Eating disorders are often considered to be a young woman’s disease, but there are other times when the risk increases.
Anyone can potentially develop an eating disorder if they are genetically predisposed. According to the National Eating Disorders Association (NEDA), 20 million women and 10 million men suffer from an eating disorder at some point in their lives, while many more suffer from body dissatisfaction and disordered eating attitudes and behaviors that don’t quite meet the clinical definition of an eating disorder.
In spite of those statistics, eating disorders are often considered to be a young woman’s disease, largely because the body changes of puberty can trigger the disorders in susceptible adolescent and teen girls. However, there are other times in a woman’s life when the risk of developing an eating disorder increases: pregnancy, midlife and the aftermath of being diagnosed with type 2 diabetes.
Pregnancy: Struggles with eating for two
While weight gain is a normal and necessary part of pregnancy, it’s hard for many women to accept that their bodies will change, said Jennifer McGurk, RDN, speaking at the annual meeting of the Academy of Nutrition and Dietetics in October. “You’re gaining weight, you’re feeling bloated, you’re feeling out of control because your body is no longer your own. It creates a ton of feelings that can cause a lot of emotional eating.”
McGurk, a New York-based registered dietitian nutritionist who specializes in eating disorders, said that 30 percent of American women don’t gain enough weight during pregnancy, and development of anorexia nervosa during pregnancy even has a name: pregorexia. The intense fear of weight gain, one of the defining characteristics of anorexia, can override a woman’s best intentions for her unborn baby. “Anorexia is not a choice, it’s not something that someone does for attention,” she said. “It is a medical, mental illness that we need to treat.”
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Many pregnant women experience morning sickness, causing nausea or vomiting that makes it difficult to eat enough during part of the day. This is a perfect setup for binging later in the day. Binge eating disorder involves frequently eating very large amounts of food while feeling out of control. This may include eating rapidly, eating until uncomfortably full, eating large amounts when you aren’t hungry — often alone, to avoid embarrassment.
Pregnancy-related food cravings and the idea of “eating for two” may also contribute to binging, especially since the most common cravings during pregnancy are for sugar and carbs. “Binges happen because of food and feelings and sometimes a little bit of both,” McGurk said. “When it comes to food, pregnancy produces cravings, real, genuine cravings for a lot of women, and it might not be the food they are used to eating.”
Eating disorders during pregnancy can harm the health of both mother and baby, and the mothers are then more likely to develop postpartum depression and anxiety. A woman who is pregnant — or considering pregnancy — while struggling with an eating disorder or disordered eating should be honest with her doctor about that fact. She will also benefit from working with a registered dietitian with expertise in eating disorders.
From diabetes to eating disorder?
Nutrition is an important part of managing type 2 diabetes, but the many food rules surrounding blood sugar management can contribute to eating disorders in susceptible individuals. “Restrictive dieting leads to binging. This doesn’t have to be a restrictive type of diet like we normally think of,” McGurk said. “This could be trying to be ‘good.’ This could be ‘I’m just watching my blood sugars,’ or ‘I’m eating clean.’ ”
Because binge eating increases caloric intake — usually from high fat, high sugar foods — it leads to weight gain, higher blood sugars and increased feelings of shame and guilt, so taking “trying to be good” too far could end up being counterproductive. Feeling out of control about your health can also lead to binging or, alternatively, to restricting. A good resource for using mindfulness, not restriction, to eat in a way that supports good blood sugar control is “Eat What You Love, Love What You Eat With Diabetes” by Michelle May, MD.
A different type of midlife crisis?
Research cited by NEDA suggests that 13 percent of women age 50 and over have symptoms of an eating disorder. Midlife changes can reawaken unresolved eating disorders from adolescence or, more often, trigger eating disorders for the first time. “We do think of puberty as a high-risk time for an eating disorder, but the high-risk time for an eating disorder is also peaking at menopause,” said Julie Duffy Dillon, RDN, a North Carolina-based registered dietitian nutritionist and host of the excellent “Love, Food” podcast.
The body changes that accompany menopause can spur an eating disorder, including a tendency to gain weight around the waist, along with other midlife changes like becoming an empty nester, retirement, or loss of a spouse to death or divorce. Additionally, many women who have been chronic dieters become frustrated that what once helped them lose weight no longer does. Dillon said that half of women in midlife report that eating produces guilt rather than pleasure, and more than half report that they are experiencing unhealthful weight control behaviors like constant dieting and over exercising.
“Women in midlife experience some typical life changes. Some are predictable, some are not. These are very stressful life experiences,” Dillon said. “What women in our culture are often hearing is to project that stress onto their bodies. If your husband has dumped you, why don’t you just join a gym? If you want to get a promotion, get a face-lift. They are not getting the support they need during these stressful times, and that is fertile ground for an eating disorder.”
This support is important, because women in midlife are more likely to experience complications from their disorder, in part because their bodies don’t recover as easily. “They’re getting sicker than people who are younger from their eating disorder,” Dillon said.