Kelly had an epiphany in her car two years ago on a lunch break.
She thought about the lifestyles of other people in their early 30s, her age. They went out. They had kids. They led full lives. When she thought about her own life, she burst into tears. Her life revolved around her binging schedule.
Kelly's plan that day: Go home after work at 2:30, binge and purge until her husband got home. Dinner with him. Binge and purge again.
Kelly, then 30, reached two conclusions in her car that day:
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The eating disorder she had since she was 15 years old could kill her.
She was the only one who could stop it.
Eating disorders among women age 30 and older in the U.S. are increasing. Some women, like Kelly of Charlotte, have suffered from an eating disorder most of their lives. For others, there's a trigger, like a divorce, or a parent's death. Many feel overwhelmed by aging and the pressure to look young.
The medical complications of eating disorders tend to worsen as women age, says Angela Redlak, a clinical psychologist at the Renfrew Center Foundation in Charlotte, where Kelly is treated. They are more prone to develop osteoporosis, dental erosion, heart disease and arthritis.
The chronic pain of these conditions causes many middle-aged women – unlike teenagers and women in their 20s – to acknowledge they have an eating disorder and seek help.
Growing up in upstate New York, Kelly says she was always about 40 pounds overweight. Her mom constantly reminded her of it by telling her she would buy her clothes if she lost weight.
When Kelly started to like boys, she noticed they weren't attracted to overweight girls. She was 15 when she read a magazine article about anorexia and bulimia and decided that would be the easiest way to get thin.
As soon as school let out for summer break after Kelly's sophomore year, she started dieting. When she went back to school in the fall, she'd lost 35 pounds. She weighed 123 pounds, a normal weight for her 5-foot, 5-inch, small-boned frame. But she didn't feel thin enough, and six months later, her weight dropped to 95 pounds. She was hospitalized and diagnosed with anorexia.
During her treatment, she met some girls with bulimia, so she started binging and purging, too. She later dropped out of the program because she didn't feel she needed help.
Kelly felt most in control of her life when she didn't eat. Kelly never met her father and was raised by her mother.
When people told her she looked too skinny, she felt emboldened to get even skinnier. Then Kelly's two best girlfriends walked away from her. Boys mocked her by making vomiting noises when she passed by in the school hall.
Once, those boys got to Kelly – or got through to her.
“I had on a bathing suit, and two guys walked by and said, ‘Oh my God, look at that girl – she looks like a skeleton,'” she said. “I thought I looked so good. It really struck a nerve. I started eating.”
She gained weight. Her life became normal. But two years later, Kelly's longtime boyfriend was killed in an ATV accident.
Kelly turned to drugs, then alcohol. She stopped eating. By the time she started starving herself, she was two months into a new relationship.
She tried hiding her disorder, but every once in a while he suspected something. She would tell him to mind his own business. “My personality was nasty, miserable, very unhappy,” Kelly said.
They never went out with other couples because Kelly's eating disorder consumed her, she says.
“I was sick of that life,” she said. “It was having no life.”
Making treatment real
Still, they married and moved to Charlotte three years ago. But Kelly's eating disorder moved with her.
A while after Kelly's lunch-break epiphany, she contacted the Renfrew Center in south Charlotte shortly after it opened in June 2007. The brick colonial-style house feels cozy rather than clinical. The rooms for group therapy are named “inspiration” and “serenity.” A wall hanging in the dining room says, “Don't postpone joy.” Rules on another wall inscribe the seriousness of that mission: Sweatshirts with pockets have to be worn inside out so women don't hide food in them.
“Eating disorders are very deceptive by nature,” says Redlak, Renfrew's clinical supervisor. To help pull women out of their disorder, Renfrew uses traditional talk therapy, group therapy, couples and family therapy.
When Kelly started going to group therapy, she was with younger girls. It made her feel bad to be reminded of how at that age, she felt invincible to the effects of eating disorders.
“I was like, ‘Look at what happens. Do you want it to follow you?'” she said. “It held me back from doing many things. I missed out on going away to school, partying, traveling.”
When Kelly was in her 20s, she wanted to be a state trooper. But when they called her to take the physical test, she declined. She knew she couldn't do it.
Looking back, she thinks she would have pursued a career had she not suffered from an eating disorder. Now she works at a delivery company.
Affecting more women
After a year of therapy, Kelly says she is finally discovering who she is.
“I realize I'm worth more than what I was doing to myself,” she said.
She and her husband travel and go out with friends. She cooks dinner for two people instead of 25, which she used to do for her binges.
Kelly says she grew out of her eating disorder. “As I got older,” she said, “it became a burden, a bad, dirty habit that needed to be broken.”
It is common for women age 30 and older to take responsibility for their disorder, says Redlak. Between 20 and 30 percent of Redlak's patients are over 30, and the number is growing.
The trend seems to be true across the country, says Cynthia Bulik, director of the eating disorders program at UNC Chapel Hill. Fifty percent of her patients are over age 30, and that number is rising, she says.
Bulik says societal pressure for lifelong thinness is prompting many women to develop the disorders later in life. It usually has a devastating effect on their families. “Partners are often beside themselves when their wife stops eating,” Bulik said. “They are often so worried about sheltering the kids from this.”
Women who are 30 and older are often more motivated than adolescents to get help, Redlak says. But they don't necessarily have better outcomes, especially if they've had an eating disorder for many years. That's true, she said, despite great strides in treatment over the past 20 years.
When Kelly was 15, she was dismissed by her dietitian and heard her doctor blame her mother for her eating disorder.
Kelly doesn't blame anyone anymore. She focuses on getting better.