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Starving themselves to stay in control

THE BALTIMORE SUN

Growing up, Becky Marsella was an active girl and a popular teenager. She was in the school band and had many friends. At home, she was well-loved and well-fed. Fond of comfort foods - fried-chicken, macaroni and cheese, roasts and rice and gravy - Marsella never got to be more than about 115 pounds.

Regarding her weight, she was, you might say, one of the lucky ones.

But something happened six years ago when Marsella, of Lakeland, Fla., turned 40.

Inexplicably, she says, her happy life began to feel out of control. A nagging despair crept in. Like many women, Marsella thought, "If I could just lose a little weight, I'll feel better."

So she began to walk and then to diet. Walking turned to jogging. Dieting turned to starving.

When 5-foot-6 Marsella reached a pre-pubescent 58 pounds, no one was calling her lucky anymore.

With every calorie counted and with each pound lost, Marsella was earning a spot on the fast-growing roster of women in their 30s, 40s and 50s who have developed eating disorders - long thought to be an illness that almost exclusively affected adolescents.

Experts say that adult women are developing eating disorders - such as anorexia and bulimia, as well as related illnesses, such as exercise addiction - at alarming rates.

These days, media images are sending messages that a 45-year-old body can - and should - look like a 25-year-old body.

Think Demi Moore, Goldie Hawn, Kim Cattrall, Teri Hatcher. In magazines and on television, women aren't aging gracefully. They're barely aging at all.

At the Remuda Ranch Treatment Center in Arizona - considered one of the leading treatment centers for eating disorders in the nation - doctors say they have seen the numbers of women in their 30s and 40s with newly developed disorders jump 300 percent to 400 percent in the last three years.

Dr. Harry Brandt, director of the Center for Eating Disorders at the Sheppard and Enoch Pratt Hospital in Towson, says he's seeing four to five times as many older women with eating disorders.

Because experts are calling this an "emerging phenomenon," to date there are no statistics or published studies documenting the severity of the problem. But doctors say that clinical observations indicate that adult-onset eating disorders are occurring with much greater frequency.

"It was rare in the past that we would see people in their 40s and 50s developing severe eating disorder syndromes," Brandt says. "I'm seeing many, many more now. Our society has become so appearance-conscious, we're probably recruiting people to develop eating disorders who otherwise wouldn't have even 10 years ago."

Karen L. Smith, a clinical social worker and director of Full Living: Resources for Celebrating Body and Self, an education and consulting service based in Philadelphia, says that the current beauty aesthetic of thinness is relatively new.

"It's not like everyone always thought that really skinny women were beautiful. In fact, quite the opposite," says Smith. "It's pretty unusual to have a beauty aesthetic that's emaciated. "We're supposed to get bigger as we get older. That's part of why our metabolism slows down. So the amount of dieting older women have to do to get an emaciated body, if women are trying to maintain the beauty ideal now, they're going to have to start starving themselves a little."

For many older women, however, the slow decline from a balanced diet and moderate exercise to an eating disorder had little to do with a desire to look like a Desperate Housewife. Instead, it was a feeling of desperation that spawned the disease, or a sense of hopelessness. Loss of control, most report, was the primary catalyst.

"There's not really one specific thing that set if off - depression, frustration throughout the years, little marital problems, a teenaged daughter, stress at work," says Marsella, who ended up hospitalized, and, now 46 and 80 pounds, still hasn't gotten strong enough to return to work.

"I felt like I didn't have control of my life, whether it be emotionally, physically, mentally," she adds. "This was something I could control within me that no one could take away from me."

Weak from daily meals of only handfuls of grapes and salads of iceberg lettuce, and exercising sometimes three times a day, Marsella would occasionally pass out in the shower. She had to use both hands to lift her legs when getting dressed. Still, she thought she was healthy.

"These are people whose lives feel out of control, and so they've decided to focus on their weight and their bodies," says Edward Cumella, director of research and education at Remuda Ranch Treatment Center. "[The thinking is,] if I can whip my body into control, I can feel like something is in control. Thin equals successful in our society, regardless of age."

Like Marsella, many women who develop a late-onset eating disorder have experienced feelings of extreme stress. Children have grown up and moved out. Husbands have left or died. Employers have passed them over for promotions, in favor of younger women.

"We have focused 20 years out of our lives on our children, and all of a sudden they're off to college or they're married or they have careers. And it turns out to be just you and your spouse, or if you're divorced, it's just you," says Dawn Montaner, founder and executive director of Lifelines, a foundation for eating disorders in Waco, Texas.

Some women may have struggled earlier in life with an eating disorder, or something close to it, but managed to keep it at bay with career responsibilities, motherhood or running a household. When those things are gone, or have changed significantly, many women feel the loss acutely.

"I think life has gotten much, much more complex in so many different areas. We have so many more stressors on us than even a few decades ago," says Patricia Pitts, a clinical psychologist with the Bella Vita, an eating-disorder treatment program in Philadelphia. "And when people get a little bit older, there's so much more demand on them. ... If you haven't really resolved underlying issues or trauma now ... it's a fertile ground to pull out an eating disorder."

Also, today's society seems more centered on the external, while our foremothers concentrated on the internal.

"One of the things that has changed from the '40s or '50s," says Brandt, is "if someone was trying to better themselves, they would say, 'I need to be a better friend to people. I need to learn more things. I need to do something in public service.' When you talk to people in a modern era about how they're going to better themselves, they often say, 'I'm going to lose weight. I'm going to get in shape. I'm going to change my hair and nails.' "

The good news is that women with adult-onset eating disorders can recover with appropriate treatment, which usually involves stabilizing medical concerns, such as weight loss, and then a program of intensive psychotherapy.

Some treatments may also involve various medications for underlying related issues. Antidepressants or anti-anxiety drugs are commonly prescribed.

"Most people who get treatment get better. There's hope," says Cumella.

Older women recover faster, he says, because, unlike teens and adolescents, they've had control over some important aspects of their lives before, and have experienced success.

"They've dealt with challenges. You can call on their strengths, the wisdom they've learned, raising their kids, finding a job or a mate," Cumella says. "A 16-year- old doesn't have that."

Debbie Mandel, author of Changing Habits: The Caregivers' Total Workout, says older women with eating disorders should remember all that they have accomplished and focus on what more they can still do.

"Let me do something creative instead of destructive," she says. "The kids are out of the house, maybe I'll start a business. To develop yourself, maybe you want to go back to school. Maybe you have things to contribute to the community with volunteer work. Really get to know yourself again."

Today, Becky Marsella is trying to do just that.

Her daughter is getting married next month, and she'd like to get up to 100 pounds for the wedding.

But she still struggles with food, only consuming more than 200 calories a day when she goes out to eat with her ever-encouraging husband.

Food and weight still are touchy subjects, but she likes to tell her story - including in national magazines and on TV shows - because she wants to help other women who have hit midlife and feel desperate or hopeless or out-of-control.

"I just want to be normal again. I don't want to think about food," Marsella says. "But for me, if talking about it even helps one person, then I feel like I've helped somebody. In order for me to get over this eating disorder, then I have to face it."

tanika.white@baltsun.com

Getting help

Experts say that, with treatment, people with eating disorders can get better. Here's where you can go for help if you or someone you know has an eating disorder:

National Eating Disorders Association: nationaleatingdisorders.org

Eating Disorder Referral and Information Center, an online database of eating disorder specialists: edreferral.com

Center for Eating Disorders at St. Joseph Medical Center in Towson: 410-938-5252; sjmcmd.org/eatingdisorders

An article in yesterday's Health & Science section listed an incorrect address for the Center for Eating Disorders. The center is at the Sheppard and Enoch Pratt Hospital in Towson.
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