Woman with anorexia being on restricted diet


Over the last decade, the number of women over age 30 seeking treatment for anorexia, bulimia and binge eating disorder has skyrocketed. Experts discuss the factors triggering eating disorders in midlife and the factors that bring women in for treatment for long standing disorders.

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  • Denise Folcik, eating disorder survivor
  • Lori Ciotti, Site Director, Renfrew Center of Massachusetts
  • Dr. Margo Maine, psychologist, co-founder, National Eating Disorders Association and author, The Body Myth: Women and the Pressure to be Perfect
  • Dr. Cynthia Bulik, founding Director, University of North Carolina Center of Excellence for Eating Disorders and author, Midlife Eating Disorders: Your Journey to Recovery

Links for more information:


Eating Disorders in Adults

Reed Pence: 55-year-old Denise Folcik of Waukesha, Wisconsin grew up with a verbally abusive father. She says his words often cut to the bone.

Denise Folcik: I had a sister who was overweight and he used to say things to her that were very very mean. There was a time where he asked her if she had another dress similar to the one she was wearing, and she said, “yes I do” and he said “well I need a tent for the weekend.” So this was kind of the language that I grew up with, that you needed to be thin or dads going to make fun of you. When I was 16 I was lying in bed and overheard him tell my mom that I was worthless.

Reed: Folcik says her father’s words defined her self-image. But she made it through life OK, or so she thought until she was in her late 20’s, had her fourth baby and looked in the mirror. She decided all the extra weight had to come off, but diets weren’t working, then a friend described her sister who suffered from bulimia.

Fulcik: And for some reason that very moment that thought was like, “Oh my god, I could eat what I want and I could get rid of it” and in my mind at that time it sounded like the perfect diet. So I started where I would eat, and then I would make myself get sick and at the time I did get results from what I was doing when it came to weight loss. What started as a way of losing weight then turned into how I started to cope with life. So from something that started once a day to twice a week to three times a week, after 16 years of bulimia I was binging and purging up to 20 times a day.

Reed: But by the time she was in her early 40’s, Fulcik was anorexic and starting to feel the health effects of her disorder.

Fulcik: I had a lot of headaches, I had chronic headaches, I was always very cold ‘cause I got very thin, I had problems with my teeth. Once I was diagnosed with my eating disorder I had different problems with my heart, my digestive system was not good; it was either diarrhea or constipation type things, I was always tired.

Reed: Eventually Fulcik blacked out while driving with her daughter as a passenger. Fortunately no one was hurt, but when doctors asked her in the emergency room why her blood electrolytes might be so out of balance, Fulcik admitted she had an eating disorder. It finally got her into treatment at age 43. But these days she’d be far from alone – most people still think of teenage girls when they think of eating disorders, especially anorexia and bulimia, but over the last 10 years the number of women in midlife seeking help has dramatically increased.

Lori Ciotti: In 2001 we sort of saw 10% of our residential population was made up of women age 35 and over and then 2003 26% were midlife and older.

Reed: Lori Ciotti is Site Director at the Renfrew Center of Massachusetts, part of the nations largest network of eating disorders clinics. In some programs, more than half of eating disorder patients are now older than 30.

Ciotti: Age does not immunize women from body image preoccupation and weight concern; in fact we’re seeing sort of a fear of aging can be more even of a cause of disordered eating for many women. So I would say that 75% of American women, who are like 25-45 report disordered eating and body image dissatisfaction. And then it’s harder as women age to maintain those ideals of what beauty really means and what we’re bombarded with in our culture.

Dr. Margo Maine: People in my mothers generation, they didn’t really think they had to continue looking like a 20 year old when they were 40 or 60. Today, women of all ages think they have to look really-really youthful, that that’s the way to be accepted, to be seen as powerful, to be seen as a force is to really look young and there’s only one way to look young and that is to have a youthful body. The body changes that we go through just are very inconvenient.

Reed: That’s Dr. Margo Maine, a psychologist specializing in eating disorders and a co-founder of the National Eating Disorders Association. She’s also author of the book, “The Body Myth: Women and the Pressure to be Perfect.”

Dr. Maine: There is one study that was done in 2012 in the U.S, of women in the general public who were over the age of 50 and 79% of them reported significant distress about their bodies and weight preoccupation. And 13% of them admitted to having eating disorder symptoms at the time of that survey. 13% is a huge number of adult women over the age of 50 and we are not identifying that number at all in our offices or in the medical field. Doctors and other medical providers, as well as mental health providers, don’t ask adult women about their eating issues, their body image issues, it’s a question that pediatricians and clinicians working with younger people often will ask, but we don’t ask that with adult women – with adult women we’re always teased if they’ve lost weight because of the war on obesity and the belief that everybody needs to be thinner.

Reed: However pressure to lose weight is only one factor behind the increase in eating disorders in midlife. As Denis Folcik says, women with anorexia or bulimia often rely on them as a way to cope with life. Today women face plenty of other pressures that can contribute to old habits resurfacing or triggering a new one.

Dr. Cynthia Bulik: A lot of things that we’re seeing are associated with transitions and loss.

Reed: Dr. Cynthia Bulik is Founding Director of the University of North Carolina Center of Excellence for Eating Disorders and author of the book, “Midlife Eating Disorders: Your Journey to Recovery.”

Dr. Bulik: These things can be, for example, all of a sudden kids are out of the house and there’s an empty nest phenomenon. Or perhaps there was infidelity in the relationship, or when parents die; that can be a very traumatic experience for people in midlife and also, and we’ve heard about this so often but it really is a phenomenon, and that this sandwich generation phenomenon – where you find yourself perhaps having a full time job but you’re also care-taking for your children and care-taking for your parents and if you don’t have a team to do that, that can be a lot of pressure on one person.

Fulcik: There’s so much that we are always navigating and women are so busy today, taking care of their families, many of whom are working also very responsible jobs doing a lot of a community work as well. There’s no time and no space for them to ever process any of this, so the way they end up coping often is by getting into rituals related to their bodies; dieting, exercise, weight loss, those kinds of things that will ground them and make them feel like they’re going to be OK because even if everything else is out of control, my body is OK and I’ve lost that 5 pounds I wanted to lose and I can lose more.
Reed: Many older women are coming for help with an eating disorder after suffering for years, maybe they look around and see that it’s no longer just 13 and 14 year olds in treatment, so they feel more comfortable. They may also realize they could be in serious trouble if they don’t get help soon. Bulik and Maine say older women are realizing, like Fulcik, that their health simply can’t take it anymore.

Dr. Maine: Eating disorders take an enormous toll on your body and when we’re younger our bodies tend to be a bit more resilient and what we’re seeing in midlife folk is their bodies are already starting to sort of go down that path of things are starting to go wrong. And if you put an eating disorder on top of that, we’re starting to see more cardiac problems, we’re seeing more circulatory problems, we’re seeing a lot more gastrointestinal problems in midlife people with eating disorders and we’re also seeing things you don’t think about, but more problems with teeth; so more dental problems. So if someone is vomiting all the time and their teeth are being bathed in their gastric acid, older teeth are a lot less resilient to that kind of insult.

Dr. Bulik: They really are tired of their eating disorder, they’re tired of feeling the way they do, and they so much, If they’re mothers, don’t want this history to be repeated in their families. Their motivation is much stronger than our younger patients – now our younger patients have this feeling that they’re immune from anything bad that’s going to happen from their eating disorder – our adult patients know that bad things are happening for them and that they need to change.

Reed: While health is a big reason for getting treatment, Maine says she believes there’s one factor among older women that’s even more important.

Dr. Maine: Many of them see that they could end up passing along this eating disorder to their children and that is the biggest motivating factor to get them in the door of help. They don’t want this to continue, they don’t want a multi-generational line of eating disorders in their family, so that’s often what gets them to make that call.

Reed: When someone with an eating disorder does call for help, increasingly treatment programs are including the family in helping midlife women get better just as they’ve always done with adolescents. After all, Ciotti says, the illness affects the family too.

Ciotti: Loved ones get very confused, there’s a lot of secrecy around eating disorders, so there is a feeling of being disconnected by the family members and pushed away by that person who’s suffering – so that they can hold onto their eating disorder as their coping strategy. It is very akin to an addiction, so there are ways that the person who’s struggling is impacting everyone around them just like any other mental health issue that can impact your loved ones and people that you’re living with.

Reed: Bulik says that couples therapy often keeps women from dropping out of treatment. Many patients are ambivalent about treatment to begin with because the disorder serves to calm anxiety – that’s how they cope with life. It’s the job of therapists to replace the eating disorder with healthier coping strategy. Maine says great recoveries are possible; it’s never too late.

Dr. Maine: Will they stop worrying about their bodies? Some of them do, some of them are able to restore their health and really get past all of the body image preoccupation. Others make tremendous progress, but still have to manage the negative pull of the eating disorder for the rest of their lives. I think that for some people the eating disorder is a chronic problem, but we just have to help them to lower the volume on it and get to a place where they’re safer.

Reed: However while success rates for bulimia and binge eating are generally more than 50%, Bulik says about a quarter of anorexia patients continue to have a severe enduring disorder. And about 5% per decade die, that’s one thing the public doesn’t understand.

Dr. Bulik: We have to begin to get people to realize that these are some of the more severe psychiatric illnesses that there are. They are not a choice, they are a psychiatric illness, and in fact anorexia nervosa has the highest mortality rate of any psychiatric illness. So it’s higher than depression, it’s higher than schizophrenia, it’s higher than bipolar disorder – so we have to just get people to realize how serious they are and how far reaching the medical and psychological co-morbidities and morbidities are in people who have these illnesses.

Reed: Bulik says about 60% of the roots of eating disorder are genetic, that’s why she says many people who suffer from them resent being blamed – they know they’ve been fighting their bodies. Bulik and her team are trying to trace those genetic roots by getting a blood sample from as many people as they can who’ve ever had anorexia. The program is called ANGI – the Anorexia Nervosa Genetics Initiative. You can find out more online about it at unceatingdisorders.org/angi or through the link on our website RadioHealthJournal.net where you can find out about all of our guests as well. I’m Reed Pence.

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