TO THE casual outsider, Mary's* life would have seemed normal. In her early forties, she was a single mum with a teenage daughter. She worked full-time and also helped her mother care for her sick father. She wasn't a big socialiser, but was close to her family. Had you looked closer, though, you might have seen the cracks.
She always layered her clothes, wearing several jumpers, one on top of the other. She never ate lunch in the office, claiming that she preferred to eat a big breakfast instead. She didn't go out for coffee with her colleagues, and never joined them on office nights out. When she cooked dinner for the family, she'd often remember she'd left the oven on just as she was bringing her own plate out of the kitchen, and would turn back to go and switch it off.
Still, when Mary was admitted to the Priory hospital in Glasgow suffering from anorexia nervosa and weighing little more than five stone, many of her relatives, friends and colleagues were shocked.
"I did a lot to try and hide it from people," confesses Mary who, now aged 46, has since had a further two spells in hospital and currently weighs seven stone. "I was very defensive with people who wanted to talk to me about it and very secretive about my behaviour. The first time I went into hospital, someone from my workplace told me she had no idea there was anything wrong with me. Nobody in my workplace knew at all. I would always avoid situations where there was food, because I didn't want to be put in a position where I couldn't cope with it."
Mary is one of a growing number of women over 40 who have recently come out of the shadows and admitted to struggling with an eating disorder. Anorexia and bulimia are traditionally seen as the province of teenage girls, but there is a growing understanding that they also affect older women. Although no official statistics are yet available, anecdotal evidence from doctors and clinics across the country suggests that the number of older women now being treated for eating disorders is on the increase.
"We are more and more aware of older people coming forward with eating disorders," says Mary George, spokeswoman for beat, formerly the National Eating Disorders Association. "For some, it might be something they've never managed to shake off entirely – they can be 'professional' anorexics, if you like, who have suffered in silence since their teenage years. They manage to maintain an eating disorder and still live a fairly normal life."
This was certainly the case for Mary, who first developed problems with her eating habits when she was 16.
"I was comfort eating and I became quite heavy. After about two years, something just clicked and I started controlling my food. Initially it was just (about] losing the extra weight, but it went from there.
"For years I was a functioning anorexic, bringing up my daughter and working full time. I was in denial for a lot of those years. For a long time I didn't know what was wrong with me. I knew something was wrong, but I felt incredibly isolated."
"We are seeing increased numbers in the amount of older women being presented for treatment," says Dr Alex Yellowlees, lead clinician at the eating disorders unit at the Priory hospital in Glasgow, many of whose patients are NHS referrals.
"Partly it is because, in the general population at large, there is an increased awareness of eating disorders and their nature and severity, and the fact that they don't just affect teenage girls. There is also more of an awareness among the medical profession about eating disorders. GPs and psychologists are now identifying these patients more readily than they once did and referring them for specialist treatment."
When Mary first saw a psychologist about her problems she was in her early thirties and there was far more ignorance surrounding the treatment of anorexia. "I was given antidepressants and that was really it. I just sort of went back to managing and no more." In fact she had been prescribed Prozac, which while lifting her mood, did little to address the underlying issues of her anorexia and can in fact act as an appetite suppressant.
Mary reached her lowest point about three years ago, following her first stint in hospital. "My father's health was dramatically deteriorating. I was looking after him and he eventually died. At that stage my daily diet was very bad: I might have a sachet of porridge oats with water, an Oxo cube with hot water – but I wouldn't have a whole one, I'd ration it throughout the day – and maybe a small soya dessert or pot of yoghurt. My intake was probably not much more than 500 calories a day."
Even then she didn't understand how serious the situation was. "I knew I could barely walk up and down stairs, but it crept up on me so gradually that it wasn't until I got to hospital again I realised there was a very strong chance that I would die. That bothered me, because the thought that my mother and my daughter would lose me to starvation was really distressing. By that point I really didn't care for my own sake, though."
Such rock-bottom experiences seem to be common among older women battling lifelong problems with their eating. "The situation can be that they had an eating disorder earlier on in life and something triggers it to come back," says George. "It can be a divorce, a bereavement or any sort of emotional trauma."
But as well as the number of women who have suffered from an eating disorder since their teens who are only now seeking treatment, there is also disturbing evidence that some women in their forties and fifties are developing an eating disorder for the first time.
"There is a group of older women who develop anorexia or bulimia later in life, and it tends to be down to the older celebrity role models that we have now," says George. "I'm not suggesting that is the entire cause, but you do have the Madonnas, the Sharon Stones, these slightly older role models who have the time and the money to look incredible. It puts a lot of pressure on women who think that's what they should look like." With television programmes bearing titles like 10 Years Younger, plastic surgery becoming increasingly acceptable and women in their fifties expected to look as if they are still in their thirties, it is perhaps not surprising the pressure is manifesting itself.
"There is no woman in our society today who escapes the pressure that is upon her to achieve some body ideal or even the thin ideal," says Yellowlees. "Women are under this constant pressure to be moving to some level of bodily perfection as our society sees it."
George believes this constant striving for perfection can have a devastating affect on some minds. "A lot of professional women are perfectionists, and this, unfortunately, is part and parcel of how they see perfection, in a way that others wouldn't. They have unrealistic ideals."
So what, then, is the prognosis for older women suffering from eating disorders?
"To a certain extent, the length of someone's illness can affect the outcome," says Yellowlees. "But at the same time, people can recover at any age and if they can't be completely cured in middle age then their illness can be vastly improved to a level where it barely interferes with their functioning in terms of their quality of life.
"Sometimes, older women – because they're more mature – can take more personal responsibility for their recovery. Perhaps they are in a relationship, and they're in an occupation where they are functioning in society, so they take a lot more responsibility for themselves."
For Mary, recovery has been a long road. At seven stones, she has lost weight since her last hospital visit and for now is simply trying to maintain her weight.
"It gets harder as you get older because there's more of a physical toll on your body," she says. "When you're younger you can function at a lower energy rate than when you're older. The way things are for me personally, I wonder if having a lifetime of this battle means it's just hardwired into my brain. I'm constantly sending negative messages to myself – it's the way my mind always works, so I wonder how I will manage ever to change that."
She deeply regrets not having sought help at a younger age.
"I really wish I had gone to the doctor when I was 18 years old and said, 'Look, I'm in really deep trouble. I literally cannot eat.' I think even just saying to someone 'help me' would have made a massive difference".
• *Mary's name has been changed
beatFORMERLY the Eating Disorders Association, beat provides practical and helpful advice on eating disorders to sufferers of all ages. You can call the helpline on 0845 634 1414 or visit
www.b-eat.co.uk for more information.
FoundationsA UK charity supporting healthy workplace programmes and education initiatives to promote healthy eating habits and effective weight management. Log on to
www.foundationsuk.org for more information.
National Centre for Eating DisordersPROVIDES counselling and treatment advice as well as support for carers of those with an eating disorder, and courses for people looking to train in treating eating disorders and obesity. Call 0845 838 2040 to find out more or see
www.eating-disorders.org.ukNeeds ScotlandFORMED from eating-disorder support groups in the North-East, Needs Scotland provides support, advice and group meetings for eating disorder sufferers across North-East Scotland. Look up
www.needs-scotland.org for more information.
The PrioryTHE Priory has a 22-bed eating disorders unit in its Glasgow hospital and provides specialist residential and outpatient care. Many of its patients are NHS referrals. Visit their site at
www.priorygroup.com for more information.
Centre for Eating Disorders (Scotland)A Glasgow-based organisation that provides treatment based on Cognitive Behavioural Therapy for anorexia and bulimia. Log on to
www.eatingdisordersscotland.co.uk for contact details.
Your GPOften, the first step to diagnosis and recovery is a visit to your GP. If you're worried about your eating habits then make an appointment to talk through the issues with your GP.
