Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics ranging from angiography to vulvar melanoma.)

This month—National Nutrition Month—Dr. Pat asks Megan Riddle, Ph.D., a new member of our Medical Advisory Board, how someone could open a conversation with a colleague suffering from anorexia nervosa, the deadliest of all mental health disorders.


Dear Dr. Pat: 

I am writing about my business partner.  She is 46 and has become obsessed with being “fit” and “eating right.”  She wakes up every morning at 5 a.m. and has a green drink “with protein in it” before rushing out the door to her demanding spinning class.  She showers there, changes clothes, and comes in to work. She has bottled water, salad with tofu and beans for lunch, green tea twice a day, 10 almonds at 3 p.m., and God only knows what she eats for dinner.  She went through a nasty divorce about two years ago and has no children.  She has lots of friends, many of them new friends who are in the same spinning, running, not-eating-much kind of group.  I am concerned that she is anorexic but she is 46!  I don’t know what to do. I am fit and exercise, but she must be a size 0 and shrinking.  Her work has not suffered but the only thing that seems to give her joy is her exercise, her new-friend groups and “staying on the healthy food plan.” Do women at this age actually have anorexia?  What can I do to help?



Dr. Pat Responds:

Dear Samantha:

Yes, women in all ages and stages can become both anorexic and develop “exercise bulimia.”  Men and women with eating disorders are often driven by a need to control something in their lives and controlling their weight, controlling how much they eat and exercise may seem to help when they are confronted by painful events over which they have no control.  It is true that finding a group of people who are as focused as your business partner is on the exercise and food control reinforces her belief that she is just ‘being healthy”.  This does make it more difficult for you to begin the conversation about weight, under eating and over exercising. 

I have asked, Megan Riddle, Ph.D., to discuss this complicated problem.  Dr. Riddle will graduate in May of this year from Weill Cornell Medical College and become Megan Riddle, M.D., Ph.D.!  She has landed a prestigious residency in psychiatry at the University of Washington that begins in July of 2014, and is a new member of our Medical Advisory Board. 
Dr. Pat


Dr. Riddle Responds:

Dear Samantha:

You are right to be concerned about your friend.  When most of us think of eating disorders, we assume it is an issue primarily for teenagers.  We are on the lookout for eating disorders amongst our daughters, our nieces, and our younger friends, but don’t realize that women of all ages may develop patterns of disordered eating.   In fact, a recent survey of women over 50 found that 13 percent had eating disorder symptoms.  Because, as a society, we expect eating disorders to be purely an issue of adolescence and early adulthood, women like your friend may suffer silently with these issues and not receive the help they deserve.   Eating disorders can be debilitating, interfering with relationships with partners, children, and family; sidelining successful careers; and taking away from the richness of life’s experiences.  Once recognized, treatment and recovery and, with it, a fuller life, are possible.

Causes of eating disorders

Eating disorders are complex, and we don’t know why some people develop them, but the best research suggests that it is a combination of our genetics, the culture in which we live, and various psychological and interpersonal factors.  While literature focused on young women has pointed to the developmental stressors and transitions of youth as causative factors, women in midlife experience their own changes and challenges that can trigger an eating disorder, like the nasty divorce your friend experienced. Whether it’s tension in a marriage, stress at work, the complications of caring for adult parents. or the physical changes that accompany aging, these factors can all contribute to the development of disordered eating patterns.     

Types of eating disorders

eating disorder 2Disordered eating can take a number of different forms.  The three most recognized types are anorexia nervosa, bulimia nervosa, and binge eating disorder.

As you suggest, your friend does seem to be showing symptoms of anorexia nervosa.   Individuals with anorexia do not eat enough to maintain their weight, resulting in significant and unhealthy weight loss.  Despite being too thin, they have an intense fear of gaining weight and perceive themselves as being overweight.   Excessive exercise can also be a component.

Bulimia nervosa involves episodes of binging followed by purging in an attempt to get rid of the food.  During periods of binging, the individual feels out of control with her eating, unable to stop.  Purging can take a variety of forms, including vomiting, using laxatives, diuretics or dieting pills, or participating in excessive exercise.  Women with bulimia may be normal weight or overweight.

Binge-eating disorder is the newest recognized eating disorder.  Women with binge-eating disorder also have episodes of uncontrolled eating, but, unlike those with bulimia, they do not purge afterwards.  As with bulimia, women with binge-eating disorder may be normal weight or overweight.

Collateral damage

You are right to be concerned about your friend, since eating disorders take both a physical and a psychological toll.  While the details may be different, all eating disorders are disruptive and debilitating.  Women often feel a great deal of shame surrounding their symptoms, eating in secret and attempting to hide these behaviors from friends and families.  Furthermore, eating disorders carry with them significant health risks.  Anorexia is the deadliest of all mental health disorders, but all eating disorders can cause damage to the heart, kidneys, and gastrointestinal system as well as increasing the risk of osteoporosis.

Moving forward

eating disorder 1 Eating disorders are extraordinarily frustrating for the friends and family of those affected.  It is painful to watch someone struggle, particularly when the “solution”—in this case, just eat more—seems so obvious.   However, an eating disorder is about much more than just the food, and the recovery process is never so simple or straightforward.  For those with anorexia, dieting and exercise can feel like the one thing in life that is working.  When there is so much of our life that cannot be controlled—like the dissolution of a marriage, in the case of your friend—being successful at weight loss can bring a sense of accomplishment and order.  To recover, she will need to realize that the eating disorder is controlling her life,  not the other way around. This can be a slow process, with nearly as many setbacks as steps forward.

As much as you care about your friend, she has to be the one to take those steps on the road to wellness, but you can encourage her along the way.  Find a private time to talk. You can start by expressing your concerns to her in a calm and nonjudgmental manner.  A simple “I have noticed you have lost a lot of weight and I’m concerned” can be a place to start.  You can ask her if she is concerned, but realize that she is likely to deny the problem.  Listen to what she has to say and try to avoid arguing with her or placing blame, shame, or guilt.           

Encourage her to set up an appointment with her physician.  In addition to checking on her physical health, he or she can refer her to an eating-disorder specialist.  If she would rather not go to her physician, there are also a number of websites that provide lists of specialists in your area (see below, Finding a treatment provider in your area).  There is no one-size-fits all treatment for eating disorders, and recovery often involves a team of committed professionals, including therapists, nutritionists, and psychiatrists.

As a friend, you can provide invaluable support to her throughout her recovery process.  Seeking treatment will be one of the most difficult and bravest things she does in life, but it will be worth the effort.  

Food should nourish the lives we want to live, not dictate the lives we lead.

Dr. Riddle


Finding a treatment provider in your area

National Eating Disorders Association

National Eating Disorders Collaboration

National Association of Anorexia Nervosa and Associated Disorders


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