What finally washed away Kari Adams’s denial was the flood of tears streaming down her dad’s face. Frightened by Kari’s plunging weight, her family had been begging the 41-year-old mother of two to seek help for months. But nobody could convince Kari that anything was wrong – until she saw her dad’s tears.
“That’s when it hit me,” she said. “He never cried before in my whole life.”
Kari’s story echoes that of many other middle-aged women in America. Major transitions and traumatic mid-life events — crumbling marriages, job losses or kids going off to college — can rekindle eating disorders that had begun years before.
“It’s rare that an eating disorder shows up completely out of the blue in mid-life,” said Douglas Bunnell, vice president and director of out-patient clinical services at The Renfrew Center, where Kari eventually sought help. The more common scenario, Bunnell said, is the resurgence of a life-long problem.
Eating disorder experts are seeing more and more patients like Kari these days. The Renfrew Center has seen a 42 percent increase in the number of women over the age of 35 seeking help. That’s prompted the center to come up with a special program geared to their older patients.
Therapists focus on stressors that trigger eating disorders in adults and on the underlying issues inflaming the problem, such as anxiety. “For these people, there’s something soothing about not eating,” Bunnell said. “The eating disorder has become embedded in the way they manage anxiety.”
Though Kari had struggled with anorexia when she was younger, she’d been eating normally for years. But when her husband left, her disordered eating patterns came roaring back. “I went into fear mode,” she explained to TODAY.com. “And the disorder took over. It told me I had to be a size zero. I had to stay in these jeans.”
New research is showing that people tend not to outgrow eating disorders. A study published in July’s issue of the Journal of the American Dietetic Association found that unhealthy eating patterns that start in childhood or teen years can spill over, sometimes even intensifying, as people get older.
Data from the 10-year study that followed 2,287 teens through early adulthood showed a sharp increase with age — 8.4 percent to 20.4 percent — in the number of young women resorting to extreme measures to control their weight.
The results come as no surprise to David Sarwer, an associate professor of psychology and director of clinical services at the Center for Weight and Eating Disorders at the University of Pennsylvania School of Medicine.
“A lot of adult patients who eventually present with eating disorders have been struggling throughout adolescence and early adulthood,” he said. “They may have always been lean and very careful about what they ate. Then there is some major stressor that becomes a tipping point and this kind of sub-clinical disorder becomes full-blown.”
Kari’s unhappy and unhealthy relationship with food began early in life. She distinctly remembers when she began to obsess about her weight.
She was just 5 and sitting on her great-grandmother’s lap. After grabbing hold of little Kari’s belly baby fat, her great-grandmother intoned, “Oh boy, look at your tummy. You’re going to have to go on a diet.”
Kari was stricken. “I remember the panic I felt,” she said. “I thought, I’m going to have to go on a diet because I’m not good enough the way I am.”
Thirty-five years later, when Kari’s family finally convinced her to seek help, her anorexia had taken a toll on her health. “I was losing hair,” she told NBC’s Dr. Nancy Snyderman. “My gums were bleeding. I had broken bones. I had lost my period for three years.”
But all those symptoms seemed so insignificant at the time. “I didn’t care,” she told Snyderman. “What mattered was the scale.”
Eating disorders for many women are about control. As they see other areas of their lives spin into chaos, they turn their focus to food. “Controlling what goes in your mouth is the last line of defense any of us have,” Sarwer said. “We can be told what to do and what to think. We can be pressured in all sorts of ways. But we decide what, if anything, crosses our lips.”
The time at Renfrew is starting to pay off for Kari. She’s gained some weight and is now beginning to feel happy with the way she looks.
Her advice to other women is that you have to be comfortable in your own skin and ignore the voices screaming in your head that you must be skeletal thin.
“It never gets better,” she said. “It only gets worse. You’ll never reach a number you can be happy with. You’ll never look in the mirror and be happy with what you see.”
But there is hope, Kari said, for women with eating disorders – no matter what their age.
“Recovery is possible,” she said, “and it is so much better than living with the disease.”
Linda Carroll is a health and science writer living in New Jersey. Her work has appeared in The New York Times, Newsday, Health magazine and SmartMoney. She is co-author of the forthcoming book, "The Concussion Crisis: Anatomy of a Silent Epidemic."