June 12, 2007
The-F-word is pleased to offer an interview with Trisha Gura, author of the recently released book Lying in Weight.
In this groundbreaking new book, science journalist Trisha Gura, Ph.D., explodes the myth that those who suffer from eating disorders, including anorexia nervosa and bulimia nervosa, are primarily teenage girls. In reality, these diseases linger from adolescence or emerge anew in the lives of adult women in ways that we are only starting to recognize.
On the subject of eating disorders, Dr. Gura is not only an expert; she’s a survivor, having successfully managed her own anorexia as a teen and an adult. Drawing on her own experience, Gura offers the most up-to-date research and extensive interviews with clinicians and sufferers. Lying in Weight is a startling, timely and imperative investigation of what happens when girls with eating disorders grow up.
You let readers know in the introduction that you too have battled anorexia. What is your story?
My childhood was fairly “normal” And then, at 15, something went wrong.
“My thighs are too fat,” I thought. I vowed to starve. I’m an overachiever; I wanted the perfect body the way I wanted a perfect grade in Calculus. And so I dieted and exercised as I earned straight-A’s.
I did this until my freshman year of college. I came home on break a skeletal 5’4” and 89 pounds. “Anorexia,” a kind psychiatrist told my parents. After four years of therapy I graduated at a normal weight. I graduated summa cum laude. I figured the eating disorder was gone.
I figured wrong.
I wasn’t eating disorder-free any more than an alcoholic can be cured. My weight moved like a roller coaster, going up and down with the level of stress in my life. One of those stresses was marriage at the age of 25. I lost 10 pounds. But I got my Ph.D. in molecular biology.
Five years later, pregnancy brought another stress. I gave birth to a healthy 6-pound, 9-ounce girl but post-partum depression and a bitter divorce brought my weight back down again.
At that point, I finally accepted that my eating disorder had never really left me. It’s always there, lying in wait, ready to spring when I am most vulnerable.
Most eating disorders literature seems to focus on the experiences of adolescent girls with eating disorders. What led you to focus on adult women with eating disorders?
During a conversation over coffee, I spoke to a writer-colleague who told me about her eating disorder and recovery as a teenager. She relapsed in her 30s, after her first pregnancy. Her story so paralleled my own that I had to find out if we were alone in this experience. I went looking for resources that could help adult women with eating disorders like me. Astonishingly, I found none.
And so at the age of 40, I used my skills as a scientist, 15-year medical journalist, and my personal experience to write Lying in Weight.
You write: “A girl with an eating disorder is a woman prone to relapse.” What are the statistics and reasons why girls with eating disorders later relapse?
Studies show that at least two thirds of girls with eating disorders do not fully recover, even with therapy. Half of those stay sick all their lives and the other half either relapse later in life or hang onto a remnant of their problem, although not a full-blown eating disorder. This is much like an alcoholic in recovery, a “dry drunk” but still an alcoholic.
This person is vulnerable to getting sick again, just as an alcoholic can go back to the bottle.
The catalyst is a life transition – i.e. marriage, pregnancy, parenting, mid and late life. I divided my book into chapters that examine each of these life stages and how the events and changes of these times can provoke an eating disorder that is lying in wait.
This is an important insight. Therapists have overlooked the power of transition to trigger a latent eating disorder, or start one for the first time later in life; the experts have long focused on teenagers, who have not yet lived through the tumult of later life transitions. But knowing that life transitions are huge triggers can help women to fortify themselves with therapy and other support when they know a chaotic time is coming.
How do adult-onset eating disorders differ from eating disorders which develop in adolescence?
Right now we are witnessing an epidemic of adult women checking in to eating disorder treatment programs in numbers triple and quadruple those of 15 years ago. Many are getting sick for the first time. Many others are finally realizing that it’s time to stop a very long-time problem. So, because women are coming out of the closet, we are just now starting to understand the differences between eating disorders occurring earlier and later in life.
The major difference between eating disorders occurring earlier and later in life is the context. Older women have jobs and families. The costs to both are huge.
For example, in the UK, the number of people with eating disorders who are claiming “incapacity benefits” has risen by 129 percent in the last 10 years. This fraction is 19 in every 100,000 working age people, costing the equivalent of $5.4 million in the city of Norwich alone. This price tag does not include lost productivity and direct and indirect health care bills. Medical complications of eating disorders begin to skyrocket as a person gets older; the physical toll of the eating disorder eventually catches up and overwhelms a person’s health.
Later in life, a woman with an eating disorder has more at stake. She’s likely involved with a partner and responsible for children, even grandchildren. All these people get drawn into the eating disorder vortex. Healing becomes even more difficult because it has to include a web of intimate relationships, including husbands, whom I interviewed for Lying in Weight to hear their perspectives.
In your book, you estimate the numbers of people with eating disorders – 25 to 30 million according to national associations – may be off by millions. Why?
First, the diseases carry such a stigma, particularly when a person is older, like cancer, alcoholism and AIDS did, each in their time. Therefore, many people have eating disorders but are hiding out from treatment – and therefore don’t show up in the statistics.
Second, because the definitions of eating disorders are so narrow, many people have serious eating problems that cannot be counted as anorexia, bulimia, or binge eating disorders. For example, if a person weighs 85 percent of normal but does not lose her periods for three consecutive months, she cannot be counted as having anorexia. Nonetheless, even without the official label, she still has a serious, potentially life threatening, eating problem.
You introduce a term in your book: “subthreshold” eating disorders. What are subthreshold disorders, and how do they differ from diagnosed eating disorders?
At least 30 million individuals in the U.S. are diagnosed with eating disorders, including anorexia, bulimia, and binge eating disorder (which means a person binges, but does not purge). These stats do not include the millions more who have “subclinical disorders” — eating problems that involve dieting, bingeing, or purging (including overexercising) but are not serious enough to qualify for diagnosis. So if a woman binges and purges but only once a month, she does not have bulimia. She has a “subclinical” eating problem.
You cite that symptoms diagnosed as an eating disorder in an adolescent are often written off by physicians as something else when they appear in a mature woman. Are eating disorders often viewed by the medical establishment as an adolescent disease? Why?
When I ask people to tell me what they picture when I say the words, “eating disorder,” usually the answer is an image of a young, skeletal fashion model. Our society believes a myth that eating disorders are about teens who want to look like fashion models, rather than women (and some men) who fall prey to eating disorders as they pass through key life transitions. Physicians who are not trained about eating disorders also believe the fallacy. Thus, when a woman is pregnant and says that she has terrible morning sickness, a gynecologist may not think to inquire as to whether this woman has a history of bulimia. And yet, a disease called “hyperemesis gravidarum,” characterized by excessive vomiting during pregnancy, occurs 100 times more often in women with a history of bulimia. The oversight is a tragedy not only for mothers but also their unborn babies, who suffer higher rates of being born low birthweight or dying due to abortion, miscarriage, or other later term complications.
You write that you have a 12-year-old daughter. What is the likelihood that children of women with eating disorders will also develop a disorder?
Studies show that eating disorders run in families. If a person has an eating disorder, his or her relatives are 7-12 times more likely to have one compared to the relatives of a person without an eating disorder. No one has drawn a clear line saying that if a mother has an eating disorder, her daughter will most certainly get one too. But the risk is much higher of passing on the legacy. And the eating disorder passed down can be different. For example, a mother with binge eating disorder and obesity may have a daughter who gets anorexia. Overcompensation.
Was there anything that surprised you in researching for this book?
One woman acquired anorexia for the first time at the age of 68. And the oldest woman with an eating disorder was 92. Both were struggling with the difficult transitions related to late life. For example, the 68-year old was afraid that she would “run out of time: before she could put her affairs in order for her children. She said that she had “no time to eat” and subsisted on black coffee and toast. The 92-year-old believed she was “getting fat” just lying around the hospital, recovering from pneumonia. She therefore ate prunes and walked repetitive laps around her hospital ward. Clearly there is a lot more going on than teens who want to look like fashion models.
How have you been changed by writing this book?
Lying in Weight was part of the process of my real healing, which, of course, is ongoing. As I talked to each woman in the book, I saw myself. What I could become — if I truly wanted to heal — and where I would fall if I did not make my best attempt now. As interviewed every therapist and expert, read all the journal articles, I learned many of the reasons why I was suffering.
Today, I feel healthier than ever. That’s because I’ve learned to experience my body in a new way. I focus less on appearance and more on how I feel inside. Who I am, apart from weight and shape.
After keeping secrets in silence for so long, I’ve found my voice in writing Lying in Weight. To do this, I had to revisit many moments in the past. I had to accept what I’ve done. What I’ve lost. And what I’ve gained. And that is far more powerful than anything I could do on a bathroom scale.
Author Trisha Gura holds a Ph.D in molecular biology and has written extensively for such publications as Science, Nature, Scientific American, the Chicago Tribune, the Boston Globe, Child, Yoga Journal, and Health among many others. She lives in Boston with her 12-year-old daughter. Read more about Gura at her site, TrishaGura.com.