Eating Disorders
Inner Turmoil of Eating Disorders

When an eating disorder strikes the elderly, it's more deadly

Singer Karen Carpenter's death 20 years ago from an eating disorder introduced a nation to a malady bubbling beneath the surface of public awareness.

OVERWEIGHT Jeanie Smith wipes away tears as she talks about her life as a bulimic. "I'm Jeanie Smith, not bulimia. I just happen to have it," Smith noted about her slow but steady recovery.

In the years since, the medical community and the rest of us have learned much about the conditions afflicting as many as 10 million Americans today - anorexia, bulimia and binge eating - including the damage they wreak on the body.

To most, the face of eating disorders still tends to be young and female, fostered by the admitted addictions of celebrities like Princess Diana; actresses Tracey Gold, Jamie-Lynn Sigler, Courtney Thorne-Smith and Christina Ricci; singers, models and performers like Victoria Beckham, better known as Posh Spice, Carrie Otis, Paula Abdul; our own reigning Miss Ocala/Marion County Allison Kreiger - plus a raft of other high profilers.

But experts in the field are beginning to see a shift. More and more, the faces that appear in the doorways of eating disorder treatment centers belong to older Americans, those in their 50s, 60s and 70s.

They are people like Deb Cobb, a 56-year-old Ocala, Florida woman who was hospitalized last weekend. Bulimic since her teens, she remains an active bulimarexic - eating barely enough to stay alive and purging even that.

"My husband can fix eggs in the morning and I'll eat some, and then go throw them up," she says. "At one point last year I was down to 76 pounds. Right now I weigh 96 pounds, and I'm just under 5-foot-6-inches. I just stopped eating and I exercised."

Moreover, she's had two heart attacks in recent years attributed to the ravages of her condition.

"I'm going to die, and it bothers me that my family will have suffered," Cobb says.

Alarmingly, experts say eating disorders can be even more deadly in seniors like Cobb.

A University of British Columbia study in 1996 found evidence of increased anorexia among older people. The study also found that while the condition is more common in the young, "when it strikes the elderly, it is more deadly, accounting for 78 percent of all anorexia nervosa deaths."

While attention continues to focus mostly on the young, reports of older sufferers trickle in: The Guardian in England recently reported on a Laura Faulkner who died from anorexia at age 80. The International Journal of Eating Disorders not long ago published a case study of a 92-year-old New York woman diagnosed and hospitalized with anorexia.

The numbers of men, of all ages, with eating disorders also are up; by some estimates one for every four or five women.

Case in point: another Ocala, Florida resident identified only as Richard, 68. Through his adopted childhood he found comfort and escape in food. Always considered a "healthy eater," he was gifted with candy and cakes rather than "ties and shirts" and merely fed a growing, consuming food addiction that continued through high school, college and a career as dean of students and counselor at several colleges.

"I hid it really well. No one, not my family or associates, knew my inner turmoil," he says. "It's a lonely process. Most people don't want others to see the bingeing, the furtive shopping where you buy and eat a whole carton of ice cream."

But Richard emphasizes he never threw up after bingeing. Instead, he exercised until exhaustion, figuring he could burn off the excess calories that way. Today, though he doesn't follow a strict food plan, he considers himself in recovery.

Because it is an emerging trend that has yet to be studied intensively, experts don't know the extent of the problem.

"We just don't know," says Kathy Kelly, an Ocala therapist specializing in eating disorders. "Anecdotally, more and more older people with eating disorders are making their way to help. But the elderly population is still an unknown, what's going on with them."

Dr. Leonard Lado, a psychiatrist who was medical director at the Willough of Naples, a nationally regarded eating disorder treatment center, agrees, saying he too has noticed an increase in the number of older patients. Lado says 30 of his 200 patients this year, 15 percent, were age 65 or older.

"Years ago we saw only young people, but right now there are three or four people who are at least 45 or older. They look like walking cadavers," he says. "One of them has a BMI (Body Mass Index) of 10; we don't know how she's still alive, she's been restricting for about 20 years. And just this week a woman from Chicago came in with anorexia who is 75."

Dr. David Herzog, president of the Harvard Eating Disorders Center in Boston, says triggers for a disorder in an older person can include a "greater discomfort with getting older. People are fearful of their changing bodies. This is one of the ways they can manage control."

Lado says some have had a disorder all their lives and never grow out of it. Others are predisposed to a disorder and some life-altering event - the last child leaving home or the death of a spouse - triggers the latent condition, experts say. Or they just act on a lifelong distorted body image.

A DEATH AND A DISEASE

Jeanie Smith, 62, a resident of western Marion County, Florida is a lifelong sufferer. "There are many, many like me, men and people who are older, who suffer with this disease every day." Her mother was bulimic, though the condition didn't have a name then.

At 17, Smith married a man she'd known a month to escape a home poisoned by incest and constant taunting by her mother who'd tell her "I didn't want you." Still, she didn't begin to purge until she was 34 - even though through her life she found comfort in gobbling gobs of goodies.

It began Sunday, Sept. 23, 1979. Her oldest child, a 17-year-old son, Jackie, died of a brain aneurysm. "The three who were left behind were 8, 10 and 11, and the day my son died they lost the mother that they knew forever," she says. "That's when my disease that had always been there but didn't include throwing up took off in that direction."

The first time she ate in the weeks after his death "I ate so much and when I consumed so much food that my stomach hurt, I said, 'Oh, I can go throw it up, my mother did.' And it worked."

Her life from that point was one of bingeing, purging, hiding it. And nearly getting caught. She downed a dozen powered-sugar doughnuts driving home from work and put her car into a ditch as she wiped away telltale traces; she snitched cookies and candies from the Philadelphia supermarket where she was a manager, gobbling and purging them in the ladies' lounge.

"My family was fond of Entenmann's apple crumb pie. I promised I would bring one home from work, and I did. I started picking at it. And I picked and I picked and I consumed the whole pie. I couldn't throw this away in my trashcan because somebody might see it. I got back in my car and found somewhere else to throw it away. I didn't dare go back to the store where I worked; somebody might remember I'd already bought one.

"This is really crazy: Go someplace else and buy one, like anybody really cares. But this is how you're thinking," she says.

Smith would binge and purge four, five times a day, each time reveling in the euphoria of it even as she wallowed in the guilt. Experts say the episodes can be even more excessive; 40, 50, even 70 times a day is not unusual. "I'd crossed the line," she says. "I knew the restaurants that had single bathrooms so I could go pig out at the restaurant and get rid of it before I left.

"You're sick but you get sick at what you're doing," she adds. "Every time I threw up I'd say, like the drunk, 'this is the last time,' and at that moment I meant it. But I'm addicted to food, I probably have been since birth. The alcoholic can put down the booze; what about me? You have to have food."

For 10 years it continued - until a night she considered suicide. "I took every pill in my medicine cabinet and held them in my hand. I just cried and dumped them down the toilet and sat in that bathroom for the longest time just crying and crying and crying."

Treatment followed, and recovery - of a sort. "A lot of that recovery was really white-knuckling it. I had my binges and my weight went up and down, but my mind said 'you're not throwing up.' "

Six years ago she married Hal, who, they both say, was aware of her background but didn't understand the disease.

"He can eat one cookie and then put the bag down," Smith says. So he'd encourage her to eat a sandwich, other things, not realizing he was feeding her addiction. She was soon secretly bingeing and purging again - while Hal was on the golf course or sleeping. "I'd go to Publix and sit in the parking lot and eat a whole carton of ice cream," she says.

In August 2002 after an evening of bridge, Smith got up and proceeded to cram in cashews from a three-pound can. "I couldn't get them in my mouth fast enough, I was cutting the roof of my mouth." It was time to level with Hal, and return to treatment.

She found that Willough would accept Medicare - "I found only three places that would" - and soon she was there - after a final binge cycle on the drive down to Naples. During the weeks she was being treated by Lado, she discovered a spiritual purpose to her life, and Kay Sheppard's food plan.

ADDICTION

Sheppard, a certified eating disorder specialist and author of several books who lives in Palm Bay, maintains eating disorders and food addictions walk hand-in-hand. Remove the addiction, primarily by eliminating sugar, wheat and flour, and it's easier to deal with psychological and emotional causes of an eating disorder.

Other experts in the field tackle the psychological issues first; Lado now is helping his clients find their own self-healing within. Department of Health and Human Services agencies recognize there is "no universally accepted standard treatment." A 2000 report by the Office of Women's Health also notes "relapse rates for disturbed eating patterns can be very high."

"The term 'food addiction' means people's physiological and biochemical condition that creates cravings for refined carbohydrates," Sheppard says. "This craving and its underlying biochemistry is comparable to the alcoholic's craving for alcohol. It takes over your life.

"I treat people," she adds. "Part of the problem is our food is poison. Eliminate the CRAP - that's caffeine, refined foods, animal fats and processed foods. We're talking about eating whole foods, fresh foods."

Moreover, she emphasizes the precepts of 12-step recovery programs. Recovery from Food Addiction, or RFA, modeled after Alcoholics Anonymous, embraces her food plan.

Sheppard discovered her concept in the 1970s while working with addicted servicemen facing obesity problems. "We started treating them for food addiction," she says.

Today, with more than 200,000 copies of her books sold and thousands worldwide following her food plan, Sheppard is considered one in the forefront of the battle against eating disorders.

Smith is almost fanatical in her adherence to Sheppard's plan; she deviates not a whit. Earlier this month she attended a Sheppard workshop in Atlanta on coping with holiday stress, and a few weeks earlier they spent a day at Universal Studios theme park in Orlando.

"If it wasn't for her, I'd probably be dead," Smith says.

In September, Smith helped launch an RFA chapter in Ocala; it meets weekly at the TimberRidge facility on west State Road 200. Also, she's in constant phone and Internet communication with others like her around the country through The Loop bulletin board on Sheppard's Web site, offering support and encouragement. Their pleas for help and stories, hundreds of them, are reflected images of Smith's, Cobb's and Richard's.

Smith adds it's important for her recovery to tell her story, to let others, particularly older people who think they are alone, know they are not alone.

Still, even as publication of her story drew near, Smith experienced doubts. "Oh, boy, my stomach is all in a roil."

"But if my life, and what this disease has done to it, is to stand for anything, I have to do this," she adds. "Am I doing the right thing? . . Yes, I am."

Source: Oscala Star Banner

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