What's eating us? Eating disorders among adults

Content warning: The following article contains references to eating disorders, including anorexia and bulimia, which some readers may find distressing.

Caroline Drummond-Smith’s eating disorder began at age 16 when she went to boarding school. She hated being there. “I felt so out of control, but the one thing I could control was what I ate,” recalls the 55-year-old health and wellness coach from near Frome in Somerset. “I focused on sport and decided not to eat.” 

Over the next 35 years her anorexia reared its head every time she found herself in a situation she struggled with, like a broken relationship or a skiing accident that meant she couldn’t exercise. Terrified of piling on the calories, she would restrict her eating when she got to a certain weight. “I had a lot of rules around food,” she explains. “I would eat certain foods at certain times. I could only have carbs, like bread, after 8 o’clock at night. It was totally irrational. At times my weight was life-threatening.” 

Caroline Drummond-Smith now helps other women recover from eating disorders

She tried therapy and being a day-patient at a recovery centre, which helped, but she wasn’t ready to get better. It was when she found herself at home with three teenagers during the summer holidays that the anorexia came back with a vengeance. Even her daughter saying, “I’m really scared Mummy’s going to die,” didn’t prompt her to tackle it. It had been with her so long. “Anorexia was my best friend,” says Drummond-Smith. 

But eventually she took herself in hand. Recovery, using the tools she’d learnt from her previous attempts, took four years but, at the age of 50, she was finally free of anorexia. “In retrospect, I wish I’d had support,” Drummond-Smith says. “Although I knew how to do it, it was scary.” She now helps other women recover from eating disorders. 

An estimated 1.25 million people in the UK have an eating disorder, according to Beat, the eating disorders charity. We usually associate these conditions with girls and young women, but older adults suffer too, including those in middle age and beyond. The NHS Health Survey for England 2019 found that one in six adults screened positive for a possible eating disorder. Sometimes, like Caroline Drummond-Smith, they have been suffering since adolescence. Sometimes, it develops in adulthood. “When that happens there’s a lot of shame and embarrassment,” says Drummond-Smith. “Older people think, ‘I should be able to sort it out myself.’” 

It’s not just women who are affected. Up to 25 per cent of people with eating disorders are men. As Martha Williams, Beat’s clinical advice coordinator, says: “Eating disorders do not discriminate against an individual’s age, gender or race.” 

But there’s a lot we don’t know about eating disorders. They make up around nine per cent of people with a mental health condition in the UK, yet between 2015 and 2019 they accounted for just one per cent of the UK’s mental health research funding, according to a 2021 report compiled by Beat for the All-Party Parliamentary Group on Eating Disorders. 

As a result, stigmas and old attitudes about eating disorders being self-inflicted or trivial persist. It’s often difficult to access treatment, and harder still for older people who don’t fit the stereotype of an anorexic young woman. “Adults are forced to wait too long for potentially life-saving treatment, with some waiting up to two years,” says Dr Agnes Ayton, chair of the eating disorders faculty at the Royal College of Psychiatrists.  

The coronavirus pandemic has compounded the problem. Referrals to eating disorder services have increased rapidly since the start of the pandemic. Hospitalisations are up too, yet there are fewer beds because of COVID measures, meaning even longer waiting times.  

The most common eating disorders are anorexia nervosa (not eating enough or over-exercising, or both), bulimia (eating too much and then making yourself vomit or taking laxatives to purge) and binge-eating disorder (regularly eating a lot of food in a short space of time). “We are seeing increasing numbers of older women with anorexia nervosa,” says Dr Ayton. 

Eating disorders are complex and it can be hard to pinpoint what causes them

Experts are unsure why some people develop eating disorders. “They are complex and serious mental illnesses,” says Martha Williams, “We do know they can develop due to a combination of biological, psychological and environmental factors, which can include but are not limited to genetics, abuse, grief, perfectionism, low self-esteem or big life changes such as divorce.” 

For many adults, their problem is the result of an accumulation of life events. “They have often been struggling for a while,” says Rachel Evans, a chartered psychologist who specialises in eating disorder recovery.  “It doesn’t just start.” They might have been serial dieters or even recovered from an earlier eating disorder. 

 “Many also have other psychological difficulties or disorders, such as anxiety, depression, obsessive compulsive disorder or personality disorders,” Dr Ayton points out. Cognitive behavioural and other talking therapies can be very successful, but older patients’ needs are often more complex, because their issues are so ingrained.

Sometimes they have health complications too—Caroline Drummond-Smith now has osteoporosis because of poor nutrition over many years. Adults may need a multiagency approach, involving mental health services, GPs, hospitals and social services. But treatment is vital. “If an eating disorder develops from an early age and is left untreated, then sadly that person will likely continue to suffer, and their eating disorder will follow them throughout their lifetime,” says Martha Williams. 

Sam Thomas, a 36-year-old writer from Brighton, believes lack of support for his bulimia in his teens and early 20s contributed to a later alcohol problem. At age 13 he would hide from bullies in the school toilets, binge-eat the contents of his lunchbox, then make himself sick. “The relief it gave me from that build-up of tension and anxiety, it was a cathartic experience,” he says. “I used bulimia as a weapon I could self-harm with.” 

He overcame his bulimia himself, aged 21, while still on the waiting list for counselling. Writing and volunteering at a charity he founded for men with eating disorders gave him a sense of self-worth and living with his father meant fewer opportunities to binge and purge in secret. But he started abusing alcohol instead. “If I’d had treatment when I was 16 or 18, would I have gone on to become alcohol dependent?” he wonders. “I would have had other healthier coping mechanisms.”

It can be hard for men to find the care that they urgently need

He has come across many other men whose eating disorder has gone untreated. “The services didn’t and still don’t exist,” says Thomas, who has now beaten his drink problem. “Some eating disorder units still don’t admit men.”  Policies around mixed-sex inpatient wards and the need for separate bathrooms sometimes lead to men being excluded from the care they so desperately need. 

There need to be changes in order to help all adults with an eating disorder, experts believe. Parity between adult and child and adolescent eating disorder services would be an important first step. “This must start with urgent funding to ensure more adults get timely treatment to prevent suffering, dangerous complications and avoidable deaths,” says Dr Ayton. 

“Health professionals also need proper training on eating disorders, so they can identify the signs, provide closer monitoring, discuss healthy approaches to nutrition, develop a prevention plan and refer people to more specialist help, if needed,” she adds. On average, according to Beat, medical students get less than two hours’ teaching in eating disorders. As a result, GPs often lack understanding of these complex conditions. 

Ultimately, the key to recovery is wanting to get well. “The longer you’ve had it, the more difficult it is,” says Rachel Evans. “But I tell my clients, ‘You also have the life experience and skills you can use to help you now.’”  

If you’re worried you or someone you know has an eating disorder, you can contact Beat on 0808 801 0677 or www.beateatingdisorders.org.uk

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