the other men­tal health is­sues, such as anx­i­ety or de­pres­sion, that of­ten ac­com­pany the dis­or­der, says Dr. Lara Os­tolosky, as­sis­tant clin­i­cal pro­fes­sor at the Univer­sity of Al­berta. “An eat­ing dis­or­der doesn’t ex­ist on its own,” she says, adding that drug abuse, ex­ces­sive spend­ing or other ad­dic­tive be­hav­iours can also be present.

McCal­lum agrees. She says that many women with eat­ing dis­or­ders have ex­pe­ri­enced some sort of trauma that needs to be ad­dressed through ther­apy.

The sec­ond step is ac­cess­ing treat­ment. For those with anorexia who have very low BMIs and are in dan­ger of dy­ing, hos­pi­tals may take them in on an emer­gency ba­sis and of­fer refeed­ing.

If a woman isn’t in im­me­di­ate dan­ger, an in-pa­tient stay at a hos­pi­tal with an eat­ing dis­or­ders pro­gram may be an op­tion, though wait­ing lists are long, and only 50 beds ex­ist in Canada for adults with eat­ing dis­or­ders, says McCal­lum. Th­ese fa­cil­i­ties of­fer refeed­ing pro­grams and coun­selling.

How­ever, many of the anorexia treat­ment pro­grams are geared to­wards younger women, whether through food se­lec­tion or the all-or-noth­ing coun­selling ap­proaches, says McCal­lum.

Women over 40 “feel quite alien­ated in that group,” says McCal­lum, adding that many women would pre­fer to have pro­grams tai­lored to their life­styles, which of­ten in­clude jobs and kids. “There’s some flex­i­bil­ity needed in th­ese pro­grams,” she says. “With a ma­ture adult, how about say­ing ‘Here are three dif­fer­ent veg­eta­bles. Pick

one.’” She feels an ap­proach more tai­lored to their life stage might in­crease help-seek­ing and re­duce pre­ma­ture dis­charges.

Pri­vate clin­ics that in­te­grate coun­selling, cog­ni­tive be­havioural ther­apy (a type of ther­apy that chal­lenges neg­a­tive think­ing), meal plan­ning and sup­port groups are an­other path to treat­ment. But they can cost any­thing from $200/hour for out­pa­tient vis­its to tens of thou­sands of dol­lars for longer in-pa­tient stays.

Kyla Fox, a for­mer anorexic, is the founder of The Kyla Fox Cen­tre, an eat­ing dis­or­der re­cov­ery cen­tre in Toronto. She says that when she was di­ag­nosed with anorexia in her 20s, there was no treat­ment avail­able to her due to lengthy wait lists and a lack of pro­fes­sion­als who un­der­stood eat­ing dis­or­ders, so she could not ac­cess ser­vices that she des­per­ately needed. Fox, who ad­mits she was “in de­nial” when first di­ag­nosed, had been se­verely un­der­weight, suf­fer­ing from hy­po­glycemia, faint­ing spells and hair loss, as well as panic at­tacks and a loss of men­strual pe­ri­ods. “I felt like I was on the verge of los­ing my life,” she says.

She be­gan to track her eat­ing and to an­a­lyze her toxic re­la­tion­ship with food. Slowly she cut back on her exercising, and started eat­ing more calo­ries — con­sum­ing foods she en­joyed. “I re­ally started to ed­u­cate my­self about food,” she says, while sur­round­ing her­self with women she saw as men­tors. She says it taught her that hav­ing role mod­els is in­te­gral in re­cov­ery. “Find peo­ple who re­ally un­der­stand you — and un­der­stand eat­ing dis­or­ders.” Her pri­vate clinic, which opened in 2012, is all about flex­i­bil­ity. “No two peo­ple have the same re­cov­ery.”

Though it can be elu­sive, re­cov­ery is pos­si­ble, es­pe­cially for those deal­ing with bu­limia and binge eat­ing. “I can usu­ally stop a per­son with binge eat­ing dis­or­der in their 40s,” says Dr. Os­tolosky.

Dr. Al­lan Ka­plan, se­nior clin­i­cian/sci­en­tist at the Cen­tre for Ad­dic­tion and Men­tal Health, and vice dean and pro­fes­sor of psy­chi­a­try, at the Fac­ulty of Medicine, Univer­sity of Toronto agrees: A com­bi­na­tion of cog­ni­tive be­havioural ther­apy and phar­ma­cother­apy can usu­ally treat bu­limia suc­cess­fully. “Bulim­ics can be treated and can get better,” says Dr. Ka­plan.

MAP­PING OUT TREAT­MENT

Ex­perts be­lieve that for a treat­ment plan to work, a pa­tient has to take own­er­ship. One step is to iden­tify emo­tional trig­gers. “A per­son has to look at their life and look at the things that are caus­ing them stress,” says Dr. Os­tolosky. “Women in their 40s tend to do more and more and eat­ing falls by the way­side.”

Sup­port­ive friends and fam­ily are crit­i­cal. “I can’t stress enough the im­por­tance of spousal sup­port and fam­ily sup­port,” she says. This can in­clude help with meal plan­ning, as well as emo­tional sup­port to pre­vent iso­la­tion. Crit­i­cism of any kind is dis­cour­aged.

Other key strate­gies in­clude the fol­low­ing:

DITCH THE SCALE. “I do not see re­cov­er­ies hap­pen when peo­ple are at home weigh­ing them­selves,” she says.

IN­CREASE EX­ER­CISE. Ex­er­cise is en­cour­aged to man­age stress and pro­mote a pos­i­tive mood — but should not be done to ex­cess. “Some women get into an ex­er­cise pro­gram that is far too intense — they’re not do­ing it for health,” says Dr. Os­tolosky. She says the best ap­proach is to ex­er­cise in groups such as on a vol­ley­ball or soccer team. “They should stay away from gyms, which can pro­mote com­pe­ti­tion and look­ing at other gym go­ers.”

AVOID UNIQUE DI­ETS. Spe­cial di­ets, such as go­ing gluten-free — which are of­ten used to re­strict calo­ries and carbs — need to be shelved un­less they have been for­mally di­ag­nosed by a physi­cian. So should overly restricted di­ets such as ve­g­an­ism, she says.

PART­NER WITH PRO­FES­SION­ALS. Be­cause re­cov­ery can in­duce un­pleas­ant di­ges­tive symp­toms, Dr. Os­tolosky ad­vises work­ing with a health-care ex­pert to min­i­mize them. Th­ese is­sues can in­clude gassi­ness, se­vere bloat­ing, ab­dom­i­nal pain and ir­reg­u­lar bowel habits, as cer­tain foods are rein­tro­duced.

CON­SIDER COUN­SELLING. Women re­cov­er­ing from eat­ing dis­or­ders may also have mood swings and emo­tional out­bursts as they cope with what they per­ceive to be a loss of con­trol, says Dr. Os­tolosky. At­tend­ing coun­selling can help with those emo­tions and pro­vide much-needed sup­port. “Women with eat­ing dis­or­ders have isolated them­selves — it takes away from their con­nec­tion to peo­ple. They need to re­build that.”

BOT­TOM LINE? Dr. Os­tolosky be­lieves progress is be­ing made with eat­ing dis­or­ders in women over 40, but ad­mits it’s a long process. “It’s a work in progress all of the time.

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