Photograph by lance lanagan
Katie Nelson of Milton has been in recovery for about three years. She still exercises—but for fitness, not for weight control.
By the time she reached adolescence, Katie Nelson of Milton remembers putting on some weight and thinking, “I’m fat.” She began reading food labels and restricting her intake of carbohydrates. At one point, she was eating nothing more than hard-boiled eggs, boiled fish and vegetables. “There was probably some nutritional value, but I was getting pretty malnourished,” says Nelson, who is now 27.
She was also an avid runner, compounding the problem. The weight on her 5-foot-three-inch frame dropped from 125 to 92 pounds. “I was nothing but skin and bones,” she says. Her parents took her to the doctor, but she soon became bulimic. “It was a vicious cycle,” she says. “My life was chaos. By trying to control my body, I was completely losing control.”
Nelson’s recovery began when she embarked on a career in law enforcement. Working with men, she developed a different perspective on body image. “I always thought you had to be skinny, and if you didn’t look like that, you were ugly,” she says. “When they started talking about lifting weights and getting stronger, it was a different mentality to me and I kind of liked it.”
Nelson has been in recovery for about three years. She still exercises but for fitness not for weight control. And she has a new relationship with food. “I look at food as fuel for my body, so I’m going to put fuel in my body so it runs better,” she says. “And, occasionally, I’m going to treat myself too.”
Nelson’s story is not uncommon. According to the National Institute of Mental Health, one in five women has an eating disorder, including anorexia nervosa, bulimia and binge eating. An increasing number of women in their 30s, 40s and 50s are included in those numbers, challenging beliefs that eating disorders occur mostly in adolescent girls.
Even though eating disorders have pushed their way into the lives of adult women, experts maintain they are still primarily a disease of youth, as most midlife women developed the problem prior to age 18.
“Generally speaking, eating disorders start in adolescence,” says Linda J. Lang, M.D., chair of the department of psychiatry and behavioral health at Christiana Care Health System. “The average age is between 12 and 25.”
Experts acknowledge that it’s difficult to determine whether the incidence of eating disorders in adult women is really increasing. Many older women are actually dealing with an untreated disorder from a much earlier age. “The body becomes distorted, and that can trigger a feeling of being out of control,” says Lang.
For some people, a preoccupation with food serves as a way for them to gain control over their lives. For others, like Nelson, it can be a way of expressing anger and resentment toward a body they feel has in some way failed them.
“I find that people with bulimia tend to have lots of stored anger,” says Jan Rudzinski, a psychotherapist and owner of the Center for Mindful Change in Wilmington and Lewes. “The whole act of purging becomes an angry act toward themselves, an abusive act toward themselves, and they feel relieved after they’ve been abused.”
A growing body of research also indicates that there may be a genetic predisposition toward eating disorders, as with the other psychiatric disorders that often accompany them, including depression, bipolar disorder or obsessive-compulsive disorder.
Eating disorders are serious problems and need to be diagnosed and treated like any other medical condition. Failure to seek treatment can result in severe or even life-threatening complications, including cardiac arrhythmia, osteoporosis, dental problems, cognitive impairment, infertility and even death.
If treated early, chances for a full recovery are good, but after five years, the behavior becomes chronic and much more difficult to treat, says Lang. And because people with eating disorders are so adept at hiding the problem, the disease often becomes severe before anyone notices that anything is wrong, experts say.
“I have clients who say they don’t have issues with food, but when you get down to it, they’re not eating the appropriate portion sizes,” says Rudzinski. “There are some who might even seem that they’re at a healthy weight or just barely underweight, but when you get their blood work back, they have all sorts of deficiencies.”
Treatment of eating disorders nearly always includes cognitive-behavioral or group psychotherapy. Not all patients are ready to work on their eating disorder when they first meet the therapist.
“I’ve had a few come in specifically for their eating disorder, but most of them don’t come in because they want to get rid of their eating disorder,” says Rudzinski. “They come because they have too much anxiety, their marriage is falling apart. They just can’t cope. I have to come in through the back door, make them feel connected.”
Yoga can also play an important role in the treatment plan. The focus is not so much on specific postures but about being in tune with how one feels and what is going on inside one’s body.
Registered dietitians are also important members of the treatment team. “Frequently, clients with eating disorders come to us first because they think it’s a ‘diet’ problem,” says Marianne Carter, a registered dietitian and director of the Center for Health Promotion at Delaware State University in Dover.
“We’re trained to assess whether a client has an eating disorder, and if they do, we make sure they get connected with a physician and a therapist. As part of the treatment team, we provide nutrition education, devise individualized meal plans and monitor intake/weights.”
Katie Nelson says she’s in a good place now. She just celebrated her fifth wedding anniversary and is working as a park ranger for the state of Delaware. Her advice to anyone struggling with an eating disorder: Seek treatment, cultivate and maintain a support structure, and step outside yourself.
“For a long time, I focused on the eating disorder and not on the life around me,” she says. “When I started to notice the other things in my life, I realized I couldn’t let the eating disorder define me.”