‘Absolutely brutal’: The hidden group at risk of eating disorders

When Courtney Rattle found out she was pregnant at 34, she couldn’t believe it. The Blue Mountains yoga instructor, now mum to nine-month-old Anya, struggled with anorexia for more than half her life. Not only did she not menstruate for 12 years, but Rattle discovered she had an extremely low ovarian reserve in her early 30s, which she believed meant she was infertile.

“I held a lot of anger towards how much anorexia had stripped from my life, and it had taken me too long to recover,” she says of this discovery.

Courtney Rattle has spent her life battling anorexia. She is now a mother to a nine-month-old daughter, Anya.Credit: Wolter Peeters

Having moved to the Blue Mountains at 29, where she found healing and recovery in a supportive community, Rattle felt both physically and mentally well. To learn she might not be able to conceive felt like a blow after all the work she’d done to regain her health.

“Pretty much until six months into my pregnancy, there were mornings I was still waking up, pinching myself that I was pregnant because I had really created this belief that it would never, ever, ever happen to me.”

For Rattle, seeing her body change during pregnancy was a tough but ultimately empowering experience.

“I felt very free to eat. I think it was because I was growing a baby, that was the most important thing to me,” she says.

It was afterwards, in the postpartum period, that she struggled.

We tend to think of eating disorders as mainly occurring in teen girls. But a new report, published by The Butterfly Foundation last month, found pregnancy and menopause were close behind puberty as high-risk periods for eating disorders and body image issues in women. For men, body dissatisfaction was most common in young adulthood, with a small spike in middle age.

Eating disorders during pregnancy are estimated to sit at about 7.5 per cent, while almost 70 per cent of women, like Rattle, are dissatisfied with their weight and figures in the postpartum period.

“I felt sore and broken and huge still,” Rattle says of her postpartum period.

Breastfeeding was particularly difficult. She developed mastitis, and felt uncomfortable with the size of her breasts.

“It was absolutely brutal,” she says.

“After not having my period for such a long time, I felt very disconnected from my feminine traits and body acceptance and change.”

Practising yoga, talking to her parents and having open conversations with others in her community have all been beneficial to her recovery.

“It [anorexia] was keeping me in a very immature space by not wanting to have a period, not wanting to be any bigger,” she says.

“And really, what I’ve learnt is that as we mature, as women, our bodies change.”

The ‘three Ps’

While eating disorders and body dissatisfaction are governed by a complex set of factors, there are a few reasons body image disturbance may increase during the “three Ps” – puberty, pregnancy and perimenopause.

Sarah Cox, The Butterfly Foundation’s national helpline manager and a clinical psychologist, says these three stages of life are periods of great hormonal change, as well as “times of really significant shifts in personal identity and perceived self-worth and value in society”.

“In Western cultures, but other cultures as well, there is an overvaluing of youthfulness and beauty, and physical appearance as defining whether they’re seen as successful, or even worthy. So when those significant changes start happening, it can lead to the risk of turning to unhealthy coping strategies to manage weight, body size or shape.”

‘Women are incredibly confused as to whether it’s an eating disorder symptom or a menopausal symptom.’

Professor Gemma Sharp

Professor Gemma Sharp, who leads the body image and eating disorders research program at the University of Queensland, says these are all periods of significant stress, whether from the school environment, transition to parenthood, caring for children or elderly parents or career change.

While for some women, such as Rattle, pregnancy can be a period of relative “freedom” from disordered eating patterns, for others, the experience of a changing body can be distressing, Sharp says.

She says midlife can be particularly tricky, since many symptoms of perimenopause and menopause – including menstrual disturbance, mood issues and fatigue – can also be symptoms of eating disorders.

“What our research is showing [is] that women are incredibly confused as to whether it’s an eating disorder symptom or a menopausal symptom,” she says.

‘I should know better’

Sue Cody, 55, had struggled with bulimia in her 20s, but her eating disorder “went onto the backburner” when she became a mother.

“I had something to focus on other than myself,” she says.

It wasn’t until she hit her 50s and entered perimenopause – something she’d never heard of before – that her bulimia returned.

“I know it’s [menopause] another stage of life, but it’s just so daunting because you don’t know enough about it,” she says.

Cody, who lives near Warrnambool, Victoria with her husband, started to gain weight, and while her GP provided some help, she still didn’t feel she had the resources or support to cope.

An estimated 75 per cent of women aged 42 to 52 experience dissatisfaction with their bodies, and present higher rates of depressive symptoms.

Sue Cody, a 55-year-old from regional Victoria, is in recovery for bulimia and anorexia.Credit:

Her daughter had also left home for university, and then COVID hit, further shrinking her world.

“I became an empty-nester and felt like I lost my purpose in life,” she says.

Cody attempted to her take her life and ended up in hospital. In her 20s, she also attempted suicide several times.

After this, she says her bulimia morphed into anorexia, which she suspects was a way of feeling more in control.

“I felt like a freak because I thought, ‘I should know better than doing something stupid like this’,” she says.

With age, the long-term physical effects of disordered eating have begun to manifest. Some of her teeth are decaying, and her weakened bones are vulnerable to fracture – Cody cracked three ribs last year after a fall.

‘I don’t want to reach the end of my life and have any regrets.’

Sue Cody

It wasn’t until she joined a 12-week recovery pilot program with Eating Disorders Victoria last year that she met others like her. As part of the program, she continues to meet with others in recovery monthly.

“It just made me feel so much more normal and not alone,” she says.

While Cody is still in the early stages of recovery, she is looking forward to what lies ahead. Because she feels self-conscious about her body, she appears in very few family photos.

“I’ve always been the one offering to take the photo,” she says.

“[But] I don’t want to reach the end of my life and have any regrets.”

‘People are crying out for age-appropriate services’

If you are struggling with body image disturbance or an eating disorder, Cox recommends seeking support as soon as possible. The Butterfly Foundation has a free helpline, as well as information about support groups and healthcare professionals across Australia.

Cox says greater education for healthcare providers is needed to properly care for those dealing with eating disorders at all stages of life.

“There’s a lot of stigma and misconceptions among healthcare professionals around health, weight and wellness,” Cox says.

Eating disorders occur across the size spectrum, with more than half of eating disorders in Australia presenting in people of higher weight.

“We really need person-centred and appropriate care because there are a lot of people who, if they don’t fit the stereotype of what people think an eating disorder looks like, slip through the cracks or receive quite damaging care,” she says.

This includes moving away from body mass index (BMI) as a singular marker of health.

In January, 58 international and Australian experts called for a radical overhaul of the way obesity is diagnosed, including moving away from BMI as a sole marker of obesity.

Recovery programs tailored to those in midlife, and beyond, are desperately needed, Sharp says.

“What people are crying out for is age-appropriate eating disorder services,” she says.

“When you seek eating disorder care, particularly inpatient or partial day programs, it is very youth-oriented. So [older] people do not want to go to such programs.”

Sharp has led the development of a free online resource, hosted by Eating Disorders Victoria, designed for those at risk of or experiencing an eating disorder during the menopause transition.

Sharp would also like to see more funding for research programs to investigate “exactly why menopause and pregnancy are such risk periods”.

“We know a little bit more about puberty, but how do we effectively mitigate risk if we don’t exactly understand how that risk comes about?”

Lifeline 13 11 14; Butterfly National Helpline 1800 33 4673

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