The Weight-Bearing Years and The Body Myth: The Perfect Storm of Eating Disorders and Body Image Despair in Adult Women
By Margo Maine, PhD, FAED, CEDS
The face of eating and body image disorders is no longer a young one—age does not immunize women from body image preoccupation and weight concerns. While in the past, body satisfaction increased with age, today 79% of women older than age 50 in the U.S. express significant body distress and weight preoccupation, threatening their health and well-being, with 13% admitting to current eating disorder symptoms (Gagne et al., 2012). More adult women are seeking treatment for their eating disorders than ever before (Zerbe, 2013), with one treatment center specializing in eating disorders reporting a 400% increase in admissions of patients older than 40 in the previous decade (Cumella & Kally, 2008).
In The Body Myth (Maine & Kelly, 2005), I proposed that the increase in eating disorders in adult women was the result of interactions among many complex biopsychosocial experiences, including a rapidly changing social role in a globalized, consumer culture; strict cultural standards regarding women, weight, and appearance; unattainable media images; and the fear of obesity, fueled by misinformation and a $60 billion diet industry. Today’s women are emotional and cultural immigrants living in a world of unprecedented opportunities and equally unprecedented stress, with many finding their only comfort in the rituals of disordered eating, rigid dieting, exercise, and other body obsessions. Contemporary women carry the weight of novel responsibilities in their multiple roles today, still maintaining their families and personal lives while being pressured to adapt and achieve in this new world. Developmental transitions including marriage, divorce, pregnancies, parenting, midlife, career issues, empty nesting, and retirement all create risk in an era that promotes weight loss, thinness, and a youthful appearance as the ultimate signs of success for women. Add to this the rhythmic cycles of the female body, many of which are associated with weight gain. Premenstrual bloating, pregnancy, and the slower menopausal metabolism are great challenges today. If a woman’s power is still defined in terms of beauty and a youthful body, post-pregnancy weight gain and the pounds gained at menopause are nothing less than distressing and disempowering. Young or old, women are constantly bombarded by the relentless marketing of body-change technology (e.g., pills, surgeries, exercise equipment, “cosmeceuticals”). For many, the focus on appearance and youth intensifies as their bodies age and progress through the natural stages that include weight gain, graying hair, and wrinkled skin. Thus, aging creates new vulnerabilities for body image distress and eating disorders for all contemporary women.
Although both clinical experience (Samuels & Maine, 2012) and research (Lewis & Cachelin, 2001) now tell us that disordered eating and a fear of aging go hand in hand for many women, many obstacles prevent adult women from seeking treatment. First and foremost is the lack of both professional and public recognition that eating and body image disorders occur, and occur frequently, in adult women. Add to that decades of living with the symptoms and with an unforgiving self-image, as well as the many secondary gains that extreme dieting, excessive exercise, and related behaviors can bring. Weight loss, a sculpted body, or a tightly controlled diet and exercise routine all elicit compliments and praise, no matter how self-destructive these symptoms really are. An adult patient of mine struggled early in her treatment, savoring the constant comments that she looked “just like Barbie.” Her eating disorder had reduced this woman of great substance to that plastic icon, and she feared that her “Barbie” body was the only quality that made her special or lovable. Addressing her eating disorder frightened her, but she did so bravely and found a new way to relate to her body and to her world, leaving the eating disorder and “Barbie” behind.
Shame and self-blame also create major obstacles to admitting a problem and seeking help (Maine & Kelly, 2005; Maine, 2010; Samuels & Maine, 2012). While shame is always integral to an eating disorder, for adults it is magnified exponentially, as they berate and chastise themselves for having “teenage” problems. Midlife women also have more serious everyday responsibilities, with more people to take care of and, they fear, to disappoint if they do start paying attention to themselves. Despite the long-term threat to their emotional and physical health, these women may find the ritualized behaviors associated with eating and body image disorders comforting and grounding.
In light of the medical bias that eating disorders and body image distress are adolescent phenomena, it is easy to see why we have not grasped the extent of these issues in women’s health. Globalization has unfortunately contributed to their emergence in diverse countries and cultures (Nasser & Malson, 2009), making it imperative for all mental health and medical providers to understand the risk factors, signs, and symptoms of adult eating disorders, and to develop the resources to treat them. These resources include:
- Specialized outpatient options
- Support and education for eating-disordered women in their role as mothers to enable them to act as healthy role models, to foster healthy home environments, and to keep eating disorders from becoming multigenerational
- Psychoeducation about eating disorders and inclusion in treatment for their partners, families, and significant others
- Group therapy opportunities to counter the secrecy and shame so common in adult women suffering from eating disorders
The adult women I have treated are resourceful, intelligent, and often very motivated despite years of symptoms, a deep fear they cannot get better, and a nagging question of whether they deserve a better life. Pardon the pun, but they are “hungry” for our help. We need to do everything we can to get eating disorders at and beyond midlife out of the closet and into our offices and treatment settings, to feed the desire for recovery, to starve The Body Myth, and to challenge a culture that puts women of all ages at war with their own bodies.
Cumella, E. J., & Kally, Z. (2008). Profile of 50 women with midlife-onset eating disorders. Eating Disorders: The Journal of Treatment and Prevention, 16,193-203.
Gagne, D. A., Von Holle, A., Brownley, K. A., Runfola, C.D., Hofmeier, S., Branch, K. E., & Bulik, C. M. (2012).Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study. International Journal of Eating Disorders, 45(7),832-44.
Lewis, D. M., & Cachelin, F. M. (2001). Body image, body dissatisfaction, and eating attitudes in midlife and elderly women. Eating Disorders: The Journal of Treatment and Prevention, 9,29-39.
Maine, M. (2010). The weight- bearing years: Eating disorders and body image despair in adult women. In M. Maine, B. McGilley & D. Bunnell (Eds.), Treatment of eating disorders: Bridging the research – practice gap (pp. 285-300). London, UK: Elsevier.
Maine, M., & Kelly, J. (2005). The body myth: Adult women and the pressure to be perfect. New York: John Wiley.
Nasser, M. & Malson, H. (2009). Beyond western dis/orders: Thinness and self-starvation of other-ed women. In H. Malson & M. Burns (Eds.), Critical feminist approaches to eating dis/orders (pp.74-86). London, UK: Routledge.
Samuels, K. & Maine, M. (2012). Treating eating disorders at midlife and beyond: Help, hope, and the Relational Cultural Theory. Work in Progress: No. 110. Jean Baker Miller Training Institute at Wellesley Centers for Women.
Zerbe, K. J. (2013). Late life eating disorders. Eating Disorders Review, 24 (6) pp.3-5.
About the author
A founder and adviser of the National Eating Disorders Association and founding fellow of the Academy for Eating Disorders, Dr. Maine is author of Treatment of Eating Disorders: Bridging the Research – Practice Gap; Effective Clinical Practice in the Treatment of Eating Disorders; The Body Myth; Father Hunger;and Body Wars;and senior editor of Eating Disorders: The Journal of Treatment & Prevention.The 2007 recipient of The Lori Irving Award for Excellence in Eating Disorders Prevention and Awareness, she is the 2014 designee for the NEDA Lifetime Achievement Award. A member of the Renfrew Center Foundation Conference Committee and its Clinical Excellence Board, Maine lectures nationally and internationally on eating disorders and maintains a private practice, Maine & Weinstein Specialty Group, in West Hartford, CT.