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BulikNotJustTeenGirls
So another myth – that eating disorders are
somehow the province of white upper middle class teenage
girls. Another one that's got to go. The number of
middle age women that come into our clinic and say that
they went to their physician and were told by their
physician that they can't have an eating disorder because that's only for teenagers. Or the
number of guys that show up and have the courage to say,
“I think I'm suffering from this women's illness,” and
then their physician puts them through a huge battery
of tests because you can't have a teenage girl's illness.
That's the kind of things we're still running into
out there. Running into out there that we need to get
into medical education to change people's perceptions about
who is affected by these disorders. Eating disorders
absolutely do not care about your race, your ethnicity, your sex, your
socioeconomic status. They cut across all of those lines.
And so, we need to be vigilant and aware for everyone
who comes through the door who might be at risk for
these disorders. So these are the official U.S.
epidemiological statistics. So anorexia nervosa, about one
percent in females, about three percent in males. Bulimia,
about 1.5 percent in females, .5 percent in males.
Binge eating disorder as you can see is the most common
eating disorder, afflicting about 3.5 percent of
females and two percent of males. And this is just binge eating
behavior. So binge eating just as a behavior occurs in
about five percent of females and four percent of males.
That all translates to about 14 million Americans – and
that number is probably an under-estimate. And it goes
up when you include sub threshold conditions. The PIMDs down there will take you directly
to the article that I was referring to, or that I
pulled the stats from.
Okay. So this is just a little bit about men. One of the reasons that we really had no idea
how often men are afflicted by eating disorders is we
just failed to ask them the questions. When we do ask
them, they tell us. So this is a study in 1800 men in
the northwestern United States. About 26 percent
reported overeating, 20 percent talked about losing
control, which, as you remember, is the hallmark feature
of binge eating. Eight percent binge ate every week,
1.5 percent purged, and three percent used laxatives.
So we need to ask men these questions in order to elicit
this information. The only complicated thing in
assessing bulimia and binge eating disorders in men
is we found that men don't particularly like to say that
they feel ou-of-control. It's just not something that
flows naturally off their tongues. So we have to
go around that question backwards sometimes and say
things simply like, “do you ever feel like once you start
eating you just can't just stop?” It's a lot easier
for them to say yes to than actually asking the out-of-control
question.
So here are some realities. So this is a really interesting work about African-Americans
and eating disorders. So there's some suggestion
that African-Americans women might be slightly
protected against the development of anorexia, but there
are higher rates of binge eating disorder in the
African- American population. Here's a quote from Stephanie
Armstrong, "I needed to suffer in silence, that somehow
my legacy of strong, independent ancestors did not allow
me to lean on anyone outside my community. These
beliefs swallowed me up and separated me from the very
people who would've been able to help me." So there's a
second layer of shame about talking about eating
disorders in various racial and ethnic groups, especially if it doesn't jibe with what the
belief is about how you "should" feel about your body.
So eating disorders in Latinos. This is from Rosie Molinari. There is also a higher prevalence
of binge eating disorder and bulimia nervosa
in Latina women than in Caucasian women, but underutilization
is a huge problem. So we're seeing much less use
of healthcare than the prevalence would suggest.
So Rosie says, "Many Latinas report feeling caught between two standards of beauty, leaving
them either not feeling beautiful in either culture
or feeling beautiful in one, but not the other.
They feel as if they are on the precipice of judgment,
caught between American pop culture and the values
and cultural traditions of their families." I think nicely
capturing that feeling – like you have a foot in two
cultures and how that can be pulling you apart.
The LGBT community. So again, and this is another thing that has kept many from seeking
treatment. This myth that if you have an eating disorder and
you're a guy, of course you're gay because only gay
men get eating disorders. Not the case at all. So
the prevalence of eating disorders is somewhat
higher in gay than in straight men, but we don't know if
that's just because they're more comfortable disclosing
that they have an eating disorder or seeking healthcare
for it. There's no difference in prevalence between
lesbian and straight women, and the myth that only gay
men get eating disorders keep men from seeking treatment.
And Frank Bruni, one of my favorite New York Times writers, tells a wonderful story about
his development of anorexia and bulimia when he as at the
University of North Carolina. And his one quote is, "It
was Haagen-Dazs or love. I couldn't have both." But he
tells a wonderful story about how it is to be coming out
and dealing with an eating disorder as a man at the same
time.
And then there's the age myth. Back to those teenage girls. So we have become increasingly
interested, because when I opened my program in 2003,
we were wedged between a child and adolescent psychiatric
unit, because we thought most of our patients were going
to be adolescents. But within three years, over 50
percent of our patients were over the age of 30. And now,
at any given time, up to 70 percent of our patients are
women and men in middle age and beyond. So we did an online survey of over 1800 women,
ages 50 and over, just trying to find out what they're
thinking about their body image and what kind of
disordered eating behaviors they're exhibiting. Eight
percent purging in the last five years. So remember,
this is women 50 and older –3.5 percent binge eating.
Remember that's exactly the number that we saw in the
national co-morbidity study – 7.5 percent diet pills,
seven percent excessive exercise, 2.5 percent diuretics,
two percent laxatives, one percent vomiting, and 41
percent of women over 50 checked their body daily. And
this is an eating disorder behavior whereby people might
pinch fat or measure their thighs or their waists just
to see if the size is changing at all. So this is
really common behavior in mid-life women. In 62 percent, their weight or shape
negatively impacted their life. Thirty-six percent said
that they spent at least half of their time in the last
five years dieting. Seventy-nine percent said that
weight or shape affected their self-perception, and
64 said that they thought about their weight or shape
daily. This is robbing energy from a very important
productive and growing portion of the United States
population.
Why mid-life and why now? You'll find out in
a minute that genetic factors underlie risk for eating
disorders. But one of the things that's always interesting is what environmental factors
might trigger the onset of that underlying genetic predisposition.
And what we're starting to see is a lot of pressure on
middle-aged women and men not to age, and to stay fit,
and to not do what their bodies might naturally do as
they get older. Expectations of aging have shifted, and
you've probably heard this over and over again that 70
is the new 50. So the expectations are definitely there
not to age.
Three patterns. So one pattern is people might've had an eating disorder when
they were adolescents, and then it sort of went underground.
It might've smoldered for a while. They never
completely recovered. They might've gotten careers, gotten
their education, had children, and then something
happens again in mid-life, and it resurfaces. That’s
probably the biggest group.
The second group in terms of size are people who have had chronic illness all along, and
are still alive, and are still suffering from one of
the other disorders. There's a lot of crossover across
eating disorders, so someone might've had anorexia
as a teen, and then bulimia or binge eating disorder
later in their life.
And then the intriguing group are those people who really do have onset in mid-life. This
is a smaller group, but nonetheless really intriguing.
And we dig and dig, but don't necessarily find
a history in adolescence.
So some of the triggers that we're seeing when
we look at the mid-life triggers -- infidelity, empty
nest, lots of transition and loss – really captures it.
Bounce back children. You launch them, they go off to
college, they can't get a job. All of a sudden they end
up back home. Lots of issues related to unemployment, illness, or surgery. A very understudied biological
factor is peri-menopause. We're having so many women
talk to us about the impact that menopause and peri-
menopause has on their eating disorder symptoms. And
then death, retirement, and trauma – either new trauma or
reactivation of an old trauma.
And this is just a fun picture. Every once in
a while these things just jump out at me. This is sort
of a nice classic pizza making grandma. This is my
great grandmother on my dad's side. She had so many
talents. She had an ample lap. She read me lots of
books. And then I see these pictures of the weight
lifting grandma and the sort of hipster grandma. And
the title of this was "Want to Look Like This at 72?"
And I think that sort of shows how the expectations of
grandma have changed over time.