Complex and harmful relationships with food can extend far beyond the teenage years. Photo: Michael Stern.
Mindy Gorman-Plutzer used to be afraid of food, and this fear took her from starving herself to compulsive bingeing and throwing up. She started to diet in her early teens, but the obsession with calories and the size of her thighs continued even after she became a mother of two, and then, a widow. She was in her late 40s before she finally decided to confront her eating disorder.
“I had gone through various life changing experiences as a midlife woman, and I came to the realization that I had a choice to make,” Gorman-Plutzer, now 62 and a health coach, said. “The catalyst was being sick and tired of being sick and tired.”
More women like Gorman-Plutzer have begun to come forward as treatment centers and studies show increasing numbers of midlife women with disordered eating, defined as thoughts and actions related to food that interfere with quality of life. In January 2017, a group of researchers from the United Kingdom and the U.S. discovered that over 15% of almost 6,000 women over 40 had experienced an eating disorder in their lifetime. The study, published in BioMed Central, also stated that “active conditions are common in midlife, both due to new onset and chronic disorders.” Another study in the International Journal of Eating Disorders, carried out by researchers at the University of North Carolina in 2012, found that 13 percent of almost 2,000 female participants over 50 exhibit disordered eating.
As the psychiatric illness with the highest mortality rates nationwide – a person dies every 62 minutes as a direct result of an eating disorder – the increase in the number of older women seeking care has led to more customized treatment options, and also highlighted the need for more research into the effects of the aging process. The National Association of Anorexia Nervosa and Associated Disorders reports that 60 percent of people with eating disorders who have undergone treatment will recover, while 20 percent will make only partial recoveries, which includes intermittent disordered eating. The remaining 20 percent will not improve, even with treatment.
When Gorman-Plutzer was in the deepest stages of her struggle, she said it was “cultural and societal messages from the outside” that prevented her from recognizing her behavior as self-harm. “I was latching on the latest fad diet, or I needed to be the thinnest woman in the room, and I just thought I was a very good dieter,” she said. Following her own treatment, she studied nutrition and eating psychology to start helping others.
As part of her work as a health coach, Gorman-Plutzer offers women over 30 tailor-made treatments according to a blueprint she named “The Freedom Promise.” This includes step-by-step plans to prioritize lifestyle choices, regular private therapy sessions, and 8-week group programs. “It’s a question of re-framing, and rather by being symptom- and solution-oriented, I am more concerned with helping my clients change the environment with within which those [eating disorder] systems occur,” she said. Gorman-Plutzer said that most of her clients suffer from binge eating; she had one woman in her 90s come to her for help.
The Renfrew Center, which opened in 1985 in Philadelphia, Pa. and now operates in 19 locations, was the first residential treatment facility for eating disorders in the United States. In the last decade, Renfrew has noted a 42 percent increase in the number of women over 35 seeking treatment, which led to the launch of a specialized outpatient Midlife Program.
“The needs are really unique and being around others in the same life stage is important,” said Catherine Silver, a psychologist and formerly the senior team leader at Renfrew’s New York location, about the group-based therapy. There are numerous triggers specific to midlife that can exacerbate pre-existing disorders or, though less common, begin new ones, including menopause, divorce, or children “leaving the nest,” she said.
Silver adds that treatment within the Midlife Program is developed to take daily-life obligations into consideration, as well as the absence of parental support that younger patients typically have. “Another hard thing that happens in midlife is that people are either losing their parents or finding themselves taking care of both parents and children, so they are a ‘middle-sandwich generation,’ if you will. Due to that, we have to take support systems into account,” she said.
Joanne Labiner, a New York-based clinical therapist specializing in body image issues, says that menopause can have a negative impact on a woman’s eating habits. “Women tend to gain weight during this time, and depression is also associated with menopause. For many women, sex also becomes painful, so they sometimes substitute food for sex after the loss of intimacy with a partner,” she said.
But the core causes do not discriminate according to age. “Anything that creates an emotional abyss or emotional stress is going to require coping mechanisms,” said Sondra Kronberg, a specialist in eating disorders and group treatment programs who is mainly based in New York.
Shame remains a “big factor” delaying women seeking treatment, said Labiner, and the delay can last decades, as it did for Gorman-Plutzer. Kimberly Hershenson, 36, a psychotherapist in New York who is also in recovery from anorexia, sees this in her patients. “I have a client who is now 55, and she’s had an eating disorder since she was 12 but was really too ashamed to seek treatment until she had medical complications,” she said. Hershenson, whose early career at 11 as a professional ballerina negatively impacted her body image, only began recovery when she was pregnant with her daughter.
Jaime, 38, who cannot share her last name due to the press policies of Overeaters Anonymous’ 12-Step-Program, said that her eating disorder had been “a lifelong friend” before she finally sought help at age 32 when she and her husband were hoping to have a child. For Jaime, her bingeing, bulimia, and restrictive eating were just another addiction to add to the alcohol, drug, and sex problems she had struggled with for most of her life. She said that this behaviour was “a way to get through and numb myself” during difficult transitions, such as her parents’ divorce and her mother’s coming out as gay. Self-destruction also played a role, and Jaime started treatment for her eating disorder only after years of therapy for other addictions. “If I let go of the eating disorder, how else would I hurt myself?” she said.
Jaime reached out to Overeaters Anonymous in 2012 after getting married to her supportive husband, whom she credits with kick-starting her recovery. She attends meetings in Long Island and said that she was “amazed by the energy in the room” from the very first day. Jaime is thankful that the group treatment is free of charge and tries to contribute by speaking to others about her experiences. “I hope I’m smart enough to never leave,” she said.
For Gorman-Plutzer, an initially negative view of treatment that fueled her lifelong commitment to helping others. “My first exposure to recovery was an internist, a therapist, and a nutritionist, and basically what I needed was an exorcist,” Gorman-Plutzer said. “They were just dealing with my body, and maybe a little bit with my mind, but nobody was dealing with me on a deeper level,” she said. “I came to this work to embrace my own recovery and pay it forward.”
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