"Education, Faculty of"@en . "Educational and Counselling Psychology, and Special Education (ECPS), Department of"@en . "DSpace"@en . "UBCV"@en . "Palandra, Ashley Lauren"@en . "2015-04-14T16:43:08Z"@en . "2015"@en . "Doctor of Philosophy - PhD"@en . "University of British Columbia"@en . "To date, the vast majority of research exploring disordered eating (DE) and eating disorders (EDs) among women has been conducted with younger populations. However, a small but growing body of literature has demonstrated the increasing prevalence of eating problems among mid-life women. Despite recent scholarly interest in this area, very little is known about mid-life women\u00E2\u0080\u0099s experiences of living with eating challenges, and the meanings they attribute to this phenomenon. The current study was designed to address this gap in the literature, using a hermeneutic phenomenological methodology (van Manen, 1990). The research question that guided this inquiry was: \u00E2\u0080\u009CWhat is the meaning and experience of having a problematic relationship with food for women in mid-life?\u00E2\u0080\u009D In-depth, audio-recorded qualitative research interviews were conducted with nine women between the ages of 41 and 65. Interviews were transcribed verbatim, and a thematic analysis consistent with van Manen\u00E2\u0080\u0099s (1990) hermeneutic phenomenological approach was conducted. Six common themes emerged from the participants\u00E2\u0080\u0099 experiences of having a problematic relationship with food in mid-life: (1) Sense of Food as Comfort and a Means of Coping, (2) Sense of Guilt and Shame, (3) Sense of Needing Control, (4) Sense of Food and Eating as Addiction, (5) Sense of Pressure to Conform, and (6) Sense of Loss of Social Power and Visibility. The study findings are discussed within the context of the extant literature exploring EDs among younger and mid-life women, and similarities and differences between these demographic groups are explored. Finally, implications of the study findings for theory, research, and clinical practice are discussed."@en . "https://circle.library.ubc.ca/rest/handle/2429/52717?expand=metadata"@en . "!! A Phenomenological Analysis of Mid-life Women\u00E2\u0080\u0099s Challenges in Their Relationships with Food by Ashley Lauren Palandra B.A. York University, 2005 M.A. University of Toronto, 2006 M.A. New York University, 2010 A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Counselling Psychology) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) April 2015 \u00C2\u00A9 Ashley Lauren Palandra, 2015 ii!! Abstract To date, the vast majority of research exploring disordered eating (DE) and eating disorders (EDs) among women has been conducted with younger populations. However, a small but growing body of literature has demonstrated the increasing prevalence of eating problems among mid-life women. Despite recent scholarly interest in this area, very little is known about mid-life women\u00E2\u0080\u0099s experiences of living with eating challenges, and the meanings they attribute to this phenomenon. The current study was designed to address this gap in the literature, using a hermeneutic phenomenological methodology (van Manen, 1990). The research question that guided this inquiry was: \u00E2\u0080\u009CWhat is the meaning and experience of having a problematic relationship with food for women in mid-life?\u00E2\u0080\u009D In-depth, audio-recorded qualitative research interviews were conducted with nine women between the ages of 41 and 65. Interviews were transcribed verbatim, and a thematic analysis consistent with van Manen\u00E2\u0080\u0099s (1990) hermeneutic phenomenological approach was conducted. Six common themes emerged from the participants\u00E2\u0080\u0099 experiences of having a problematic relationship with food in mid-life: (1) Sense of Food as Comfort and a Means of Coping, (2) Sense of Guilt and Shame, (3) Sense of Needing Control, (4) Sense of Food and Eating as Addiction, (5) Sense of Pressure to Conform, and (6) Sense of Loss of Social Power and Visibility. The study findings are discussed within the context of the extant literature exploring EDs among younger and mid-life women, and similarities and differences between these demographic groups are explored. Finally, implications of the study findings for theory, research, and clinical practice are discussed. iii!! Preface This dissertation is original, unpublished, independent work by the author, A. Palandra. The current study involved human participants, and was therefore reviewed and approved by the UBC Behavioural Research Ethics Board prior to the commencement of the research. The number of the original certificate pertaining to this research is: H13-00298. iv!! Table of Contents Abstract .......................................................................................................................................... ii Preface .......................................................................................................................................... iii Table of Contents .......................................................................................................................... iv List of Tables .............................................................................................................................. viii Acknowledgements ....................................................................................................................... ix Dedication ...................................................................................................................................... xi Chapter 1: Introduction ................................................................................................................ 1 Statement of the Problem ......................................................................................................... 1 Purpose of the Current Study .................................................................................................. 6 Rationale for the Current Study .............................................................................................. 8 Chapter 2: Review of the Literature .......................................................................................... 11 Mid-life Women and Disordered Eating ............................................................................... 11 Disordered Eating among Mid-life versus Younger Women ............................................... 13 Sociocultural Influences ....................................................................................................... 14 Developmental Factors ......................................................................................................... 17 Diversity Issues .................................................................................................................... 20 In-depth Review of Extant Literature ................................................................................... 23 Summary ................................................................................................................................. 36 Chapter 3: Method ...................................................................................................................... 37 Introduction ............................................................................................................................ 37 Hermeneutic/Interpretive Phenomenology .......................................................................... 38 Feminist Research .................................................................................................................. 41 Situating the Researcher ........................................................................................................ 44 Social Locations .................................................................................................................. 45 Personal Knowledge ............................................................................................................ 45 Presuppositions and Expectations ....................................................................................... 47 Beliefs and Biases ................................................................................................................ 49 Conduct of the Research Inquiry .......................................................................................... 50 Criteria for Inclusion of Participants ................................................................................... 50 Roles and Responsibilities ................................................................................................... 52 v!! Participant Recruitment Procedures .................................................................................... 52 Data Collection Procedures ................................................................................................. 54 Data Analysis Procedures .................................................................................................... 56 Communicating the Results and Dissemination Plans ........................................................ 59 Criteria for Ensuring Rigor and Trustworthiness .............................................................. 60 Credibility ............................................................................................................................ 60 Transferability ..................................................................................................................... 61 Dependability and Confirmability ....................................................................................... 61 Resonance ............................................................................................................................ 62 Pragmatic Value .................................................................................................................. 63 Reflexivity ........................................................................................................................... 64 Ethical Considerations ........................................................................................................... 65 Study Limitations ................................................................................................................... 67 Chapter 4: Results ....................................................................................................................... 69 Summary of Demographic and Diversity-related Information .......................................... 69 Participants\u00E2\u0080\u0099 Biosynopses ...................................................................................................... 72 Geena ................................................................................................................................... 72 Charlotte .............................................................................................................................. 73 Kimberly .............................................................................................................................. 75 Suzanne ................................................................................................................................ 77 Simone ................................................................................................................................. 78 Evelyn .................................................................................................................................. 80 Janette .................................................................................................................................. 81 Carmen ................................................................................................................................ 82 Barbara ................................................................................................................................ 84 Common Themes .................................................................................................................... 86 Sense of Food as Comfort and a Means of Coping .............................................................. 87 Using Food to Cope with Emotions and Stress .................................................................... 90 Relationships with Food as Polarized and Paradoxical ........................................................ 98 Eating as a Habitual and Cyclical Pattern .......................................................................... 100 Food as Emotional Comfort ............................................................................................... 103 Sense of Guilt and Shame .................................................................................................... 105 vi!! Relentless Self-criticism ..................................................................................................... 109 Secrecy ............................................................................................................................... 114 Shame Associated with Weight Gain ................................................................................. 119 Desire to Hide their Bodies ................................................................................................ 121 Sense of Needing Control ...................................................................................................... 123 Feeling out of Control with Food ........................................................................................ 126 Trying to Establish Control Over Food and Eating ............................................................. 129 Trying to Control Body Weight .......................................................................................... 132 Sense of Food and Eating as Addiction ............................................................................... 135 Food as a Potentially Addictive Substance ......................................................................... 138 Obsession with Food and Weight ........................................................................................ 140 Resignation .......................................................................................................................... 144 Sense of Pressure to Conform .............................................................................................. 146 Perceived Pressure via Media .............................................................................................. 150 Perceived Pressure from Close Others ................................................................................ 157 Increased Pressure in Mid-life ............................................................................................. 161 Sense of Loss of Social Power and Visibility ....................................................................... 165 Chapter 5: Discussion ............................................................................................................... 171 Contextual Considerations for Interpreting the Findings ................................................. 171 Similarities and Differences in the Eating Challenges of Mid-life vs. Younger Women.174 Significant Findings ............................................................................................................... 180 Sense of Food as Comfort and a Means of Coping ............................................................. 180 Sense of Guilt and Shame .................................................................................................... 181 Sense of Needing Control .................................................................................................... 183 Sense of Food and Eating as Addiction ............................................................................... 185 Sense of Pressure to Conform ............................................................................................. 186 Sense of Loss of Social Power and Visibility ..................................................................... 198 Implications ............................................................................................................................ 190 Implications for Theory in Eating Disorders Research ....................................................... 190 Implications for Counselling Psychology/Psychologists and Clinical Practice .................. 195 Implications for Future Research ........................................................................................ 203 Personal Statement and Researcher Reflections ............................................................... 207 vii!! References .................................................................................................................................. 210 Appendix A: Descriptions of Eating Disorders & A Working Definition of \u00E2\u0080\u009CDisordered Eating\u00E2\u0080\u009D ........................................................................................................................................ 238 Appendix B: Recruitment Poster ............................................................................................. 240 Appendix C: Online and Social Media Recruitment Notice .................................................. 241 Appendix D: Telephone Screening Form ................................................................................ 242 Appendix E: Informed Consent ............................................................................................... 244 Appendix F: Orienting Statement ............................................................................................ 246 Appendix G: Sample Interview Questions .............................................................................. 247 Appendix H: Transcription Confidentiality Agreement ........................................................ 250 Appendix I: Referral List ......................................................................................................... 253 viii!! List of Tables Table 1: Basic Summary of Participants\u00E2\u0080\u0099 Demographics and Eating Challenges\u00E2\u0080\u00A6\u00E2\u0080\u00A6...\u00E2\u0080\u00A6.71 Table 2: Common Themes and Sub-Themes\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A6\u00E2\u0080\u00A686 ix!! Acknowledgements The completion of this project was, indeed, a communal effort. To my research supervisor and mentor, Dr. Judith Daniluk: Thank you for your untiring support; continued guidance, dedication and commitment as a mentor; and the assistance you have offered throughout the doctoral program \u00E2\u0080\u0093 and particularly on this project. I feel honoured to have worked with you, and I remain in awe of your incomparable abilities as a researcher, teacher, and mentor. I have admired your insight, intellect, strength, and exceptional work ethic, and you have been an inspiration and a most important role model. I will be forever thankful to/for the courageous and resilient women who volunteered to participate in this research. I am grateful to these women for inviting me into their lives and homes; their honesty, openness, and enthusiasm for this work; and for trusting me with their experiences. These women\u00E2\u0080\u0099s voices were the heart of this project, and I have been moved and changed by hearing and bearing witness to their stories. Indeed, there is great power in unsilencing women\u00E2\u0080\u0099s voices. Many thanks to my amazing committee members, Drs. Anusha Kassan and Laura Hurd Clarke. Your supportive, insightful perspectives and contributions were vital to this project, and I feel incredibly lucky to have worked with you. I have been surrounded by an extraordinary support network throughout the completion of this degree, to whom I will be forever grateful. Thank you to my brilliant and wonderful Ph.D. cohort \u00E2\u0080\u0093 Karlee Fellner, Leah Wilson, Megan Hughes-Jones, Tanya Elez, Kirby Humuinik, and Roger John \u00E2\u0080\u0093 for their unwavering love and support, and for the bonds we created throughout this journey. Thank you to all my fabulous friends and colleagues near and far for your care, support, and laughter, and especially for making each day over the past four and a half years that x!!much brighter. (A special thanks to my dear friend, Briana Brown, for witnessing my journey, and bringing \u00E2\u0080\u009Chome\u00E2\u0080\u009D all the way to Vancouver). And to my family: there are no words to express my heartfelt and deepest gratitude for all you have done for me, and for supporting my dreams without question. xi!! Dedication Dedicated to the mid-life women who participated in this research, and to all women who struggle in their relationships with food. And to my mother, who gave me wings. 1!! Chapter 1: Introduction Statement of the Problem Historically, eating disorders (EDs) were widely regarded as disorders of youth, primarily affecting female adolescents and young adult women (e.g., Bruch, 1979; Brumberg, 2000; Cosford & Arnold, 2004). This conceptualization continues to date despite the reality that disordered eating (DE), including EDs, are now impacting the lives of girls and women from increasingly diverse populations, including those of strikingly different ages and life stages (e.g., Beck, Casper, & Anderson, 1996; Bordo, 2009; Cumella & Kally, 2008b; Forman & Davis, 2005; Franko, Thompson-Brenner, Thompson, Boisseau, Davis, Forbush, et al., 2012; Joughin, Crisp, Gowers, & Bhat, 1991; Midlarsky & Nitzburg, 2008; Nasser & Malson, 2009; Striegel-Moore & Smolak, 2000). Disordered eating practices are varied, and include, but are not limited to: chronic dieting and restricted food intake, overeating/bingeing, purging and excessive exercise, and the use of diet pills and laxatives (see APA, 2000; Garfinkel, 2002; Grilo, 2002; Herzog & Eddy, 2007; Kashubeck-West & Mintz, 2001; Polivy & Herman, 2002). Importantly, DE practices and behaviours vary in severity along the continuum from normal eating to full-blown EDs (e.g., see Hesse Biber et al., 2006; Peck & Lightsey, 2008; Tylka & Subich, 1999), including anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS) \u00E2\u0080\u0093 the most common ED presentations (APA; see Appendix A for descriptions of EDs, as well as a working definition of DE)1. In addition, DE practices are observed among individuals who live with compulsive overeating, habitual dieting, and chronic restrained eating (see NEDIC, 2014). Women who live with DE, and clinically !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!1!Of!note,!given!the!pathologizing!nature!of!dominant!language!used!in!this!field!(i.e.,!\u00E2\u0080\u009Ceating!disorders,\u00E2\u0080\u009D!\u00E2\u0080\u009Cdisordered!eating\u00E2\u0080\u009D)!which!inherently!implies!\u00E2\u0080\u009Cdisorder\u00E2\u0080\u009D!within!the!individual,!less!pathologizing!language!compatible!with!a!feminist!perspective!will!be!used!interchangeably!with!dominant!language!throughout!this!document,!to!describe!women\u00E2\u0080\u0099s!difficulties!with!food!and!eating!(e.g.,!\u00E2\u0080\u009Ceating!challenges,\u00E2\u0080\u009D!\u00E2\u0080\u009Ceating!problems,\u00E2\u0080\u009D!\u00E2\u0080\u009Cproblematic!relationship!with!food\u00E2\u0080\u009D).!!!2!!diagnosable EDs, typically experience body image problems, as well as preoccupation and dissatisfaction with their body weight, shape and size (e.g., see Herzog & Eddy). The perception of DE as a younger woman\u00E2\u0080\u0099s problem is being challenged by research that is beginning to demonstrate the impact of DE in the lives of an older demographic of women \u00E2\u0080\u0093 women that historically were believed to be immune to developing such problems (e.g., see Brandsma, 2007). Although DE is still most commonly associated with, and reported by, adolescent girls and young adult women (Herzog & Eddy, 2007), emerging evidence suggests that DE frequently occurs across the lifespan, and may even present for the first time among women in their 30s, 40s and even 50s (e.g., see Brandsma; Cumella & Kally, 2008a; Cumella & Kally, 2008b; Forman & Davis, 2005). In addition, the results of one quantitative study examining DE among 125 participants in four demographic groups (i.e., adolescents, emerging adults, middle-aged adults, and later-life adults), suggest that middle-aged and older adults are experiencing EDs in numbers that approximate those reported by adolescents and young adults (Patrick & Stahl, 2009). It is becoming increasingly more apparent that \u00E2\u0080\u009Cage by itself is no barrier to the onset of EDs\u00E2\u0080\u009D (Beck, Casper, & Anderson, 1996, p. 389). Most notably, DE occurring in mid-life \u00E2\u0080\u0093 the developmental stage typically defined as between the ages of 40 and 65 \u00E2\u0080\u0093 appears to be an increasingly common phenomenon. Prevalence rates among women in this demographic group appear to be rising, although it remains unclear why this is the case (e.g., Brandsma, 2007). For example, the results of one longitudinal study spanning ten years has provided evidence of the drastic increase of DE behaviours among a community sample of mid-life women in Australia (Hay, Mond, Buttner, & Darby, 2008). Specifically, Hay et al. found that prevalence rates of purging and strict dieting/fasting rose from 11% to 28.6%, and 8.7% to 21.4%, respectively, between 1995 and 2005 among women between 3!!the ages of 45 and 54. In addition, rates of binge eating, purging, and strict dieting/fasting increased from 1.7% to 7.4%, 6.7% to 7.5%, and 0% to 9.7%, respectively, among women between the ages of 55 and 64 (Hay, Mond, Buttner, & Darby). Furthermore, inpatient ED treatment programs have witnessed significantly higher admission rates among mid-life women in recent years (e.g., Cumella & Kally, 2008a; Wiseman, Sunday, Klapper, Harris, & Halmi, 2001). For example, since the late 1990s the Remuda Ranch inpatient treatment facility in Arizona witnessed a 400% increase in the number of women over the age of 40 seeking treatment for an ED (Cumella & Kally, 2008a). Interestingly, prevalence rates of binge eating disorder (BED) have been found to gradually increase from adolescence to mid-life, peaking in prevalence at 8% among women between the ages of 46 and 55 (see Johnson, Spitzer, & Williams, 2001). Research has also demonstrated that increasing numbers of mid-life women are engaging in DE and other body-altering practices with the intention of losing weight (e.g., herbal supplements, diuretics, self-induced vomiting, excessive exercise, chewing and spitting, dieting, etc.) (e.g., Bedford & Johnson, 2006; Gallada, 2008; Mangweth-Matzek, Rupp, Hausmann, Assmayr, Mariacher, Kemmler, et al. 2006; McLaren & Kuh, 2004). In addition, the onset of a clinically diagnosable ED in mid-life is being reported in greater numbers (e.g., Cumella & Kally, 2008b). Importantly, the results of one quantitative study exploring prevalence rates among a community sample of 715 mid-life women, suggest that women with subthreshold ED symptomatology evidence similar levels of distress and impairment, as compared to women who meet full criteria for EDs (Mangweth-Maztek et al., 2014). Since the experience and range of DE in mid-life is an understudied phenomenon, precise estimates regarding incidence rates are currently unavailable. While there are anecdotal accounts of the consequences of body image and weight dissatisfaction among mid-life women, much of 4!!the limited available research literature on DE among this population is focused on the prevalence of full blown, diagnosed EDs. The results of several studies suggest that at least one out of every 10 individuals diagnosed with an ED is over the age of 40 (Hoek, 2006; Hoek & van Hoeken, 2003; Nielson, 2001). Providing a more conservative estimate, based on their twenty-year longitudinal study of prevalence rates of BN and EDNOS among 654 male and female participants, Keel, Gravener, Joiner, and Haedt (2010) indicate that EDs are experienced by approximately one in 20 women in their mid-life years. However, these figures do not include mid-life women who experience DE that does not fall within the diagnostic criteria for an ED. In addition, the prevalence rates for EDs among mid-life women may in fact be higher, given it is believed that EDs are underdiagnosed and underreported in this population (Hall & Driscoll, 1993; Lewis & Cachelin, 2001). In part, the underreporting of EDs is thought to be related to the failure of medical doctors to adequately recognize and screen for DE and EDs among this population (e.g., see Bulik, 2013; Zerbe, 2008). Importantly, recent research has demonstrated that physicians in Canada feel inadequately trained to assess, diagnose, and manage EDs (Lafrance, Boachie, & Lafrance, 2013), and that physicians often fail to recognize DE and EDs among mid-life women (Johnson, Spitzer, & Williams, 2001). What is clear from the available research is that the onset of a significant number of ED cases appears to be occurring after the period of peak risk (i.e., adolescence) (e.g., Keel et al., 2010). This suggests that adult women may be more vulnerable to developing problematic eating patterns throughout mid-life and perhaps even beyond, than had previously been recognized (Keel et al.). The current generation of mid-life women may be at greater risk for developing DE practices and even EDs, or experiencing the recurrence of problematic eating patterns that 5!!initially began at an earlier life stage. The reasons why this might be the case will be discussed in detail in Chapter Two. Disordered eating and the resulting weight extremes often have significant health implications, including heart problems, electrolyte imbalance, osteoporosis, endocrine and gastrointestinal abnormalities, infertility and other reproductive health concerns, and mortality (Herzog & Eddy, 2007). These implications may be even more serious for the health and well-being of women during mid-life, as they negotiate the metabolic and physical changes of the menopause and cope with other common mid-life health and lifestyle issues (e.g. raising children, dealing with aging parents, career and financial issues, weight gain, etc.). The consequences of eating challenges for mid-life women may also be exacerbated due to their vulnerability toward nutritional deficiencies (e.g., Allaz, Bernstein, Rouget, Archinard, & Morabia, 1998; Lewis & Cachelin, 2001). Importantly, EDs can also be costly for women of all ages in terms of their social and emotional consequences and sequelae (e.g., challenges with emotion regulation, mood disturbance, alexithymia, withdrawal from social relationships, decreased libido) (e.g., Dalle Grave, 2011; Harrison, Tchanturia, Naumann, & Treasure, 2012; Nowakowski, McFarlane, & Cassin, 2013; Polivy, 1996). Social and emotional difficulties associated with, and resulting from, eating challenges may have particularly important implications among mid-life women, given the nature of their relational contexts and roles (e.g., work responsibilities, parenting, negotiating romantic relationships) (Bulik, 2013). Despite the trend toward increasing numbers of mid-life women developing and coping with the range of DE practices, including EDs, academic and clinical research in this area is relatively sparse. With the prevalence of DE in mid-life possibly equaling those in younger populations, and the potentially serious health, social and emotional implications of DE 6!!behaviors for women at this life stage, there is a need for increased scholarly attention to this population (e.g., Keel, Baxter, Heatherton, & Joiner, 2007; Midlarsky & Nitzburg, 2008). There is evidence to suggest that the contextual and developmental realities of mid-life women\u00E2\u0080\u0099s lives may significantly differ from younger populations, and it remains to be determined whether the treatment models currently designed to address DE and EDs with younger populations are applicable to, and effective with, mid-life women (Zerbe, 2008; Zerbe, 2013). Despite the increased scholarly interest in mid-life women\u00E2\u0080\u0099s eating challenges, we know relatively little about this important phenomenon. The current study aimed to fill this gap in the literature by attempting to increase our understanding of the lived experience of eating challenges for women in mid-life. Purpose of the Current Study In light of the very limited research and treatment literature on the topic of eating challenges for women in mid-life, the focus of the current study was on exploring the meaning and lived experience of having a problematic relationship with food among women between 40 and 65 years of age. The question that guided this qualitative inquiry is: \u00E2\u0080\u009CWhat is the meaning and experience of having a problematic relationship with food for women in mid-life?\u00E2\u0080\u009D This research question lends itself to a phenomenological methodology, given its focus on \u00E2\u0080\u009Cexploring lived experience \u00E2\u0080\u0093 the actuality of experience \u00E2\u0080\u0093 from the inside\u00E2\u0080\u009D (Osborne, 1990, p. 168). Phenomenology is particularly appropriate when studying an experience about which little is known (van Manen, 1997), as is the case for mid-life women who are experiencing challenges in their relationship with food. This type of bottom-up research approach is also consistent with feminist theory, which informed this research. 7!! The current study was heavily grounded in, and inspired by, feminist theory. More specifically, this research was grounded in a feminist-developmental theoretical perspective (Baker Miller, 1976; Gilligan, 1982; Greene, 2003; Kaschak, 1993), which positions gender as a primary, formative factor that shapes women\u00E2\u0080\u0099s development and experiences, including women\u00E2\u0080\u0099s relationships with our bodies and with food. For example, the current study stems from the feminist tenet that body image dissatisfaction and DE behaviors are a normative response to facing certain challenges presented to girls and women living in an oppressive sociocultural milieu (e.g., the social control of women\u00E2\u0080\u0099s bodies) (Orbach, 1978). In addition, feminist theories on women\u00E2\u0080\u0099s development informed the current study by providing a developmental framework from which to understand mid-life women\u00E2\u0080\u0099s eating challenges. Given the lack of knowledge about the developmental realities of women\u00E2\u0080\u0099s lives and their relation to DE in mid-life, gaining an understanding of the developmental and contextual factors impacting mid-life women\u00E2\u0080\u0099s experiences were of importance in this research. According to Brown (1994), feminist understandings must take women\u00E2\u0080\u0099s unique contexts and experiences into account. Similarly, speaking of the importance of studying mid-life women\u00E2\u0080\u0099s lives in context, Banister (2000) suggests that an examination of \u00E2\u0080\u009Ccontextual factors helps broaden our appreciation of individuals\u00E2\u0080\u0099 unique experiences of various phenomena\u00E2\u0080\u009D (p. 747). Thus, given that the current study explored women\u00E2\u0080\u0099s lived experiences of eating challenges \u00E2\u0080\u0093 an experience influenced by sociocultural factors (e.g., see Maine & Bunnell, 2010) \u00E2\u0080\u0093 attention to contextual factors in the lives of the participants was imperative. Feminist research principles were utilized throughout all stages of the research process (e.g., Hesse-Biber & Leavy, 2007; McHugh & Cosgrove, 2004; Morowski, 2001). For example, the current study: a) prioritized, privileged, and documented women\u00E2\u0080\u0099s voices and experiences; 8!!b) was conducted using a process-oriented, bottom-up methodology; c) was grounded in non-pathologizing feminist theoretical perspectives of women\u00E2\u0080\u0099s development; d) included women in the validation of the research findings; and e) was characterized by collaborative, respectful research relationships. Rationale for the Current Study Exploring mid-life women\u00E2\u0080\u0099s experiences of living with eating challenges is an important area of scholarly inquiry for several reasons. Firstly, despite the apparent increase in the prevalence of body image dissatisfaction and DE among women beyond adolescence and young adulthood (e.g., Brandsma, 2007), this issue has been mostly overlooked in the literature, and as a result, remains largely unexplored and not well understood (e.g., see Cumella & Kally, 2008a). There still remains much to learn about the experience of eating difficulties during this later developmental period, in terms of etiology, consequences, treatment, and prognosis. At present, the extant literature in this area consists of a very small number of studies focused almost exclusively at the EDs end of the DE continuum, effectively limiting our understanding of the range of DE behaviors that may be experienced by mid-life women. Secondly, much of the limited available research has predominantly been conducted from a positivist, medical model perspective, based on a priori assumptions and utilizing quantitative methods. Qualitative research is much less common, rendering women\u00E2\u0080\u0099s perspectives on their experiences largely absent from the extant literature. In addition, our current understanding of mid-life women\u00E2\u0080\u0099s experiences of eating challenges lacks a certain depth and richness that often emerges from qualitative inquiry. Thus, the results of the current study privileged women\u00E2\u0080\u0099s voices by providing an in-depth account of their experiences from their perspectives based on the aspects of this phenomenon that they perceived as being relevant to their lives and experiences. 9!! Thirdly, much of what we know about and how we understand women\u00E2\u0080\u0099s eating challenges stems from research conducted with adolescent girls and young adult women who have been diagnosed with an ED (e.g., Smith, 2010). Consequently, there may be important age and cohort differences in the causes, prognosis, and treatment of women who experience DE in mid-life that are not currently understood (Forman & Davis, 2005). Although the medical and physiological consequences of DE are well-documented in the EDs literature (e.g., see Herzog & Eddy, 2007), and have been discussed in the context of mid-life women\u00E2\u0080\u0099s eating challenges (e.g., Allaz et al., 1998), the social and emotional consequences of eating problems among mid-life women remain largely unexplored. In addition, given the unique contextual aspects and developmental challenges during the mid-life decades, current available treatment models developed for working with adolescent girls and young women experiencing EDs may not be relevant to, or effective with mid-life women who are experiencing DE, including EDs. This point has been underscored by some ED scholars who have highlighted the importance of developing contextually relevant treatments addressing the particular needs of mid-life women presenting with DE (e.g., Zerbe, 2003; Zerbe, 2008). Without a clearer, more comprehensive understanding of the experience of eating problems during mid-life, it is not possible to provide the required, targeted support for women struggling with these challenges. Given that an increasing number of mid-life women appear to experience body dissatisfaction and engage in DE practices, it is likely that more mental health practitioners will be dealing with this issue among their mid-life clientele. In illuminating the lived experiences of mid-life women who struggle in their relationships with food, it is hoped that the results of this study may help to inform more developmentally-appropriate treatment approaches for this population. 10!! Stemming from an in-depth exploration of mid-life women\u00E2\u0080\u0099s challenges in their relationship with food, the results of this study offer important insights into this increasingly common phenomenon. In using a \u00E2\u0080\u009Cbottom-up\u00E2\u0080\u009D phenomenological approach, the findings deepen our understanding of this important phenomenon, and may serve to guide future research in this area. Consistent with extant research, the study findings highlight the ways in which the experience of eating challenges in mid-life differ from, and are similar to, the experience at earlier developmental stages. These results highlight important developmental and contextual factors that the participants perceived as having an important impact on their eating behaviours, as well as psychological, sociocultural, and relational factors they believed contributed to their problematic relationship with food. In addition, much of the extant research in the ED field does not privilege and account for the contextual and developmental realities of women\u00E2\u0080\u0099s lives which may impact the onset and experience of DE. As such, grounded in a feminist-developmental theoretical perspective, the current study aimed to increase our understanding about the contextual factors operating in mid-life women\u00E2\u0080\u0099s lives that may impact their relationship with food. Indeed, the results of this study offer support for a sociocultural understanding of the etiology and experience of EDs \u00E2\u0080\u0093 a perspective that is often marginalized in a field that, to date, has been largely dominated by the medical model (e.g., see Polivy & Herman, 2002). 11!! Chapter 2: Review of the Literature In this chapter I begin to contextualize the current study by providing a synopsis of the extant literature regarding what is known about disordered eating (DE) and eating disorders (EDs) among women in mid-life, how the experience of DE and EDs is similar to, and different from the experience of DE and EDs during adolescence and young adulthood, as well as the sociocultural context and developmental issues that are more specific to the experiences of women in mid-life. I also briefly discuss diversity issues in EDs research, and review a very small number of studies exploring DE among diverse populations that have included mid-life women as participants. As noted above, the extant literature exploring eating challenges among mid-life women has largely been conducted with women who are at the more severe end of the DE continuum \u00E2\u0080\u0093 that is, women living with anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS) and binge eating disorder (BED) \u00E2\u0080\u0093 the most common ED presentations (APA, 2000; Herzog & Eddy, 2007) (see Appendix A for descriptions of EDs and DE). As a result, this review will focus largely on the small body of extant literature exploring EDs among mid-life women. Mid-Life Women and Disordered Eating A mid-life woman may develop DE or a full-blown, clinically diagnosable ED for the first time during her mid-life years, or she may experience the re-emergence of problematic eating patterns that initially developed during an earlier life stage. Although the majority of mid-life women presenting with DE and EDs have likely struggled with eating problems for years (e.g., Kally & Cumella, 2008; Forman & Davis, 2005; Scholtz, Hill, & Lacey, 2010; Zerbe & Domnitei, 2004), cases of ED onset in mid-life are not entirely uncommon (Bueno et al., 2014; Cumella & Kally, 2008b; Hall & Driscoll, 1993; Hsu & Zimmer, 1988; Joughin, Crisp, Gowers, 12!!& Bhat, 1991; Kellett, Trimble, & Thorley, 1976). For example, more than half of the 193 mid-life women admitted to an inpatient treatment facility reported ED symptoms in adolescence and early adulthood; however, a third of these women did not report any ED-related symptoms until after the age of 30 (Forman & Davis, 2005). In another quantitative study conducted in Spain, 10% of the participant sample evidenced later age of onset (LAO) for EDs (i.e., onset over the age of 25) (Bueno et al., 2014). The women in the LAO group reported experiencing the first onset of an ED between the ages of 26 and 53. In comparison to participants who experienced ED onset at a more typical age (i.e., under 25), LAO was associated with lower levels of ED symptomatology, less self-harm behaviours, and less drug abuse (Bueno et al.). It has been suggested that etiological factors, as well as the course and duration of an ED may differ among mid-life women experiencing a first-onset ED in mid-life versus those experiencing a relapse during this developmental period (Forman & Davis, 2005). Although some scholarly work explicitly addresses differences in etiological factors implicated in the onset of DE and full-blown EDs among mid-life versus younger samples of women (e.g., Cumella & Kally, 2008a), we know relatively little about similarities and differences between these groups of mid-life women in terms of precipitating factors and triggers, as well as the relative course and duration of DE and EDs (Forman & Davis). Moreover, we do not know if/how the experience of DE differs among women presenting with DE and EDs for the first time in mid-life versus those experiencing the re-emergence of problematic eating patterns. In sum, little research has been conducted to investigate similarities and differences between these two subgroups of mid-life women living with eating challenges. 13!! Disordered Eating among Mid-life versus Younger Women Extant research investigating DE in mid-life has explored similarities and differences in how EDs are manifested in younger versus older cohorts of women. Overall, similarities have been found in the clinical presentation, predictors, etiological factors, and comorbidities associated with EDs among mid-life and younger women (e.g., Cosford & Arnold, 1992; Forman & Davis, 2005; Cumella & Kally, 2008a; Ng, Lee, & Chou, 2013; Procopio, Holm-Denoma, Gordon, & Joiner, 2006; Slevec & Tiggeman, 2010). Interestingly, the clinical presentation exhibited by girls and women living with EDs appears to be quite similar irrespective of age and life stage. While underlying causal factors may differ among different cohorts of women, it has been suggested that \u00E2\u0080\u009Ceating disorders are so powerful that they become all-consuming, regardless of phase of life\u00E2\u0080\u009D (Forman & Davis, p. 241). Among mid-life women, risk factors associated with DE and EDs include, but are not limited to, sociocultural pressures toward thinness, body image disturbance and dissatisfaction, and perfectionism \u00E2\u0080\u0093 closely paralleling those reported for younger women (Forman & Davis, 2005; Midlarsky & Nitzburg, 2008). Overall, there appears to be some agreement that younger and older women similarly use DE \u00E2\u0080\u009Cto cope with developmental challenges, identity issues, and distress\u00E2\u0080\u009D and that both younger and mid-life women \u00E2\u0080\u009Cmay be susceptible to the same cultural standards that equate self-worth with looks and thinness\u00E2\u0080\u009D (Cumella & Kally, 2008a, p. 183). Despite similarities between mid-life and younger women presenting with EDs, research has also highlighted important differences between these groups. In contrast to younger women presenting with EDs, mid-life women are significantly more likely to present with AN and EDNOS, than with BN (e.g., Cumella & Kally, 2008a; Woodside & Garfinkel, 1992). There is some evidence to suggest that mid-life women presenting with EDs may experience more 14!!attenuated symptomatology in comparison to girls and younger women (Cumella & Kally, 2008b) although contradictory research findings also exist (Cumella & Kally, 2008a). Among older cohorts of women, there appear to be differences in the way body image concerns are manifested and acted upon (Forman & Davis, 2005). For example, body image disturbances appear to be less central to the clinical picture for mid-life women living with EDs than for younger women (Forman & Davis; Cumella & Kally, 2008a). Although mid-life women may internalize the same unrealistic beauty standards upheld by North American culture, developmental tasks, as well as roles and life circumstances (e.g., financial and familial obligations), may take on more importance than body image concerns for mid-life women, in comparison to younger women whose contextual realities are typically vastly different. In addition, mid-life women may also experience more shame and embarrassment about living with eating challenges, which they may perceive as a younger person\u00E2\u0080\u0099s problem, possibly precluding efforts to seek treatment and contributing to underestimations in the prevalence of DE among women in mid-life (Cumella & Kally, 2008a). Sociocultural Influences From an early age, girls and women are socialized toward the embodiment and internalization of beauty ideals glorifying thinness. Once an expectation only for young women, in North American culture this unrealistic ideal has increasingly been promoted by the media and beauty industries (e.g. cosmetic companies; fashion industry; fitness and diet industries, etc.) as both desirable and attainable for women into their 30s, 40s and even 50s (Hesse-Biber, 2007; Marshall, Lengyel, & Utioh, 2011; Winterich, 2007; Wolf, 1990). This \u00E2\u0080\u009Cthin ideal\u00E2\u0080\u009D has proven unrealistic for the vast majority, yet many women strive toward its achievement by dieting, often unsuccessfully, which actually increases their risk of developing DE and clinically diagnosable 15!!EDs (e.g., Polivy & Herman, 1985; Stice, Marti, & Durant, 2011). Not surprisingly, many women express a \u00E2\u0080\u009Cnormative discontent\u00E2\u0080\u009D (Rodin, Silberstein, & Striegel-Moore, 1984) about their bodies \u00E2\u0080\u0093 a form of self-hatred that often begins in early adolescence and continues for many women throughout their lives (e.g., see Grippo & Hill, 2008). Unfortunately, with these changing standards and expectations, \u00E2\u0080\u009Cthe difficulty developing a healthy body image in adolescence often follows women into and throughout adulthood\u00E2\u0080\u009D (Brandsma, 2007, p. 161). As a case in point, the results of one quantitative study demonstrated that 91% of 5,868 women between the ages of 25 and 89, desired a smaller physique and struggled with body dissatisfaction (Runfola et al, 2013). Compared to girls and young women, it would appear that women in mid-life are equally susceptible to sociocultural pressures to be thin \u00E2\u0080\u0093 and that in fact these pressures have increased in the last 15 to 20 years (e.g., Forman & Davis, 2005; Marshall, Lengyel, & Utioh, 2011; Midlarsky & Nitzburg, 2008). Indeed, adult women appear to be just as preoccupied with physical appearance as younger women (Gupta & Schork, 1993). Body dissatisfaction and DE practices such as chronic dieting, are common among girls and women of all ages, including mid-life and older women (e.g., Allaz, Bernstein, Rouget, Archinard, & Morabia, 1998; Bennett & Stevens, 1996; Grippo & Hill, 2008; Hetherington, 1994; Hetherington & Burnett, 1994; Lewis & Cachelin, 2001; McKinley, 1999). For example, in a community-based population survey, approximately 75% of a sample of 1,000 women (aged 30-74) wished to be thinner despite being normal weight, and approximately half of the sample reported dieting as a means of achieving a slimmer physique (Allaz et al., 1998). The current cohort of women enter mid-life within a cultural context that privileges and reveres youthful appearances \u00E2\u0080\u0093 with the media and fitness industries promoting the thin, fit female physique as both desirable and attainable for women well into their 50s. Women are 16!!increasingly expected and encouraged to look both youthful and thin (Saucier, 2004). Yet the reality is that the aging process makes both of these ideals increasingly unrealistic (e.g., Calasanti, 2005; Marshall, Lengyel, & Utioh, 2011). The ideal body type has also become significantly thinner over time (Brown & Jacobson, 2007; Garner, Garfinkel, Schwartz, & Thompson, 1980; Sypeck, Gray, & Ahrens, 2004; Wiseman, Gray, Mosimann, & Ahrens, 1992), subjecting today\u00E2\u0080\u0099s older women to even more pressure to obtain a slim figure than they may have experienced as younger individuals (Allaz et al., 1998). Thus, it is not uncommon for women to experience an increase in body dissatisfaction as they begin to deal with the effects of the aging process that typically include weight gain, wrinkles, and greying hair (e.g., Saucier, 2004; Zerbe & Domnitei, 2004). Within this sociocultural context, as women enter mid-life they may well find themselves becoming increasingly conscious about their bodies and experience higher levels of body-related anxiety (Saucier). The increase in demand for cosmetic surgery and anti-aging products suggests that older women are becoming increasingly interested in retaining an \u00E2\u0080\u009Cattractive,\u00E2\u0080\u009D youthful appearance (Ring, 2000). Notably, women\u00E2\u0080\u0099s investment in their appearance has been cited as a significant risk factor in the development of EDs (Keith & Midlarsky, 2004). Within our ageist North American cultural climate, mid-life women may be increasingly vulnerable to developing eating challenges. As our aging population grows, our cultural obsession with youthful appearance is predicted to increase, at both media-driven and individual levels (Gupta, 1995). Not surprisingly, a fear of aging has been associated with body dissatisfaction and DE among women (Gupta, 1995; Gupta & Schork, 1993; Lewis & Cachelin, 2001; Slevec & Tiggemann, 2010; Slevec & Tiggemann, 2011; Zerbe, 2008). By internalizing ageist beauty norms, mid-life women may have difficulty constructing and maintaining positive 17!!self-perceptions and evaluations (Hurd, 2000), turning toward the pursuit of thinness and a youthful appearance, through behaviours such as dieting, purging, and excessive exercising as a way of coping with the changing social and biological realities of their lives and bodies. Within the context of a youth-oriented culture, the aging process may also trigger feelings of loss and invisibility for mid-life women (Hurd Clarke, 2001; Zerbe, 2008). In North American culture, older women are often depicted as less attractive, desirable, employable, and marriageable. As women transition to this new reality in mid-life, they may become more acutely aware of their changing social existence (e.g., Calasanti, 2005). Indeed, as they age, women begin to lose not just their youthful bodies but also their social power (Banister, 2000). Thus, by examining the sociocultural influences impacting mid-life women\u00E2\u0080\u0099s lives, we become increasingly aware that \u00E2\u0080\u009Cit is not simply low self-esteem or unconscious fantasy that makes [women] take appearance seriously\u00E2\u0080\u009D (Zerbe, 2008, p. 205). While eating difficulties in mid-life may be considered by some as a perplexing phenomenon, the rise in prevalence rates among mid-life women living with DE and EDs may become more understandable when interpreted within the context of these pervasive sociocultural influences. Developmental Factors The developmental stage of mid-life has been represented as an important period in women\u00E2\u0080\u0099s lives \u00E2\u0080\u0093 one that involves numerous, potentially challenging developmental transitions, tasks, and life changes (e.g., divorce, caring for ageing/dying parents, parenting, health issues, etc.) (Degges-White & Myers, 2006; Ingram & Fortier, 2001; Lachman, 2004). The developmental stresses related to the transitions and challenges in the middle adult years may contribute to the first-onset of an ED, or trigger a relapse for those having experienced an ED at an earlier stage of life (e.g., Cosford & Arnold, 1992; Keith & Midlarsky, 2004; Midlarsky & 18!!Nitzburg, 2008; Zerbe, 2008). Family issues (e.g., divorce, caring for aging parents, loss of a parent or sibling, children leaving home or the transition to new parenthood, etc.) and health concerns have been noted as a few of the common triggers of DE and EDs among women over the age of 40 (Kally & Cumella, 2008; Harris & Cumella, 2006). Mid-life and older women also experience unique biological and physiological changes related to age (e.g., aging bodies, health issues, pregnancy, menopause, normative weight gain) that correlate with body- and weight-dissatisfaction (Peat, Peyerl, Muehelenkamp, 2008; Slevec & Tiggemann, 2010). These factors have been identified as important predictors in the development of DE and EDs. Interestingly, the transition to middle age has been equated with the social and biological changes often experienced during the developmental phase of puberty (Crisp, 1980, as cited in Cosford & Arnold, 1992; Lewis & Cachelin, 2001). Hall and Driscoll (1993) suggest that the \u00E2\u0080\u009Cthe fear of aging and losing attractiveness and sexuality may perhaps be as traumatic as the prospect of acquiring [attractiveness and sexuality] and be dealt with by similar psychological mechanisms\u00E2\u0080\u009D (p. 498). In this developmental context when so many circumstances may seem out of her control, a mid-life woman may turn to the safety, control, and promise of eating-disordered behaviour to \u00E2\u0080\u009Cmake her life simpler, more certain, and more efficacious\u00E2\u0080\u009D (Polivy & Herman, 2002, p. 199). The onset and experience of DE and clinically diagnosable EDs in mid-life has been associated with an inability to make smooth developmental transitions, as well as difficulty mourning significant losses \u00E2\u0080\u0093 losses which may be triggered by, or result from, demands and tasks particular to this developmental and situational stage of women\u00E2\u0080\u0099s lives (e.g., death of close others, divorce, adult children leaving the family home) (Zerbe, 2003). It has been suggested that women whom feel unable to grieve, mourn, or process the losses commonly experienced in mid-19!!life may be especially vulnerable to developing DE and full-blown EDs (Zerbe). As a result, Zerbe advocates for developmentally-appropriate treatments for mid-life women presenting with eating challenges, that include a specific focus on issues related to grief and loss. There is some evidence to support this recommendation, with mid-life women receiving treatment for EDs reporting grief and loss therapy as significantly more helpful than younger patients (Forman & Davis, 2005). Broadly speaking, \u00E2\u0080\u009Cevidence-based\u00E2\u0080\u009D psychological treatments for EDs typically include a focus on the reduction of problematic eating behaviours, the development of healthy coping skills, enhancing emotion regulation, and examining the relational context of a client\u00E2\u0080\u0099s life and other triggers for problematic eating patterns (e.g., see Fairburn, 2008; Wilson, Grilo, & Vitousek, 2007). In more severe ED cases, hospitalization may be required. The primary goals of inpatient treatment programs include weight restoration and medical re-stabilization. However, with few exceptions, many \u00E2\u0080\u009Cevidence-based\u00E2\u0080\u009D treatment approaches for EDs fail to consider and address clients\u00E2\u0080\u0099 developmental and cultural contexts (see McLean, Paxton, & Werthem, 2011; Wilson, Grilo, & Vitousek). By examining DE in mid-life from a developmental perspective, several unique, contextual factors that surround the emergence of DE in mid-life women are evident. The developmental stage of mid-life typically includes a range of life experiences and biopsychosocial challenges that some women may find particularly challenging, depending on their unique circumstances, supports and coping styles. The developmental realities of mid-life women\u00E2\u0080\u0099s lives are radically different from those of adolescent girls or young adult women. Similarly, the experience of eating problems at these various life stages may have different implications for the experience, as well as treatment and recovery options. For example, a mid-life woman who is a single, working mother may not have the same ability to seek in-patient 20!!treatment for an ED \u00E2\u0080\u0093 a treatment option which may be more feasible for younger girls and women who may not have the same vocational or familial commitments. To date, the literature exploring DE in mid-life has largely failed to address mid-life women\u00E2\u0080\u0099s developmental and contextual realities as they relate to the DE experience. Of note, the findings of the current study have illuminated some of the developmental and contextual realities of mid-life women\u00E2\u0080\u0099s lives that participants perceived as having a significant impact on their eating challenges, which will be further discussed below. Diversity Issues Despite the importance of diversity and culture in women\u00E2\u0080\u0099s lives, there is a relative paucity of research exploring cultural factors in the emergence, and experience, of DE \u00E2\u0080\u0093 particularly in the literature exploring EDs among mid-life women. Broadly speaking, research exploring DE and EDs has been primarily focused on women of European descent (Talleyrand, 2012). In addition, the extant literature in this area is mixed, with some studies providing evidence of the increasing prevalence rates of EDs among minority women (e.g., Franko et al., 2012), and others pointing to the protective factors inherent in certain minority cultures against the development of EDs (e.g., Warren, Gleaves, Cepeda-Benita, del Carmen Fernandez, & Rodriguez, 2005). Nonetheless, it appears as though EDs are no longer \u00E2\u0080\u009Cjust a white girl\u00E2\u0080\u0099s thing\u00E2\u0080\u009D (Bordo, 2009, p. 46). Findings from recent research suggest that DE and EDs are affecting the lives of women from increasingly diverse backgrounds, including those identifying with racial, ethnic, sexual, and religious minority identities (e.g., Clark & Winterowd, 2012; Feldman & Meyer, 2007; Forbes, Jung, Vaamonde, Omar, Paris, & Formiga, 2012; Heffernan, 1996; Latzer, Witztum, & Stein, 2008; Nouri, Hill, & Orell-Valente, 2011). For example, EDs appear to be equally as prevalent among women of colour as compared to White women (Marques, Alegria, 21!!Becker, Chen, Chang, Chosak, et al., 2011; Talleyrand), and may be increasing in prevalence in non-Western countries (e.g., Chandra, Abbas, & Palmer, 2012). However, there may be differences in the types of DE practices that emerge among women from different backgrounds. For example, Black women appear to be more likely to develop binge eating behaviours, while there is a higher prevalence of AN among White women (e.g., Taylor, Caldwell, Baser, Faison, & Jackson, 2007). In addition, women from non-Western cultures may present with symptomatology that differs from the traditional diagnostic criteria outlined in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV; APA, 2000) (e.g., Nasser & Malson, 2009). To the best of my knowledge and based on a thorough review of the literature, there appears to be an absence of empirical work focusing exclusively on eating challenges among diverse groups of mid-life women. Nonetheless, a comprehensive literature review using a variety of search terms (e.g., \u00E2\u0080\u009Cmiddle aged,\u00E2\u0080\u009D \u00E2\u0080\u009Ceating disorders,\u00E2\u0080\u009D \u00E2\u0080\u009Cdiversity,\u00E2\u0080\u009D \u00E2\u0080\u009Cculture\u00E2\u0080\u009D) yielded a very small number of studies exploring diversity variables in EDs, which have included mid-life women in participant samples. For example, Reagan and Hersch (2005) used a population-based sample of 573 women and 360 men, ranging in age from 18 to 97, to explore gender-based and racial differences in demographic and socioeconomic correlates of binge eating. No significant differences were found in binge eating frequency between Black and White participants. Interestingly, the social environment was found to have a significantly greater impact on women than men. Specifically, among women, greater frequency of binge eating was associated with being married, experiencing depressive symptoms, and spending much of their lives in disadvantaged neighbourhoods. Relevant to the current study, the frequency of binge eating did not begin to decline among women until the end of their mid-life years (i.e., after 65 years of age). 22!! As noted above, eating challenges may present differently among women identifying with diverse cultural identities (e.g., Nasser & Malson, 2009). This finding is supported by the results of one quantitative study conducted with 205 women living in Bulgaria (aged 18 to 81) (Angelova & Utermohlen, 2013). Participants completed self-report measures assessing BMI, faith/religious beliefs, dietary restraint and ED symptomatology, body dissatisfaction, consumption of Western Media, and identification and internalization of Western beauty ideals. Consistent with research demonstrating the negative impact of the proliferation of Western beauty ideals on girls and women\u00E2\u0080\u0099s eating patterns and body image (e.g., Becker, Burwell, Gilman, Herzog, & Hamburg, 2002), higher rates of media consumption, thin-ideal internalization, and body dissatisfaction were found among women reporting DE behaviours (i.e., dieting). In addition, women who reported higher rates of eating symptomatology \u00E2\u0080\u009Cseemed inclined to employ fasting as an additional weight loss strategy and use faith to camouflage, justify, or reinforce dietary restraint\u00E2\u0080\u009D (Angelova & Utermohlen, p. 389) \u00E2\u0080\u0093 in contrast to women whose faith appeared to protect them against body image and eating challenges. Consistent with this finding, extant research has demonstrated that a strong identification with one\u00E2\u0080\u0099s culture may offer protective factors for some women (of all ages) against the development of DE (e.g., Feinson & Meir, 2012). Indeed, DE behaviours may interact in interesting ways with women\u00E2\u0080\u0099s cultural identities and beliefs, and there is evidence to suggest that some ED manifestations may be \u00E2\u0080\u009Cculture-bound syndromes\u00E2\u0080\u009D (Keel & Klump, 2003). Sexual minority status is an important diversity variable that has important implications for mental health (Meyer, 2003). Relevant to the current study, some studies exploring eating challenges among lesbian and bisexual women have included mid-life women as participants. Research in this area is mixed, with some studies demonstrating protective factors associated 23!!with sexual minority identities among women, and others finding no differences between heterosexual, lesbian and bisexual women, in terms of EDs and body image problems (e.g., see Share & Mintz, 2002). For example, in Feldman and Meyer\u00E2\u0080\u0099s (2007) study, no significant differences were found in the eating symptomatology of bisexual, lesbian, and heterosexual women. Similarly, another study exploring DE among heterosexual and lesbian women (aged 24-52) found no significant differences between these groups of women in terms of body esteem, DE, and awareness of cultural standards of female beauty (Share & Mintz). Taken as a whole, these studies offer only a beginning understanding of the complex relationship between cultural identities and DE among mid-life women. However, overall, we know relatively little about the relationship between mid-life women\u00E2\u0080\u0099s culture(s) and their eating challenges. Importantly, the dearth of studies exploring eating challenges among diverse groups of mid-life women points toward a significant gap in the extant literature to be addressed in future research. In-depth Review of Extant Literature The small body of extant literature specifically exploring DE among mid-life women is comprised of studies examining the range of DE practices, from dieting and binge-eating to full-blown, diagnosable EDs. To understand DE practices at the \u00E2\u0080\u009Cless severe\u00E2\u0080\u009D end of the DE continuum, some researchers have explored the prevalence of DE among community samples of mid-life women. The limited empirical research studies are discussed in detail below. To better understand weight dissatisfaction and dieting behaviours among mid-life and older women, Allaz, Bernstein, Rouget, Archinard, and Morabia (1998) conducted a population survey with 1,053 women living in Geneva, Switzerland. The desired weights and dieting behaviours of women between the ages of 30 and 74 were explored. In-person interviews and 24!!self-report measures were used as the primary data collection strategies. According to the results of the study, the majority of mid-life and older women in this sample expressed body dissatisfaction and engaged in dieting in an attempt to lose weight. Overall, 71% of the sample wanted to lose weight, despite the fact that 73% were at normal weight for their age and height. In an effort to lose weight, almost half of the women had dieted in the past five years. Of those who dieted 67% were of normal weight. These results underscore the high prevalence of body dissatisfaction and weight control behaviours (e.g., restrictive eating) experienced by mid-life women. Indeed, many mid-life women appear to experience the \u00E2\u0080\u0098normative discontent\u00E2\u0080\u0099 characteristic of many women\u00E2\u0080\u0099s relationships with their bodies (e.g., Rodin, Silberstein, & Strigel-Moore, 1984). Allaz et al. note the trend toward an increasingly thin beauty ideal over time, suggesting that the mid-life and older women in their sample may have experienced greater pressure toward the thin ideal in their later developmental years. As such, they concluded that the \u00E2\u0080\u009Cthe social pressure to be thin already observed in younger women [also] exists in middle-aged and older women\u00E2\u0080\u009D (p. 293). Similarly, based on a study exploring psychosocial factors associated with DE among women in mid-life, Midlarsky and Nitzburg (2008) suggest that \u00E2\u0080\u009Ccurrent cohorts [of mid-life women] may have even higher expectations regarding their own physical attractiveness (including thinness) than did past cohorts\u00E2\u0080\u009D (p. 403). The study findings suggest that factors commonly associated with DE (e.g., body dissatisfaction, sociocultural pressures to be thin, perfectionism) are observed in both mid-life and younger women. In this study, women between the ages of 45 and 60 (n=290) participated in an internet survey and completed self-report measures exploring DE symptomatology, body dissatisfaction, sociocultural pressure toward thinness, aging-related concerns about appearance, perfectionism, life stress, and depression. A 25!!multiple regression analysis was conducted to explore the extent to which sociocultural pressures, aging concerns, body dissatisfaction, perfectionism and depression were related to DE. The statistical model reached significance and accounted for 33% of the variance in DE scores. In addition, sociocultural pressures, perfectionism, and body dissatisfaction were significantly associated with DE. Using a similar methodology, McLean, Paxton and Wertheim (2010) also explored factors associated with body dissatisfaction and DE among mid-life women. The participant sample was comprised of 200 women between the ages of 35 and 65 living in Australia. Participants completed self-report measures on body dissatisfaction and DE, the importance of physical appearance, cognitive reappraisal (i.e., the degree to which participants were accepting of age-related body changes, or changed their expectations of their bodies over time), and body-related self-care (e.g., physical activity, attitudes toward the body). Self-reported estimates of height and weight were also gathered. A higher BMI was related to higher levels of DE. In addition, the results of a multiple regression analysis suggest body image attitudes, self-care, BMI and age accounted for 26 to 51% of the variance in scores on a measure of DE. The importance of appearance was also significantly related to DE among this demographic. Researchers have also investigated binge eating behaviours among community samples of mid-life women. For example, de Freitas, Appolinario, de Moura Souza, and Sichieri (2008) examined the prevalence of binge eating among a community sample of Brazilian women living in Rio de Janeiro. The total sample was comprised of 1,298 women over the age of 35 who were interviewed about their eating behaviour. A total of 679 women were between the ages of 45 and 65. Women between the ages of 45 and 54 made up the largest demographic (n=423). Of the total sample, 11.5 % engaged in regular episodes of binge-eating (two or more episodes per 26!!week), and 10.2% engaged in weight control methods such as dieting and self-induced purging behaviours. These findings are also consistent with estimates of the prevalence of full-blown EDs among mid-life women, specifically that approximately 1 in 10 women may experience a diagnosable ED in mid-life (e.g., Hoek, 2006). In contrast to the findings presented by Allaz et al. (1998) which demonstrated the high prevalence of restrictive eating among mid-life women, the findings of this study demonstrate that binge-eating behaviours may also be experienced among this demographic, suggesting that women may be susceptible to engaging in a range of DE practices in mid-life. In addition, Marcus, Bromberger, Wei, Brown & Kravitz (2007) found similar rates of binge eating in a community sample of women living in various cities across the United States. These researchers explored the prevalence of binge eating, weight control behaviours, and body dissatisfaction among a sample of 589 middle-aged women (i.e., aged 42-52). Participants completed a questionnaire designed to measure eating habits, methods of weight loss, and self-perceptions of health. Binge eating was found to be experienced by 11% of the participants. Interestingly, similar to younger populations with EDs (e.g, Fennig & Hadas, 2010; Polivy & Herman, 2002; Sanci, Coffey, Olsson, Reid, Carlin, & Patton, 2008), eating problems among these women were associated with higher rates of childhood abuse and depressive symptoms. These results suggest that mid-life women\u00E2\u0080\u0099s early experiences may play a role in the emergence and maintenance of eating challenges in various developmental stages of their lives. The results also underscore the importance of assessing past abuse and mood-related issues among mid-life women presenting for treatment for DE, and tailoring treatment accordingly. In addition, given that White, Black and Latina women evidenced equal rates of DE in this study, the results also suggest that ethnic minorities are no less likely to experience DE, in comparison to women 27!!identifying with non-minority racial and ethnic identities. Given that DE was once thought to be experienced largely by White women (e.g., Brumberg, 2000), this study supports more recent theory and research suggesting that DE is affecting the lives of increasingly diverse populations of women (e.g., Bordo, 2009). A recent study conducted by Gagne et al. (2012) explored ED symptoms and body image concerns in a community sample of 1,849 mid-life and older women (i.e., over the age of 50). Participants completed online questionnaires assessing demographic information, ED symptoms, weight control and body checking behaviours (e.g., looking in mirrors, pinching body fat), and concerns about body weight/shape. Among mid-life women between the ages of 50 and 54, 7.1% reported currently engaging in binge eating. Additionally, these women reported a history of purging in the absence of binge eating (8.1%), low BMI (18.2%), binge eating (6.2%), and binge eating and purging (2.1%). Similarly, women between the ages of 55 and 64 reported current binge eating (2.5%), and a past history of purging in the absence of binge eating (7.9%), low BMI (20.6%), binge eating (4.4%), and binge eating and purging (1.5%). In addition, a high percentage of mid-life women in both age ranges were currently trying to lose weight \u00E2\u0080\u0093 74.3% and 70.6%, respectively. Women in the younger versus older mid-life groups were found to engage in body checking behaviours (46.1% vs. 42.9%), frequently weighed themselves (35.9% vs. 40.6%), and engaged in harmful weight control practices, such as vomiting (2.3% vs. 0.7%), laxatives (3.8% vs. 1.8%), diet pills (10.8% vs. 6.7%), and excessive exercise (8.3% vs. 6.7%). A significant percentage of mid-life women in this study reported that concerns about weight and shape had a significant impact on their life (67.6% vs. 61.7%) and self-perceptions (82.2% vs. 80%), and they reported being significantly less satisfied with their overall appearance in mid-life (67.6% vs. 67.4%), in comparison to their youth. Thus, overall, younger age was found to be 28!!associated with a greater prevalence of ED symptoms among mid-life women. Interestingly, body image concerns were reported in relatively equal numbers among younger and older mid-life women, possibly signifying the importance of weight and shape among this demographic of women. Relatedly, using data from the Canadian Community Health Survey (Statistics Canada, 2002), Gadalla (2008) explored the presence of DE among a national, community sample of 9,014 Canadian women over the age of 50. The purpose of the study was to explore prevalence rates of DE, as well as the relationship between DE, and physical health and sociodemographic factors among mid-life and older women. Among mid-life women in the sample (aged 50-64), 2.6% reported DE symptomatology (e.g., dieting). In addition, 16% of these women indicated being \u00E2\u0080\u009Cstrongly\u00E2\u0080\u009D concerned about their weight/shape. Not surprisingly, stress levels were positively correlated with DE behaviours, whereas physical health was negatively correlated to DE among this demographic group. Similar to younger cohorts, mid-life women who reported living with DE also indicated a higher prevalence of anxiety and depression. Recent research has also explored the impact of media consumption on DE among mid-life women \u00E2\u0080\u0093 particularly consumption of media with thin and physically fit mid-life actresses who closely approximate cultural ideals of beauty (i.e., \u00E2\u0080\u009Caging beauty\u00E2\u0080\u009D programming) (Hefner et al., 2014). In this study, 166 mid-life women ranging in age from 30 to 66 (Mean age = 44.57, SD=10.06) completed an online questionnaire about DE, food choices, body ideals, and exposure to television programming and films, including \u00E2\u0080\u009Caging beauty\u00E2\u0080\u009D media (e.g., television shows such as Cougar Town and Hot in Cleveland). Results of this study suggest that exposure to \u00E2\u0080\u009Caging beauty\u00E2\u0080\u009D media was positively correlated with DE, dieting when in the presence of others, and body dissatisfaction. These findings support extant research that has also demonstrated 29!!positive correlations between body dissatisfaction, DE, and media exposure/consumption among mid-life women (Slevec & Tiggemann, 2011). In light of these findings, Slevec and Tiggemann (2011) demonstrated the appropriateness of extending sociocultural EDs theory to mid-life women (e.g., Thompson et al., 1999; van den Berg, Thompson, Obremski-Brandon, & Coovert, 2002). In addition to exploring DE practices at the \u00E2\u0080\u009Cless severe\u00E2\u0080\u009D of the DE continuum, researchers have also explored clinically diagnosable EDs in mid-life women. The extant literature in this area largely consists of studies conducted with women who have received a DSM-IV ED diagnosis. For example, Kally and Cumella (2008) conducted a study at the Remuda Programs for Eating Disorders \u00E2\u0080\u0093 an inpatient facility in Arizona specializing in the treatment of EDs \u00E2\u0080\u0093 exploring the etiological factors implicated in the onset of EDs among two groups of mid-life female inpatients (i.e., those whose ED onset was either above or below the age of 40). The developmental stage of mid-life was defined as between 40 and 65 years of age. Retrospective chart reviews were conducted with a total of 100 mid-life patients. Specifically, the charts of 40 women who experienced the onset of an ED after the age of 40, and 60 women who experienced the onset of an ED below the age of 40, were reviewed. Using Interpretive Phenomenological Analysis, etiological factors were classified into background contributors, immediate triggers or sustainers, as they related to mid-life women\u00E2\u0080\u0099s experiences of EDs. Regardless of age of onset, family-of-origin issues emerged as background contributors. Body image issues were also found to be major background contributors for both the younger-onset and older-onset groups of women, and were also important immediate triggers for the younger-onset patients. Family-of-choice and health issues were important background contributors and immediate triggers only for the women experiencing the onset of an ED in mid-life. These results 30!!suggest that there are both similar and different experiences that may lead to the onset of an ED among different cohorts of women. As such, the results support the notion that developmental factors may play a particularly important role in mid-life women\u00E2\u0080\u0099s experiences of DE (e.g., Zerbe, 2003). Further supporting the notion that mid-life women\u00E2\u0080\u0099s experiences with DE may differ from those of younger girls and women, another retrospective chart review conducted at the Remuda Programs for Eating Disorders found several characteristics unique to mid-life inpatients (i.e., women over the age of 40) presenting for ED treatment, as compared to younger inpatients (i.e., women between 18 and 25 years of age) (Cumella & Kally, 2008a). Of the 604 participants that comprised the study, exactly half were women in mid-life. Women in mid-life were found to receive significantly more diagnoses of AN. Compared to younger women, BN was uncommon among this group. Comorbid mood disorders, sexual abuse histories, and suicidality were higher among mid-life inpatients. Mid-life women were also found to exhibit more severe ED symptomatology, and less body image issues and distortion. Interestingly, as compared to younger inpatients, mid-life women were more likely to report using calming/sedative substances. Interestingly, in contrast to the predominance of AN among this participant sample, Mangweth-Maztek et al. (2014) found that 4.6% of a community sample of 715 mid-life women met criteria for BN, BED, or EDNOS. None of the mid-life women in their sample met criteria for AN. In addition, BED and EDNOS were the most common diagnoses among this sample of mid-life women. Discrepancies between the findings of these two studies, in terms of particular diagnoses evidenced by mid-life participants, may relate to the nature of the different participant samples (i.e., inpatients vs. women in the community). 31!! Similarly, a third study conducted by Cumella and Kally (2008b) specifically explored characteristics of mid-life women experiencing a first-onset ED. Reviewing and analyzing the information in the charts of 50 inpatients between the ages of 40 and 65, these researchers found that in comparison to younger patients presenting with EDs, mid-life patients were found to present with decreased severity of ED, anxiety and depressive symptomatology. In contrast to younger inpatients, mid-life women reported higher rates of sexual abuse histories and restrictive eating behaviours, and lower rates of Cluster C Axis II diagnoses. Thus, the decreased severity of ED symptomatology found in this study contrasts with the finding that mid-life women may experience more severe symptomatology (Cumella & Kally, 2008a). These discrepant findings may be related to the fact that these two studies explored different groups of mid-life women experiencing an ED (i.e., those presenting with an ED for the first time in mid-life, and those experiencing an ED at an earlier life stage). As a result, it appears as though the experiences of women developing an ED for the first time in mid-life may differ from those who have struggled with an ED at a different developmental life stage. Forman and Davis (2005) also set out to explore characteristics of mid-life patients seeking inpatient treatment for an ED, and to examine differences between mid-life and younger patients in terms of their characteristics and treatment experiences. Participants were 193 women admitted to an inpatient treatment facility in Philadelphia who were diagnosed with AN, BN, or EDNOS. Of the total sample, 23% of the women were in their mid-life developmental years (i.e. defined as above age 35) (n=43). Self-report measures of anxiety, depression, body image, eating attitudes, and media influence were completed upon admission and discharge. Scores on measures of eating attitudes, anxiety, and depression were comparable among mid-life and younger women at admission. Etiological factors and clinical presentation were also similar 32!!among both mid-life and younger women. However, younger patients scored significantly higher on measures of body image dissatisfaction and media influence. In addition, compared to younger patients, mid-life women reported that grief and loss and family therapies were significantly more helpful in their recovery process. Thus, similar to the findings presented by Kally and Cumella (2008), the results of this study provide support for the importance of exploring developmental factors in mid-life women\u00E2\u0080\u0099s experiences of eating challenges. A longitudinal study spanning 20 years provides evidence of clinically significant EDs among a community sample of mid-life women (Keel, Gravener, Joiner, & Haedt, 2010). Participants were college students at a university in the United States in 1982 (Mean Age = 20 +/- 2) (see Keel, Baxter, Heatherton, & Joiner, 2007). Surveys and structured clinical interviews were conducted with 465 female and 189 male (Mean Age = 40 +/2) participants at follow-up. The results of this study demonstrate that a large proportion of mid-life women diagnosed with an ED at an earlier life stage were in remission from their ED. However, 4.5% of mid-life women reported still currently experiencing a clinically significant ED. The researchers suggest that the assumption of adult roles (e.g., marriage, parenthood) were associated with the decrease in DE symptomatology observed over time among mid-life women. Ackard, Richter, Frisch, Mangham, and Cronemeyer (2013) explored changes in prevalence rates of EDs over two decades, among young adult and mid-life women. They also examined similarities and differences between these demographic groups of women, in terms of ED symptomatology. The participant sample was comprised of 1,040 young adult women (aged 18-39) and mid-life women (aged 40+) who presented for EDs treatment at an inpatient facility in Minnesota. In study 1, unique admissions by mid-life women to the Park Nicollet Melrose Institute inpatient facility between 1989 and 2006 were reviewed. The study findings 33!!demonstrated a significant increase in the percentage of mid-life women who presented for EDs treatment. Specifically, inpatient admissions among mid-life women significantly increased from an average of 4.7% between 1989 and 2001, to an average of 11% between 2002 and 2006. In study 2, younger and mid-life women admitted to the same treatment facility were compared at intake on various questionnaires measuring eating-related symptomatology, body image issues, self-esteem, depression and anxiety. No significant differences were found between mid-life and younger women on these measures. In addition, results demonstrated that at intake, mid-life women were more likely to be married, to report a longer duration of their ED, and to be older upon first onset of the ED. These results corroborate extant research that has demonstrated similarities in the clinical presentation of EDs among younger versus mid-life women (e.g., Forman & Davis, 2005). Recent research has also explored treatment outcomes for mid-life women presenting for inpatient EDs treatment (Ackard, Richter, Egan, & Cronemeyer, 2014). Ackard and colleagues (2014) sought to assess sociodemographic and clinical differences, outcome rates, and predictors of poor outcome among youth (under age 18) and young adult women (aged 18-39), versus mid-life (aged 40+) patients who sought inpatient or partial hospitalization treatment at the Park Nicollet Melrose Institute inpatient EDs treatment facility. \u00E2\u0080\u009CPoor\u00E2\u0080\u009D outcomes were determined using criteria developed by Bardone-Cone et al. (2010). The study sample consisted of 219 female patients, and 31 known female decedents. Questionnaire data measuring body shape disturbance and depression, as well as information contained in patients\u00E2\u0080\u0099 medical charts, were gathered at initial intake and subsequently analyzed. In addition, outcome data (e.g., diagnostic, sociodemographic, and treatment information; BMI; measures for eating pathology, recovery from ED, depression, anxiety, self-esteem, self-efficacy, and quality of life) was gathered 1 to 11 34!!years post-treatment. The results demonstrated that mid-life women fared significantly worse than younger patients at follow-up, in terms of quality of life, relational concerns, feelings of ineffectiveness, and psychological adjustment. Mid-life women also evidenced the highest rates of poor outcome or death. Predictors of poor outcome or death included alcohol and drug abuse, endocrine problems, older age at initial intake, and an absence of a family history of EDs. Relevant to these findings, the results of a longitudinal study demonstrated that symptoms of BN were relatively stable over a period of 2.5 years among women in mid-life (Procopio, Holm-Denoma, Gordon, & Joiner, 2006). In addition, in light of Ackard and colleagues\u00E2\u0080\u0099 (2014) finding that mid-life women evidenced poorer treatment outcomes and higher death rates, extant research exploring ED treatment patterns among younger, mid-life and older men and women has demonstrated that adults over the age of 55 are most likely to drop out of treatment prematurely (Ballard & Crane, 2014). An interesting recent study explored the impact of menopausal status on body image and EDs among a community sample of 436 mid-life women between the ages of 40 and 60 (Mangweth-Maztek et al., 2013). In this study, participants completed questionnaires assessing demographic information, BMI, ED symptomatology and menopausal symptoms, preoccupation with weight and shape, depression, and perceived health. In comparison to premenopausal women, perimenopausal women reported significantly higher rates of EDs and body disturbance. Interestingly, women who experienced surgically-induced menopause were also found to endorse higher levels of ED symptomatology and body image challenges, in comparison to premenopausal women. Mangweth and her colleagues suggest that menopause may represent a \u00E2\u0080\u009Cwindow of vulnerability\u00E2\u0080\u009D for the development of EDs and body dissatisfaction, given hormonal 35!!changes, normative weight gain, and changes in identity and self-perceptions that occur with the menopausal transition. The extant literature on the topic of mid-life women living with EDs also includes several case reports briefly outlining the histories of several women presenting with late-onset EDs, typically defined as after the age of 40 (e.g., Beck, Casper, & Anderson, 1996; Cosford & Arnold, 1992; Gupta, 1990; Hall & Driscoll, 1993; Hsu & Zimmer, 1988; Kellet, Trimble & Thorley, 1976). For example, Hall and Driscoll (1993) provide a brief synopsis of two women, aged 61 and 64, who experienced the onset of an ED in mid-life. These women engaged in DE practices such as chewing and spitting food, laxative use, dieting, and fear of fatness. In addition, Hsu and Zimmer (1988) describe the life histories of two mid-life women aged 57 and 59 living with EDs. The younger of these women had been dieting for the majority of her life, and started binge-eating in mid-life. The 59 year old woman lived with symptoms characteristic of both AN and BN for much of her life, having experienced an ED at an earlier life stage. Lastly, Gupta (1990) reports on the history of a 47 year old woman diagnosed with AN who began engaging in highly restrictive eating after a series of stressful events in mid-life (e.g., father\u00E2\u0080\u0099s illness, divorce, hearing negative comments about her appearance). Given the brevity of these case reports, they are not incredibly informative about the phenomenon of eating challenges among mid-life women. However, they do provide evidence for the occurrence of DE and EDs among mid-life women, and suggest that developmental issues and events (e.g., personal losses, parental illness, divorce, aging, etc.) may be important precipitating factors in the onset of eating problems in this demographic of women. 36!!Summary In summary, the etiological factors implicated in the onset of eating difficulties in mid-life are both similar to and different from those observed in younger cohorts of women. Mid-life women have been found to exhibit similar risk factors for DE and EDs as younger girls and women (e.g., body image dissatisfaction, sociocultural pressures toward thinness, perfectionism), but also experience unique risk factors associated with their social context and developmental life stage (e.g., fear of aging, divorce, caring for dying/aging parents, role strain, body-related changes such as weight gain, etc.). By and large, the clinical presentation of EDs is similar across age groups. However, the preponderance of certain ED diagnoses evidenced among mid-life women may differ than the types of ED manifestations most often experienced by younger women (e.g., Cumella & Kally, 2008a). To date, there exists a paucity of research exploring the efficacy of treatment approaches with mid-life women, although there is some evidence to suggest that treatment which addresses issues pertaining to grief and loss may be particularly effective for mid-life women. However, since mid-life women appear to experience greater shame and embarrassment about living with DE, they may be more reluctant to seek treatment. Although DE and EDs in mid-life have recently been receiving significantly more attention in the media and scholarly literature, the extant research exploring this topic is still quite limited. As such, the current qualitative study was designed to explore mid-life women\u00E2\u0080\u0099s lived experiences of this important phenomenon, to address this significant gap in the literature. 37!! Chapter 3: Method Introduction To date, there exists a relatively small body of extant literature focusing on the experience of eating challenges among mid-life women. Of the limited research that has been conducted on this topic, most have been conducted from a positivist perspective using quantitative methods (e.g., Forman & Davis, 2005; Midlarsky & Nitzburg, 2008). As such, the experience of eating problems for mid-life women, and how they understand this phenomenon, has yet to be explored. The current study was conducted in an effort to address this gap in the literature. Utilizing van Manen\u00E2\u0080\u0099s (1990) hermeneutic phenomenological methodology, this inquiry was guided by the following research question: \u00E2\u0080\u009CWhat is the meaning and experience of having a problematic relationship with food for women in mid-life?\u00E2\u0080\u009D The current study was grounded in feminist theory on women\u00E2\u0080\u0099s development and \u00E2\u0080\u009Ceating disorders\u00E2\u0080\u009D (EDs) (e.g., Baker Miller, 1976; Gilligan, 1982; Greene, 2003; Kaschak, 1993), and guided by feminist research principles (e.g., attention to power and voice, privileging women\u00E2\u0080\u0099s lived experiences, engaging in reflexive practice, etc.) (Hesse-Biber & Leavy, 2007; McHugh & Cosgrove, 2004; Morowski, 2001). Importantly, feminist and phenomenological research are considered compatible methodological approaches (e.g., see van Manen, 1990). For example, the reclaiming of lived experience, privileging of voice and expression, and the importance of reflexivity and suspending theoretical biases are commensurate aspects and practices of both research traditions (van Manen). The purpose of this chapter is to provide a detailed overview of the research design guiding this study. More specifically, hermeneutic/interpretive phenomenological and feminist 38!!methodologies will be outlined. In addition, the specifics of the research design and process, as well as issues related to researcher subjectivity will be addressed. Hermeneutic/Interpretive Phenomenology In phenomenological research, lived experience is the object of study (van Manen, 1990). The aim is to \u00E2\u0080\u009Cseek fresh, complex, vivid descriptions of a \u00E2\u0080\u0098phenomenon\u00E2\u0080\u0099 (a human experience in all its complexity) as it is concretely lived\u00E2\u0080\u009D (Finlay, 2009, p. 474). The phenomenological method enables the exploration of an experience \u00E2\u0080\u009Cfrom the inside\u00E2\u0080\u009D (Osborne, 1990, p. 168) and is particularly appropriate when studying an experience about which little is known (van Manen, 1997). Given that we know very little about the meaning and experience of eating problems among mid-life women, this methodology was particularly fitting for the current study. Stemming from the work of Heidegger, hermeneutic/interpretive phenomenology strives toward in-depth understandings of lived experience and its meanings (van Manen, 1997). The phenomenological researcher strives to uncover the \u00E2\u0080\u009Cessences\u00E2\u0080\u009D of a phenomenon \u00E2\u0080\u0093 that is, to identify and delineate the internal meaning structures of lived experience that make it truly unique (van Manen, 1997). In contrast to descriptive phenomenology which solely aims to illuminate and describe core components or essences of a phenomenon, hermeneutic phenomenology goes beyond mere description to uncover the meaning structures embedded in lived experiences (Lopez & Willis, 2004). In this tradition, researchers attempt to glean deeper meanings of the \u00E2\u0080\u009Clifeworld\u00E2\u0080\u009D \u00E2\u0080\u0093 \u00E2\u0080\u009Cthe world as we immediately experience it pre-reflectively rather than as we conceptualize, categorize, or reflect on it\u00E2\u0080\u009D (van Manen, 1990, p. 9). The intention of the current study was to move beyond description of the phenomenon of having a problematic relationship with food for mid-life women, to the meanings that women attributed to their experiences. 39!! van Manen (1990) identifies four fundamental existential themes that are thought to pervade the lifeworld of all human beings \u00E2\u0080\u0093 lived space (spatiality), lived body (corporeality), lived time (temporality), and lived human relation (relationality or communality). Although these \u00E2\u0080\u009Cexistentials\u00E2\u0080\u009D cannot be separated, they can be differentiated (van Manen). Lived space is defined as felt space. It is conceptualized as a category that is particularly useful for understanding people\u00E2\u0080\u0099s day-to-day existence, as well as uncovering fundamental meaning structures of lived experience. The lived space existential was relevant to the current study, given that certain places and spaces \u00E2\u0080\u0093 particularly participants\u00E2\u0080\u0099 own homes \u00E2\u0080\u0093 held significance for these women as they engaged in DE behaviours and practices (e.g., bingeing in the privacy of their own homes; indulging in foods in private locations; procuring foods at fast-food restaurants). In addition, sociocultural limitations on the symbolic and literal \u00E2\u0080\u009Cspace\u00E2\u0080\u009D women are to take up in the world has direct implications for the size and movement of women\u00E2\u0080\u0099s bodies. For example, some theorists suggest that the ways in which a woman\u00E2\u0080\u0099s body is altered as a result of engaging in DE practices (e.g., becoming smaller and taking up less physical space) can be understood as a symbolic representation of sociocultural expectations of women\u00E2\u0080\u0099s roles and experiences in society (e.g., Bordo, 1989; Orbach, 1978). Lived body refers to the understanding that all experience is embodied \u00E2\u0080\u0093 our bodies are both revealing and concealing, communicating aspects of ourselves sometimes without our conscious awareness (van Manen). van Manen suggests that the body may change when it becomes the object of another\u00E2\u0080\u0099s gaze and attention (e.g., losing its naturalness, becoming more graceful). Given that DE is usually accompanied by body dissatisfaction and preoccupation, and the fact that women are subjected to an objectifying \u00E2\u0080\u009Cmale gaze\u00E2\u0080\u009D that often becomes internalized (e.g., Fredrickson, & Roberts, 1997), the lived body existential was particularly relevant to the current study. Indeed, the women in this study 40!!discussed the loathing they felt for their mid-life bodies, and the pressure they felt to alter their bodies, in order to approximate cultural notions of beauty (i.e., thin physique, youthful appearance). In fact, in many ways, the body appeared to be central to these women\u00E2\u0080\u0099s challenges with food (i.e., engaging in dieting and other weight loss strategies to lose weight; aging bodies as the perceived cause of loss of power and visibility). Lived time is the subjective experience of time, \u00E2\u0080\u009Cour temporal way of being in the world\u00E2\u0080\u009D (van Manen, 1990, p. 104). A person\u00E2\u0080\u0099s \u00E2\u0080\u009Ctemporal landscape\u00E2\u0080\u009D is comprised of their past, present, and future. In the current study, the temporality dimension was particularly important since the women reported ongoing attempts to maintain the appearance of their younger \u00E2\u0080\u009Cselves\u00E2\u0080\u009D and bodies over time, while simultaneously facing the challenges of the aging process (e.g., weight gain, hormonal changes, greying hair, etc.). Lastly, lived human relation (or lived other) is the relation we maintain with others in co-shared space (van Manen). Importantly, the participants\u00E2\u0080\u0099 relationships with significant others (i.e., partners, family, peers) shaped their experience of having a problematic relationship with food, as well as the meanings they attributed to the experience. Some of the participants experienced drastic changes in their intimate relationships in mid-life, for example, by entering into new partnerships after the dissolution of a long-term relationship (e.g., divorce). In addition, familial relationships were perceived as particularly relevant to the participants\u00E2\u0080\u0099 experiences. For example, the majority of these mid-life women had to negotiate their eating challenges in their homes where they lived with a partner and/or children. van Manen\u00E2\u0080\u0099s conceptualization of these four \u00E2\u0080\u009Cexistentials,\u00E2\u0080\u009D in part, guided the reflective process of phenomenological data analysis undertaken for the current study. As a methodology, phenomenology \u00E2\u0080\u009Cposits an approach toward research that aims at being presuppositionless\u00E2\u0080\u009D and \u00E2\u0080\u009Ctries to ward off any tendency toward concepts that would rule-41!!govern the research project\u00E2\u0080\u009D (van Manen, 1990). In contrast to other qualitative methodologies which are more prescribed in terms of their execution (e.g., Qualitative Action Project Method) (Young, Valach, & Domene, 2005), phenomenology is largely process-oriented. There exists a methodological structure to phenomenological research that is comprised of a dynamic interplay between several research activities. More specifically, van Manen outlines the following six research activities which comprise hermeneutic phenomenological research: (1) turning toward a phenomenon that is a serious interest, (2) investigating experience as it is lived versus conceptualized, (3) reflecting on the essential themes characterizing a phenomenon, (4) describing the phenomenon through an involved process of writing (and re-writing), (5) maintaining a pedagogical orientation to the phenomenon (i.e., so as to not veer away from the research question), and (6) \u00E2\u0080\u009Cbalancing the research context by considering both the parts and the whole\u00E2\u0080\u009D (p. 30) that comprise the phenomenon (i.e., engaging in the hermeneutic cyclical analytic process). All of these research activities were undertaken in the current study, and will be further elaborated on in this chapter. As noted above, in addition to utilizing a phenomenological methodology, the current study was also grounded in feminist theoretical perspectives and conducted according to feminist research principles. As such, the next section will provide a very brief introduction to, and overview of, feminist research. Feminist Research The social construction of gender \u00E2\u0080\u0093 \u00E2\u0080\u009Ca basic organizing principle which profoundly shapes/mediates the concrete conditions of our lives\u00E2\u0080\u009D \u00E2\u0080\u0093 is central to the feminist project, and particularly relevant to the current study (Lather, 1991, p. 71). Power relations and gender are often at the heart of feminist work. Directed at improving the lives of women and other 42!!marginalized groups (Dankoski, 2000), feminist research strives toward knowledge production that has the potential to transform gendered injustice and subordination (see Ramazanoglu & Holland, 2002). Feminist researchers recognize that women occupy an oppressed social position and that women\u00E2\u0080\u0099s experiences are important and highly valuable sources of knowledge. They acknowledge the power of consciousness-raising that often results from women sharing their experiences (Speedy, 1991). Feminist research in the human sciences aims toward \u00E2\u0080\u009C[correcting] both the invisibility and distortion of female experience\u00E2\u0080\u009D (Lather, p. 71), in part by giving voice to and representing women\u00E2\u0080\u0099s perspectives (Harvey, 1990). Consistent with hermeneutic phenomenology, feminist researchers view women as the authority on their own lives and experiences. According to Brooks (2007) \u00E2\u0080\u009Cmuch of contemporary feminist scholarship and research strive to give voice to women\u00E2\u0080\u0099s lives that have been silenced and ignored, uncover hidden knowledge contained within women\u00E2\u0080\u0099s experiences, and bring about women-centered solidarity and social change\u00E2\u0080\u009D (p. 55). Feminist researchers are charged with the responsibility of negotiating power relations and issues of reciprocity in the research relationship, and with engaging in a continuous process of reflexivity (Creese & Frisby, 2012). It is also common practice for feminist researchers to critically examine and document their own social locations (and how they may impact both the execution of the research, and the study findings), and roles in co-creating data and constructing knowledge (see Doucet & Mauthner, 2006). Historically, women\u00E2\u0080\u0099s lived experiences, voices, and life stories have gone undocumented, unseen, and unheard (Brooks, 2007). In feminist research, women are viewed as representing particular socially situated perspectives, and as the authority on their own lives and experiences (Doucet & Mauthner, 2006), and the research process is centered around women and their lived experience. In using feminist research approaches, we have the ability to \u00E2\u0080\u009Csee and 43!!understand the world through the eyes and experiences of oppressed women\u00E2\u0080\u009D (Brooks, 2007, p. 55). In this tradition, knowledge begins in women\u00E2\u0080\u0099s \u00E2\u0080\u009Ceveryday/everynight world\u00E2\u0080\u009D (Smith, 1999, p. 5). Grounded in feminist theory, the current study aims to take up the feminist project of privileging the voices and experiences of women who have a problematic relationship with food in mid-life. It is hoped that the current study can contribute to social change processes and the elimination of oppression as it relates specifically to sociocultural pressures impacting women\u00E2\u0080\u0099s relationships with their bodies \u00E2\u0080\u0093 and ultimately, themselves. By providing an account of women\u00E2\u0080\u0099s experiences of having a problematic relationship with food in mid-life, I hope to raise awareness about this issue, and contribute to the discourse which implicates sociocultural factors in the development of body dissatisfaction and DE, and to demonstrate that DE is a problem that occurs across the lifespan among girls and women. In this way, I hope to contribute to a social change process whereby people will begin to re-think, and ultimately fight against, the limited ways in which female beauty and attractiveness are defined and valued within North American culture. Issues of power, privilege and voice \u00E2\u0080\u0093 important themes in feminist research \u00E2\u0080\u0093 were attended to in the current study by drawing from feminist research principles. For example, throughout this project, I strived to: a) conceptualize research relationships with participants as collaborative and egalitarian (inasmuch as is possible given the inherent power dynamic between the researcher and participant); b) understand and accept that the participant is the expert on her own life and experiences; c) be clear and forthright with participants about the fact that they are free to discuss as little or as much as they wish; d) emphasize the rapport building process and informed consent procedures to ensure women can make informed decisions about participation 44!!in the research study; e) ensure I am not utilizing my position of power as a researcher and as a clinician to deliberately or inadvertently coerce participants to share too much of themselves and of their story; f) privilege women\u00E2\u0080\u0099s voices during the interview and data analysis processes; and g) conduct a member check with all participants to ensure that my interpretations and representation of the data accurately reflect their experiences. In addition, in the current study, I attempted to abide by feminist research practices by engaging in a bottom-up process of privileging and documenting the participants\u00E2\u0080\u0099 voices and experiences; by approaching the research from a non-pathologizing perspective; and by drawing from feminist theory to guide the conduct of the research. Situating the Researcher According to van Manen (1990), \u00E2\u0080\u009Cthe problem of phenomenological inquiry is not always that we know too little about the phenomenon we wish to investigate, but that we know too much\u00E2\u0080\u009D (p. 46). \u00E2\u0080\u0098Knowing too much\u00E2\u0080\u0099 about a phenomenon may be problematic because pre-existing knowledge may cause the researcher to prematurely interpret the essence(s) of the phenomenon (van Manen). As such, it was important for me, as a phenomenological researcher, to explicitly outline my pre-understandings of the phenomenon, including knowledge, beliefs, presuppositions, and assumptions about the phenomenon of living with a problematic relationship with food for mid-life women (van Manen). To this end, in the following sections, I will situate myself, including my social locations, personal knowledge, beliefs, experiences, expectations and biases about the phenomenon in question as part of the process of outlining my pre-understandings. 45!!Social Locations As a White, heterosexual, highly educated, middle-class woman with Italian, French, and British ancestry, and a wide social support network, I have been granted an immense amount of power and privilege throughout my life. Although I am \u00E2\u0080\u009Cable-bodied,\u00E2\u0080\u009D I live with a hearing \u00E2\u0080\u009Cdisability,\u00E2\u0080\u009D which has been a formative and significant aspect of my lived experience. Personal Knowledge Given my personal, professional and academic history, I have acquired extensive knowledge on the topic of DE and EDs. I have devoted the past 14 years of my life to studying psychology and counselling. In this time, I have accrued much scholarly knowledge about DE and EDs and have engaged in various research projects exploring normal and DE, dieting, and body dissatisfaction among women. As the principal investigator for the current study, I am immersed in a sociocultural context that perpetuates unrealistic standards of female beauty, and I certainly have not been immune to their influence. I, too, have struggled in my relationships with food and my own body. Now 32 years old, I was younger than all of my research participants. My own personal and professional knowledge of DE and EDs may have been facilitative in ways, helping me further understand participants\u00E2\u0080\u0099 experiences with this phenomenon. However, given my age, I have not yet experienced the biopsychosocial realities and pressures of mid-life, so I was vigilant and alert to potential differences in my personal and professional experiences and those of my participants. I needed to be cognizant of the age difference between me and the study participants, and be alert to how this may impact participants\u00E2\u0080\u0099 comfort in fully sharing their stories with me, or in their sense of my ability to understand and appreciate their experiences. On occasion I, too, wondered about my ability to conduct the research interviews and interpret the 46!!data in a way that captures the nuances of participants\u00E2\u0080\u0099 experiences as mid-life women. In this regard, member checking upon the completion of data analysis was of the utmost importance to ensure the results accurately reflected the participants\u00E2\u0080\u0099 experiences. In terms of my professional experience in the broad area of DE and more specifically in the area of EDs, I have worked in an outpatient facility specializing in the treatment of EDs where I gained experience counselling clients presenting with EDs. Although I was privy to the experiences of some of my colleagues\u00E2\u0080\u0099 clients \u00E2\u0080\u0093 some of whom were mid-life women \u00E2\u0080\u0093 all of my own clients were under the age of 35. I have also facilitated a post-meal activity group within the inpatient eating disorders unit at a hospital where I interacted with numerous mid-life women living with EDs. However, because this was not a therapeutic group per se (i.e., the purpose was not to engage in group therapy), I did not explicitly speak with these women about their experiences with EDs. The fact that the majority of my professional work has been conducted with younger women living with DE on the more severe end of the continuum, and its possible impact on the current study, was important for me to consider. For example, I was alert to how my own personal knowledge coupled with my professional experience counselling clients presenting with EDs could have potentially introduced bias into the way in which I conducted the research interviews and data analysis. I was also vigilant to the possibility of interpreting women\u00E2\u0080\u0099s experiences as being further along the DE continuum than they actually are. In contrast, I was aware of how I could possibly interpret DE experiences on the \u00E2\u0080\u009Cless severe\u00E2\u0080\u009D end of the continuum as less problematic in women\u00E2\u0080\u0099s lives than they are in \u00E2\u0080\u0098reality.\u00E2\u0080\u0099 It was of the utmost importance to be aware of these possibilities, and to be reflexive when conducting the data 47!!collection interviews, when engaging in the analysis and interpretation of the data, and when writing up the findings. Presuppositions and Expectations On the basis of my personal and professional knowledge of DE, I expected that many (if not all) of the participants would have lived with some degree of body dissatisfaction throughout their lives (i.e. prior to experiencing DE in mid-life), and that they may have engaged in DE behaviors at an earlier life stage. I believe that many women are subjected to an immense amount of pressure to conform to unrealistic beauty ideals (e.g., thin body, unwrinkled skin, etc.) \u00E2\u0080\u0093 ideals which become harder to attain with age. Therefore, I expected participants to have experienced an increase in body dissatisfaction in mid-life, in response to experiencing the challenges of the aging process (e.g., normative weight gain, decreased skin elasticity, greying hair, etc.) \u00E2\u0080\u0093 challenges which move women farther away from earlier bodily versions of themselves, and from socioculturally imposed youthful beauty ideals. Thus, in part, I view body dissatisfaction in mid-life as a response to bodily changes associated with the aging process \u00E2\u0080\u0093 a process which I expected to be a negative experience in participants\u00E2\u0080\u0099 lives. I also expected mid-life women\u00E2\u0080\u0099s relationships with their bodies to be more complex \u00E2\u0080\u0093 perhaps feeling pride in their bodies for some reasons (e.g., having given birth to children) and feeling disdain at other aspects of their physicality (e.g., weight gain, greying hair, wrinkled skin, decreased energy). I imagined women would speak about the various changes they have experienced with their bodies (e.g., post-pregnancy weight gain, menopause), and to discuss the implications of these changes for their self-perceptions, and possibly their intimate relationships. For example, I suspected that married/partnered women might have wondered if their significant others still found them as attractive as they used to (i.e., in comparison to when the women were younger). I also expected 48!!that newly single women, faced with entering into new intimate relationships, may have felt unique anxieties about their bodies in mid-life. Given the developmental life stage of these women, I also expected some significant life stressors to be implicated in the onset/worsening of their DE experiences (e.g., divorce, illness, role strain, etc.). I expected the participants to report a range of experiences with, and symptoms of, DE (e.g., dieting, overeating, excessively exercising, restricting certain foods, weight loss programs and supplements, etc.). In terms of mid-life women\u00E2\u0080\u0099s relationships with food, I expected mid-life women to exhibit similar kinds of DE behaviours that are observed in younger girls and women who experience DE and EDs. For example, I suspected that some mid-life women, particularly those at the more severe end of the DE continuum, may report an obsession with food that pervaded their thoughts and affected many (if not all) aspects of their lives. I wondered if they may experience chronic dieting, the elimination of certain foods or food groups from their diet, calorie-counting, binge-eating, diet pills and laxative use, avoiding having certain foods in the house, and so on. Based upon findings from the extant literature (e.g. Cumella & Kally, 2008a; Forman & Davis, 2005), I did not expect many women to have experienced purging behaviours characteristic of BN. Instead, I anticipated my participants\u00E2\u0080\u0099 experiences would more closely align with AN-type symptoms (e.g., severe food restriction, excessive exercise) and BED-type symptoms (e.g., overeating) (e.g. Cumella & Kally, 2008a; de Freitas, Appolinario, de Moura Souza, & Sichieri, 2008; Forman & Davis). Lastly, I expected there to be some mention of systemic issues related to societal standards for women\u00E2\u0080\u0099s appearance/beauty (e.g., role of the media). For example, I expected women to feel negatively about their bodies when comparing themselves to the pervasive media imagery of thin female models, which may act as a perpetual motivator, and reminder of their desire, to lose weight. I also expected that some women may have engaged in other body-altering procedures 49!!such as plastic surgery. Lastly, despite my desire to recruit a diverse participant sample, I expected the majority of my participants to be White, middle-class women who were either married or divorced. This expectation stemmed, in part, from my interactions with mid-life inpatients in the eating disorders unit within a hospital located in a large city on the west coast, who fit this demographic. Beliefs and Biases I have identified several beliefs and biases that had the potential to affect the way in which I conducted my research interviews, and interpreted the data. Firstly, I identify as a feminist and am developing an increasingly broader systemic theoretical lens in my research, counselling work, and everyday life. I feel very strongly about social justice issues, and very much wish to work toward social change processes. To me, DE and EDs are experiences that cannot be examined without attending to the greater systemic/oppressive forces operating in the lives of women. I believe that beauty and body ideals for women are an overt, yet insidious method of social control. Because these standards are often internalized at such a young age, and the societal messages are so widespread and ever-present, I believe that many women are unaware of the larger systemic/economic forces sustaining unrealistic beauty ideals. I was aware of and vigilant to the possibility that my feminist beliefs may have caused me to interpret the data in such a way that confirms such beliefs. Consequently, during the interview and data analysis processes, I remained vigilant about staying as close to participants\u00E2\u0080\u0099 experiences as possible, and made sure to sustain engaging in reflexive practices (e.g., journaling) so as to minimize the chances of unduly biasing my results while engaging in the analysis process. In addition, from a psychological perspective, I believe that many women use food as a way of coping with the demands of their lives, and that eating-related symptoms can act as a 50!!symbolic representation of psychosocial difficulty (Schneer, 2002). I also adhere to the continuum model which suggests that DE exists on a continuum, for example from normal eating to chronic dieting to more severe ED presentations such as AN or BN (Peck & Lightsey, 2008; Tylka & Subich, 1999). I was vigilant to how adherence to the continuum model, coupled with my personal knowledge of, and clinical experience with women presenting at the more severe end of the continuum, may have cause me to interpret women\u00E2\u0080\u0099s eating practices as more \u00E2\u0080\u009Cproblematic\u00E2\u0080\u009D than women perceive them to be. Alternatively, I was aware of the possibility of regarding eating practices at the \u00E2\u0080\u009Cless severe\u00E2\u0080\u009D end of the continuum as less problematic and impactful in women\u00E2\u0080\u0099s lives than they really are. Conduct of the Research Inquiry Criteria for Inclusion of Participants For the purposes of the current study, \u00E2\u0080\u009Cmid-life\u00E2\u0080\u009D was defined as the period of psychosocial development between the ages of 40 and 65 (e.g., Kally & Cumella, 2008; see Lachman, 2004). The final participant sample was comprised of nine women who self-identified as: a) between the ages of 40 and 65; b) having a \u00E2\u0080\u009Cproblematic relationship with food\u00E2\u0080\u009D during mid-life for a period of one year or more; c) having a \u00E2\u0080\u009Cproblematic relationship with food\u00E2\u0080\u009D within the past five years (to ensure participants could recall their experience); and d) never having received a formal DSM-IV diagnosis of an ED. Of note, because the focus of this study was not on the development of food- and weight-related issues in mid-life, women were eligible to participate if they had also struggled in their relationships with food at earlier life stages (i.e., prior to entering mid-life). By chance, to varying degrees all of the participants in the current study reported having struggled in their relationships with food at earlier stages in their lives. Participants were also required to be willing and able to reflect upon, and share with the 51!!researcher \u00E2\u0080\u0093 in English \u00E2\u0080\u0093 their experiences of having a problematic relationship during mid-life. The nine women who formed the final participant sample for this study ranged in age from 41 to 65 (further demographic information will be described below). Of note, a data collection interview was conducted with a tenth participant for this study; however, her data was unfortunately lost due to technical problems with the recording devices, and subsequent to the research interview, I was unable to make contact with her. As such, the decision was made to not include this participant in the final sample. In contrast to pathologizing language describing problematic eating behaviours (e.g., \u00E2\u0080\u009Cdisordered eating,\u00E2\u0080\u009D \u00E2\u0080\u009Ceating disorders\u00E2\u0080\u009D) \u00E2\u0080\u0093 terminologies that have the potential to inflict harm on individuals (e.g., Ali, Kaplan & Fagnant, 2010; see Kroska & Harkness, 2008) \u00E2\u0080\u0093 a \u00E2\u0080\u009Cproblematic relationship with food\u00E2\u0080\u009D was used as the language in the research question for the current study, and the basis for the phenomenon to be explored. Focusing on women\u00E2\u0080\u0099s \u00E2\u0080\u009Crelationships with food\u00E2\u0080\u009D seemed to be the most non-pathologizing way to approach an inquiry into mid-life women\u00E2\u0080\u0099s problems with food and eating. Furthermore, using potentially pathologizing diagnostic information in the inclusion/exclusion criteria for this study seemed incompatible with a feminist approach (e.g., see Brown, 1991; Brown, 1997). An inherent tension in this project was trying to conduct this research in a non-pathologizing manner, while at the same time, acknowledging that the current study was informed by, and conducted within the context of, the vast literature on \u00E2\u0080\u009Ceating disorders\u00E2\u0080\u009D and \u00E2\u0080\u009Cdisordered eating.\u00E2\u0080\u009D Importantly, I wanted this study to capture the experiences of a wide range of women who are often silenced in EDs research \u00E2\u0080\u0093 that is, \u00E2\u0080\u009Ceveryday\u00E2\u0080\u009D women in the community who struggle in their relationships with food, and have not been diagnosed with an \u00E2\u0080\u009Ceating disorder.\u00E2\u0080\u009D As a result of the nature of the language utilized in the research question (i.e., \u00E2\u0080\u009Cproblematic 52!!relationship with food\u00E2\u0080\u009D), the women in this study had the power to self-define their relationship with food, which is highly consistent with a phenomenological methodology and a feminist approach. However, while women had the ultimate power to self-define this aspect of their experience prior to and during the research interviews, some problematic eating behaviours were posited in advance of the data collection process (e.g., excessive or restricted eating, preoccupation with food and weight, laxative or diet pill use, chronic dieting, excessive exercise), for the purpose of recruitment (see Appendix B for the recruitment poster). Allowing for a broad range of problematic eating behaviours and practices provided the opportunity to be open to the phenomenon in all its forms (i.e., the meaning and experience of living with a problematic relationship with food during mid-life). Roles and Responsibilities Participants\u00E2\u0080\u0099 role in this research was to participate in one data collection and one member check/validation interview, which were facilitated by the researcher. Participants were also required to read the common themes and their individual biosynopsis, in preparation for the validation interviews, to ensure the trustworthiness of the research. Guided by my research supervisor and dissertation committee, my role(s) as the researcher included: being knowledgeable about the literature and methodology/methods, conducting research interviews and data analysis, writing up the final results in manuscript form, and taking primary responsibility for the dissemination of the results. The details of each of these research processes will be further reviewed below. Participant Recruitment Procedures Recruitment for this study occurred between May and July 2013. Participants were recruited for this study via notices displayed at specific locations in Vancouver likely to be 53!!attended by mid-life women (e.g., gyms, coffee shops, medical centers, community centers, etc.) (see Appendix B for recruitment poster). In addition, online recruitment notices were posted on Craigslist and Facebook (see Appendix C for the online recruitment notice). In phenomenological research, \u00E2\u0080\u009Cthe nature and number of participants cannot be mechanically determined beforehand or by formula\u00E2\u0080\u009D (Wertz, 2005, p. 171). As such, participants continued to be recruited and interviewed until the point of saturation of the data was reached (i.e., no new themes emerged from the data) (Wertz). Importantly, saturation occurred in advance of the tenth and final interview for this study (see Guest, Bunce & Johnson, 2006). Of note, it is not uncommon for phenomenological research to be conducted with 6 to 10 participants (e.g., Creswell, 1998; Hirakata & Daniluk, 2009; Majcher & Daniluk, 2004; Wiens & Daniluk, 2009). Indeed, within phenomenological research of all traditions, \u00E2\u0080\u009Csmall\u00E2\u0080\u009D sample sizes between 1 and 12 are typical (Coyle, 2014), in part due to the \u00E2\u0080\u009Cin-depth nature of the interviewing,\u00E2\u0080\u009D and resultant gathering of rich data (Higginbottom, 2004, p. 12). Additionally, studies utilizing van Manen\u00E2\u0080\u0099s (1990, 1997) hermeneutic phenomenological approach have typically included samples comprised of 4 to 12 participants (e.g., Allan & Dixon, 2009; Barnable, Gaudine, Bennett & Meadus, 2006; Clarke & Borders, 2014; Djivre, Levin, Schinke, & Porter, 2012; Iverson, Graue, & Raheim, 2013). All of the participants contacted me to inquire about participating in this study. A mutually agreed upon time was determined to speak with the women on the telephone, in order to engage them in a screening process. As part of the telephone screening, I asked a series of questions to ensure they were eligible to participate (i.e., based on the inclusion criteria). If women met all of the criteria for participation I more fully informed them about the purpose of the study and its requirements, and allowed ample time for them to ask questions about the study 54!!(see Appendix D for telephone screening script). If participants indicated interest in participating in the study we set a time and date for the data collection interview to take place. Ultimately, it was up to the participants to determine where they would feel most comfortable conducting the interviews. Three of the data collection interviews took place in participants\u00E2\u0080\u0099 homes, and the rest were scheduled to take place at a private office on campus at the University of British Columbia. All of the interviews were scheduled within two weeks from the date at which the telephone screening occurred. As participants contacted me to inquire about participating in the study, I kept a wait-list, in case more interviews were required at a later date. Data Collection Procedures Phenomenological data collection occurs via in-depth interviews conducted by the researcher (Lopez & Willis, 2004). In the current study, the data collection process consisted of one in-depth, largely unstructured interview conducted with each participant. The duration of the data collection interviews ranged from 1.5 to 2 hours. As noted above, the interviews took place either in participants\u00E2\u0080\u0099 homes or in an office on the University of British Columbia\u00E2\u0080\u0099s campus, according to participants\u00E2\u0080\u0099 preferences. As the primary researcher, I assumed the responsibility of conducting the research interviews. Prior to each interview being conducted, each participant was asked to read and sign a consent form \u00E2\u0080\u0093 and to keep a copy for her own records (see Appendix E). At this time, I answered any additional questions participants may have had about the study. When the participant indicated that she was ready to begin the interview, the digital recording devices were turned on and I read an orienting statement (see Appendix F). The participant was then asked to reflect upon her experiences of having a problematic relationship with food during mid-life, and to share her thoughts and feelings about her experiences (e.g., see Majcher & Daniluk, 2004). I also had access to several additional guiding questions to deepen 55!!the exploration of topics if they were raised by the participants (see Appendix G). These guiding questions were developed to encompass a wide variety of nuanced aspects of women\u00E2\u0080\u0099s lived experiences of eating challenges (e.g., psychological, emotional, embodied, relational, developmental, cultural), and were developed within the context of the extant literature. Ultimately, the research interviews ended when the participants felt they had sufficiently communicated their experiences, and I (as the researcher) felt that there was no further information to gather that would have significantly enhanced the data generated from the interview. As the principal investigator, my role during these interviews was to maintain an openness to participants\u00E2\u0080\u0099 experiences, and to keep participants continually oriented to the research question (van Manen, 1990). Consistent with the theoretical framework utilized for this study, I remained alert for issues pertaining to biopsychosocial and developmental pressures that emerged during the data collection interviews. During the interviews I was sure to listen for, and explore, issues related to van Manen\u00E2\u0080\u0099s four existentials \u00E2\u0080\u0093 in the event that relevant experiences and topics arose. Interview questions were developed to specifically address the existentials (see Appendix G). Broadly speaking, my role as the researcher was to ask questions that allowed the participants to share their experience of living with a problematic relationship with food during mid-life, as well as to assist them to elaborate on the meanings they attribute to their experiences. It was equally as important to listen intently to the participants as they shared their stories, and to be continually aware that this topic may be sensitive for women to talk about. I viewed these interviews as a collaborative process. As such, I tried to foster a safe, supportive, non-judgemental, respectful atmosphere and research relationship, where participants could share 56!!their stories without feeling judged, and where their voices and experiences were heard and validated. As further detailed in an earlier section, consistent with feminist research principles, I attempted to decrease the power differential inherent in the researcher-participant relationship as much as possible. For example, I was explicit about the fact that participants were free to share as much or as little about themselves and their experiences as they wish \u00E2\u0080\u0093 thereby granting them a great degree of control and power over the interview process. Data Analysis Procedures Upon completion of the data collection interviews, each interview was transcribed verbatim. Of the nine interviews conducted, I transcribed five, myself. The remaining four were transcribed by a confidential, professional transcription service based in Toronto. To ensure confidentiality of the sensitive material contained in the interviews, a confidentiality agreement was signed by myself and the transcription agency (see Appendix H). A primary goal of the transcription process was to have the final transcripts reflect the actual interview process as much as possible. To this end, more subtle aspects of the interview process were noted in the transcripts (e.g., emotional reactions, pauses, tonal inflections/changes). Prior to data analysis, I engaged in a reflexive practice to aid my process of better understanding the phenomenon so as to situate myself in a position to engage in the analytic process (see van Manen, 2011). Specifically, I described and narrated my own experience of developing and living with a problematic relationship with food, in written form (van Manen, 1990), prior to conducting my first research interview. Because my experience with this phenomenon stems so far back to an earlier life stage, and because I have not engaged in DE practices for years, I was not confident about my ability to remember all the nuanced details of my own experience. For this reason, I did not formally analyze my narrative for emerging 57!!themes, but instead used the narrative as a way of engaging in reflexive practice, and gaining an understanding of the potential meanings (and structure) participants may identify in terms of their experiences with having a problematic relationship with food in mid-life (van Manen, 1990). As such, my narrative was not included in the analysis. Rather, it was meant to be an exercise to prepare me for engaging in the research process. According to van Manen (1990), \u00E2\u0080\u009Cthe purpose of phenomenological reflection is to try to grasp the essential meaning of something\u00E2\u0080\u009D (p. 77). At a fundamental level, the aim of data analysis was to understand the meaning and experience of having a problematic relationship with food for women in mid-life \u00E2\u0080\u0093 or more specifically, to uncover the pre-reflective lived understanding of this phenomenon. Since meanings are always multi-dimensional, the task of analysis involves arriving at the essence of a phenomenon (van Manen). In phenomenological research, the essence of a phenomenon is communicated by way of common themes. Despite the fact that common themes are meant to capture the essence of the phenomenon in question, such themes are also, at best, a simplification of human experience (van Manen, 1990). Uncovering themes is not a rote cognitive process, but rather \u00E2\u0080\u009Cthe process of insightful invention, discovery, disclosure\u00E2\u0080\u009D (van Manen, p. 88). Themes are tools for discovering meaning, and are attempts at expressing the core of the experience in question, which helps facilitate the description of the phenomenon. Ultimately, in the current study, thematic analysis involved an examination of the text (i.e., transcripts) in an attempt to understand the meaning structures embedded in the participants\u00E2\u0080\u0099 embodied human experience of having a problematic relationship with food (van Manen, 2011). In the current study, data analysis was first comprised of reading and re-reading the detailed transcripts while listening to the audio-digital recordings. In preparing for data analysis, 58!!and familiarizing myself with the data, I asked myself, \u00E2\u0080\u009CWhat is going on here? What is this an example of? What is the essence of this experience and how can I capture it by way of thematic reflection?\u00E2\u0080\u009D (van Manen, 1990, p. 86). In the first stage of data analysis, each transcript was coded separately. In the second stage, an across-participant analysis occurred whereby emerging themes common to all participants were identified. Data were primarily analyzed by way of both macro- and micro-thematic reflection processes (van Manen, 2011)2. Most prominently, analysis was comprised of the following approaches: 1) Wholistic/Sententious, and 2) Selective/Highlighting. First, in the wholistic reading approach, I attended to each transcript individually, reviewed it numerous times and attempted to produce a word or phrase that captured the fundamental meaning of the text. Second, I then moved onto the selective/highlighting analytic process by identifying statements or phrases in each individual transcript that appeared to be particularly revealing about the phenomenon of living with a problematic relationship with food for mid-life women, or its essence. As a part of this process, parts of sentences, full sentences, or sentence clusters that appeared to illuminate the phenomenon were identified, and coded thematically. Ultimately, essential (versus incidental) common themes were identified by using the \u00E2\u0080\u0098free imaginative variation\u00E2\u0080\u0099 method, whereby essential qualities of the phenomenon of living with a problematic relationship with food for mid-life women were identified (van Manen)3. After each transcript was individually analyzed and coded for emerging themes, I conducted an across participant analysis, looking for themes common to all participants. Subsequently, as an additional aspect of the analysis process, I met with my research supervisor to discuss themes that were emerging !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!2!However,!as!noted!by!van!Manen!(1990)!\u00E2\u0080\u009Cgrasping!and!formulating!a!thematic!understanding!is!not!a!ruleMbound!process!but!a!free!act!of!\u00E2\u0080\u0098seeing\u00E2\u0080\u0099!meaning\u00E2\u0080\u009D!(p.!79).!!3!Questions!such!as,!Is#this#phenomenon#still#the#same#if#we#imaginatively#change#or#delete#this#theme#from#the#phenomenon?#Does#the#phenomenon#without#this#theme#lose#its#fundamental#meaning?!were!asked!during!the!free!imaginative!variation!method!(van!Manen,!1990,!p.!107).!59!!from the data, and a tentative list of themes were devised. Following this meeting, I then went back to the data to confirm the presence of these tentative themes in all of the participants\u00E2\u0080\u0099 narratives, and a \u00E2\u0080\u009Cfinal\u00E2\u0080\u009D list of themes common to all the participants was created. During the writing process (reviewed below), some of these themes were found to collapse, and as such, the themes were solidified through an iterative process. Themes emerging from the across-participant analysis comprised the final results of the study. Importantly, during member check/validation interviews (further described below), these final themes were validated by 8 of the 9 women who participated in this study. All participants indicated that they believed the findings were highly resonant for them, and accurately captured their experiences. As noted above, during the research interviews I remained alert to biopsychosocial issues and developmental pressures that were raised by participants as they discussed their experiences of having a problematic relationship with food (e.g. relationship and parental status\u00E2\u0080\u0099, health issues, changes in weight and appearance). I was also alert to aspects of their experience that related to the four existentials (e.g., lived space, lived time, lived body, and lived human relation). Similarly, during the data analysis process, I continued to remain vigilant about and explore developmental issues, as well as those relating to the existentials, as they pertained to mid-life women\u00E2\u0080\u0099s experiences of having a problematic relationship with food in mid-life. Communicating the Results & Dissemination Plans In hermeneutic/interpretive phenomenological research, writing is a primary part of the research activity and reflection (van Manen, 1990). As a \u00E2\u0080\u009Cmethod without techniques\u00E2\u0080\u009D (van Manen, p. 131), the research/analytic process involves continuous interrogation of the phenomenon, which involves writing and re-writing, thinking and re-thinking, about the phenomenon in question. Describing the themes in writing was, indeed, another important part of 60!!the analytic process for this study. Thus, after a highly thoughtful analytic process, the results, or final themes, describing the phenomenon in question have been communicated in a piece of phenomenologically-oriented writing (i.e., the current results) \u00E2\u0080\u0093 a text that was intended to be compelling, transparent, rich, deep, engaging, and transformative (van Manen). In terms of dissemination plans, it is hoped that the results of this study will be published in an academic journal, and presented at academic conferences. In addition, to work toward realizing the feminist goal of achieving social change, it is hoped that I will be able to create community events to offer a platform and an opportunity for dialogue and discussion, and to increase awareness about this important phenomenon. Criteria for Ensuring Rigor and Trustworthiness Trustworthiness and rigor of the current study were evaluated by the following six criteria: credibility, transferability, dependability/confirmability, resonance, pragmatic value and reflexivity (Morrow, 2005; Schwandt, Guba, & Lincoln, 2007; Tracy, 2010). How each of these criteria were met is elaborated upon in the following sections. Credibility Are the results of this study trustworthy, plausible, and characterized by verisimilitude (Tracy, 2010)? In an effort toward achieving credibility in the current study, my research supervisor thoroughly reviewed the transcript of the first research interview I conducted to assess and verify the integrity of the data collection process (e.g., ensuring that I wasn\u00E2\u0080\u0099t asking leading questions during interviews). Similarly, during data analysis, my supervisor and I met to discuss the findings, in part, to avoid the possibility of introducing my own biases into the results. In addition, I highlighted the results of the study by providing \u00E2\u0080\u009Cthick descriptions\u00E2\u0080\u009D of the participants\u00E2\u0080\u0099 experiences, in an effort to stay as close to the data as possible in describing the 61!!phenomenon (Morrow, 2005; Tracy). In addition, triangulation of the data with theoretical accounts and findings from the extant literature on the topic was undertaken. Finally, member checks were conducted with each participant to ensure the accuracy of the results, which will be further detailed below (Schwandt, Guba, & Lincoln, 2007; Morrow). Transferability Are the results of this study applicable to, and resonant with, other individuals who have experienced the phenomenon (i.e., mid-life women who have lived with a problematic relationship with food) (Tracy, 2010)? I strived to achieve transferability in the current study by providing sufficient information about myself (as the researcher), the research context and process, and the participants (Morrow, 2005). In addition, \u00E2\u0080\u009Cthick descriptive data\u00E2\u0080\u009D was interwoven throughout the final text (Schwandt, Lincoln, & Guba, 2007, p. 19). A thorough review of the literature was also undertaken to assess the degree to which the current findings are resonant with, and support, extant research centered on women\u00E2\u0080\u0099s eating challenges \u00E2\u0080\u0093 particularly those experienced by women in mid-life. Dependability and Confirmability Is there consistency in the research, and do the results accurately reflect the phenomenon in question (as opposed to reflecting the researcher\u00E2\u0080\u0099s beliefs, biases, etc.) (Morrow, 2005)? In qualitative research, dependability refers to the issue of consistency in the research (e.g., across time and researchers, in conducting the analysis, etc.). Confirmability refers to the integrity of the findings (Morrow). To accomplish the goals of both dependability and confirmability I kept an extensive audit trail of the research process, influences on the process of data collection and analysis, emerging themes, and analytic memos, and I continued to engage in reflexive practices (e.g., keeping a researcher\u00E2\u0080\u0099s journal) (Morrow; Schwandt, Guba, & Lincoln, 2007). In addition, 62!!as noted above, during the process of data analysis I discussed the emerging themes with my research supervisor, Dr. Judith Daniluk, to ensure they were accurately reflective of participants\u00E2\u0080\u0099 experiences of the phenomenon. Resonance Do the results of the study resonate with, and adequately/accurately capture, participants\u00E2\u0080\u0099 experiences (Tracy, 2010)? This criterion was assessed by conducting member check/validation interviews. Each participant was invited to participate in one follow-up interview and to provide feedback on the identified themes \u00E2\u0080\u0093 specifically confirming whether the themes and thematic descriptions adequately represented and resonated with their experiences of living with a problematic relationship with food in mid-life. To date, validation interviews have been conducted with eight of the nine women who participated in this study. One of the participants has been unable to commit to an interview time, given that she has recently made a significant geographical move to a remote location. However, she has indicated an interest in speaking at a future date. All of the validation interviews were conducted over the telephone, and lasted between 15 and 50 minutes. During the interviews, the purpose of the study was reviewed, and the fact that the themes were common across participants was reiterated. The purpose of the validation interviews was also reiterated to the women \u00E2\u0080\u0093 namely to receive feedback from the participants about the findings, and to discuss whether or not the findings were resonant for them. These interviews were unstructured, and the women were offered the time and space to share feedback, as well as any reactions, thoughts, and feelings that arose while reading the findings \u00E2\u0080\u0093 or anything else they felt was significant for me to know. Questions and gentle probes were asked to help clarify participants\u00E2\u0080\u0099 perspectives on the findings, when needed (e.g., \u00E2\u0080\u009CWhat was the experience like of reading the findings?\u00E2\u0080\u009D \u00E2\u0080\u009CWas there 63!!anything missing that you think is important to include?\u00E2\u0080\u009D \u00E2\u0080\u009CIs there anything you believe should be changed?\u00E2\u0080\u009D). All of the participants stated that they felt the findings accurately reflected their experiences, captured their experience as they have lived it, and were \u00E2\u0080\u009Cvery much\u00E2\u0080\u009D resonant for them. In describing their reactions to the findings, some of the women said, \u00E2\u0080\u009CThis is my life,\u00E2\u0080\u009D \u00E2\u0080\u009CThis is what it\u00E2\u0080\u0099s like,\u00E2\u0080\u009D \u00E2\u0080\u009CThat\u00E2\u0080\u0099s what my relationship is,\u00E2\u0080\u009D and \u00E2\u0080\u009CIt felt like I was reading my diary.\u00E2\u0080\u009D One participant colloquially noted that I had \u00E2\u0080\u009Cnailed\u00E2\u0080\u009D her experience in the description of the common themes. Of note, several of the women indicated that they were unable to tell when I had quoted them or another participant in the findings. The participants also noted how \u00E2\u0080\u009Cinteresting,\u00E2\u0080\u009D \u00E2\u0080\u009Carticulate\u00E2\u0080\u009D and \u00E2\u0080\u009Ccomprehensive\u00E2\u0080\u009D they thought the findings were, and commented on how they felt there were significantly more similarities than differences between their own experiences and the experiences of other participants. All of the participants reported feeling that the findings, in their entirety, accurately captured their experience (i.e., all of the themes were deemed resonant by each of the women), and none of the women requested any changes to the findings. Of note, one of the participants reported that the sense of pressure to conform and sense of loss of social power and visibility themes were resonant for her, albeit slightly less than the rest of the themes. In addition, all of the women stated that their individual \u00E2\u0080\u009Cbiosynopsis\u00E2\u0080\u009D accurately reflected their history and experience, and minor editorial changes were addressed, as needed. Pragmatic Value Do the results of the study hold potential to benefit academics and therapists (and their clients) working in the ED area (see Tracy, 2010)? Given the applied nature of my discipline, Counselling Psychology, it was important to me to conduct research that could hold the potential to have implications for counselling clients presenting with eating challenges. It is believed that 64!!the results of this study have the potential to be useful and valuable to researchers, as well as clinicians who are in a \u00E2\u0080\u0098frontline\u00E2\u0080\u0099 position in working with mid-life women presenting with eating challenges. The in-depth description of this phenomenon (as lived by the nine women who participated in this study) offers a deeper understanding of the challenges these mid-life women experienced, in living with eating problems. In particular, the results offer some insight into the developmental and contextual realities of these women\u00E2\u0080\u0099s lives, which they perceived to be inextricably related to their difficulties with eating. Ultimately, it is hoped that the results of this study may be used to support mid-life women \u00E2\u0080\u0098in recovery\u00E2\u0080\u0099 from eating challenges by aiding in the development of treatment recommendations and relevant population-specific therapeutic approaches. Reflexivity Since researcher reflexivity is an important process that facilitates the trustworthiness of qualitative research, I continually engaged in self-directed reflexive practices throughout the conduct of the study (e.g., journaling, consulting with colleagues) (see Morrow, 2005). Throughout the facilitation of this study, reflexive practice was essential to the research process, and I journaled and consulted with colleagues about the research interviews, results, and the often emotional process of being immersed in the participants\u00E2\u0080\u0099 stories. More specifically, my journaling practice consisted of writing about my research-related experiences, where I detailed thoughts, feelings, questions, or concerns I may have had about any aspect of the research, and experiences related to the research. In particular, reflexive practice was essential to processing emotional experiences that arose for me about, and during, the research process. I primarily wrote about my process spontaneously (i.e., whenever something arises that I feel I need to reflect upon and record). However, I also set aside specific times to journal about this research 65!!project, for example, after facilitating each interview. Overall, at each stage of the research process I needed to be vigilant about maintaining a reflexive practice in order to increase my awareness about, and heighten my sensitivity to, the phenomenon, as well as to engage in a continual process of being mindful of my own assumptions, biases, and expectations so as to not unduly bias the findings. Overall, the primary purpose of these journal entries was to facilitate my own process of researcher reflexivity, and as such, were not included in the data analysis or representation of the findings. Ethical Considerations The potential for harm was estimated to be limited for participants in this study. In fact, phenomenological research has the potential to have a positive, lingering effect on participants (van Manen, 1990). For example, during validation interviews for the current study, some of the participants reported that they gained greater \u00E2\u0080\u009Cinsight\u00E2\u0080\u009D into, and awareness of, their experiences with eating challenges, which may eventually lead to positive changes in their relationships with food and their bodies. In fact, many of the women noted that since the research interview and reading the findings, they have been engaged in a process of trying to address their problems with food/eating; for example, some of the women said they have been trying to cope with stress in different ways (e.g., taking up new hobbies), are trying to \u00E2\u0080\u009Cbe more gentle with [themselves],\u00E2\u0080\u009D and feel more \u00E2\u0080\u009Chopeful\u00E2\u0080\u009D that a new relationship with food is possible. In speaking about the contextual and developmental factors associated with the mid-life stage, one participant in her forties noted that she feels \u00E2\u0080\u009Cmore prepared for what\u00E2\u0080\u0099s coming\u00E2\u0080\u009D in her later mid-life years. These reported experiences suggest that participating in this study had a significant, empowering impact on some of these women. After having participated in the interviews, these women reported feeling increasingly able to try to make changes to their relationships with food, thereby 66!!contributing to the catalytic validity of the current study (Koelsch, 2013; Lather, 1986). As a marker of catalytic validity, Koelsch stated, \u00E2\u0080\u009Cif a research project has empowered the participants to action, then the participants were able to know reality enough to engage and change it\u00E2\u0080\u009D (p. 171). Additionally, sharing their experiences of living with a problematic relationship with food in mid-life, and reading the results, reportedly lead all of the participants to feel that they weren\u00E2\u0080\u0099t \u00E2\u0080\u009Calone,\u00E2\u0080\u009D which was described a \u00E2\u0080\u009Crelief.\u00E2\u0080\u009D In addition, knowing there are other women who participated in the study who also struggled with similar issues reportedly \u00E2\u0080\u009Cnormalized\u00E2\u0080\u009D and \u00E2\u0080\u009Cvalidated\u00E2\u0080\u009D the participants\u00E2\u0080\u0099 experiences of living with eating challenges. Feeling less alone may have been particularly important for the women in this study given that eating problems in mid-life are often experienced as embarrassing and shameful \u00E2\u0080\u0093 a secret which many women, including the participants, attempt to conceal (e.g., Cumella & Kally, 2008a). For one participant, the research interview was described as \u00E2\u0080\u009Ccathartic,\u00E2\u0080\u009D and the first time she spoke aloud about her challenges with food. After the research interview, she reportedly felt \u00E2\u0080\u009Clike a weight had been lifted,\u00E2\u0080\u009D and \u00E2\u0080\u009Clike [she] had a voice.\u00E2\u0080\u009D The majority of the women were motivated to participate in this study in order to help other women struggling with this issue, and expressed feeling \u00E2\u0080\u009Cgood\u00E2\u0080\u009D that their experiences may benefit others. At the same time, given that issues pertaining to body image, food intake, and weight are often very sensitive for women, participants in this study experienced some uncomfortable emotions while reflecting on their experiences of having a problematic relationship with food in mid-life during the data collection interviews (e.g., shame, guilt, self-criticism, embarrassment, anger, etc.). In the event that a participant expressed distressing emotions, I was prepared to make use of my counselling skills during the interview to provide containment, if needed. In 67!!addition, I devised a list of possible therapeutic referrals in the community to share with the participants, with the aim of resourcing women appropriately, if requested (see Appendix I). Of note, this list was provided to only one of the participants after completing the research interview, after she requested it. Study Limitations It is important to contextualize the results of this study as stemming from the perspective of women who self-identified as \u00E2\u0080\u009Chaving a problematic relationship with food in mid-life.\u00E2\u0080\u009D Using different language to circumscribe the phenomenon for this study (e.g., \u00E2\u0080\u009Cdisordered eating,\u00E2\u0080\u009D \u00E2\u0080\u009Ceating disorder\u00E2\u0080\u009D) may have attracted a different sample of women, and may have led to different results. Moreover, all of the women in this study discussed a propensity toward binge eating/overeating, in addition to restrictive eating behaviours. Had the participant sample been comprised of women primarily experiencing restrictive eating behaviours, the results may have differed. In addition, this study was conducted with women who were currently experiencing a problematic relationship with food at the time of data collection. It is plausible that this may have impacted their ability to accurately reflect upon their experiences, and how they made meaning of such experiences. Furthermore, the fact that participants willingly self-selected to participate in the current study may have inadvertently biased the results (i.e., self-selection bias) (Robinson, 2014). As such, the women who volunteered to participate in the current study may share certain characteristics or experiences that are not representative of other women experiencing the phenomenon of eating challenges during mid-life. Also, the results of this study are limited by the fact that only English-speaking women were eligible to participate. As a consequence, the diversity of the participant sample was limited, which may have had implications for the results of the study (i.e., the findings may largely reflect the experiences of 68!!certain cultural groups). Despite my best efforts and intentions, recruiting a diverse sample proved difficult. As will be further described below, the participant sample for this study was largely comprised of White, heterosexual, and \u00E2\u0080\u009Cable-bodied\u00E2\u0080\u009D women. In this way, diverse cultural experiences were underrepresented in the current study. All of these limitations will be further discussed in the final chapter. In addition, the study results are inevitably limited by my experience and knowledge as a privileged, White woman and as a student in the process of learning to conduct qualitative research. The findings may have also been limited by my age and lived experience as a young adult woman. The difference in age and life stage between me and the participants may have impacted the experiences participants were willing to share, as well as my ability to accurately interpret the subtle nuances of the women\u00E2\u0080\u0099s experiences embedded in data. 69!! Chapter 4: Results The research question guiding this inquiry was: \u00E2\u0080\u009CWhat is the meaning and experience of having a problematic relationship with food for women in mid-life?\u00E2\u0080\u009D This chapter begins with a summary of the participants\u00E2\u0080\u0099 demographic and diversity-related information, followed by a table presenting selected demographics, as well as the nature of the participants\u00E2\u0080\u0099 current challenges with food (see Table 1). In order to further contextualize the results of the current study, biographical synopses (i.e., \u00E2\u0080\u009Cbiosynopses\u00E2\u0080\u009D) are then presented for each of the participants in this study, which include a brief summary of the women\u00E2\u0080\u0099s challenges with food and related experiences throughout their lives (e.g., their relationship with their body, the impact of significant others on their eating behaviour). Next, I have included a table listing the common themes and subthemes (see Table 2), followed by the detailed findings. Summary of Demographic and Diversity-related Information Selected aspects of the participants\u00E2\u0080\u0099 demographic information, as well as the nature of their current challenges with eating, are presented in a table below (see Table 1). Women in this study ranged in age from 41 to 65. Of the nine women who participated in this study, four were in their forties, three were in their fifties, and the remaining two women were in their sixties. In terms of racial identity, six of the women identified as White, and one woman identified as Latina. Two additional participants identified as White and of a \u00E2\u0080\u009Cmixed\u00E2\u0080\u009D racial background, respectively, and both of these women indicated First Nations ancestry. The women in this study reported identifying with British, Irish, Scottish, Greek, Spanish, Portuguese, Italian, and Lebanese ethnicities. All of the women identified as heterosexual and able-bodied, although one participant identified her \u00E2\u0080\u009Cage, sex, and weight\u00E2\u0080\u009D as \u00E2\u0080\u009Cdisabilities.\u00E2\u0080\u009D Although the majority of these women were married, three identified as being single \u00E2\u0080\u0093 two of whom had been divorced for 70!!many years. In terms of education, one participant is a high-school graduate, three participants reported completing college/university degrees, two participants attended technical/vocational school, and three participants had graduate degrees. The majority of women in this study were currently employed, one was retired, and another said she devotes her time to raising her children. In terms of salary, three women reported a total annual combined household income of $15,000-$40,000, $90,000-$115,000, and $115,000-$140,000, respectively. An additional three women reported incomes between $40,000 and $65,000, and the final three participants reported incomes over $140,000. Only six of the women indicated a religious affiliation, identifying as Protestant, Catholic, Christian, Agnostic, Spiritual, and Non-Denominational. Lastly, all of the women reported that their challenges with eating and body image stem back to childhood or adolescence. They described a complex evolution of their eating challenges over the course of their lives, including periods of time when they were less troubled by their relationship with food, as well as those periods where their struggles intensified. None of the women reported ever being diagnosed with an \u00E2\u0080\u009Ceating disorder.\u00E2\u0080\u009D71##Table 1 Basic Summary of Participants\u00E2\u0080\u0099 Demographics and Eating Challenges Pseudonym Age Relationship Status Race/ Ethnicity Onset of eating challenges Nature of eating challenges in mid-life Geena 58 Divorced/ Single White Childhood Dieting, laxative use, portion control, concealing eating, eating for comfort, body dissatisfaction, obsession with food. Charlotte 44 Married White# Childhood Dieting/restricted eating, body dissatisfaction, emotional eating. Kimberly 41 Single White/ Greek, Irish, British, & \u00E2\u0080\u009CNative Indian\u00E2\u0080\u009D # Childhood Compulsive overeating/bingeing, obsession with food, lack of control while eating, eating to cope with emotions, fasting/dieting, exercise. Suzanne 62 Divorced/ Single White/Scottish # Childhood; onset of purging behaviour in mid-life Eating for comfort, eating to cope with stress/emotions, bingeing, purging. Simone 41 Married \u00E2\u0080\u009CMixed\u00E2\u0080\u009D racial background & First Nations # Childhood Bingeing, eating to cope with stress/emotions, eating when bored/lonely, strategies to decrease food intake (e.g., drinking water). Evelyn 58 Married (2nd) White/British & Irish # Childhood Eating for comfort, bingeing/overeating, eating to cope with loneliness, body dissatisfaction, exercise, keeping certain foods out of the house. Janette 65 Married White/ British & Irish# Adolescence Obsession with weight/appearance/food, eating to cope with stressful experiences/emotions/boredom, dieting. Carmen 43 Married Latina/ Spanish, Portuguese, & Italian ancestry# Childhood Body dissatisfaction, dieting/restricted eating, bingeing, emotional eating, eating to cope with stress/emotions, need to control food intake. Barbara 57 Married White/Lebanese# Childhood; onset of purging behaviour in young adulthood Bingeing, eating for comfort, feeling out of control with eating/food, concealing eating, obsession with food, eating to cope with stress/emotions, controlling food intake. 72##Participants\u00E2\u0080\u0099 Biosynopses Geena Geena is a 58 year old single, heterosexual, White woman who has not been in a serious relationship for over a decade. She is a mother to a daughter who is deceased. A couple of years ago her elderly mother came to live with her. Geena underwent a career change in mid-life, having previously worked in the service industry internationally prior to moving to the west coast; she now works as an administrative assistant. As a \u00E2\u0080\u009Cbaby boomer,\u00E2\u0080\u009D Geena stated that she feels she worked hard to advance the status of women in society; for example, she said she fought for equal pay within her workplace as a younger woman. Geena reported that she attributes the origin of her challenges with food and eating to familial relationships and practices, particularly how food was presented and utilized (i.e., to soothe or comfort, as \u00E2\u0080\u009Cgood\u00E2\u0080\u009D or \u00E2\u0080\u009Cbad\u00E2\u0080\u009D). She also reported being teased about her weight as a child, by other children at school whom called her \u00E2\u0080\u009Cfat.\u00E2\u0080\u009D Geena discussed being impacted by sociocultural beauty and body ideals throughout her life, and her experience of feeling \u00E2\u0080\u009Cmarketed to\u00E2\u0080\u009D was particularly salient throughout her story. She described being in a \u00E2\u0080\u009Cconstant battle\u00E2\u0080\u009D with her body, weight, and shape throughout her life, and noted that she has tried numerous \u00E2\u0080\u009Cfad diets\u00E2\u0080\u009D in an attempt to lose weight. Currently, she reported dieting, laxative use, \u00E2\u0080\u009Cportion control,\u00E2\u0080\u009D weight loss programs (e.g., Weight Watchers), and exercise as methods she employs to lose weight. Geena described a continuous cycle of dieting, \u00E2\u0080\u009Cfalling off\u00E2\u0080\u009D her diet plan, subsequently gaining weight, and turning toward dieting again as a way of trying to manage her weight. She noted that she particularly struggles to stick to a diet and/or make healthy food choices when she is alone in the presence of food, and said she may also \u00E2\u0080\u009Chide\u00E2\u0080\u009D eating from others. Geena spoke of turning to food for comfort, particularly \u00E2\u0080\u009Ccarbs\u00E2\u0080\u009D and other dessert-type foods (e.g., breads, chocolates, muffins). In 73##addition, Geena described a pattern of overeating in response to stress, which she feels subsequently impacts her sleep quality; she also noted that this pattern begins to \u00E2\u0080\u009Csnowball\u00E2\u0080\u009D on her. After almost reaching her \u00E2\u0080\u009Cgoal weight\u00E2\u0080\u009D six months ago, Geena reported that she has since gained 15 pounds. She reported that she perceives herself as \u00E2\u0080\u009Coverweight.\u00E2\u0080\u009D She said she lives with an \u00E2\u0080\u009Cobsession\u00E2\u0080\u009D about food that worsened in mid-life, and struggles with the normative weight gain she experienced in mid-life and entering menopause, noting that it is now much harder for her to lose weight than it was in younger years. In the past, Geena also took \u00E2\u0080\u009Cdiet pills,\u00E2\u0080\u009D counted calories, and engaged in excessive exercise. Ultimately, Geena reported that \u00E2\u0080\u009Cfood is such a negative in [her] life.\u00E2\u0080\u009D She said she is struggling with the aging process, and noted feeling that she is being treated differently as an \u00E2\u0080\u009Colder\u00E2\u0080\u009D woman. In addition, she reported feeling societal pressure to try to remain as youthful as possible, in spite of her decision not to undergo cosmetic surgical options (e.g., Botox). Geena said that she wanted to participate in this study to \u00E2\u0080\u009Chave [her] voice heard in this stage of life,\u00E2\u0080\u009D \u00E2\u0080\u009Cto help the next generation along\u00E2\u0080\u009D and to \u00E2\u0080\u009Cgive back.\u00E2\u0080\u009D She said the interview process was \u00E2\u0080\u009Ccathartic\u00E2\u0080\u009D for her, and she noted she believes women \u00E2\u0080\u009Cshould just be more kind to ourselves\u00E2\u0080\u009D in the face of various gendered pressures, including achieving largely unattainable and unrealistic beauty and body ideals. Geena said she would want other mid-life women living with eating challenges to \u00E2\u0080\u009Crealize that [they\u00E2\u0080\u0099re] not alone.\u00E2\u0080\u009D Geena has never attended counselling to address her challenges with eating. Charlotte Charlotte is a 44 year old heterosexual, White, married woman and mother of four children \u00E2\u0080\u0093 one of whom is a step-child. She currently lives with her husband and three of her children, and works in accounting. Charlotte was an \u00E2\u0080\u009Coverweight kid\u00E2\u0080\u009D who was \u00E2\u0080\u009Cincessantly\u00E2\u0080\u009D teased by other children about her weight, and who grew up feeling as though her weight 74##\u00E2\u0080\u009Cdefined\u00E2\u0080\u009D her. Charlotte said she grew up believing she was not beautiful, often wishing she had genes more like her mother, a beauty pageant winner. As a child, Charlotte said she experienced pressure from her mother and her grandmother, both of whom were \u00E2\u0080\u009Cobsessed with appearance,\u00E2\u0080\u009D to \u00E2\u0080\u009Cmake good food choices.\u00E2\u0080\u009D She noted that she was \u00E2\u0080\u009Ccriticized\u00E2\u0080\u009D for her appearance by extended family members in the past, and she also currently experiences pressure from her in-laws to lose weight. In addition, in the recent past, Charlotte\u00E2\u0080\u0099s husband has reportedly tried to exercise some control over her eating, for example, by throwing out or hiding junk food from her in their house. She noted that pressures from other people increase her desire to eat, in part as an act of \u00E2\u0080\u009Crebellion.\u00E2\u0080\u009D Charlotte said she believes she would be \u00E2\u0080\u009Chappier if [she] were thinner.\u00E2\u0080\u009D For the past year, Charlotte has been in the care of a naturopath. The purpose of seeking naturopathic treatment was to lose weight and be \u00E2\u0080\u009Cbeautiful.\u00E2\u0080\u009D Initially, Charlotte started on a \u00E2\u0080\u009Cfairly strict diet regime\u00E2\u0080\u009D that was quite \u00E2\u0080\u009Crigid,\u00E2\u0080\u009D where she was eating two meals per day, measuring meats, and was inhibited from mixing certain foods. She was also instructed to eat whatever she desired at certain times, including \u00E2\u0080\u009Cforbidden foods,\u00E2\u0080\u009D which she termed \u00E2\u0080\u009Cloading days.\u00E2\u0080\u009D She subsequently lost 25 pounds, and then gained weight back after her eating again \u00E2\u0080\u009Cspiraled out of control.\u00E2\u0080\u009D At the time of the interview, she was into her second week of not eating carbohydrates or sugar. She identified certain foods that she tries to eat only very occasionally (e.g., cheesecake, chips, chocolate, cake), to try to maintain weight loss and control over her eating. Charlotte discussed a fear of gaining weight, a \u00E2\u0080\u009Cgripping feeling\u00E2\u0080\u009D which ultimately becomes a \u00E2\u0080\u009Cself-fulfilling prophecy.\u00E2\u0080\u009D Charlotte said she dislikes weighing herself, and feels that her metabolism has slowed since entering mid-life. She reported being very self-conscious of her weight, eating behavior and food choices around others. Charlotte said she tends to eat in response to stress and engages in \u00E2\u0080\u009Cemotional eating.\u00E2\u0080\u009D She said she feels that the types of stressors that may lead her to 75##eat for comfort now that she is in mid-life, are distinctly different from those that led her to over-indulge during earlier life stages (e.g., financial, career, and parenting stressors). Charlotte also reported experiencing negative body image, and \u00E2\u0080\u009Cdisgust\u00E2\u0080\u009D when looking at herself in the mirror when she\u00E2\u0080\u0099s perceives herself as being \u00E2\u0080\u009Cheavier.\u00E2\u0080\u009D As a mother, Charlotte expressed concern about making healthy food choices for her children. She said she would refrain from giving advice to other women who were living with eating challenges because it\u00E2\u0080\u0099s a \u00E2\u0080\u009Csensitive subject\u00E2\u0080\u009D and \u00E2\u0080\u009Cthere\u00E2\u0080\u0099s so much emotion tied up in [her own] relationship to food.\u00E2\u0080\u009D However, Charlotte mentioned that she has a friend who also struggles with food and weight, whom she invites out for walks, in part, so that she can provide a space for them both to discuss and process their challenges with eating, and other aspects of their lives. Kimberly Kimberly is a 41 year old single, heterosexual, White woman who identifies as being of Greek, Irish, British, and \u00E2\u0080\u009CNative Indian\u00E2\u0080\u009D ancestry. She recently experienced the dissolution of a romantic relationship, and currently lives with her mother. She works in the field of administration. Kimberly said her challenges with food, eating, and body image stem back to childhood. As a child, Kimberly noted that her father teased her about her weight and eating habits, describing her as \u00E2\u0080\u009Cchunky\u00E2\u0080\u009D and a \u00E2\u0080\u009Cgood eater.\u00E2\u0080\u009D As a teenager, she reported being \u00E2\u0080\u009Cobsessed\u00E2\u0080\u009D with becoming \u00E2\u0080\u009Cthin.\u00E2\u0080\u009D At an earlier time in her life, Kimberly used to chew and spit (and not swallow) her food as a way of managing her weight. She said that \u00E2\u0080\u009Cfood became [her] friend and a coping mechanism all through [her] life,\u00E2\u0080\u009D and that she turns to eating in the face of stressors or \u00E2\u0080\u009Cdifficult emotions.\u00E2\u0080\u009D Turning 40 was a reportedly difficult developmental transition and milestone for Kimberly. She turned to food as a way of coping during this challenging time, and subsequently gained 40 pounds. She said she uses food and eating for its \u00E2\u0080\u009Csedating\u00E2\u0080\u009D effect \u00E2\u0080\u0093 76##to \u00E2\u0080\u009Ccalm [her] mind\u00E2\u0080\u009D \u00E2\u0080\u0093 and as an \u00E2\u0080\u009Cavoidance tactic.\u00E2\u0080\u009D She described eating \u00E2\u0080\u009Cin isolation\u00E2\u0080\u009D to be particularly comforting, and noted that she experiences obsessive thinking about food. Kimberly engages in binge eating and identifies as a \u00E2\u0080\u009Ccompulsive overeater.\u00E2\u0080\u009D She said she feels out of control when bingeing, and sometimes eats to the point of physical pain. Describing a binge, Kimberly said she would \u00E2\u0080\u009Cload up\u00E2\u0080\u009D on junk foods after work with the intention of bingeing at home. For example, she said she might eat \u00E2\u0080\u009Cfour chocolate bars, a bag of chips, a bottle of pop\u00E2\u0080\u00A6some kind of junky meal \u00E2\u0080\u0093 or just like a box of crackers, and a tub of butter, cheese,\u00E2\u0080\u009D subsequently have a nap, and eat more upon waking. Kimberly identified fatigue, boredom, stress, perfectionist thinking, the pressure of expectations, and emotions as triggers for engaging in binge eating. However, given her current participation in counselling where she is learning other ways to manage her emotions, Kimberly said that her desire to engage in binge eating is lessening, and she noted that she can no longer handle the \u00E2\u0080\u009Cdepression\u00E2\u0080\u009D and \u00E2\u0080\u009Caftermath\u00E2\u0080\u009D (e.g., self-loathing, shame, guilt) that ensues after a binge. Kimberly currently \u00E2\u0080\u009Crelies on exercise to avoid the consequences of overeating\u00E2\u0080\u009D (i.e., weight gain), and said she may also engage in \u00E2\u0080\u009Cfasting\u00E2\u0080\u009D the day after bingeing where she will go as long as she can without eating, and drink water and tea throughout the day. In the past, Kimberly has attended 12-step programming to receive support for her eating challenges, which she found helpful in reducing her \u00E2\u0080\u009Cshame.\u00E2\u0080\u009D She noted that she is now more accepting of her body than she has been at earlier points in her life. Kimberly said she wanted to participate in the current study to \u00E2\u0080\u009Cgive back\u00E2\u0080\u009D to other women living with eating challenges, and noted that the interview process was \u00E2\u0080\u009Chealing\u00E2\u0080\u009D for her \u00E2\u0080\u0093 an exercise in \u00E2\u0080\u009Clifting the shame.\u00E2\u0080\u009D If she were speaking to another mid-life woman living with eating challenges, Kimberly tearfully expressed a desire to \u00E2\u0080\u009Cput [her] arms around her and just hold her,\u00E2\u0080\u009D and let her know \u00E2\u0080\u009Cshe\u00E2\u0080\u0099s not alone\u00E2\u0080\u00A6it\u00E2\u0080\u0099s not worth torturing yourself over.\u00E2\u0080\u009D 77## Suzanne Suzanne is a 62 year old heterosexual, White woman who identifies with Scottish ancestry, and lives with her cat. She has been divorced for over a decade, and has two children and one grandchild. Following her divorce, Suzanne moved to the west coast, leaving behind her rural community. Since then, she said she has not cooked any of her own food. She identified her \u00E2\u0080\u009Cage, weight, and sex\u00E2\u0080\u009D as \u00E2\u0080\u009Cdisabilities,\u00E2\u0080\u009D and noted that she was diagnosed with arthritis in her twenties. Suzanne went back to school in mid-life and now does administrative/secretarial work. She noted that she has \u00E2\u0080\u009Cnever had a healthy relationship with [her] food, ever.\u00E2\u0080\u009D As a child, she said her mother restricted her food intake, and she learned to \u00E2\u0080\u009Csneak eat\u00E2\u0080\u009D in response. Throughout her life, Suzanne said she has been \u00E2\u0080\u009Coverweight,\u00E2\u0080\u009D and has used food to \u00E2\u0080\u009Cstuff down\u00E2\u0080\u009D emotions and stressful experiences. She also described engaging in crash diets and \u00E2\u0080\u009Crestricted\u00E2\u0080\u009D eating (i.e., chronic dieting). In her late-twenties, Suzanne underwent gastric bypass surgery. She currently identifies as having an \u00E2\u0080\u009Ceating disorder,\u00E2\u0080\u009D and described struggling with binge eating throughout her life. She also reported currently engaging in purging behavior (i.e., self-induced vomiting), the onset of which occurred at the age of 42. She discussed eating/bingeing on foods such as popcorn, chips, fast foods, and baked goods, as a way to \u00E2\u0080\u009Csoothe\u00E2\u0080\u009D herself, and noted stress as a particularly salient trigger for engaging in binge eating. For example, Suzanne reported that when she recently started a treatment program for women living with eating disorders (ED), she would binge \u00E2\u0080\u009Call the way home\u00E2\u0080\u009D and \u00E2\u0080\u009Cstop at every freakin\u00E2\u0080\u0099 drive-through and grab whatever [she] could, come home and just hork out until [she] was almost in a sugar coma.\u00E2\u0080\u009D Suzanne said she has a small fridge, and doesn\u00E2\u0080\u0099t keep a lot of food in the house, as a way of controlling her tendency to binge. Since moving to a large city on the west coast, she said that she has become more aware of thinness as a primary marker of self-worth. At the same time, 78##now in her sixties, Suzanne believes the aging process has given her \u00E2\u0080\u009Cpermission\u00E2\u0080\u009D to be more relaxed about her weight and appearance, since she believes society expects older women to have grey hair, wrinkles and \u00E2\u0080\u009Crolls\u00E2\u0080\u009D (i.e., stomach fat). Suzanne is currently participating in a group-based (ED) treatment program; however, she stated she has never received a formal ED diagnosis. If she were to converse with another mid-life woman who struggles with food and eating, Suzanne shared that she would discuss her own eating challenges, as well as helpful facets of her own treatment/recovery process, in order to \u00E2\u0080\u009Cgive her the tools without hauling her on the rack.\u00E2\u0080\u009D Simone Simone is a 41 year old heterosexual woman who identifies with a \u00E2\u0080\u009Cmixed\u00E2\u0080\u009D racial background, and as First Nations. She has been married for over a decade and has two children, whom she devotes her time to raising as a stay-at-home parent. She currently lives with her husband, children, and two of her husband\u00E2\u0080\u0099s sisters. In her thirties, Simone was diagnosed with Type 1 diabetes. Simone reported both positive attachments to food starting at a young age (e.g., seeing her father, whom she did not live with), as well as what she described as past \u00E2\u0080\u009Ctraumatic\u00E2\u0080\u009D experiences involving food (e.g., being intensely berated for eating her mother\u00E2\u0080\u0099s fast food; having to eat \u00E2\u0080\u009Chalf-cooked\u00E2\u0080\u009D meals prepared by her grandmother). She currently identified as being \u00E2\u0080\u009Cobese\u00E2\u0080\u009D and \u00E2\u0080\u009Cheavy set\u00E2\u0080\u009D and said she tries to walk every day as a form of exercise. She has previously enrolled in Weight Watchers in an attempt to lose weight, and said she would ideally like to lose 30 to 40 lbs. Her husband, whom she described as supportive, prepares food in the family home. Simone noted that she is afraid of being \u00E2\u0080\u009Ctoo good\u00E2\u0080\u009D at cooking and subsequently \u00E2\u0080\u009Csitting around eating all the time.\u00E2\u0080\u009D She noted that her husband will cook various meal options every night for dinner, which makes it \u00E2\u0080\u009Coverwhelming\u00E2\u0080\u009D for her to address her concerns about her 79##weight. Given the multicultural nature of her immediate and extended families (e.g., Phillipino, Italian, First Nations, Irish, French), she said that her eating is often affected by sometimes conflicting cultural norms, and she noted that she believes her eating habits would be healthier if she had been more influenced by her First Nations heritage. She described engaging in binge eating and turning to food as a way of managing stress and other emotions, and noted that her eating is influenced by her mood. She identified foods such as cookies, chips, fast foods, and peanut butter as foods she may turn to for comfort. Simone described eating as a \u00E2\u0080\u009Creward system,\u00E2\u0080\u009D which may serve to \u00E2\u0080\u009Cfill a void\u00E2\u0080\u009D and distract herself from imminent stressors. She also discussed sometimes having difficulty stopping herself from eating certain foods, despite feeling satiated, and eating past the point of fullness. Generally, Simone shared that she feels she is eating healthier than she did during earlier stages in her life, and that she has become more health-conscious as she has entered mid-life. She noted that she may eat too much of the healthy food that is available and said she thinks about food a considerable amount in a day. In order to curb her tendency to eat when bored, she drinks water and waits a short amount of time to assess whether or not she is, in fact, hungry. Simone said she believes her tendency to eat out of boredom and/or loneliness increased when her youngest child started school and she was alone more frequently in the family home. Simone stated that now that she is in her mid-life years, she is finding it easier to resist media imagery depicting North American beauty ideals. Simone said she would try to \u00E2\u0080\u009Csupport\u00E2\u0080\u009D and \u00E2\u0080\u009Cencourage\u00E2\u0080\u009D other women living with eating challenges to the best of her ability, by helping women deepen the value placed on other aspects of their lives, aside from food and eating, and also would try to help them widen their indicators of self-worth, beyond their weight and shape. She noted that she has never received counselling for her difficulties with eating. 80## Evelyn Evelyn is a 58 year old heterosexual, White woman who identifies with British and Irish ancestry, and now works in the field of education after pursuing post-secondary studies in her thirties. She has been married to her second husband, with whom she lives, for eight years. She relocated to the west coast from a rural community in her thirties, after divorcing her first husband. Evelyn is currently estranged from one of her two children, and she has three grandchildren. She stated that her \u00E2\u0080\u009Crelationship with food has been problematic since [she] was a young child, for as long as [she] can remember.\u00E2\u0080\u009D She said she was \u00E2\u0080\u009Ctaught to overeat,\u00E2\u0080\u009D given that her parents reportedly used food to pacify her and her siblings \u00E2\u0080\u009Cwhen [they] were sad, angry, whatever range of emotions that a human might experience.\u00E2\u0080\u009D She said she has always been considered a \u00E2\u0080\u009Cbig girl,\u00E2\u0080\u009D and noted that family members would often comment on her body size (e.g., weight loss/gain). In her twenties, Evelyn attended Overeaters Anonymous (OA) meetings, and she said she would \u00E2\u0080\u009Cvacillate between starving [herself], exercising\u00E2\u0080\u009D and binge eating. Through participating in OA, she subsequently \u00E2\u0080\u009Cgained some control over\u00E2\u0080\u009D her eating, and lost 40 lbs. In the face of her divorce and other life stressors, she increasingly turned to food for comfort, and consequently gained weight. She noted that she still struggles with her weight, and sometimes \u00E2\u0080\u009Cfights like crazy with it,\u00E2\u0080\u009D alternating between eating and \u00E2\u0080\u009Cexercising outrageous amounts.\u00E2\u0080\u009D She noted that she perceives herself as currently \u00E2\u0080\u009Coverweight, but not obese.\u00E2\u0080\u009D Evelyn said she is now exercising more regularly than she has at any other life stage (as opposed to \u00E2\u0080\u009Cbinge exercising\u00E2\u0080\u009D). She also identified hunger, anger, and fatigue as triggers for binge eating, and noted that she refrains from keeping certain foods in the house (e.g., ice cream) in an attempt to control her eating and weight. She said that she will usually binge on foods that are available in the house (e.g., yogurt, nuts, cookies), and that she typically eats too much of the healthy food 81##that is available, as opposed to the junk food she would primarily gravitate towards during her younger years. In mid-life, Evelyn believes her challenges with eating are largely \u00E2\u0080\u009Ccompounded by loneliness\u00E2\u0080\u009D and feelings of isolation, given that she feels she lacks meaningful social relationships. Evelyn feels that eating serves to \u00E2\u0080\u009Cprevent any kind of feelings, particularly the loneliness.\u00E2\u0080\u009D She said she was motivated to participate in this study because she \u00E2\u0080\u009Cwants to hear others\u00E2\u0080\u0099 stories\u00E2\u0080\u00A6that\u00E2\u0080\u0099s what [she\u00E2\u0080\u0099s] hungry for.\u00E2\u0080\u009D Evelyn would try to support other women living with eating challenges by inviting them to \u00E2\u0080\u009Ctell their story,\u00E2\u0080\u009D and sharing her own experiences, in return. She noted that she would \u00E2\u0080\u009Cwant to acknowledge and affirm and be part of saying, \u00E2\u0080\u0098you\u00E2\u0080\u0099re okay\u00E2\u0080\u0099.\u00E2\u0080\u009D Janette Janette is a 65 year old heterosexual, White woman of British and Irish ancestry who has earned a doctorate. She currently lives with her husband of twenty-five years, and is retired from her consulting career. Despite her desire to become a mother, she was unable to have children in her forties due to infertility. Janette discussed how she has always struggled with the perception of her body weight and shape, commenting on how she has \u00E2\u0080\u009Calways [felt] heavier than [she] should be, even when [she] was a kid and was not [overweight].\u00E2\u0080\u009D In her family of origin, thinness and appearance were reportedly valued. Her life-long \u00E2\u0080\u009Cobsession\u00E2\u0080\u009D with weight and appearance worsened in mid-life, and \u00E2\u0080\u009Ccame up like a tsunami in [her] forties.\u00E2\u0080\u009D During this time, she turned to food as a way of coping in the wake of various developmental challenges and stressors (e.g., marriage, career-building, moving, parental death), as well as physiological changes and experiences (e.g., physical pain, hormonal changes, endometriosis, infertility). Janette lamented the weight gain she has experienced in mid-life, and she expressed feeling that she is \u00E2\u0080\u009Cheavy\u00E2\u0080\u009D and \u00E2\u0080\u009Cmarginally overweight.\u00E2\u0080\u009D She discussed constantly engaging in social 82##comparison with other women around weight and shape, admiring thinness and being contemptuous of fat. She noted that she thinks about food hourly and constantly throughout the day. Janette expressed being very conscious of what she is eating and knowing \u00E2\u0080\u009Cthe calorie count of any food on the planet,\u00E2\u0080\u009D as well as \u00E2\u0080\u009Cevery theory about food and food combining there is.\u00E2\u0080\u009D She said she has been on \u00E2\u0080\u009Cevery diet you could think of,\u00E2\u0080\u009D including Weight Watchers, Jenny Craig, and the Bernstein Diet, which is how she has attempted to moderate her weight throughout her life, in light of what she perceives as challenges with self-control around food and eating. She noted using food as a \u00E2\u0080\u009Creward system,\u00E2\u0080\u009D as \u00E2\u0080\u009Ccelebration,\u00E2\u0080\u009D and as a \u00E2\u0080\u009Cpalliative\u00E2\u0080\u009D for managing emotions, particularly feelings characteristic of \u00E2\u0080\u009Cdepression.\u00E2\u0080\u009D She also discussed being a \u00E2\u0080\u009Cbad night eater\u00E2\u0080\u009D and eating in response to boredom. Given that Janette feels she is still struggling with her own relationship with food, she stated that she doesn\u00E2\u0080\u0099t feel she is in a position to give advice to other mid-life women who may also be living with eating challenges. She noted that she has been in counselling several times throughout her life, for issues unrelated to her challenges with food. Carmen Carmen is a 43 year old heterosexual, Latina woman who immigrated to Canada as a child, and identifies with Spanish, Portuguese, and Italian ancestry. She has been married to her second husband for 16 years and has four children. She currently lives with her husband and her youngest child, and works in administration. Carmen shared memories of her father making \u00E2\u0080\u009Cjokes\u00E2\u0080\u009D about her appearance, and recalled being teased by other children, who mocked her body weight and shape \u00E2\u0080\u0093 commenting on her \u00E2\u0080\u009Cbigger breasts\u00E2\u0080\u009D and \u00E2\u0080\u009Cbig butt\u00E2\u0080\u009D \u00E2\u0080\u0093 comments that eventually wore on her self-esteem. She also explained that she believes her challenges with food are impacted by her mother, who also struggles with weight and appearance, and made critical 83##comments about Carmen\u00E2\u0080\u0099s eating habits as a child. She said she also turned to eating/food, and subsequently gained weight, as a way of protecting herself against being sexualized, after experiencing trauma as a young girl. However, Carmen believes her challenges with food primarily started in her forties when she realized she wasn\u00E2\u0080\u0099t able to lose weight as easily, in the face of normative weight gain, and when she noticed changes in her metabolism and appearance (e.g., \u00E2\u0080\u009Csagging\u00E2\u0080\u009D body parts, wrinkles). Carmen said she perceives herself as \u00E2\u0080\u009Coverweight.\u00E2\u0080\u009D She noted that she is \u00E2\u0080\u009Cconstantly watching what [she\u00E2\u0080\u0099s] eating\u00E2\u0080\u009D and feels an incredible amount of guilt after \u00E2\u0080\u009Cbinge eating.\u00E2\u0080\u009D She said she started \u00E2\u0080\u009Cemotional eating\u00E2\u0080\u009D in mid-life, and discussed turning to foods such as chocolate, breads, cookies, and crackers \u00E2\u0080\u0093 \u00E2\u0080\u009Csomething sweet, starchy\u00E2\u0080\u009D and \u00E2\u0080\u009Cemotionally satisfying\u00E2\u0080\u009D \u00E2\u0080\u0093 as a way of managing stress, soothing emotions, and improving her mood. Carmen increasingly turned to food, and gained weight, when experiencing loneliness after moving to the west coast from another Canadian province, where her family of origin still resides. In addition, for the past four months she has been eating a vegan diet, refraining from dairy, meat, and animal byproducts. Her inspiration for starting a vegan diet was a documentary, Vegucated. Her motivation to pursue veganism increased after she learned she could lose weight on a vegan diet \u00E2\u0080\u0093 and after her weight loss was reinforced by others. She spoke of the need to control the food that she puts in her body, particularly when other facets of her life feel chaotic. Discussing the need to control her food intake on the one hand, and her tendency to binge on sweets on the other, Carmen said she \u00E2\u0080\u009Ccan't seem to have [different types of food] meet where [she] can just have a healthy diet.\u00E2\u0080\u009D She also spoke of sometimes alternating between \u00E2\u0080\u009Cstarving\u00E2\u0080\u009D herself and subsequently bingeing. She expressed fear that her husband may no longer be attracted to her in light of her weight gain, and she noted that he has exerted seemingly subtle pressure about, and drawn attention to, her weight. For example, he has reportedly made 84##comments about her body (e.g., that her \u00E2\u0080\u009Clegs aren\u00E2\u0080\u0099t quite as jiggly as they used to be\u00E2\u0080\u009D) and encouraged her to join a gym. She noted that she now feels more self-conscious about her appearance since entering mid-life, and discussed the shame associated with not being able to achieve North American and Latina beauty/body ideals. Her primary motivation for participating in this study was to be able to help other women struggling with eating challenges. Carmen said she would want other mid-life women living with eating challenges to \u00E2\u0080\u009Cjust accept [themselves] for who [they] are,\u00E2\u0080\u009D and to cease self-critical and -judgemental tendencies. Carmen has never sought counselling for her eating problems. Barbara Barbara is a 57 year old heterosexual woman who has been married for over thirty years, and currently lives with her husband. She has two step-children and five grandchildren. Barbara identifies as Lebanese-Canadian, and is semi-retired from her career in business. Barbara shared that she been turning to food for comfort since she was a child, which lasted until her early fifties, and she noted that she has struggled with her body image throughout her life. In her early twenties, Barbara \u00E2\u0080\u009Cfell into a brief episode with bulimia,\u00E2\u0080\u009D characterized by bingeing and purging, although she never received a formal ED diagnosis. At this time, she reportedly saw a psychologist to address her eating-related symptoms. In addition, verbalizing her struggle with \u00E2\u0080\u009Cbulimia\u00E2\u0080\u009D to her doctor was reportedly enough to cause her to cease engaging in the purging behavior. In her early mid-life years, she described living an \u00E2\u0080\u009Cunhealthy\u00E2\u0080\u009D lifestyle where she would eat large quantities of food throughout the day, and turn to food for comfort in the evenings. Sometimes, she would \u00E2\u0080\u009Ceat to excess\u00E2\u0080\u009D until her stomach felt sore. She again \u00E2\u0080\u009Cballooned up\u00E2\u0080\u009D (i.e., gained weight) in her late-thirties, after her mother\u00E2\u0080\u0099s death, when she engaged in eating as a way of managing her emotions. Barbara said she would binge on foods 85##such as pastries, baked goods, and other \u00E2\u0080\u009Csugary things.\u00E2\u0080\u009D Five years ago, Barbara suddenly became ill for a duration of approximately one year, and through this, she feels that her relationship with food improved. She believes the onset of her illness (a diagnosis for which was never confirmed) began with eating contaminated food, and early on in her illness, she subsequently lived with a \u00E2\u0080\u009Cfear of food\u00E2\u0080\u009D and \u00E2\u0080\u009Ccould barely eat.\u00E2\u0080\u009D During this time, she attended counselling and worked through past difficulties in her life, and through counselling she said \u00E2\u0080\u009Csomehow her relationship to food changed\u00E2\u0080\u009D in a process that \u00E2\u0080\u009Cwasn\u00E2\u0080\u0099t conscious.\u00E2\u0080\u009D She has since lost approximately 30 pounds, and she noted that she is conscious of trying to maintain that weight loss. During mid-life, Barbara said that she experienced \u00E2\u0080\u009Cshame,\u00E2\u0080\u009D \u00E2\u0080\u009Cself-loathing,\u00E2\u0080\u009D and feeling out of control around her eating for the first time, and started to hide her eating. She makes meaning of her eating challenges worsening in mid-life due to the \u00E2\u0080\u009Cthe culmination of all life's experiences that you don't deal with kind of building and just turning more and more to food.\u00E2\u0080\u009D Barbara said that at this current stage in her mid-life years, she no longer feels she has to \u00E2\u0080\u009Ccontrol\u00E2\u0080\u009D her eating, and that she has found healthier ways to cope with stress and emotions, in lieu of reaching for food. However, she said she is still \u00E2\u0080\u009Cconstantly thinking of food\u00E2\u0080\u009D albeit in a \u00E2\u0080\u009Cmore reasonable way,\u00E2\u0080\u009D and she noted that food is still a \u00E2\u0080\u009Ctreat.\u00E2\u0080\u009D She said that she is still \u00E2\u0080\u009Cgrappling with what\u00E2\u0080\u0099s sort of normal [eating],\u00E2\u0080\u009D and declared that food has always been her \u00E2\u0080\u009CAchilles Heel.\u00E2\u0080\u009D Currently, Barbara walks or goes to the gym five times per week. She said she would encourage other women living with eating challenges to seek professional help. Common Themes Six common themes describing the \u00E2\u0080\u009Cessence\u00E2\u0080\u009D of the lived experience of mid-life women\u00E2\u0080\u0099s challenges with food are presented: Sense of Food as Comfort and a Means of Coping, Sense of Guilt and Shame, Sense of Needing Control, Sense of Food and Eating as Addiction, 86##Sense of Pressure to Conform, and Sense of Loss of Social Power and Visibility. (See Table 2 for a list of the common themes and sub-themes). Table 2 Common Themes and Sub-Themes Sense of Food as Comfort and a Means of Coping Using food to cope with emotions and stress Relationships with food as polarized and paradoxical Eating as a habitual and cyclical pattern Food as emotional comfort Sense of Guilt and Shame Relentless self-criticism Secrecy Shame associated with weight gain Desire to hide their bodies Sense of Needing Control Feeling out of control with food Trying to establish control over food and eating Trying to control body weight Sense of Food and Eating as Addiction Food as a potentially addictive substance Obsession with food and weight Resignation Sense of Pressure to Conform Perceived pressure via media Perceived pressure from close others Increased pressure in mid-life Sense of Loss of Social Power and Visibility In addition to these six themes and various sub-themes, a sense of isolation was a prominent thread that was evident throughout the women\u00E2\u0080\u0099s narratives \u00E2\u0080\u0093 one that highlighted the essence of the solitary nature of the women\u00E2\u0080\u0099s experiences of living with eating challenges \u00E2\u0080\u0093 as well as the secrecy inherent in their experiences. More specifically, this thread reflected the 87##women\u00E2\u0080\u0099s tendency to eat alone, the comfort they derived from eating alone, the difficulty with controlling their eating when alone in the presence of food, and for some, the loneliness that characterized the experience of their relationship with food. Importantly, this sense of isolation does not stand alone, but rather seems to be a strand interwoven throughout all of the themes, and as a consequence, is included throughout the discussion of the six common themes. It is important to note that the themes are not presented in any particular order; however, Sense of Food as Comfort and a Means of Coping is presented first, due to its complexity, as well as the salience, intensity, and clarity with which the women described this particular aspect of their experience. To add depth to the presentation of the themes, rich and resonant quotations from the participants are liberally utilized to add depth and breadth to the thematic descriptions. Sense of Food as Comfort and a Means of Coping All of the women in this study were unanimous in describing their experience of turning to food as a source of comfort, and consuming food in order to cope with various challenges and a wide range of developmental, intrapersonal and interpersonal stressors throughout their lives. Examples of these stressors included caring for aging parents, divorce, personal upheaval and change (e.g., moving to a new city), death of family members, traumatic experiences (e.g., physical, sexual, and emotional abuse; therapeutic abortion), parenting and financial pressures, biological changes, menopause, relational challenges and infidelity, career challenges, perceptions of having not achieved important developmental milestones, illness, infertility, normative weight gain, and the stresses of daily living. In addition, a prominent sub-theme was using food to cope with emotions and stress. As expressed metaphorically by one participant, the women in this study described a \u00E2\u0080\u009Ctendency to run in the other direction and eat,\u00E2\u0080\u009D when facing challenging stressors, emotions, and self-critical thoughts. The participants also discussed 88##various \u00E2\u0080\u009Ctriggers\u00E2\u0080\u009D for turning to food as a source of comfort, including fatigue, boredom, hunger, weight gain, the desire to procrastinate and/or engage in avoidance, feelings of perfectionism, and low self-esteem. Women\u00E2\u0080\u0099s relationships with food as polarized and paradoxical was also a powerful sub-theme in the participants\u00E2\u0080\u0099 narratives. The women in this study described both positive and negative associations, metaphors, and personal meanings attached to food, as well as experiences of negotiating both the pleasuring and painful aspects inherent in their relationship with food. Eating as a habitual and cyclical pattern was also a prominent sub-theme in the women\u00E2\u0080\u0099s experiences. The women in this study described turning to food for comfort as a routine, and a go-to behaviour for coping with distress. In addition, the women described a cyclical pattern of initially experiencing pleasure, comfort, and enhanced mood while eating, which was quickly followed by the onset of challenging emotions, relentless self-criticism, and an influx of negative beliefs about themselves. Lastly, the women also referred more to food as emotional comfort, and less as \u00E2\u0080\u009Cfuel\u00E2\u0080\u009D to nourish their bodies. Each of these sub-themes will be further elucidated below. In discussing their tendency to turn toward food as a source of comfort and to use food as a means of coping, the participants spoke of engaging with food in a variety of ways. Although a small number of the women primarily discussed their tendency to typically consume \u00E2\u0080\u009Ctoo much of the healthy food that was available,\u00E2\u0080\u009D the majority described a pattern of \u00E2\u0080\u009Covereating\u00E2\u0080\u009D and/or \u00E2\u0080\u009Cbingeing\u00E2\u0080\u009D on \u00E2\u0080\u009Cforbidden\u00E2\u0080\u009D or less nutritious foods to achieve a sense of comfort (e.g., fast food, popcorn, cookies, candy, chocolate, ice cream, bread, pasta, pastries). This occurred primarily in solitude, most often in the privacy and safety of their homes. To this end, all of the women reported consciously turning to \u00E2\u0080\u009Csweets,\u00E2\u0080\u009D \u00E2\u0080\u009Ccarbs,\u00E2\u0080\u009D and \u00E2\u0080\u009Cfattening\u00E2\u0080\u009D foods with a \u00E2\u0080\u009Chigh sugar content\u00E2\u0080\u009D \u00E2\u0080\u0093 \u00E2\u0080\u009Cfoods that you don\u00E2\u0080\u0099t work off quite as fast.\u00E2\u0080\u009D In contrast, healthier foods such as 89##apples, carrots, oranges, foods high in protein, and lettuce were discussed as examples of foods that the women would not seek out when they were binge-eating or seeking comfort. The intensity with which the women turned to food for comfort varied, as did the amount of food consumed by each woman while engaged in overeating and/or a binge. For example, on one end the continuum one participant discussed an isolated incident of eating a cheeseburger as a means of coping with distress. At the other end of the continuum, another participant discussed her tendency to metaphorically \u00E2\u0080\u009Cgo home into [her] nest and eat [herself] into a coma.\u00E2\u0080\u009D Relatedly, the degree to which the women felt in control of their eating, and were committed to dieting, also seemed to reflect the degree to which they would turn toward food for comfort. The act of eating was described as comforting among all of the women in this study, and for some, the feeling of physical fullness and satiety that ensued after eating and/or a binge was likewise comforting, as captured in the following quote: I\u00E2\u0080\u0099ll come home from work some days when it\u00E2\u0080\u0099s been really stressful and intense and I\u00E2\u0080\u0099ll just binge \u00E2\u0080\u0093 whatever pistachios, cookies, yogurt, anything that\u00E2\u0080\u0099s available\u00E2\u0080\u00A6quite a quantity of food. When I do get around to doing my food journal, I\u00E2\u0080\u0099m horrified with how much food I\u00E2\u0080\u0099ve consumed. But I don\u00E2\u0080\u0099t feel particularly stuffed, just really full, as if there\u00E2\u0080\u0099s a difference. I mean it\u00E2\u0080\u0099s different in that I\u00E2\u0080\u0099m really full as opposed to when I was younger there were times when I would eat to the point of pain\u00E2\u0080\u00A6I don\u00E2\u0080\u0099t know why that feeling of being stuffed is comforting. In addition, the participants also discussed various familial influences on their challenges with food, eating, and body image. Interestingly, in light of the current theme, most of the women in their fifties and sixties specifically discussed how food was utilized by their parents to pacify and soothe them as children, which they believed was the origin for their tendency to 90##associate food with comfort. This sentiment of learning in childhood to associate food with comfort is captured in the words of one participant as she reflected on how food was used in her household growing up: \u00E2\u0080\u00A6and if I ate that whole plate then I could have another. I don\u00E2\u0080\u0099t ever remember being told \u00E2\u0080\u009Cno\u00E2\u0080\u009D as long you cleaned up this on your plate, you could have more of that. That\u00E2\u0080\u0099s what creates the problem, and then you create this link to food is comfort. You skinned your knee, there was always a cookie \u00E2\u0080\u0093 that\u00E2\u0080\u0099ll make it better. That kind of thing. Some of the women in this study also reflected on the prominent role of food in their cultures, as well as familial practices and traditions, which reinforced the notion that food was associated with comfort, love, and celebration (e.g., family celebrations involving food, being constantly surrounded by food in the family home, special dinners at restaurants with family members, positive associations between food and certain beloved family members). Using Food to Cope with Emotions and Stress. The women in this study described turning to food for comfort, and engaging in overeating and/or bingeing, as a way of coping with, and escaping from, stress and challenging emotions (e.g., sadness, anxiety, regret, anger, loneliness, irritation, frustration, perceived \u00E2\u0080\u009Cfailure\u00E2\u0080\u009D). Importantly, the women differed in their ability to tolerate emotional distress, and thus, varied in their need to turn to food as a means of coping. In addition, for some of the women, the intensity of their low mood often correlated with the amount and types of foods they would reach for in an effort to cope. For example, depending on her level of internal distress, one participant discussed being able to stop herself from eating after consuming only a few crackers if she was a bit upset, whereas if she was feeling significantly more \u00E2\u0080\u009Cdepressed\u00E2\u0080\u009D she might eat the whole box of crackers. In turning to food as a means of coping with distressing emotions, the women largely 91##described the function of food as a \u00E2\u0080\u009Csedative\u00E2\u0080\u009D and \u00E2\u0080\u009Cpalliative.\u00E2\u0080\u009D They reported turning to food in order to \u00E2\u0080\u009Cfill a void,\u00E2\u0080\u009D \u00E2\u0080\u009Csoothe\u00E2\u0080\u009D and \u00E2\u0080\u009Cnumb\u00E2\u0080\u009D emotional pain, and to experience a reprieve from internal distress. This experience is represented in the strikingly emotional words of one participant, a bereaved mother, who reported turning to food in order to cope with her overwhelming feelings of grief and loss: \u00E2\u0080\u00A6for me having lost my daughter, and it\u00E2\u0080\u0099s just that pain again, you know?...And I realize now, that I think I internalized those feelings so much and I use food to numb the pain, to comfort me, to help me just get through, you know? Indeed, during the act of eating, all of the participants described feeling as though they could disconnect from their stress, block out emotional distress, and solely focus on eating and its mood-enhancing properties. The comforting and sedating effect of food, and the experience of engaging in eating as a way of coping with stress, was described by another participant in her forties: \u00E2\u0080\u00A6[nighttime] was the best time of day for me because it was me and the food and I don\u00E2\u0080\u0099t have to think about anything else. And it\u00E2\u0080\u0099s just a wonderful feeling\u00E2\u0080\u00A6I just don\u00E2\u0080\u0099t have to think about anything. It has a sedating effect because I do struggle with anxiety and I can get kind of obsessive with my thinking\u00E2\u0080\u00A6and I have issues with procrastination\u00E2\u0080\u00A6it\u00E2\u0080\u0099s almost like I\u00E2\u0080\u0099d rather not do that thing at all and just eat and avoid it than tackle something and just be my harshest critic and not ever be good enough. So, I think a lot of times I use food as an avoidance tactic\u00E2\u0080\u00A6I would just eat until I was so painfully full that I would just go to sleep because you can\u00E2\u0080\u0099t do anything else. And it was, \u00E2\u0080\u009COk, well, I got out of doing that difficult task\u00E2\u0080\u009D and then it would just go on and on. In addition, some of the women also described turning to food as a means of coping with 92##feelings of loneliness and disconnectedness. For example, one woman\u00E2\u0080\u0099s experience of turning to food for comfort largely revolved around a deep sense of loneliness and frustration at failed attempts to create satisfying social connections and relationships. She noted that \u00E2\u0080\u009Cnothing seems to satisfy\u00E2\u0080\u009D her feelings of loneliness \u00E2\u0080\u009Cexcept eating\u00E2\u0080\u009D: \u00E2\u0080\u00A6these days I know that my eating is compounded by loneliness. And the fact that I have a very stressful job that is very isolating in its own way and I have a wonderful husband but I don\u00E2\u0080\u0099t have any family in Vancouver. I\u00E2\u0080\u0099ve done tons of hours of volunteer work and gone out and done other things but somehow I just don\u00E2\u0080\u0099t seem to meet people that I connect with. And so I then spend a lot of time wondering, is it me? Is there something wrong with me? Every other place I\u00E2\u0080\u0099ve lived I had no problem making friends. But somehow here I am challenged wondering if it\u00E2\u0080\u0099s me. And of course, then I eat. I come home, I\u00E2\u0080\u0099m tired, I isolate, I eat\u00E2\u0080\u00A6And I alternate between eating and exercising outrageous amounts. For the single women in this study, food was also described as something they sometimes sought out to mitigate their loneliness, as expressed in the following quote: \u00E2\u0080\u00A6relationships are usually a pretty positive thing and you can tend to [lose weight] because you\u00E2\u0080\u0099re not [overeating]. You don\u00E2\u0080\u0099t want to gain weight\u00E2\u0080\u00A6but also your mind\u00E2\u0080\u0099s on something else, and therefore I\u00E2\u0080\u0099m not alone. I\u00E2\u0080\u0099m not [alone], you know? You\u00E2\u0080\u0099ve got something else to comfort you instead of food. Although all of the women described eating as a way of alleviating emotional pain, one mid-life woman in her sixties discussed how eating also seemed to effectively mitigate her physical pain in mid-life. Reflecting on developmental challenges she experienced in her forties, this participant described how she turned to food to provide comfort and alleviate the physical 93##pain caused by hormonal changes and a gynecological condition: I remember when I was premenstrual, I would just have this unbelievable desire to eat and it was a comforting thing. It actually made me physically feel better. So, my guess is that whole thing - the hormones, the endometriosis, maybe even the trying to have children and not - led me to overeat, to kind of let my weight get out of control...It felt so much like eating actually medicated some of the physical pain, and I don\u00E2\u0080\u0099t know if that was true or not, but it certainly felt that way. Interestingly, several of the participants described the developmental stage of mid-life as \u00E2\u0080\u009Cthe perfect storm\u00E2\u0080\u009D \u00E2\u0080\u0093 a time during which the onset of a series of contextual stressors coalesced to worsen the women\u00E2\u0080\u0099s challenges with food, including their tendency to turn towards food for comfort (e.g., aging, menopause and hormonal changes, shifting identity, slower metabolism, normative weight gain, significant life changes). The women described turning to food to cope with various developmental and contextual stressors they experienced during mid-life. The majority of the women in this study underwent significant changes and challenges in their lives during mid-life (e.g., going back to school, going through a divorce or ending a serious romantic relationship, moving to a new city, changing careers, facing infertility and letting go of the dream of motherhood), and noted how they turned to food to cope with these challenges. One participant commented on how her eating challenges \u00E2\u0080\u009Ccame back up like a tsunami in [her] forties\u00E2\u0080\u009D in the face of various life changes that were ongoing during her transition to mid-life. In addition, all of the women in this study discussed turning to food as a means of coping with tasks, demands, and experiences that are often characteristic to, and heightened during mid-life (e.g., building a career, parenting, financial stress, the death of parents, caring for ageing family members). For example, for the women in this study who were mothers, the stresses of parenting 94##were often cited as a salient trigger for turning to food for comfort, as captured in the words of one participant: ...other stress could be sometimes difficulties with my kids and primarily my eldest\u00E2\u0080\u00A6he can be challenging sometimes and he needs an explanation for all the things I ask him to do. So, I find that exhausting sometimes\u00E2\u0080\u00A6and occasionally I will just decide, \u00E2\u0080\u009COk, I\u00E2\u0080\u0099m not feeling well now. I\u00E2\u0080\u0099m going to make myself feel better by eating something I shouldn\u00E2\u0080\u0099t, right?\u00E2\u0080\u009D Interestingly, the mothers in this study all expressed a strong desire \u00E2\u0080\u009Cnot to pass on\u00E2\u0080\u009D their eating challenges to their children \u00E2\u0080\u0093 to raise them to have a \u00E2\u0080\u009Chealthier\u00E2\u0080\u009D relationship to food. The participants also commonly cited work and financial stressors as a reason they turned to food for comfort, an experience exemplified in the words of one participant whose career was particularly demanding during her 40s: \u00E2\u0080\u00A6It was definitely through my 40s where I just - I don't know\u00E2\u0080\u00A6I worked late\u00E2\u0080\u00A6working weekends was a very common thing\u00E2\u0080\u00A6if it was month-end, working until ten o'clock was not uncommon. And so eating was kind of like the only comfort\u00E2\u0080\u00A6what I would have thought of initially as my only happy time in a way. I don't want to make it sound like it was all gloom and doom because it wasn't, but definitely I really turned to food\u00E2\u0080\u00A6and you sort of slip into patterns and then those patterns magnify\u00E2\u0080\u00A6 In addition, some of the participants specifically described the developmental transition to mid-life as being particularly challenging. As they made the transition to mid-life, the participants recalled being more aware of the aging process and their changing bodies, and evaluating the state of their lives. Entering mid-life was most poignantly described as a time of self-reflection by one participant whose life goals came into sharp focus, and who subsequently turned to food 95##to cope with the stress and pressures during this developmental transition: Yeah, I think I was just taking stock in my life, like where I\u00E2\u0080\u0099ve been. I\u00E2\u0080\u0099m 41 and I\u00E2\u0080\u0099ve never been married. I don\u00E2\u0080\u0099t have children. So, that\u00E2\u0080\u0099s a very big one! Because I kind of was always on the fence about having children. And I was in a relationship where I thought he was ok with not having children at the time, but it turns out he wasn\u00E2\u0080\u0099t. So, that was really tough\u00E2\u0080\u00A6not being married, not having children. I don\u00E2\u0080\u0099t know. My window is getting smaller. Not really sure where I want to be with my career. Like, I want to change jobs. I just felt like I was at a huge crossroads. And I just didn\u00E2\u0080\u0099t want to think about it. I\u00E2\u0080\u0099d just rather go home and watch some sitcoms and eat some chips. Like, I just don\u00E2\u0080\u0099t want to deal with it! The women in this study also discussed seeking comfort from food as a reprieve from challenging internal stressors and intrapersonal processes such as relentless self-criticism, painful memories and experiences, and low self-esteem. For example, one participant discussed how she often turns to food in an effort to cope with feelings of low self-esteem: I think it has a lot to do with self-esteem. When I'm feeling like a failure and like I haven't done something right or when I make a mistake - especially when I make mistakes at work - that\u00E2\u0080\u0099s what triggers me a lot [and makes me want to eat]. Interestingly, the act of simply thinking about food was sometimes enough to create a reprieve from feelings of distress. Several of the women spoke of trying to cope with periods of acute stress by thinking ahead and planning how they would later engage in overeating, with food serving as a future salve to deal with their discomfort. The words of one participant poignantly reflect the powerful role of food as a mechanism for coping with stress: If things are really stressful, I can think, \u00E2\u0080\u009COh, all I got to do is just wait till I get home. I 96## just got to put up with this now\u00E2\u0080\u00A6Just deal with it now, and then when you get home you can let it all out. You can have your bag of chips, you can have whatever you want. Just get through right now. You\u00E2\u0080\u0099ll be safe in a little while.\u00E2\u0080\u009D And it\u00E2\u0080\u0099s true. That\u00E2\u0080\u0099s how I get through some stuff. To varying degrees, in time and with some distance from the source of their distressing feelings, all of the participants eventually became aware of their pattern of turning to food as a way of coping with, and sometimes blocking, distressing experiences and feelings. These sentiments were reflected in the following words of one participant: It was almost like smothering my feelings with food, you know, just focusing on that. I truly wasn't really conscious of them in a way. I knew my mother's death and my father's death later had a real influence on me\u00E2\u0080\u00A6that's kind of normal. But there was a sense of loss about a lot of things around that time that I realized in mid-life I had to really kind of forgive myself for and just accept, and that was, I think, a lot of the food and the obsession with food was just kind of blocking all that stuff out. Similarly, another participant described her later realization of how she had turned to food to block her feelings of grief, after hearing about the death of a baby: \u00E2\u0080\u00A6I went out and I went over to Tim Horton\u00E2\u0080\u0099s and I got a sundried tomato bagel toasted with cream cheese and a soup - you know, carbs\u00E2\u0080\u00A6And then on my way home I bought two chocolate bars. I consumed both those chocolate bars by the time I got home. And then I had dinner...but that night I had toast with peanut butter and still, nothing. And then it was the following day, then I\u00E2\u0080\u0099m thinking, \u00E2\u0080\u009CGod, why did I have those chocolate bars?\u00E2\u0080\u009D And then I thought, \u00E2\u0080\u009CThat poor baby. That poor baby didn\u00E2\u0080\u0099t make it.\u00E2\u0080\u009D The women who had experienced the death of loved ones throughout their lives discussed 97##the important role food played in coping with their grief. For example, one participant reflected on the role of food in mid-life, in helping her cope with her mother\u00E2\u0080\u0099s terminal illness and subsequent death. She shared that eating was a primary coping mechanism during this time to help her through the immense grief she experienced, with which she suffered in silence: \u00E2\u0080\u00A6it was about two years from when we found out her cancer was terminal 'til a while after she passed on. Those were really bad years of peak eating\u00E2\u0080\u00A6a real focus on kind of non-thinking eating\u00E2\u0080\u00A6It was just engrained. It was habit. It was just what I reached out for. I didn't find it easy to really talk about it to anyone, even to my husband\u00E2\u0080\u00A6I was strong. People at work would think, \u00E2\u0080\u009COh, you know, she's juggling this and coming through that.\u00E2\u0080\u009D I wouldn't show it. It was just bottled up; and then it was me and food. Interestingly, in the absence of stressors, the need to engage in eating as a means of coping was not as necessary or prevalent for the women. Specifically, some of the women reported that they felt no need to turn to food for comfort when they felt positively about themselves, their bodies and weight, and their lives, and when there was a notable absence of stress in their lives. These sentiments were captured in the following words of one participant: \u00E2\u0080\u00A6when I\u00E2\u0080\u0099m feeling good and positive, that\u00E2\u0080\u0099s when I don\u00E2\u0080\u0099t have trouble with it\u00E2\u0080\u00A6then I do make healthy choices and I\u00E2\u0080\u0099m much more active. Food, I think I\u00E2\u0080\u0099m really recognizing now, it\u00E2\u0080\u0099s brought on by stressful experiences or negatives\u00E2\u0080\u00A6So, if I am out and about socializing I can make good [food] choices\u00E2\u0080\u00A6if everything is positive, I don\u00E2\u0080\u0099t have a problem, and my food relationship is not bad\u00E2\u0080\u00A6my food becomes a problem when there\u00E2\u0080\u0099s negative triggers. This sentiment was also echoed by another participant who said she only seeks comfort from food and eating when she is facing stressful life circumstances: 98## When things go bad in my life, I\u00E2\u0080\u0099m heavier. When things go good in my life and I\u00E2\u0080\u0099m feeling better about myself, I\u00E2\u0080\u0099m thinner. [Because when things are bad, I overeat]\u00E2\u0080\u00A6Because that\u00E2\u0080\u0099s what I find that soothes me. When everything else is going wrong, I can count on that to soothe me. Even if it\u00E2\u0080\u0099s just a little window of time, it does soothe me. Whereas when things are going good, I could care less about food, because I have other things in my life that are making me happy. Relationships with Food as Polarized and Paradoxical. All of the participants in this study discussed their relationship with food as being immensely complicated, paradoxical, and polarized. On the one hand, the women reported deriving a powerful sense of comfort and pleasure from food and their relationship with it, describing food as \u00E2\u0080\u009Ca security blanket,\u00E2\u0080\u009D a \u00E2\u0080\u009Cfriend,\u00E2\u0080\u009D an \u00E2\u0080\u009Cescape break,\u00E2\u0080\u009D a \u00E2\u0080\u009Creward,\u00E2\u0080\u009D a \u00E2\u0080\u009Ctreat,\u00E2\u0080\u009D \u00E2\u0080\u009Cnon-judgmental,\u00E2\u0080\u009D \u00E2\u0080\u009Csafety,\u00E2\u0080\u009D \u00E2\u0080\u009Cdependable,\u00E2\u0080\u009D \u00E2\u0080\u009Ccalming,\u00E2\u0080\u009D \u00E2\u0080\u009Cgrounding,\u00E2\u0080\u009D and creating a sense of \u00E2\u0080\u009Czen.\u00E2\u0080\u009D One of the participants described food as, \u00E2\u0080\u009Cmy comfort, my savior, my guide, so to speak,\u00E2\u0080\u009D particularly during the dissolution of her marriage in mid-life. Similarly, another participant described the powerful and positive role of food in her life, noting that, \u00E2\u0080\u009C[Food is] always there. Dependable\u00E2\u0080\u00A6Because it\u00E2\u0080\u0099s always there no matter what you do. It\u00E2\u0080\u0099s safe. Yeah, it loves me when no one else will.\u00E2\u0080\u009D This experience was further captured in the words of a participant in her sixties who identified as living with a reportedly undiagnosed \u00E2\u0080\u009Ceating disorder.\u00E2\u0080\u009D She described the safety that eating created for her during a time of great stress, change, and upheaval: \u00E2\u0080\u00A6at that time it was the only thing that I had because I lost everything. I had to leave my home community and come down here for school, so I rented my place out. I didn\u00E2\u0080\u0099t have any of my stuff. I was in a rented place and I was by myself. I wasn\u00E2\u0080\u0099t surrounded by the stuff that I felt safe in anymore, so the only thing I had was my eating disorder. And I 99## gained weight. Because I was trying to protect myself. I was feeling abandoned, betrayed, didn\u00E2\u0080\u0099t know where I was going, so it was the only thing that kept me safe and sane for a long time\u00E2\u0080\u00A6it was my old friend. At the same time, the women noted being troubled by their relationship with food, discussing aspects of this relationship less favorably. Despite their positive associations to food, and the pleasure that the women derived from eating, the act of eating was also associated with the onset of challenging emotions, self-criticism, and negative beliefs about themselves (further discussed below). Paradoxically, the women in this study ended up being hurt by the process of attempting to derive comfort from food \u00E2\u0080\u0093 a substance that they ultimately turned to for pleasure and comfort. The paradoxical and complex nature of the women\u00E2\u0080\u0099s relationships with food is poignantly captured in the words of one participant who referenced food as her \u00E2\u0080\u009Cenemy\u00E2\u0080\u009D: \u00E2\u0080\u00A6then you beat yourself up and then you\u00E2\u0080\u0099re looking for comfort. Well, the best comfort I find is in food because right now I don\u00E2\u0080\u0099t have a boyfriend\u00E2\u0080\u00A6so there\u00E2\u0080\u0099s a lot of time where I am alone in front of the TV or reading and there\u00E2\u0080\u0099s my comfort again\u00E2\u0080\u00A6it\u00E2\u0080\u0099s like food is the friend, and yet food is my enemy...your mind, it makes you crazy sometimes. Maybe it\u00E2\u0080\u0099s not my friend. Food is my comfort but it\u00E2\u0080\u0099s also my enemy. Thus, the women were faced with trying to negotiate both their positive and negative experiences with food and eating. Importantly, it was often difficult for the women to reconcile their contradictory experiences with food, and to understand why they continued to engage in a behaviour (i.e., turning to food for comfort) that ultimately felt as self-harming as it was self-soothing. This tension between the pleasurable and comforting, and painful aspects of the participants\u00E2\u0080\u0099 relationships with food is perhaps most poignantly captured by one woman\u00E2\u0080\u0099s description of being in \u00E2\u0080\u009Cmortal combat\u00E2\u0080\u009D with food throughout her life. Understandably, this 100##rendered the women\u00E2\u0080\u0099s relationships with food as immensely challenging, and ultimately, the women in this study expressed longing for more \u00E2\u0080\u009Cnormal,\u00E2\u0080\u009D less emotionally fraught, and less challenging relationships with food. Eating as a Habitual and Cyclical Pattern. The women in this study described turning to food for comfort as a habitual behaviour \u00E2\u0080\u0093 something they routinely sought out and engaged in when attempting to manage internal distress, and/or when they wanted to provide themselves with some pleasure. Thus, over time, the women fell into a pattern of perceiving, and engaging with, food as a coping mechanism. The habitual nature of using food to cope is captured in the words of one participant who identified herself as a \u00E2\u0080\u009Ccompulsive overeater\u00E2\u0080\u009D and described how \u00E2\u0080\u009Cbeing in the cycle of compulsive eating\u00E2\u0080\u00A6takes its own momentum and that\u00E2\u0080\u0099s just a trigger, in and of itself.\u00E2\u0080\u009D In addition, the women in this study described an overarching cyclical pattern of eating that was initially characterized by pleasure, and subsequently followed by the onset of painful thoughts and emotions (further discussed below). As noted above, during the first phase of the women\u00E2\u0080\u0099s cyclical eating pattern, the act of eating was described as a time when the women could solely focus on the pleasure and \u00E2\u0080\u009Crelease\u00E2\u0080\u009D that eating created, and briefly \u00E2\u0080\u009Cdisconnect\u00E2\u0080\u009D from their distress. During and shortly after having eaten, the participants described experiencing an improvement in their mood and \u00E2\u0080\u009Cfeeling better.\u00E2\u0080\u009D This experience is captured in the words of one participant as she reflected on her reactions to a particularly stressful experience at her son\u00E2\u0080\u0099s school: \u00E2\u0080\u00A6my son\u00E2\u0080\u0099s high school placement was breaking down\u00E2\u0080\u00A6the school was calling me and there was a Dairy Queen right across from the school. So, before I would go into the meeting I was worried: What\u00E2\u0080\u0099s going to happen with my son? What haven\u00E2\u0080\u0099t I done? And 101## then I\u00E2\u0080\u0099d think, \u00E2\u0080\u009COk, I can have a cheeseburger.\u00E2\u0080\u009D You know, really just a cheeseburger made me feel better even if it was only for 30 minutes. It was 30 minutes that I was willing to take. Food was also described as one of the few sources of comfort in an otherwise busy and stressful existence for some of the women in this study. The women described the time during which they were engaged in the act of eating as a kind of solace and haven, and an uninterrupted and pleasurable experience that was theirs alone. These sentiments were captured in the words of one participant: \u00E2\u0080\u00A6in my mid-life, [eating] was very much a comfort thing. It was a time to relax, to just slow down, stop. But it was also very unhealthy\u00E2\u0080\u00A6Usually I would read. It\u00E2\u0080\u0099s not like I would think about other things. So, maybe it was a little escape break \u00E2\u0080\u0093 take my mind off of the immediate things that were going on at my job or whatever. In addition, eating was also \u00E2\u0080\u009Cassociated with a kind of quiet,\u00E2\u0080\u009D a break from the demands of daily living, and one of the ways the women allowed themselves to indulge and receive pleasure, comfort, and reward, as expressed in the following quote: \u00E2\u0080\u00A6sometimes I feel a little bit unappreciated [by my family]. And I think, \u00E2\u0080\u009CWhy can\u00E2\u0080\u0099t I go get my [nails done]? But then I think, \u00E2\u0080\u009COK, if I go get my nails done, then I can\u00E2\u0080\u0099t pay the cable or I can\u00E2\u0080\u0099t pay the phone. The kids can\u00E2\u0080\u0099t have this.\u00E2\u0080\u009D So, I\u00E2\u0080\u0099m always feeling like I can\u00E2\u0080\u0099t have what I want. So, maybe that\u00E2\u0080\u0099s why I eat whatever I want sometimes. All of the women spoke of seeking comfort from food by eating in isolation, and being alone was described as a state and condition that propelled the women to eat for comfort. The experience of eating alone was described as pleasurable and habitual, and one that served to amplify the relaxing and comforting qualities that the women derived from food, as reflected in 102##the following quote: \u00E2\u0080\u00A6sometimes when kids give me chocolates at Christmas or whatever I\u00E2\u0080\u0099ll isolate in my room and eat all the chocolates \u00E2\u0080\u0093 boxes of chocolates\u00E2\u0080\u00A6I mean I might overeat at a meal, have a second helping or something, but it\u00E2\u0080\u0099s not the same degree as when I\u00E2\u0080\u0099m alone. And I will seek out opportunities to be alone in order to indulge in that\u00E2\u0080\u00A6I think it\u00E2\u0080\u0099s partly there\u00E2\u0080\u0099s a sense of being more relaxed when I\u00E2\u0080\u0099m alone. And the activity of eating I can only associate with a baby with a soother or something. Importantly, however, the initial pleasure-filled experience of eating comfort foods was usually relatively short-lived, and began to dissipate with the onset of feelings of guilt, shame, and self-deprecating thoughts (further discussed below), and for some women, feeling physically \u00E2\u0080\u009Cawful\u00E2\u0080\u009D and/or being full to the point of extreme physical discomfort. The negative state that ensued shortly after eating was certainly the more challenging aspect of the women\u00E2\u0080\u0099s cyclical eating pattern. The experience of temporary relief when turning to food for \u00E2\u0080\u009Cshort-term comfort\u00E2\u0080\u009D is concisely captured in the following quote: I think more in the case of when I\u00E2\u0080\u0099m worried I think, \u00E2\u0080\u009COh, I went to Safeway twice this week.\u00E2\u0080\u009D When I\u00E2\u0080\u0099m anxious, [the food] is almost like a security blanket. The food is there and if I\u00E2\u0080\u0099m worried or disappointed with myself, I can go [and eat] and that makes me feel better \u00E2\u0080\u0093 which is ridiculous because 30 minutes later I don\u00E2\u0080\u0099t feel any better. It\u00E2\u0080\u0099s not a long-term solution, and I\u00E2\u0080\u0099ve slowly started to realize that. Overall, the power of the habitual and cyclical nature of this challenging eating pattern was perhaps most poignantly described in the words of one participant who noted that she felt like she was in a \u00E2\u0080\u009Creal rut\u00E2\u0080\u009D with her eating pattern, one \u00E2\u0080\u009Cthat was hard to pull out of\u00E2\u0080\u009D and one that caused her \u00E2\u0080\u009Cpain and such negative feelings\u00E2\u0080\u009D: 103## \u00E2\u0080\u00A6even though it was comfort, it was awful. It wasn\u00E2\u0080\u0099t comfort\u00E2\u0080\u00A6you\u00E2\u0080\u0099d think, in a way, if you develop a pattern where something is so constantly on your mind, such an integral feature of your life, but it caused you pain and such negative feelings afterward, you think you might break that pattern\u00E2\u0080\u00A6But I was somehow unable to. I didn\u00E2\u0080\u0099t. I just would fall into it and think, \u00E2\u0080\u009COh, I\u00E2\u0080\u0099ll just have that one. I\u00E2\u0080\u0099ll just have it this time. Maybe tomorrow I won\u00E2\u0080\u0099t.\u00E2\u0080\u009D But then it would be the same thing. It was just such a rut. It was a real rut that was hard to pull out of\u00E2\u0080\u00A6 In addition, to varying degrees the women also described a cycle whereby they would get into a \u00E2\u0080\u009Cpattern\u00E2\u0080\u009D of turning to food for comfort, subsequently gain weight, then attempt to assert control over their eating, and eventually eat again for comfort in the face of the distress caused by gaining weight. This experience was described as a \u00E2\u0080\u009Cvicious circle\u00E2\u0080\u009D by one participant, and is concisely captured in the following quote: And I would eat until I'm feeling like really full. And then I just want to go to sleep because I'm feeling bad. And then my stomach hurts because I've eaten too much. So, you go to sleep and then that kind of has that effect where you gain weight because you just ate a whole bunch and now you're going to sleep. So, it's kind of a vicious circle. It's not a pleasant thing, you know? Food as Emotional Comfort. In describing the experience of turning to food for comfort and using food as a means of coping with distressing emotions and experiences, the women noted that they did not generally perceive food as a nutritional substance intended to nourish their bodies. Instead, they perceived and used food as a source of emotional comfort, as captured in the words of one participant: I really think that food, my relationship with food, has so much to do with my external 104## world, and I take food in as my zen, comfort or numbing\u00E2\u0080\u00A6I use food \u00E2\u0080\u0093 like food really is our fuel. Food is what keeps our body functioning, right? But I don\u00E2\u0080\u0099t necessarily always use it as fuel. The tendency to view food as an emotionally comforting substance appeared to account for some of the \u00E2\u0080\u009Cpower\u00E2\u0080\u009D that food held over the women in this study. Insightfully, one participant expressed believing that her inability to perceive food as nourishment for her body, is central to her challenges with eating: \u00E2\u0080\u00A6the core issue is I have a problem with how I see food. I don\u00E2\u0080\u0099t see food as nourishing my body. I see food as nourishing my emotions, my psyche, my soul. And until I disconnect that link, I\u00E2\u0080\u0099m always going to have a problem. In line with the participants\u00E2\u0080\u0099 desire for a more \u00E2\u0080\u009Cnormal\u00E2\u0080\u009D relationship with food, one woman expressed how she wished she could \u00E2\u0080\u009Ceat for nourishment as opposed to for comfort.\u00E2\u0080\u009D Thus, the women in this study were keenly aware of using food for various reasons aside from ensuring proper nutrition, as expressed in the following quote: In the mid-life stage, I would say that I turned to food for comfort\u00E2\u0080\u00A6I use food as a kind of reinforcement. I use food as celebration. I use food for a lot of things. Certainly, if I were setting all the reasons that I eat on a scale, nutrition would be fairly low down on that scale. I'm conscious of what I'm supposed to be eating and how often. I could give you the calorie count of any food on the planet. So, I know what I'm supposed to be eating and I kind of try to, but there are so many more reasons why I eat them, [other than] just fuelling me\u00E2\u0080\u00A6if I were just doing what was healthy, I would not be eating the way I eat. So, there's obviously other stuff going on for sure. Overall, the women in this study described a lifelong relationship with food that they 105##negotiate on a daily basis, often down to the hour and minutes, depending on their present circumstances. According to the participants, food had acquired a prominent, and sometimes special, place in their lives, and the role of food in providing emotional comfort was revered as a source of pleasure, and paradoxically, also as a source of personal pain and shame. Sense of Guilt and Shame To varying degrees, the women in this study all expressed a deep sense of guilt and shame about their tendency to overeat/binge, their choice to seek out and eat \u00E2\u0080\u009Cforbidden\u00E2\u0080\u009D foods (i.e., typically foods high in carbohydrates and fat), and/or their body weight and shape. The women gave voice to a sense of relentless self-criticism that was present at all times, but which became particularly salient after they ate unhealthy foods and/or overate. Overall, the women described being critical of themselves for a variety of reasons, including but not limited to, eating in a way that they deemed reprehensible, struggling in their relationships with food, and the appearance of their mid-life bodies. The women also discussed the importance of secrecy and their strong desires to keep their eating challenges and behaviors a secret. Feelings of shame associated with weight gain were also prevalent in the women\u00E2\u0080\u0099s stories. Also, the participants\u00E2\u0080\u0099 desire to hide their bodies was a very powerful and saddening sub-theme throughout their narratives. The sense of guilt and shame that the women experienced about their eating behaviour and their bodies was discussed as a consistent, powerful, and very painful aspect of their relationship with food \u00E2\u0080\u0093 one that lurked in the background as a warning and threat against overeating, and one that served to reprimand and \u00E2\u0080\u009Cpunish\u00E2\u0080\u009D the women for engaging in overeating or bingeing. Most notably, the onset of guilt and shame that the women felt after eating too much was described as an onslaught \u00E2\u0080\u0093 a tidal wave of challenging emotions and thoughts that were 106##often particularly distressing and difficult to endure. As reflected in the words of one participant, some of the women in this study described the sense of guilt and shame they experienced as the most challenging aspect of living with a problematic relationship with food: ...you can feel really happy at one moment and then feel really sad or real guilty. And I think that\u00E2\u0080\u0099s the most challenging. Because the emotional is hard to deal with, you know? The guilt, especially. Because I'm so used to feeling guilty for [eating]. You're eating because it makes you feel good. But then you're feeling bad because you're feeling good. Because you're getting [fat] \u00E2\u0080\u0093 you're going to gain weight. And there's never a balance. For another mid-life woman, the feelings of guilt, shame and other challenging emotions that typically ensued after overeating/bingeing were so painful and powerful that they motivated her to try to make changes to her eating behaviour, and more broadly, to her relationship with food: \u00E2\u0080\u00A6[after bingeing] it would just be a cycle of self-loathing and [being] despondent with my friends and relationships\u00E2\u0080\u00A6Like, I just was in my own little world\u00E2\u0080\u00A6it\u00E2\u0080\u0099s easy for me to fall into that\u00E2\u0080\u00A6I have binged in the last couple of weeks \u00E2\u0080\u0093 not solidly but I did it once or twice and I hadn\u00E2\u0080\u0099t done it in a while\u00E2\u0080\u00A6And I can\u00E2\u0080\u0099t do this. I can\u00E2\u0080\u0099t go down this road because the depression from the aftermath of that is just too much. It\u00E2\u0080\u0099s too much. The guilt and shame that the participants associated with both overeating and subsequent weight gain was cited as one of the reasons that they engaged in behaviours aimed at controlling their food intake (e.g., dieting, exercising, purging). For example, two of the participants reported currently engaging in purging behaviours after eating (e.g., self-induced vomiting, laxative use) to mitigate the negative feelings and consequences, particularly weight gain. Both of these women described purging as a way to rid themselves of the food they consumed, largely in order to cope with the guilt and shame they experienced about overeating. In the words of one 107##participant: And it wasn\u00E2\u0080\u0099t until I was about 42 that it clicked with me that I can\u00E2\u0080\u0099t always control what goes in, but I can control what goes through. So, that\u00E2\u0080\u0099s when I started to purge. And it was like somebody had turned on the light. Holy crap, you know? I didn\u00E2\u0080\u0099t know!\u00E2\u0080\u00A6I thought, \u00E2\u0080\u009CWow. Wow! Here\u00E2\u0080\u0099s the answer!\u00E2\u0080\u009D I can still have my soothing little friend, but now I won\u00E2\u0080\u0099t feel so much shame and guilt about overeating because I can manage my weight. Well, that didn\u00E2\u0080\u0099t work either. The other mid-life woman who reported currently engaging in purging also discussed this behaviour as a way to cope with the guilt she felt after eating. Interestingly, she also expressed a strikingly similar experience and motivation to purge: \u00E2\u0080\u00A6I\u00E2\u0080\u0099ve gone through little phases where I would use laxatives. And that\u00E2\u0080\u0099s not good for your system\u00E2\u0080\u00A6I\u00E2\u0080\u0099ve been on them for a week. But the guilt, the guilt of eating too much \u00E2\u0080\u0093 then it\u00E2\u0080\u0099s like, \u00E2\u0080\u009COh wow, I\u00E2\u0080\u0099ll take some laxatives and it\u00E2\u0080\u0099ll be gone in the morning. I\u00E2\u0080\u0099ll get rid of it before it turns to more fat.\u00E2\u0080\u009D That\u00E2\u0080\u0099s the mindset. The \u00E2\u0080\u009Coverpowering\u00E2\u0080\u009D sense of guilt and shame that the women often experienced led them to be highly conscious of their food intake, and to self-monitor their eating behaviours \u00E2\u0080\u0093 to be \u00E2\u0080\u009Calways, constantly watching\u00E2\u0080\u009D what, and how much, they were eating. This aspect of their problematic relationship with food is captured in the words of one participant who constantly managed her food intake, and reportedly always felt guilty after eating \u00E2\u0080\u009Cforbidden\u00E2\u0080\u009D foods: \u00E2\u0080\u00A6and then it\u00E2\u0080\u0099s like throw one wrong thing in there like a muffin. The muffin shouldn\u00E2\u0080\u0099t be the enemy! But when it\u00E2\u0080\u0099s all carbs and it\u00E2\u0080\u0099s empty carbs, and it\u00E2\u0080\u0099s going in the body, it\u00E2\u0080\u0099s the guilt \u00E2\u0080\u0093 you know, you might as well just apply it to the hips. It\u00E2\u0080\u0099s the guilt all the time. In response to these negative feelings and consequences, five of the women in this study 108##reported seeking out professional counselling or attending 12-step programs for their challenges with eating and/or body image, throughout their lives. Importantly, the shame that these mid-life women experienced in relation to their eating challenges often acted as a barrier to seeking treatment, as expressed in the words of one participant who discussed the prevalence, and sensitive nature, of dual relationships and anonymity in a rural community where she previously resided: Well, because that\u00E2\u0080\u0099s a fault. That\u00E2\u0080\u0099s a weakness, right? And I was on the board of directors for a few organizations. I was on the crisis line. I was here, I was there, I was everywhere. So, all of a sudden in mid-age I\u00E2\u0080\u0099m going to start going to a mental health provider, who I\u00E2\u0080\u0099ve worked with before, and say, \u00E2\u0080\u009CYeah, I want some help because I have a weakness, and I\u00E2\u0080\u0099m going to admit that I have a weakness to you?\u00E2\u0080\u009D No! However, those women who pursued 12-step programming, such as Overeaters Anonymous, and weight-loss programs such as Weight Watchers, described attending meetings as an important exercise in \u00E2\u0080\u009Clifting the shame\u00E2\u0080\u009D related to living with eating challenges, and consequently learning that they weren\u00E2\u0080\u0099t alone in the experience. The relief that was engendered by knowing she was not alone in her struggles with food were captured in the words of one mid-life woman: I went to a 12 step program and actually that was very helpful because it really lifted the shame off of it. The first meeting I went to I couldn\u00E2\u0080\u0099t believe the number of people that were in the room. Like, I just felt like I had arrived home\u00E2\u0080\u00A6I wasn\u00E2\u0080\u0099t alone. Prior to engaging in group-based programs, these participants described feeling quite isolated in their experience of living with eating challenges, and with carrying the burden of their \u00E2\u0080\u009Csecret\u00E2\u0080\u009D \u00E2\u0080\u0093 and sense of shame \u00E2\u0080\u0093 on their own. Relentless Self-criticism. The women in this study described being relentlessly critical of 109##themselves, during mid-life and for some since childhood. They divulged a wide range of self-critical thoughts that spanned almost every aspect of their being (e.g., their eating, bodies, character, abilities, lack of control). These self-critical thoughts were familiar to the women, and they were very easily able to share examples of self-criticism that they experienced in their daily lives. Interestingly, during the interviews, these examples of self-criticism were most often shared by the participants very quickly, in rapid-fire succession. For example, one mid-life woman shared some of the \u00E2\u0080\u009Cloud\u00E2\u0080\u009D self-critical thoughts she experienced about living with eating challenges, particularly her tendency to binge eat: The shame, it\u00E2\u0080\u0099s bad\u00E2\u0080\u00A6I think it just reaffirms my beliefs that I\u00E2\u0080\u0099m not good enough \u00E2\u0080\u0093 that I\u00E2\u0080\u0099m not capable\u00E2\u0080\u00A6the older I get it\u00E2\u0080\u0099s like, \u00E2\u0080\u009CYou\u00E2\u0080\u0099re 41 years old and you\u00E2\u0080\u0099re still doing this?! Get it together. This is ridiculous. You shouldn\u00E2\u0080\u0099t be at this place in your life.\u00E2\u0080\u009D There\u00E2\u0080\u0099s the self-criticism. It is quite loud, I guess, in my mind. The women\u00E2\u0080\u0099s tendency to be critical of themselves was described as an aspect of their experience that was ever-present, but which became particularly salient and prominent after overeating. This sentiment is expressed in the words of one participant who typically experienced the \u00E2\u0080\u009Cbombardment\u00E2\u0080\u009D of self-criticism shortly after eating: Half-hour after it was like, \u00E2\u0080\u009COh my God. Why did I do that? What's the matter with you? Why can't you control this? Look how fat you are.\u00E2\u0080\u009D Just the whole negative boom, you know, bombardment of thoughts\u00E2\u0080\u00A6 And the other thing was sort of ruminating on things. The food led to really ruminating on \u00E2\u0080\u009CWhy?\u00E2\u0080\u009D and \u00E2\u0080\u009CWhat's the matter with you?\u00E2\u0080\u009D and just that kind of thing. Interestingly, some of the women in this study described their self-criticism as a behaviour that either started or worsened during mid-life, as expressed in the words of one 110##participant who discussed the onset of the relentless self-criticism she experienced about her eating behaviour: \u00E2\u0080\u00A6And it was kind of a feeling like, \u00E2\u0080\u009CReally? What's the matter with you? You've got a good career. You've got a great husband. Things are going well. What's the matter with you? Why can't you get yourself -- Why can't you be reasonable about it? Why do you have to overeat? Why is your stomach always sore and distended? Why are you always feeling \u00E2\u0080\u0093 like, look at you! You can't fit your clothes. You've got all these clothes and you can't wear them.\u00E2\u0080\u009D That kind of thing was midlife. That was midlife. That wasn't earlier. Many of the women in this study lamented the fact that their eating behaviour was the only aspect of their life that they felt unable to control, which became another source of their self-criticism. These sentiments are explicitly captured in the following words of one participant who felt that she \u00E2\u0080\u009Cexcelled\u00E2\u0080\u009D at everything in her life, aside from her relationship with food: \u00E2\u0080\u00A6the guilt and the shame. Oh yeah, \u00E2\u0080\u009CYou ruined it again. What an idiot.\u00E2\u0080\u009D Every other aspect of my life I can be great at. Like, I was an honours student when I went back to school. I got a great job. When I had the kids at home, I canned thousands of jars. I won prizes at the fall fair. I wrote a cookbook. I was the recipe queen. Wrote the column in the paper for 12 years. Everything I did I excelled at, except for the eating part. Somehow I just could not get a handle on it, no matter what\u00E2\u0080\u00A6And then you think, \u00E2\u0080\u009COh, God. You really are a mess. You really are a mess! It doesn\u00E2\u0080\u0099t matter how good you are in other aspects \u00E2\u0080\u0093 if you can\u00E2\u0080\u0099t lick this before you die, that\u00E2\u0080\u0099s a fail.\u00E2\u0080\u009D While all of the women were generally aware of their tendency to harshly criticize themselves, some commented on their apparent obliviousness to the pervasiveness of this behaviour. The women\u00E2\u0080\u0099s tendency to berate themselves had seemingly become so much a part of 111##their daily existence that it had become an aspect of their experience that they sometimes rarely questioned or were even aware of. This experience is reflected in the words of one participant who commented on how she likely wasn\u00E2\u0080\u0099t aware of the extent to which she engages in self-criticism throughout the day: Yeah, [the self-critical thoughts], they\u00E2\u0080\u0099re kinda all over the place. They start with, \u00E2\u0080\u009CYou shouldn\u00E2\u0080\u0099t weight so much\u00E2\u0080\u009D or \u00E2\u0080\u009CYou shouldn\u00E2\u0080\u0099t be this fat. You should have more self-control.\u00E2\u0080\u009D It's kind of an image violation\u00E2\u0080\u00A6And I think, \u00E2\u0080\u009COh well, other people are judging me the way I judge other people.\u00E2\u0080\u009D So, it's pretty brutal in that sense and it's, \u00E2\u0080\u009CYou shouldn\u00E2\u0080\u0099t eat this. You should be eating that.\u00E2\u0080\u009D So, pretty much every time I'm eating something, I'm conscious of how much I'm eating and what I'm eating, and there's a judgment around, \u00E2\u0080\u009CGood girl, you're eating properly\u00E2\u0080\u009D or a \u00E2\u0080\u009CBad girl, you're not.\u00E2\u0080\u009D So, it's pretty much the entire gamut of negative self-criticism I would say, honestly. And I\u00E2\u0080\u0099m so familiar with them that I probably don\u00E2\u0080\u0099t even realize sometimes how many there are\u00E2\u0080\u00A6I'm being pretty mean to myself, for sure \u00E2\u0080\u0093 the constant critic. The women in this study described being critical not only of their eating behaviours, but also of their body weight, shape and size. Relatedly, the women discussed what one participant referred to as the \u00E2\u0080\u009Cincessant monitoring\u00E2\u0080\u009D of their bodies. One participant who reported constantly being aware of, and making judgements about, the appearance of her body, described the experience this way: \u00E2\u0080\u00A6every time I see a picture of myself, there'll be a judgment about, \u00E2\u0080\u009CDo I look fat or do I not look fat?\u00E2\u0080\u009D And I went on one diet and they actually suggested that you take a photograph of yourself in your underwear or naked, from three different angles, before and after. And so [my husband] took the pictures, and I did it again when I was ten 112## pounds lighter\u00E2\u0080\u00A6.but even when I had lost the ten pounds I would look at it and think, \u00E2\u0080\u009CNo, it's still not the right shape.\u00E2\u0080\u009D Because I like the shape of my body, I keep thinking, \u00E2\u0080\u009CWell, why wouldn\u00E2\u0080\u0099t I make sure it carried the right amount of weight?\u00E2\u0080\u009D\u00E2\u0080\u00A6So, I think, \u00E2\u0080\u009CWell, that\u00E2\u0080\u0099s not a good thing to be doing. You have a nice shaped body. Why wouldn't you have it at the right way?\u00E2\u0080\u009D So, it's just another way I get at myself in terms of being critical. Although some of the participants experienced external criticism and overt pressure to change their eating behaviour and/or lose weight (further described below), the majority of the women described their tendency to criticize themselves as a behaviour that was largely self-inflicted, as captured in the following quote: And it\u00E2\u0080\u0099s my self-worth, or lack of self-worth, that is telling me that I\u00E2\u0080\u0099m not good enough: \u00E2\u0080\u009CSee, you\u00E2\u0080\u0099re just too fat. You don\u00E2\u0080\u0099t have any self-control. Nobody\u00E2\u0080\u0099s going to want you while you\u00E2\u0080\u0099re fat.\u00E2\u0080\u009D But then, when I actually think about it, when I was married, [my ex-husbands] didn\u00E2\u0080\u0099t care. I mean, they probably cared but it wasn\u00E2\u0080\u0099t such a big deal if I gained 5 or 10 pounds or 20 pounds. It wasn\u00E2\u0080\u0099t, \u00E2\u0080\u009COh, you fat cow, go on a diet.\u00E2\u0080\u009D No. I never had them say that. So, I was very, very lucky that way. It\u00E2\u0080\u0099s only me that says that to me. It was clear from the women\u00E2\u0080\u0099s stories that they believed this aspect of their experience to be one that they constantly negotiated, \u00E2\u0080\u009Cin-relationship to [themselves].\u00E2\u0080\u009D Interestingly, the women appeared to struggle with making meaning of their self-criticism, and only one participant pondered its origin. This experience is highlighted in the words of this participant, as she discussed how she believed her relationship with food was the \u00E2\u0080\u009Croot\u00E2\u0080\u009D of her self-critical thoughts: 113## I think in middle age you look back and you think about who you were\u00E2\u0080\u00A6 And maybe sometimes I've been kind of hard on myself. I didn't have parents who berated me. No one said to me, \u00E2\u0080\u009CWhy are you so stupid?\u00E2\u0080\u009D Nobody ever said that in my family, but I would say it to myself. So, I'm not sure where it quite came from, but it [happened]. And usually it had to do with eating. I think the start of it was through food and then that negative talk branched off into other parts of my life. But I think the food was really the root of it. Ultimately, the self-critical thoughts that these participants experienced were described as \u00E2\u0080\u009Cmean\u00E2\u0080\u009D and \u00E2\u0080\u009Cpunishing.\u00E2\u0080\u009D The women used strong language to describe this aspect of their experience, noting that their self-critical thoughts served to \u00E2\u0080\u009Cbeat themselves up,\u00E2\u0080\u009D and that they \u00E2\u0080\u009Cberated,\u00E2\u0080\u009D and sometimes \u00E2\u0080\u009Cloathed\u00E2\u0080\u009D and \u00E2\u0080\u009Chated\u00E2\u0080\u009D themselves after indulging in food. One participant reflected on her self-criticism as being \u00E2\u0080\u009Ca mild form of self-abuse.\u00E2\u0080\u009D Notably, although the pain inherent in the women\u00E2\u0080\u0099s self-criticism was highly apparent in their narratives, only one participant explicitly discussed the possible detrimental effects of engaging in such self-criticism, and reflected on how she viewed this aspect of her behaviour as problematic: \u00E2\u0080\u00A6the real psychological piece of this is that the thought processes here are mean. You know, they're pretty punishing\u00E2\u0080\u00A6if you're wandering around on a daily basis and firing criticism at yourself every five minutes, it's probably not good. I don\u00E2\u0080\u0099t think it's good for your brain either. In sum, the women\u00E2\u0080\u0099s self-criticism was an unceasing, relentless, and at times, tiresome behaviour \u00E2\u0080\u0093 one full of pain and strife \u00E2\u0080\u0093 as provocatively captured in the words of one participant who expressed feeling exasperated with her self-critical thoughts, as well as a desire for them to cease: 114## And the mind gets racing and then you\u00E2\u0080\u0099re on these sugar highs and then the sugar lows and then you\u00E2\u0080\u0099re beating yourself up and you\u00E2\u0080\u0099re driving yourself crazy. Sometimes I feel like I\u00E2\u0080\u0099m that little gerbil on the wheel and things get going so much that you can\u00E2\u0080\u0099t \u00E2\u0080\u0093 like, when does it stop? When does it get better? Secrecy. Specifically related to the shame that the women expressed about struggling in their relationships with food, over half of the participants explicitly described a desire to keep their eating challenges a secret from other people. All of the women spoke of engaging in overeating/bingeing primarily when they were alone, which partially served to maintain a sense of secrecy around their eating, and relatedly, was a way of mitigating the shame they felt about their problematic eating behaviours. This was reflected in the experience of one mid-life woman who described how she wouldn\u00E2\u0080\u0099t overeat, or eat certain foods, in front of people she knew, in an effort to \u00E2\u0080\u009Chide\u00E2\u0080\u009D her tendency to overindulge in food: \u00E2\u0080\u00A6my times with myself were food. My husband probably has no idea of all the things I would eat because mostly I would do it outside the house. I didn't sit with a bucket of ice cream and eat at home. I wouldn't do it in front of someone I knew. It was me and food and kind of hidden because it was sort of shameful. Similarly, another participant discussed how she would \u00E2\u0080\u009Chide\u00E2\u0080\u009D her tendency to overindulge in food by eating alone, partially to avoid the \u00E2\u0080\u009Cjudgment\u00E2\u0080\u009D and shame she felt when her eating behaviours were observed, and sometimes criticized by others: \u00E2\u0080\u00A6mostly at home. And mostly when I'm by myself in the kitchen, actually\u00E2\u0080\u00A6I guess I try to hide it. I'm just realizing that now because my husband will be somewhere else. And my mother-in-law, who's staying with us for a little while, and who's like thin as a stick, she's in another room. And I'll be in my kitchen eating because everything's really 115## close\u00E2\u0080\u00A6Or if I'm at work and I'll go get like a cinnamon roll or something like that to eat at my desk. And I usually eat it really fast so nobody will see me\u00E2\u0080\u00A6[to avoid] the judgement. The judging of, you know, \u00E2\u0080\u009CWhat are you doing? Why are you eating that? You just finished lunch,\u00E2\u0080\u009D or \u00E2\u0080\u009CWhy are you eating so fast? Why are you eating bread?\u00E2\u0080\u009D\u00E2\u0080\u00A6My mother-in-law doesn\u00E2\u0080\u0099t eat bread, and so she says, \u00E2\u0080\u009CIt's like spaghetti. It's made out of dough. You shouldn\u00E2\u0080\u0099t be eating that.\u00E2\u0080\u009D It's like, okay. So, it's judgement. Another participant described how she strove to maintain a sense of secrecy surrounding her tendency to binge eat, by purchasing fast foods at several different restaurant locations in succession, and subsequently eating the food in the privacy of her own home: \u00E2\u0080\u00A6And then you\u00E2\u0080\u0099ve got all these little flashing, beautiful lights and you can secretly drive in and grab whatever you want, and secretly pay for it, and then come home and secretly eat it, and then secretly get rid of it. Nobody knows. Consequently, considerable attention and energy was invested by the participants, in their efforts to hide their problematic eating. This is perhaps most concretely explicated in the experience of one woman who went to great lengths to conceal her desire to eat \u00E2\u0080\u009Csomething sweet\u00E2\u0080\u009D \u00E2\u0080\u0093 a food decision that she perceived as shameful: \u00E2\u0080\u00A6things I\u00E2\u0080\u0099ve observed myself doing in the past is being very conscious of myself around other people and how those people might respond to my actions or my decisions. And in particular I would notice if I wanted something maybe sweet to eat or something\u00E2\u0080\u00A6what I would tend to do is, if I want a piece of cake from the store, I would buy a whole cake even though I only wanted a piece. And I was doing that, thinking that if someone else saw, they would think I\u00E2\u0080\u0099m buying the cake for a reason, you know, to share\u00E2\u0080\u00A6that was my motivation \u00E2\u0080\u0093 to kind of hide what I was doing. So, I probably have a lot of shame 116## about making those food decisions. Some of the participants discussed how the sense of secrecy they experienced in relation to their eating challenges was an aspect of their experience that either started or became more prominent in mid-life, as reflected in the words of one participant: When I was younger, food was a big part of our family, but I don't think I felt that out of control. I liked food. I ate it. We ate things [as a family]. I'd sit there with my aunts and uncles and cousins and we'd eat big bags of pistachio nuts. We all did it\u00E2\u0080\u00A6So, it's more in mid-life when it really got that kind of \u00E2\u0080\u0093 the loathing, kind of the shame, the hiding it kind of thing. I don't think it was a hidden kind of problem when I was younger. That came later. Thus, it was common for the women to experience an increased sense of shame about their eating behaviour in mid-life. In part, this had to do with the women\u00E2\u0080\u0099s beliefs that they were of an age where they \u00E2\u0080\u009Cshould\u00E2\u0080\u009D be able to better control their eating, and learn to cope in healthier ways. The participants in their fifties and sixties reflected on how they grew up in an era when people kept their personal difficulties to themselves \u00E2\u0080\u0093 a time when challenges with eating such as \u00E2\u0080\u009Canorexia\u00E2\u0080\u009D and \u00E2\u0080\u009Cbulimia\u00E2\u0080\u009D were not openly discussed in society, or well-known. These participants described how coming of age in that particular cultural context had a lasting effect on how they viewed their struggles with eating, and how they learned to try to keep their eating challenges a \u00E2\u0080\u009Csecret.\u00E2\u0080\u009D This sentiment was expressed by one participant who said she would never \u00E2\u0080\u009Cconfess\u00E2\u0080\u009D to her struggles with eating: I feel like this generation, we\u00E2\u0080\u0099ve done a lot and yet now we are here and a lot of us do struggle with food\u00E2\u0080\u00A6and maybe there was a lot of that stuff going on behind closed doors 117## [in the past] but there was no diagnosis because it was like you hid that, you know? I would hide eating\u00E2\u0080\u00A6when I\u00E2\u0080\u0099m in front of people I have no problem. But the food issue is hard\u00E2\u0080\u00A6I will stop and I will eat two chocolate bars on my way home from work\u00E2\u0080\u00A6and yet I would never confess to my mom. I don\u00E2\u0080\u0099t tell anybody about that. The mothers in this study also expressed a desire to hide their eating challenges, especially from their children, partially in an effort to try to model a healthier relationship with food. This experience was poignantly described by one participant who talked about trying to hide her challenges with food, as well as additional personal difficulties, from her children \u00E2\u0080\u0093 and sometimes even from herself: \u00E2\u0080\u00A6like eating disorders and even depression can be learned, you know? And so I'm really trying not to be that way because I don\u00E2\u0080\u0099t want my children to have that\u00E2\u0080\u00A6but it's difficult and it feels like I do have to hide those things. I have to hide being sad. I have to pretend like I'm strong. I have to pretend like I'm happy all the time, otherwise they're going to know what's really going on. And it's difficult because you're almost hiding who you really are\u00E2\u0080\u00A6I want them to live happy. I want them to be in control of themselves. I want them to be able to reach their fullest potential. But if they have a messed up mom who is crying all the time and who's eating everything in sight, what's that going to teach them, right?...I have to be the one who is in control. So, it's like hiding it from everyone. Sometimes I even have to hide it from myself so that I don\u00E2\u0080\u0099t break down. Importantly, the sense of secrecy that the women attempted to maintain about their challenges with eating sometimes served to isolate themselves from supports and relationships. This sentiment is most clearly demonstrated in the words of one participant who felt that her challenges with food sometimes affected her romantic relationships: 118## I think that definitely there\u00E2\u0080\u0099s a pattern of me eating in isolation. When the person I was dating would [want to get together]\u00E2\u0080\u00A6I\u00E2\u0080\u0099d say \u00E2\u0080\u009CWell, I\u00E2\u0080\u0099m really busy doing this, this, and this,\u00E2\u0080\u009D but actually I would stay home in isolation and eat. And then they\u00E2\u0080\u0099d want to see me and I\u00E2\u0080\u0099d be like, \u00E2\u0080\u009CWell, I can\u00E2\u0080\u0099t because I haven\u00E2\u0080\u0099t done this, this and this,\u00E2\u0080\u009D and then they\u00E2\u0080\u0099re like, \u00E2\u0080\u009CWhy not?\u00E2\u0080\u009D and then I\u00E2\u0080\u0099d say, \u00E2\u0080\u009CWell, I don\u00E2\u0080\u0099t know. I just didn\u00E2\u0080\u0099t do it.\u00E2\u0080\u009D And then that was a source of frustration for the person I was dating. Some of the women in this study described their shame when they felt that their secret \u00E2\u0080\u0093 that they struggle in their relationship with food \u00E2\u0080\u0093 was openly \u00E2\u0080\u009Cexposed.\u00E2\u0080\u009D This was poignantly reflected in the words of one participant: I would, say, buy a chocolate bar and I would stop in the parking lot on the way home and sit in the car and eat the chocolate bar way faster than I wanted to. I\u00E2\u0080\u0099d rather just sit and savour it and eat it openly around everybody else but either I knew that my kids might want some\u00E2\u0080\u00A6or else my husband is going to be upset or criticize me, so I\u00E2\u0080\u0099ll eat it and throw the garbage away in a garbage can somewhere so that he doesn\u00E2\u0080\u0099t have to see that in the car. So, anyway, that kind of frustrated me because I\u00E2\u0080\u0099d really rather just be able to take my time and eat the chocolate bar and enjoy it \u00E2\u0080\u0098cause then, of course, I\u00E2\u0080\u0099m eating it so quickly and not enjoying it at all. And then I remember a stranger walked past the car while I was eating it and smiled at me and so then, you know, I just \u00E2\u0080\u0093 I felt exposed. Interestingly, some of the participants also commented on how they felt exposed and betrayed by their own bodies, which they believed served as a signal to others that they struggled in their relationships with food. One woman who described feeling as though her eating challenges, particularly a tendency to binge eat, was revealed by the appearance of her body: 119## I was restricted when I was growing up, so I learned to sneak eat. And I would do that when I was raising my kids and family. I would serve whatever was a proper quantity, but if I felt that I wasn\u00E2\u0080\u0099t [satisfied] or I didn\u00E2\u0080\u0099t have my need fulfilled, then afterwards I would sneak eat. Or I\u00E2\u0080\u0099d take the kids for a drive and we\u00E2\u0080\u0099d go for ice-cream or we\u00E2\u0080\u0099d go to the movies so that I could eat bags and bags of popcorn, in secret, in the dark. So, it\u00E2\u0080\u0099s always been a secret. But as I gained weight, it\u00E2\u0080\u0099s not a secret to everybody else who\u00E2\u0080\u0099s looking at me. They can see quite obviously there\u00E2\u0080\u0099s something going on. But for me it was still a secret. It was my secret. Similarly, another participant described the shame she experienced when, after bingeing, her appearance changed in such a way that it became \u00E2\u0080\u009Cnoticeable\u00E2\u0080\u009D that she was somehow unwell: \u00E2\u0080\u00A6there were times when my boss would come up to me like, \u00E2\u0080\u009CAre you feeling ok?\u00E2\u0080\u009D And it was because I\u00E2\u0080\u0099d binged the night before or the weekend before and I just looked really pale and washed out. Yeah, so it was noticeable. Yeah, and then I just couldn\u00E2\u0080\u0099t wait to get back home and just do it again. Thus, it was very important for the women in this study to maintain a sense of secrecy about their eating, in large part to avoid the feelings of guilt and shame that accompanied this aspect of their experience being exposed to the outside world. Shame Associated with Weight Gain. Throughout mid-life, the women in this study unanimously expressed struggling with their weight and a desire to achieve a lower weight. The majority of the women in this study associated thinness with positive qualities (e.g., love, happiness, feeling desired and attractive), and in contrast, described being overweight in negative terms. Relatedly, among the majority of the women, weight gain was explicitly discussed as an outcome that they perceived as shameful, undesirable, and unacceptable \u00E2\u0080\u0093 and one that they 120##vehemently tried to avoid. Thus, many of the women understood their experience of guilt and shame to be related, in part, to the pain they felt after violating their diet or not achieving their weight-loss goals. Relatedly, the women described a process of paradoxically putting themselves in a position to gain weight, by indulging in unhealthy foods and/or overeating, which was noted as a prominent source of guilt and shame. This sentiment was reflected in the words of one participant who struggled throughout her life with feelings of guilt and shame related to her eating behaviour, as well as her body weight and shape: \u00E2\u0080\u00A6the shame comes from knowing that I chose those things even though I was totally aware that they could have that result, right? So, knowing that I chose to eat more or knowing that I chose to eat chips or ice cream \u00E2\u0080\u0093 knowing full well that eating those things is going to create this result I don\u00E2\u0080\u0099t like. Similarly, another participant discussed how her experience of guilt was inextricably linked to overeating, and relatedly, to her role in causing weight gain: \u00E2\u0080\u00A6the guilt \u00E2\u0080\u0093 especially because when you eat too much your body shows it, you know? If I drink too much pop, I'll break out\u00E2\u0080\u00A6if I eat too much food, my clothes don\u00E2\u0080\u0099t fit\u00E2\u0080\u00A6and then the guilt of seeing yourself in that position. Several of the women explicitly discussed trying to lose weight, or maintain their weight within an \u00E2\u0080\u0098acceptable range,\u00E2\u0080\u0099 in order to avoid the shame associated with being perceived by others as \u00E2\u0080\u009Coverweight\u00E2\u0080\u009D and/or \u00E2\u0080\u009Cobese,\u00E2\u0080\u009D as captured in the words of one participant: I do notice my pants are fitting a little bit looser because I am walking so much, but still [my weight] is not where I want to be. It's not where it's supposedly a \u00E2\u0080\u009Cdesirable weight.\u00E2\u0080\u009D Because there's that obese index or whatever: if you're 15 or 20 pounds overweight, you're considered obese. Well, who wants to be labelled obese? Not me, thank you!...I 121## think I'm really conscious of my appearance lately more so because I'm not looking and feeling as good as I did\u00E2\u0080\u00A6 it makes me feel very guilty and bad about myself. All of the women described being fearful of becoming overweight and discussed the painful process of shaming themselves for \u00E2\u0080\u009Cgetting fat\u00E2\u0080\u009D during mid-life. The fear associated with becoming overweight was most clearly captured in the words of one participant who was extremely concerned that her weight gain might result in the dissolution of her marriage: I was raised in guilt. My religion is full of guilt. And Latino culture is full of guilt. You have to be the perfect woman, the perfect housekeeper, the perfect everything, which is kind of impossible. So, I think how I deal with trying to control that is stuffing my face all the time when the guilt kicks in. And then, there is a point where I say, \u00E2\u0080\u009CYou know what? The hell with it. I'm an adult. I can eat whatever I want.\u00E2\u0080\u009D But still, in the back of my mind, I feel like I'm letting myself get fat. I'm letting myself get undesirable. I'm letting myself get all this \u00E2\u0080\u0093 and then nobody's going to want me. Nobody's going to love me. You know, my husband's going to leave me. Thus, some of the participants believed that potentially harsh consequences could arise if their eating habits resulted in too much weight gain, thereby adding to their feelings of shame and guilt, which typically arose after eating and/or bingeing on high caloric, \u00E2\u0080\u009Cforbidden\u00E2\u0080\u009D foods. Desire to Hide their Bodies. The women in this study reported being highly self- conscious of their bodies and weight, particularly given the physical changes they experienced during mid-life, which inhibited them in a variety of ways, such as engaging in physical exercise, wearing certain clothes, and/or being present and unpreoccupied during intimate moments with romantic partners. The participants closely monitored their bodies, and when they felt displeased by their weight and/or their appearance, they reported wanting to retreat and hide. For example, 122##the \u00E2\u0080\u009Cloathing\u00E2\u0080\u009D that the women sometimes felt about their bodies created a desire for them to, quite literally, hide their bodies, even from themselves. These sentiments are captured in the following quote: \u00E2\u0080\u00A6it would be nice to be able to wear shorts every once in a while but I'm so self-conscious, you know? Because then you\u00E2\u0080\u0099ve got the varicose veins coming. You\u00E2\u0080\u0099ve got the cellulite and the little spider veins. And if you wear a tank top, you got the fatty arm. You got the stretch marks. You get the rolls. Okay, you know? You don\u00E2\u0080\u0099t want other people looking at you. And you definitely don\u00E2\u0080\u0099t want to see yourself. Similarly, another participant who had previously lost weight but recently put the weight back on expressed a metaphorical desire for parts of her body to disappear \u00E2\u0080\u0093 \u00E2\u0080\u009Cwishing\u00E2\u0080\u009D the fat on her body would \u00E2\u0080\u009Cgo away.\u00E2\u0080\u009D She discussed the \u00E2\u0080\u009Cshame\u00E2\u0080\u009D and \u00E2\u0080\u009Cdisgust\u00E2\u0080\u009D she felt about her body, as well as her desire to \u00E2\u0080\u009Ccover up,\u00E2\u0080\u009D and refrain from looking at herself: \u00E2\u0080\u00A6probably disgust and shame. I don\u00E2\u0080\u0099t want to look at myself. I want to cover up. I mean, I\u00E2\u0080\u0099m pretty put off by my body. I was noticing when I started to put the weight back on recently that you know I might be snuggling with my husband and I\u00E2\u0080\u0099ll just lie on my side and if he reaches around and puts his hand on my belly then I\u00E2\u0080\u0099m really sensitive about that. You know, it\u00E2\u0080\u0099s not flat! It\u00E2\u0080\u0099s not as flat as it was when I had lost the weight\u00E2\u0080\u00A6If I just get past that first anxiety and fear of him seeing that \u00E2\u0080\u0093 because I can\u00E2\u0080\u0099t hide it with clothes, right? I can\u00E2\u0080\u0099t hide it with baggy clothes or a jacket. Most commonly, the women expressed being particularly \u00E2\u0080\u009Cembarrassed\u00E2\u0080\u009D and \u00E2\u0080\u009Cashamed\u00E2\u0080\u009D of their mid-life bodies when they were unclothed. They noted feeling increasingly negative about their bodies as they started noticing the tell-tale signs of the aging process. As reflected in the words of one participant: 123## I haven't worn a bathing suit or shorts in a really long time, because it's not pretty, you know? It's just - you get soft and mooshy. And it's not pleasant. And you get cellulite. And so I don\u00E2\u0080\u0099t like looking in the mirror just because, you know, it's uncomfortable. So, I don\u00E2\u0080\u0099t have a really good body image\u00E2\u0080\u00A6I didn\u00E2\u0080\u0099t have a really good relationship with my body to begin with, but now as I've gotten older because of the aging, it has gotten even worse. The shame that the women felt about their bodies very powerfully emerged throughout their narratives. The self-hatred that was core to their desire to hide their bodies was emotionally charged. Ultimately, the women expressed struggling with self-love, self-compassion, self-forgiveness, and self-acceptance in their relationship with their bodies, which one participant believed may ultimately be the antidote to the \u00E2\u0080\u009Cgripping\u00E2\u0080\u009D feelings of guilt and shame that were so prevalent in her life: So, I think it\u00E2\u0080\u0099s mainly that when I have kind of loving feelings toward my body and self-care then I don\u00E2\u0080\u0099t \u00E2\u0080\u0093 all those issues seem to go away. But I\u00E2\u0080\u0099ve got this gripping of you know disgust and judgement when I\u00E2\u0080\u0099m heavier. And you know, it\u00E2\u0080\u0099s hard because intellectually, I know what I can do, right? It\u00E2\u0080\u0099s just that I find it difficult to make that shift and tell myself that I\u00E2\u0080\u0099m ok as I am and just accept myself and love myself, and yet I can see that that\u00E2\u0080\u0099s what will work, right? Sense of Needing Control For the women in this study, a sense of needing control was a prominent theme in their lived experiences of their relationships with food, in two primary ways. On the one hand, the women described feeling out of control in their relationships with food, and on the other, they noted challenges in actively attempting to establish control over their eating and weight. 124##Specifically, the women described feeling out of control with food, primarily during the act of eating and/or bingeing. At the same time, the women described their ongoing efforts in trying to establish control over food and eating, typically by \u00E2\u0080\u009Cdieting.\u00E2\u0080\u009D Relatedly, the women also talked about trying to control body weight, either by striving to lose weight or to maintain weight loss. The participants continually negotiated, and sometimes struggled to maintain control over the quantity and types of food they ate, and over their weight \u00E2\u0080\u0093 something that proved more challenging as they dealt with the physical changes during mid-life. Not surprisingly, the women noted that establishing control over their eating (i.e., dieting) was a primary method they employed to try to control their weight. Interestingly, some of the women discussed trying to control their eating behaviour as an attempt to establish control in their lives more broadly, at times when life felt overly chaotic and/or when they felt particularly challenged in having to cope with multiple stressors simultaneously. This experience is captured in the words of one participant who turned to her \u00E2\u0080\u009Ceating disorder\u00E2\u0080\u009D in an effort to establish a sense of control, particularly during periods of her life that were characterized by upheaval and change: That\u00E2\u0080\u0099s the only thing I had any control over. I had no control over my kids, no control over my husband, no control over my life, because now at 52 I have to go out and find a job where all I\u00E2\u0080\u0099ve ever done is raise kids. Well, who\u00E2\u0080\u0099s going to hire a 52-year-old who has no skills, right? I had no control over any of that. The only thing I had control over was my eating disorder. Everything was out of control. Absolutely every aspect was out of control. One participant linked her desire to control her eating behaviour to her childhood. She believed that control was central to her current relationship with food, given that as a child, she felt completely out of control with her eating, in terms of having little say over what, how, and when 125##she ate: \u00E2\u0080\u00A6and that\u00E2\u0080\u0099s my relationship with food\u00E2\u0080\u00A6I control what [I eat]. When I was younger maybe I didn\u00E2\u0080\u0099t get to, but now I do. And this is the choice I\u00E2\u0080\u0099ve made. And the people around me, like it or leave it. Yeah, I didn\u00E2\u0080\u0099t get to decide when or what I had, where now [I do]. Yeah, I think that really answers a piece for me about why I do it. Some of the participants discussed their responses to current experiences when family members attempted to restrict and control their eating. The women noted that they attempted to re-establish control over their own eating in an \u00E2\u0080\u009Cact of rebellion\u00E2\u0080\u009D \u00E2\u0080\u0093 intentionally seeking out and consuming the foods they were told they shouldn\u00E2\u0080\u0099t eat. For example, one participant discussed how certain foods no longer had \u00E2\u0080\u009Cpower\u00E2\u0080\u009D over her if she felt she was \u00E2\u0080\u009Callowed\u00E2\u0080\u009D to eat them. She noted how she would \u00E2\u0080\u009Crebel\u00E2\u0080\u009D against her husband\u00E2\u0080\u0099s attempts to help her control her eating and weight by overindulging in those foods in his absence: \u00E2\u0080\u00A6my husband tries to help. He\u00E2\u0080\u0099s done things like \u00E2\u0080\u0093 a few years ago when I would come home with some bags of chips\u00E2\u0080\u00A6he would see them on the counter\u00E2\u0080\u00A6and he just had these strong feelings about junk food, and so he would either hide them and sometimes throw them in the garbage\u00E2\u0080\u00A6then I would get really angry that he was being so controlling, and he\u00E2\u0080\u0099s tall, and I\u00E2\u0080\u0099m not, so he\u00E2\u0080\u0099d put them on the very top of the kitchen cabinet, trying to keep them out of sight, out of reach. And that would make me mad, too\u00E2\u0080\u00A6I\u00E2\u0080\u0099ve told him that it makes me want to eat more! So, then I\u00E2\u0080\u0099ll just go hide, you know? I\u00E2\u0080\u0099ll eat them when he\u00E2\u0080\u0099s not around! And I\u00E2\u0080\u0099ll eat more [than I normally would]! Overall, the women\u00E2\u0080\u0099s experiences of attempting to control their eating behaviours and their weight involved a complicated and precarious process that seemed to require a considerable amount of effort and energy. One participant, in particular, spoke of the \u00E2\u0080\u009Cextremes\u00E2\u0080\u009D that she 126##experienced in attempting to negotiate her relationship with food: I just feel that you\u00E2\u0080\u0099re damned if you don\u00E2\u0080\u0099t control it, and damned if you do, you know? Because if you don\u00E2\u0080\u0099t control it you just binge, binge, binge. And if you control it, then at least you're in control. But then being in control leads to other issues. So, yeah, there's no happy medium. It seems to be extremes. Feeling Out of Control with Food. The women in this study expressed feeling out control with food in several ways. In some cases, the women described feeling urgently compelled to eat certain foods, and being unable to restrain themselves from doing so. This sentiment was expressed in the words of one participant who discussed how she sometimes felt unable to deny herself the foods she desired, and after merely thinking of \u00E2\u0080\u009Cforbidden\u00E2\u0080\u009D foods, she would sometimes feel compelled to leave her home in pursuit of such foods: \u00E2\u0080\u00A6I\u00E2\u0080\u0098ve noticed that I have had a thought to buy something and I\u00E2\u0080\u0099ve actually gone from thinking of buying it, to going to the store and making a point of going to the store and buying it and then eating it. In addition, some of the women expressed feeling unable to control themselves and their eating behaviour, in the presence of certain foods. This experience was captured in the words of one participant who described a pattern of grazing, and subsequently overeating, when literally faced with foods she might normally try to avoid: \u00E2\u0080\u00A6if it\u00E2\u0080\u0099s there I will eat it. Not maybe all at one time. But if I know it\u00E2\u0080\u0099s in the cupboard or if I know that container of ice cream is in the freezer\u00E2\u0080\u00A6I\u00E2\u0080\u0099ll have ice cream every day until it\u00E2\u0080\u0099s gone, you know? If I don\u00E2\u0080\u0099t bring that package of cookies into the place, I don\u00E2\u0080\u0099t sit there and think, \u00E2\u0080\u009CI gotta go out and get that cookie.\u00E2\u0080\u009D But if it\u00E2\u0080\u0099s there, then while I\u00E2\u0080\u0099m watching TV I\u00E2\u0080\u0099ll grab two or three cookies and sit down and eat it - you know, that kind 127## of thing. And I always think, \u00E2\u0080\u009CWhy? Why is it that I can\u00E2\u0080\u0099t just [control myself]?!\u00E2\u0080\u009D A common tactic employed by the women to remedy this difficulty was to commit to not keeping certain \u00E2\u0080\u009Cforbidden\u00E2\u0080\u009D foods in their homes. In the words of one participant: My appetite is pretty big and I would say I\u00E2\u0080\u0099m not free from binge eating\u00E2\u0080\u00A6it\u00E2\u0080\u0099s not like it used to be, but I think as I\u00E2\u0080\u0099ve aged I\u00E2\u0080\u0099ve learned to not keep certain things in the house that I might have thought I could get away with when I was younger. And so now I make myself go out if I want ice cream or something like that. The women also discussed additional, ultimately futile, strategies that they employed in an effort to control their desire to eat, for example, by trying to reason with themselves. This experience was described in the words of one participant who discussed how her \u00E2\u0080\u009Cintellect\u00E2\u0080\u009D was no match for her desire to eat certain foods, and how she sometimes felt out of control with her eating, as a result: What I always find so strange is I adhere to all that: what I need to eat and when I need to eat it and how much I need to eat. And then at the same time I'm making a beeline - you know, it's sort of like this automatic [thing]. I eat even when intellectually I'm saying, \u00E2\u0080\u009CDon\u00E2\u0080\u0099t do this. This isn't part of the plan. This isn't gonna get you where you want to go.\u00E2\u0080\u009D So, it's almost like this automatic thing that no amount of intellect totally overrides. The mid-life women in this study described a dichotomy between the \u00E2\u0080\u009Ccalm mind, and the one that takes charge\u00E2\u0080\u009D of their relationship with food. When the latter was in control, the women felt unable to stop themselves from eating, despite \u00E2\u0080\u009Cknowing\u00E2\u0080\u009D that they \u00E2\u0080\u009Cshouldn\u00E2\u0080\u0099t eat.\u00E2\u0080\u009D Thus, most notably, a common thread in the women\u00E2\u0080\u0099s stories was at times feeling out control while engaged in the act of eating or overeating, particularly foods high in calories and carbohydrates \u00E2\u0080\u0093 and ultimately losing control in the process. For some women, this occurred 128##while eating a small amount of food and/or indulging themselves in food as a \u00E2\u0080\u009Ctreat,\u00E2\u0080\u009D while for others, a loss of control occurred while overeating and/or \u00E2\u0080\u009Cbingeing.\u00E2\u0080\u009D Relatedly, some of the women described a gentle process of being carried away as they lost control over their eating, while others experienced the process as one with an abrupt onset that was unwelcome and distressing. The women described a process of feeling taken over when they experienced a loss of control over their eating \u00E2\u0080\u0093 a process that was \u00E2\u0080\u009Cautomatically\u00E2\u0080\u009D set in motion, and one that they were somehow unable to stop. Interestingly, some of the participants described being aware of the imminent threat of losing control over their eating. Although they were able to \u00E2\u0080\u009Crecognize when it was coming on,\u00E2\u0080\u009D most often once it began, it was not a process they felt they could stop. The women described this process as one that ultimately unfolded without their consent, as expressed in the words of one participant who described the \u00E2\u0080\u009Cscary\u00E2\u0080\u009D process of being unable to stop herself from eating: But I know that I'll just want to have the sweet \u00E2\u0080\u0093 and I don\u00E2\u0080\u0099t know how to stop it actually. It's a little bit scary, you know? Because I know I'm doing it \u00E2\u0080\u0093 and then I'll think about it afterwards. But then it's like I'll have the third one. So. Experiencing a complete loss of control while engaged in the act of eating was further captured in the words of another participant who equated the loss of control as \u00E2\u0080\u009Ca switch going off\u00E2\u0080\u009D and \u00E2\u0080\u009Copening the flood gates\u00E2\u0080\u009D as she engaged in binge-eating. Similar to the experiences of the other participants, she lamented how she felt paralyzed in her efforts to exert control over the process: I was bingeing quite heavily around Christmastime as a lot of compulsive overeaters do. It was bad. I was just really out of control. This lady gave me a tin of baked goods, like a big tin and I ate it all in one night, you know? And that\u00E2\u0080\u0099s not uncommon. There were times where I would just go to the drug store after work and just load up on four 129## chocolate bars, a bag of chips, a bottle of pop, and then eat some kind of junky meal \u00E2\u0080\u0093 or just like a box of crackers, and a tub of butter, cheese or basically eat it \u00E2\u0080\u0098til I was so full. And then I might fall asleep and then I would even wake up and eat more if I had a bit of room. It was crazy. It\u00E2\u0080\u0099s like a switch that goes off in the back of my head and\u00E2\u0080\u00A6it\u00E2\u0080\u0099s like opening the flood gates. It\u00E2\u0080\u0099s like I cannot stop. In addition, some of the women described the experience of losing control over their eating as one that was all-encompassing and engrossing. One participant described it as the inability to \u00E2\u0080\u009Csnap out of it until after.\u00E2\u0080\u009D The loss of control that the women experienced in terms of their eating was described as a distressing and confusing aspect of their experience, particularly given the control they were able to exert in other areas of their lives. Trying to Establish Control Over Food and Eating. Most often the participants tried to establish control over food and their eating behaviour by dieting. This was accomplished in many different ways, including: following popular diet programs such as Weight Watchers, Jenny Craig, and The Bernstein Diet; following diet regimes recommended and monitored by medical professionals (e.g., naturopaths); wholly inhibiting and/or limiting themselves from eating certain foods; controlling portion sizes; skipping meals; limiting caloric intake; and establishing ways of curtailing their hunger, such as drinking large amounts of water and taking \u00E2\u0080\u009Cdiet pills.\u00E2\u0080\u009D In addition, one participant reported that she strived to eat a vegan diet (i.e., refraining from eating meats and animal byproducts), which initially began for moral reasons, and was later reinforced after she realized it could lead to weight loss. Interestingly, two participants refrained from doing any cooking, partially in an effort to curtail their tendency to overeat. As reflected in the words of one participant, the women were vigilant about monitoring 130##their food intake, and often approached their eating in a calculated and sometimes premeditated fashion, in an effort to retain control over food: \u00E2\u0080\u00A6I knew we were taking a colleague out for lunch today and she chose [a diner] downtown. So, I didn\u00E2\u0080\u0099t have breakfast. And I usually eat breakfast because I went years and years without ever eating breakfast\u00E2\u0080\u00A6And I have a healthy breakfast. I\u00E2\u0080\u0099ll have oatmeal or cereal or yogurt, and then I\u00E2\u0080\u0099ll take my orange to work - or a banana - and have it after I\u00E2\u0080\u0099ve walked to work. And so, I\u00E2\u0080\u0099m in control of that. But in my mind I say, \u00E2\u0080\u009CI\u00E2\u0080\u0099m going to [the diner] for lunch so I\u00E2\u0080\u0099m not going to have breakfast,\u00E2\u0080\u009D you know? And yet it\u00E2\u0080\u0099s so stupid to think like that \u00E2\u0080\u0093 but it\u00E2\u0080\u0099s those kind of thoughts. I probably was going to have a burger for lunch with a bun; I was going to overdo it at lunch for the calories, so I\u00E2\u0080\u0099ll eliminate those calories [at breakfast]. Despite their attempts to establish control over their eating behaviour by dieting, many of the participants described a continual process of \u00E2\u0080\u009Cfalling off\u00E2\u0080\u009D their diet plan and subsequently reinstating it. One participant captured this process of \u00E2\u0080\u009Calways starting anew\u00E2\u0080\u009D with her diet goals: It\u00E2\u0080\u0099s like, \u00E2\u0080\u009COk, well I\u00E2\u0080\u0099ll just have this now and then that\u00E2\u0080\u0099ll be it, and tomorrow I\u00E2\u0080\u0099ll start anew.\u00E2\u0080\u009D Like, you always are starting anew\u00E2\u0080\u00A6and in a lot of ways you can\u00E2\u0080\u0099t give up, you know? But then I get up and I try and start fresh, and I\u00E2\u0080\u0099ll be good for a few days and then those kind of thoughts start coming back. The participants discussed how their attempts to assert control over their eating behaviour by dieting were frequently punctuated by episodes of violating the rules they had created for themselves. They described the importance of continually striving to keep their eating \u00E2\u0080\u009Cin check\u00E2\u0080\u009D and trying to adhere to their diet goals. This experience is captured in the words of one participant who only ate certain high-calorie foods \u00E2\u0080\u009Cvery occasionally,\u00E2\u0080\u009D in an effort to preclude 131##her eating from eventually \u00E2\u0080\u009Csnowballing\u00E2\u0080\u009D on her: \u00E2\u0080\u00A6I went through 8 months where it was really quite good because I had lost weight and I was maintaining it. And I was maintaining it despite the occasional piece of cheesecake or something like that. But that\u00E2\u0080\u0099s the key \u00E2\u0080\u0093 to keep it occasional\u00E2\u0080\u00A6And I have found that there are certain foods for me that are fine in even less than moderation, maybe just occasionally, very occasionally. But if I have them more than occasionally, then it starts to snowball on me. Often it was when they didn\u00E2\u0080\u0099t feel they had the necessary self-discipline and self-control to manage their food choices, eating, and weight on their own, that the participants turned to formal weight loss programs that required that they be \u00E2\u0080\u009Caccountable\u00E2\u0080\u009D to someone else, for their weight loss or gain. As noted by one participant: \u00E2\u0080\u00A6I truly have been on every diet that you could think of. And I think that started when I was younger. I can't tell you the first time I showed up at WeightWatchers, but it really did pick up during midlife. So I've been on Bernstein, on Jenny Craig, WeightWatchers. And so I don\u00E2\u0080\u0099t think I've ever been able to \u00E2\u0080\u0093 or never have moderated my weight on my own. I've always turned to a diet, and I know that people will say, \u00E2\u0080\u009CYou gotta make a lifestyle change,\u00E2\u0080\u009D but I have just never been able to manage that\u00E2\u0080\u00A6So, I don\u00E2\u0080\u0099t have a lot of self-control around my eating. I just sort of say that I need to put myself into some kind of \u00E2\u0080\u0093 well, prison is too strong a term, but a controlled environment, where I have to account to someone else for what I'm eating and that always feels somewhat embarrassing to me that I don\u00E2\u0080\u0099t have the self-discipline. Interestingly, only one of the participants expressed feeling as though she has made recent strides in trying to relinquish the control she has tried to exert over her eating, in an attempt to 132##\u00E2\u0080\u009Csurrender,\u00E2\u0080\u009D \u00E2\u0080\u009Caccept,\u00E2\u0080\u009D and \u00E2\u0080\u009Cmake peace\u00E2\u0080\u009D with her eating challenges: I realize control has kind of been a big thing in my life, you know? I've been quite independent and like to have things under control. [Eating] was one area where I wasn't. That was one where, for a long time, I had a lot of trouble\u00E2\u0080\u00A6it was a fight. It's sort of a thing that now you sort of have to almost surrender, accept it, and then it becomes not a fight and then you just live with it and then you can make your peace with it. Trying to Control Body Weight. As previously noted, attempting to control their body weight by striving to lose or maintain their current weight was described as the women\u00E2\u0080\u0099s primary motivation for engaging in behaviours such as dieting and exercising. Interwoven throughout their narratives, the women discussed the \u00E2\u0080\u009Cbattle\u00E2\u0080\u009D they waged with their weight. For example, one participant discussed how she \u00E2\u0080\u009Cfights like crazy\u00E2\u0080\u009D with her weight when it reaches the higher end of the 20-pound weight range within which she fluctuates. Similarly, another mid-life woman discussed her commitment and tenacity in \u00E2\u0080\u009Cfighting the fight\u00E2\u0080\u009D over her weight, particularly in the face of other physical changes she experienced as part of the aging process: \u00E2\u0080\u00A6[as you age] there are changes that happen to your body clearly, yet no matter how you're working away at the task, it starts looking not so good, you know? And this is not gonna stop. It's just going to [get worse]\u00E2\u0080\u00A6So, there is part of me that\u00E2\u0080\u0099s thinking okay I've really gotta keep fighting this fight. Relatedly, all of the women spoke of how much harder it was for them to lose weight in mid-life, as they started to experience the normative weight gain that accompanies aging. As a result, some of the women commented on how, in mid-life, they increasingly turned to dieting and exercising as weight-loss strategies, as reflected in the words of one participant whom noted that her tendency to diet became more \u00E2\u0080\u009Cpronounced\u00E2\u0080\u009D as she entered middle-age: 133## Since I turned 40, it seems to have grown a little bit. It\u00E2\u0080\u0099s more pronounced\u00E2\u0080\u00A6now I'm being more proactive because I've actually cut out things [of my diet] that I never considered cutting out before. I am in more in control of [what I\u00E2\u0080\u0099m eating than] I was in the past. I never cut out anything before. I would still eat, but I was able to exercise, and once I realized that the exercise wasn\u00E2\u0080\u0099t having the same effect as it used to, that\u00E2\u0080\u0099s when I realized, \u00E2\u0080\u009COk, I have to cut it out.\u00E2\u0080\u009D Because before I could eat East Indian food three times a week and I'd be fine. I eat three times a week, East Indian food, I'll be like 50 pounds overweight in no time, you know? For this participant, the fact that she had resorted to controlling her weight through dieting was upsetting for her, since she had previously never perceived herself as the \u00E2\u0080\u009Ctype\u00E2\u0080\u009D to do so. Although all of the women lamented the aging process, their reactions to age-related body changes (e.g., wrinkles, weight gain, gray hair, menopause) ranged from mild annoyance to distress. In a powerful quote, one mid-life woman commented on how, in the face of aging, weight loss was the only aspect of the process that she felt able to try to control: \u00E2\u0080\u00A6most people I know in their 50's and 60's start putting on weight and it's troublesome for them. \u00E2\u0080\u0098Cause you're dealing with a lot of other physical changes and dealing with getting older and looking older and at the same time you're getting bigger and you think, \u00E2\u0080\u009COh, God.\u00E2\u0080\u009D And that\u00E2\u0080\u0099s the one thing, you know - you can't stop the wrinkles and whatever, but theoretically you should be able to stop the weight gain. And it's difficult. Some of the women were steadfast in their resolve to maintain control over their weight by dieting. This experience is exemplified in the words of one participant who expressed not wanting to \u00E2\u0080\u009Crisk the experiment\u00E2\u0080\u009D of throwing her diet to the wind, for fear of gaining weight, as captured in the following quote: 134## I'm almost afraid to take the lid off, because if I just ate anything I felt like whenever I felt like it, I would weigh probably 200 pounds. I don\u00E2\u0080\u0099t know. You know, that\u00E2\u0080\u0099s the thing. If I let up on myself, might I just kind of get into a nice normal relationship with food? But I don\u00E2\u0080\u0099t think I'm willing. Knowing how hard it is to take off weight now at this particular age - it just is like glue - I just don\u00E2\u0080\u0099t wanna risk the experiment. Thus, some of the women in this study described a process in which they felt as though they were held hostage by their desire to control their weight, and confined within a constrained and restrictive relationship with food. In addition to dieting, exercise was cited as a strategy that some of the women employed to avoid weight gain, particularly when felt they had overeaten. For example, one mid-life woman commented on how she has a \u00E2\u0080\u009Ctendency to rely on exercise more than [she] should probably, to avoid the consequences of overeating,\u00E2\u0080\u009D and yet another participant noted that \u00E2\u0080\u009Cthe exercise is to make up for all the food, hopefully, and keep things in balance.\u00E2\u0080\u009D Many of the women described periods of time in their lives when they were slimmer, and when they had successfully lost weight. After losing weight, the women typically expressed a desire to continue to exert control over their bodies in an effort to maintain their weight loss. Although the majority of the women reported that they wished to lose weight at the time of the interview, one mid-life woman particularly expressed wanting to maintain her weight loss, in order to retain some of the positive effects she experienced after losing a significant amount of weight in recent years: I don't want to get back to where I was. I don't want to slip back [and gain weight]. I don't want my clothes to feel uncomfortably tight. You know, one thing I notice after I dropped weight and I started walking, is I had an ease of movement that I never even realized \u00E2\u0080\u0093 a 135## way of getting in and out of a chair that didn't feel awkward, things like that. So, I want to keep that. I try to make it more about keeping a good feeling rather than avoiding a bad feeling. But yeah, it's something that I feel like I have to work on. I don't feel like it's just nothing in my life. It's still an important aspect of my life. Sense of Food and Eating as Addiction Interestingly, the women in this study discussed certain aspects of their challenges with food and weight as being similar to \u00E2\u0080\u009Caddiction.\u00E2\u0080\u009D They described food as a potentially addictive substance, noting the resemblance between their use of food and the use of other addictive substances, such as nicotine, recreational drugs, and alcohol. In addition, the women described having an obsession with food and weight, most commonly characterized by obsessive thinking about, and a constant preoccupation with, food and their weight. Notably, the women also reported a resignation to the life-long nature of their struggles with eating and their body-image challenges, expressing the belief that they would forever have a problematic relationship with food and negative body image. Some of the women expressed adhering to a process-oriented, day-to-day approach in their attempts to cope and come to terms with their eating challenges and poor body image. In an attempt to make meaning of their challenges with food, some of the women specifically made the comparison between alcohol addiction and the difficulties they experience in their relationships with food. As reflected in the following quote, one mid-life woman expressed her hypothesis that she may struggle with a \u00E2\u0080\u009Cfood addiction\u00E2\u0080\u009D in the same way that others in her personal and familial lives have struggled with an addiction to alcohol: \u00E2\u0080\u00A6I have sometimes questioned myself that I\u00E2\u0080\u0099m not an alcoholic, but is food my issue? And that sometimes when you\u00E2\u0080\u0099re in the moment, you\u00E2\u0080\u0099re not thinking it\u00E2\u0080\u0099s an obsessive 136## behaviour, but why [do] I have that thinking in my mind: if [food is] there I\u00E2\u0080\u0099ve got to have it. I will eventually; I\u00E2\u0080\u0099m drawn to it. It\u00E2\u0080\u0099s there, you know? Is that part of that gene, only for me it\u00E2\u0080\u0099s not alcohol? Similarly, another participant pondered the similarities between her eating challenges and alcoholism. She compared her husband\u00E2\u0080\u0099s desire to help her stop \u00E2\u0080\u009Cabusing\u00E2\u0080\u009D herself with food by hiding \u00E2\u0080\u009Cjunk\u00E2\u0080\u009D food in their family home, to the way that a distant relative helped his wife with her addiction by checking for alcohol around their house: I know it\u00E2\u0080\u0099s happened with other couples with drinking. I know someone in my cousin\u00E2\u0080\u0099s family who was an alcoholic and she would hide vodka bottles in the toilet\u00E2\u0080\u00A6her husband was doing the checking similar to what my husband was doing for me. He would dilute [the bottles] because he didn\u00E2\u0080\u0099t want her to be abusing herself so much. So, that\u00E2\u0080\u0099s how I compare it. I mean, I know alcoholism is different, but there\u00E2\u0080\u0099s some similarities, you know? Maybe it isn\u00E2\u0080\u0099t different if I\u00E2\u0080\u0099m seeking comfort from food. In addition, food was discussed as a substance that was perceived as a more socially acceptable \u00E2\u0080\u009Ccoping mechanism,\u00E2\u0080\u009D and one that can be \u00E2\u0080\u009Cused\u00E2\u0080\u009D and procured less conspicuously, in comparison to recreational drugs or compulsive sexual behaviours. For example, one participant commented on how, unlike other addictions, she believes \u00E2\u0080\u009Cabusing\u00E2\u0080\u009D food is often encouraged in society, and is perceived as an acceptable behaviour, particularly in certain environments (e.g., all-you-can-eat buffets): That instead of using drugs or drinking or smoking or sex or whatever, food is more socially acceptable. You can go out to a buffet and nobody bats an eye, right? You can eat like a horker at a buffet and it\u00E2\u0080\u0099s, \u00E2\u0080\u009CYeah, right on!\u00E2\u0080\u009D Right? Another participant said she perceives an \u00E2\u0080\u009Ceating disorder\u00E2\u0080\u009D as the most \u00E2\u0080\u009Cgentle of the addictions\u00E2\u0080\u009D 137##that she could have turned to, in an effort to cope with various challenges throughout her life: Well, I would be surprised if I didn\u00E2\u0080\u0099t have an eating disorder. After seeing everything that I\u00E2\u0080\u0099ve gone through, if I didn\u00E2\u0080\u0099t have an eating disorder I would probably have a drug habit or I would\u00E2\u0080\u0099ve been dead by drinking and driving or overdrinking, over-drugging. Anything to escape who I was. Eating disorder is probably the most gentle of the addictions that I could\u00E2\u0080\u0099ve had. Interestingly, some of the women discussed grappling with the reality that food is a necessity \u00E2\u0080\u0093 a substance that is needed for survival \u00E2\u0080\u0093 which rendered negotiating their relationship with food, and making changes to their eating behaviour, that much more difficult. For example, one participant who referred to herself as a \u00E2\u0080\u009Cfood addict,\u00E2\u0080\u009D commented on how, unlike her mother\u00E2\u0080\u0099s ability to abstain from being around and using drugs and alcohol, it isn\u00E2\u0080\u0099t possible to abstain from eating: \u00E2\u0080\u00A6alcohol addiction or drug addiction \u00E2\u0080\u0093 those are things that you can remove from your life, you know? Like, my mom fortunately matured and said, \u00E2\u0080\u009CI don\u00E2\u0080\u0099t want to [use anymore],\u00E2\u0080\u009D so she stopped. It wasn\u00E2\u0080\u0099t easy. But my sister and I, we can\u00E2\u0080\u0099t stop food\u00E2\u0080\u00A6food addicts don\u00E2\u0080\u0099t have a choice\u00E2\u0080\u00A6food is always [there], like it\u00E2\u0080\u0099s not going anywhere. You have to have it. You can\u00E2\u0080\u0099t change it. You always need food. You can\u00E2\u0080\u0099t just say, \u00E2\u0080\u009COk, I\u00E2\u0080\u0099m not gonna eat.\u00E2\u0080\u009D Food as a Potentially Addictive Substance. Some of the women in this study explicitly expressed the sentiment that food was, for them, a potentially addictive substance. They discussed how they engaged with food (i.e., as a coping mechanism, losing control over eating, using food as a \u00E2\u0080\u009Cfix,\u00E2\u0080\u009D \u00E2\u0080\u009Cabusing\u00E2\u0080\u009D food by overeating), the physical \u00E2\u0080\u009Clust\u00E2\u0080\u009D that they felt for certain foods, as well as the \u00E2\u0080\u009Caddictive\u00E2\u0080\u009D chemical properties of some foods and their role in altering 138##mood. In addition, some of the women perceived their relationships with food, including their food choices and eating behaviour, as harmful to their physical and emotional well-being, noting \u00E2\u0080\u009Cabusive\u00E2\u0080\u009D elements to their relationships with food. These sentiments are captured in the words of one participant who discussed the \u00E2\u0080\u009Caddictive\u00E2\u0080\u009D parts of her relationship with food, including the strong \u00E2\u0080\u009Cneed\u00E2\u0080\u009D she felt to eat certain foods, the \u00E2\u0080\u009Cself-harming\u00E2\u0080\u009D aspects of her eating behaviour, and the \u00E2\u0080\u009Cabuse\u00E2\u0080\u009D cycle that exists as part of her relationship with food: And I\u00E2\u0080\u0099ve often compared my use of food to cigarette smoking or alcoholism\u00E2\u0080\u00A6like a need for it. Feeling like I absolutely have to have that thing. Also in the sense of self-harm. So, smoking and drinking too much alcohol are not good for our bodies and I feel excessive eating or continuous food choices that aren\u00E2\u0080\u0099t good are harmful to my body, and in my case, they\u00E2\u0080\u0099re not only harmful to my body, they\u00E2\u0080\u0099re harmful to my emotional well-being and my sense of myself. So, I can see the harm that they cause and yet I continue to do it\u00E2\u0080\u00A6even though I know this is bad for me, I\u00E2\u0080\u0099m going to do it anyway\u00E2\u0080\u00A6I\u00E2\u0080\u0099ll be telling myself I know I shouldn\u00E2\u0080\u0099t be doing this, but I\u00E2\u0080\u0099m going to do it anyway. In addition, the women spoke of having to negotiate the ongoing \u00E2\u0080\u009Ctemptation\u00E2\u0080\u009D inherent in particular foods, which made resisting those foods a challenge, especially when they were trying to change their eating habits. Relatedly, one woman spoke of the \u00E2\u0080\u009Ctemptation\u00E2\u0080\u009D she felt to engage with food as a coping mechanism \u00E2\u0080\u0093 a temptation that she was hyper vigilant to in the face of distress, and one that she actively tried to steer herself away from: \u00E2\u0080\u00A6But I still struggle, still get the temptation. It\u00E2\u0080\u0099s still a thought in my mind trying to be comforted with food in isolation. It\u00E2\u0080\u0099s just such a well-traveled road for me that it\u00E2\u0080\u0099s always a temptation and I have to make a conscious effort to steer myself to examine my emotions and thoughts, and it\u00E2\u0080\u0099s not always easy \u00E2\u0080\u0098cause those are painful. They can be 139## painful and a little too much to handle sometimes. Thus, food was sometimes perceived as a dangerous substance, and one to be wary and fearful of, particularly for the women who were engaged in a \u00E2\u0080\u009Crecovery\u00E2\u0080\u009D process of trying to embrace healthier eating and living. The women\u00E2\u0080\u0099s experiences of turning to food to cope with distress, and losing control over the act of eating, have been previously discussed in this chapter. However, it is important to note that some of the women interpreted both of these experiences through an addiction lens, perceiving food as an addictive and chemical substance that had the capacity to help them \u00E2\u0080\u009Cescape\u00E2\u0080\u009D reality, \u00E2\u0080\u009Cdisconnect\u00E2\u0080\u009D from their feelings, and enhance their mood \u00E2\u0080\u0093 similar to how the function of, and motivation to use, other addictive substances are often described. In addition, some of the women perceived their tendency to lose control during eating as an aspect of their \u00E2\u0080\u009Caddiction\u00E2\u0080\u009D to food, as captured in the words of one participant who stated, \u00E2\u0080\u009CI guess it\u00E2\u0080\u0099s kind of like being a drug addict, where you lose that control, and what drives you is that desire, that physical need.\u00E2\u0080\u009D The experience of feeling drawn to food, compelled to eat, and a desire to experience the mood-altering effects of food, is perhaps most strikingly captured in the words of one participant who described her physical \u00E2\u0080\u009Clust\u00E2\u0080\u009D for food and seeking out food for a \u00E2\u0080\u009Cfix\u00E2\u0080\u009D: \u00E2\u0080\u00A6sometimes I used to think like, \u00E2\u0080\u009CGod, I feel like a smoker going for a nicotine fix,\u00E2\u0080\u009D you know? There were days where I\u00E2\u0080\u0099d even go to the drug store on my lunch break and get a bag of chocolate \u00E2\u0080\u0093 something like Smarties \u00E2\u0080\u0093 something I could pick at where nobody would notice, and just keep it in my drawer and just sneak it, just to get something. Yeah, it was very strong. Yeah, like I\u00E2\u0080\u0099d just get so obsessive like even physically\u00E2\u0080\u00A6your mouth just wanting it, your tongue. Just your mouth was watering and just the heightened sense in your throat and just can\u00E2\u0080\u0099t even sit still. Just kind of jumpy and \u00E2\u0080\u009CI just want it.\u00E2\u0080\u009D 140## Obsession with Food and Weight. To varying degrees, the women in this study described an \u00E2\u0080\u009Cobsession\u00E2\u0080\u009D with food and weight that was unrelenting, and typified by obsessive thinking about food and their bodies. Specifically, the women described their experience of constantly thinking about food and weight \u00E2\u0080\u0093 thoughts that were \u00E2\u0080\u009Calways in the forefront\u00E2\u0080\u009D of their minds. They reported continually thinking about what foods they should and should not eat, when and where they were going to eat, and how they could procure the foods they desired. This preoccupation with food is captured in the words of one participant who \u00E2\u0080\u009Cconstantly\u00E2\u0080\u009D thought of food, and was always planning when and what she would eat throughout the day: \u00E2\u0080\u00A6like constantly thinking what I was going to eat and when. Even down to, you know, like at lunch I'm planning when I'm going to go for my coffee break and shall I go here and have this cookie or shall I go there and have a butterscotch sundae or something like that. So, it was just always there. It was noise. It was just always on my mind. Similarly, another participant aptly described the obsessive and relentless preoccupation with thoughts related to food throughout the day: I constantly [think about food]\u00E2\u0080\u00A6at the Weight Watchers meeting, they gave us the statistics that on average\u00E2\u0080\u00A6I think it\u00E2\u0080\u0099s 256 times a day you\u00E2\u0080\u0099re thinking of food. And everybody at the meeting [was shocked] but it didn\u00E2\u0080\u0099t shock me. Because it\u00E2\u0080\u0099s not \u00E2\u0080\u0093 like you can\u00E2\u0080\u0099t think of it in terms of 256 times that you\u00E2\u0080\u0099re thinking, \u00E2\u0080\u009CI need to eat this.\u00E2\u0080\u009D But for me, it\u00E2\u0080\u0099s those thoughts \u00E2\u0080\u0093 \u00E2\u0080\u009CDon\u00E2\u0080\u0099t eat that.\u00E2\u0080\u009D \u00E2\u0080\u009CWhen am I going to eat that?\u00E2\u0080\u009D \u00E2\u0080\u009CWhy did I eat that?\u00E2\u0080\u009D \u00E2\u0080\u009CWhy?\u00E2\u0080\u009D \u00E2\u0080\u009COh my God, my pants are too tight.\u00E2\u0080\u009D It\u00E2\u0080\u0099s all related to food. Another participant commented on the pervasive nature of her \u00E2\u0080\u009Cmild obsession\u00E2\u0080\u009D with food: There is not a day that goes by - I don\u00E2\u0080\u0099t think there's an hour that goes by that I'm not conscious of what I'm eating, when I'm eating it, whether I should be eating it. And so, it 141## is a mild obsession I would say. [It\u00E2\u0080\u0099s there] all the time. The participants often described these obsessive, food-related thoughts as tiring and exhausting \u00E2\u0080\u0093 as \u00E2\u0080\u009Ctaking up so much energy.\u00E2\u0080\u009D One participant lamented on the costs of being obsessively preoccupied with thoughts of food and weight: It\u00E2\u0080\u0099s hard sometimes, my thoughts. Sometimes you\u00E2\u0080\u0099re just - you\u00E2\u0080\u0099re tired. You\u00E2\u0080\u0099re tired. Why can\u00E2\u0080\u0099t it just be ok to be the way you are, you know? Why am I so, \u00E2\u0080\u009CI have to \u00E2\u0080\u0093\u00E2\u0080\u009D, \u00E2\u0080\u009CI have to lose weight\u00E2\u0080\u009D, \u00E2\u0080\u009CI have to\u00E2\u0080\u009D, \u00E2\u0080\u009CI can\u00E2\u0080\u0099t let it get out of control\u00E2\u0080\u009D, \u00E2\u0080\u009CI can\u00E2\u0080\u0099t \u00E2\u0080\u0093.\u00E2\u0080\u009D It\u00E2\u0080\u0099s like this undercurrent all the time. Importantly, the women\u00E2\u0080\u0099s obsession with food typically extended beyond their thoughts, into their actual eating behaviours (e.g., monitoring and restricting food intake), which varied in severity among the participants. Relatedly, one participant described feeling that her obsession with food and weight would soon escalate to counting calories, which she described as \u00E2\u0080\u009Cscary\u00E2\u0080\u009D and \u00E2\u0080\u009Cnot exciting\u00E2\u0080\u009D: \u00E2\u0080\u00A6just thinking about that, it's kind of scary. I never wanted to be the kind of person that counted calories. And I haven't gotten there yet. But, you know, pretty close to it, actually. I'm going to start calculating my own calories and that\u00E2\u0080\u0099s not exciting, you know? The participants also reported experiencing obsessive thoughts about their weight. Some of the women said their struggles with weight really intensified in mid-life. As reflected in the words of one participant: \u00E2\u0080\u00A6the difference is now it\u00E2\u0080\u0099s become a daily obsession. Like, I think in my younger years, you tried a new diet, so you were on the diet for a week or two or something, and then you\u00E2\u0080\u0099re gonna fall off\u00E2\u0080\u00A6and then you\u00E2\u0080\u0099re going out for dinner or there\u00E2\u0080\u0099s going to be a party 142## or barbecue or something like that, \u00E2\u0080\u009CWell, I\u00E2\u0080\u0099ll skip the diet. I\u00E2\u0080\u0099ll do that next week\u00E2\u0080\u009D. So, that kind of thing. I wasn\u00E2\u0080\u0099t obsessed all the time. I mean, yes, we had to try this diet\u00E2\u0080\u00A6so you\u00E2\u0080\u0099d go up and down the scales that way. But now, in recent years, it\u00E2\u0080\u0099s become daily. It\u00E2\u0080\u0099s become more \u00E2\u0080\u0093 it\u00E2\u0080\u0099s become part of my life. Like, every day I think about it. Many of the women were sensitive not only to their own weight and the appearance of their own bodies, but also to the bodies and appearance of other women. Particularly since entering mid-life, weight became something that the women constantly attended to, and processed, in their daily lives. For example, one participant described perpetually engaging in social comparison with other women about body weight, shape and size, which she used as a criterion to assess her own mid-life body, and her self-worth: I don\u00E2\u0080\u0099t want to over exaggerate this, but my guess is that almost every woman I meet, I size up - her size versus my size\u00E2\u0080\u00A6And so there's this judgment, and it may be a bit of, \u00E2\u0080\u009COk, if I'm thinner than that person, I'm kind of better than that person. And if I'm fatter, then they're better than I am.\u00E2\u0080\u009D So, yeah, it's a criteria I use to assess myself and other people in the world for sure. Many of the women noted that their \u00E2\u0080\u009Cobsessive struggle\u00E2\u0080\u009D with weight either began or worsened in mid-life in the face of weight gain and resultantly becoming \u00E2\u0080\u009Cpretty unhappy\u00E2\u0080\u009D with their changing bodies. Interestingly, many of the women discussed how their obsession with food and weight was perpetuated in their relationships with other women. This shared experience of obsession was described as almost normative \u00E2\u0080\u0093 a commonplace and acceptable aspect of women\u00E2\u0080\u0099s relationships. For example, one participant described how her conversations with other women were sometimes dominated by talk of dieting, weight, and food: 143## So, I certainly talk a lot about food and dieting and weight\u00E2\u0080\u00A6it is unusual to get together with a group of women for any period of time, like longer than an evening and not have the subject come up - about food, weight, people fussing about their weight, diets they've tried, people giving other people advice about, you know, cut out carbs or do the two-day fast diet or - it is a constant source of conversation. So, I realize that I'm obsessed, but I also know so many people [that are, too]. And maybe just those I hang around with, but I hang around with a lot of people. And the thing about you shouldn\u00E2\u0080\u0099t eat this \u00E2\u0080\u0093 oh, you know it's a special occasion, I'll have that \u00E2\u0080\u0093 you know, people apologizing for eating. Similarly, another participant discussed how she is \u00E2\u0080\u009Csurrounded\u00E2\u0080\u009D by other women who also struggle in their relationships with food, and obsess about their weight, and about what and how much food they consume: And I'm surrounded by people who have the same concerns. Like, I have this one friend. She's younger. She's 33 and she's a little bit chubbier - not overly but she's concerned about these things. So, her and I talk about, you know, the breakfast smoothies, the no gluten, the no meat, and what's good for you, and what's good for that. And so it\u00E2\u0080\u0099s kind of just become my social circle lately. Given the degree to which their days were punctuated with thoughts about food and weight, it is not surprising that the participants described a sense of unquiet and dis-ease about their relationships with food and their bodies. The essence of their obsessive struggles with food and weight is reflected in the words of one participant who highlighted the pervasiveness of this experience throughout her life: I\u00E2\u0080\u0099ve matured with the next fad diet or \u00E2\u0080\u009Cthis is going to be a breakthrough\u00E2\u0080\u009D or \u00E2\u0080\u009Cthis is the diet pill\u00E2\u0080\u009D\u00E2\u0080\u00A6And so now we we\u00E2\u0080\u0099ve reached our mid-40s, and number one, you\u00E2\u0080\u0099re going 144## through pre-menopause\u00E2\u0080\u00A6you\u00E2\u0080\u0099ve got a metabolism that\u00E2\u0080\u0099s all screwed up [from dieting]. You\u00E2\u0080\u0099ve got this constant obsession with \u00E2\u0080\u009Cgood\u00E2\u0080\u009D food, \u00E2\u0080\u009Cbad\u00E2\u0080\u009D food, what you\u00E2\u0080\u0099re eating, what you\u00E2\u0080\u0099re not eating. You go on these fad diets, well it doesn\u00E2\u0080\u0099t work so you fall off and then you gain weight and you know, you constantly \u00E2\u0080\u0093 it\u00E2\u0080\u0099s constantly there. Resignation. Interestingly, in discussing their relationships with food, the women in this study expressed being resigned to their belief that they would forever battle their challenges with food and body image. For some of the participants this was a recent revelation, while for others, it was something they had already come to terms with. All of the women expressed their sense of resignation in a way that was calm and matter-of-fact. This sense of resignation stood in stark contrast to the ongoing struggles they expressed, in so many different ways, as they reflected on their relationships with food, their bodies, and themselves. Ultimately, the women described their challenges with food, weight, and body image as something they will live with, in some capacity, for the rest of their lives. They attributed their eating challenges to being an integral part of their \u00E2\u0080\u009Cmake-up\u00E2\u0080\u009D and lived experience, believing that these challenges will be something that will forever be \u00E2\u0080\u009Cwith\u00E2\u0080\u009D them. This sentiment is concisely captured in the words of one participant who has struggled with her eating behaviour since childhood: \u00E2\u0080\u009CGoodness, it\u00E2\u0080\u0099s been with me all my life, and I can\u00E2\u0080\u0099t imagine that miraculously I\u00E2\u0080\u0099m finally going to get it together.\u00E2\u0080\u009D The following quote captures the participants\u00E2\u0080\u0099 sense of resignation to the \u00E2\u0080\u009Clifelong battle\u00E2\u0080\u009D they expect to have to fight in their relationships with food: So yeah, it\u00E2\u0080\u0099s a lifelong battle\u00E2\u0080\u00A6I know there\u00E2\u0080\u0099s never going to be a cure. Like, there\u00E2\u0080\u0099s never going to be one day that I\u00E2\u0080\u0099m going to wake up and I\u00E2\u0080\u0099m never going to have food be my first thought of self-comfort. But having said that, I hope I get to the point where when I do feel overwhelmed that, yes, food may be in my mind but it will only be one of 145## the coping tools that I have available. Of note, one of the participants did, in fact, report that she has been successful in enhancing her \u00E2\u0080\u009Ctool box\u00E2\u0080\u009D of coping strategies, resultantly claiming that she is less prone to use food as a coping mechanism. However, she expressed concern that she may not yet be completely \u00E2\u0080\u009Cout of the woods,\u00E2\u0080\u009D and reported being fearful that she may \u00E2\u0080\u009Cslip back\u00E2\u0080\u009D into old, unhealthy eating habits and negative patterns in relation to food: I'm still not absolutely confident\u00E2\u0080\u00A6the worry is still there. There\u00E2\u0080\u0099s always a bit of a concern\u00E2\u0080\u00A6hopefully those really negative patterns have kind of fallen by the wayside, but you know what? I don't know if I'm yet fully out of the woods. Maybe you never are. Maybe it's always just something you live with. Two of the women in this study spoke explicitly about being in a recovery process from their eating challenges. Both of these women were actively engaged in a treatment/recovery process, which they described as ongoing and sometimes \u00E2\u0080\u009Cmoment to moment.\u00E2\u0080\u009D In the words of one of these women who described being in a recovery process from \u00E2\u0080\u009Ccompulsive overeating\u00E2\u0080\u009D: \u00E2\u0080\u00A6to have this problem as long as I have, I know that it will never \u00E2\u0080\u0093 I don\u00E2\u0080\u0099t want to say never because I don\u00E2\u0080\u0099t want to speak in absolutes \u00E2\u0080\u0093 but it\u00E2\u0080\u0099s with me. It\u00E2\u0080\u0099s with me, and I think it could very well always be with me. And it\u00E2\u0080\u0099s something that I\u00E2\u0080\u0099m going to have to work at, and I know some days will be harder than others, but I think I\u00E2\u0080\u0099m just more accepting of it. I guess I just always thought there would be a day where I would be cured and I\u00E2\u0080\u0099ve come to accept that that\u00E2\u0080\u0099s not really how it works. It\u00E2\u0080\u0099s a process. A daily process. And when it\u00E2\u0080\u0099s hard it\u00E2\u0080\u0099s an hourly process. But I think for every moment you can be mindful of that is a good moment. Because that moment passes and it leads to another moment and another moment and that\u00E2\u0080\u0099s how you get through. So, yeah. It\u00E2\u0080\u0099s just an 146## evolution of itself. The women in this study believed that they will live with some degree of negative body image, and struggle with their weight, for the duration of their lives. This experience is richly captured in the words of one participant who expressed coming to terms with the fact that she may have to forever \u00E2\u0080\u009Cwork away on\u00E2\u0080\u009D her challenges with body image and weight, and \u00E2\u0080\u009Caccept\u00E2\u0080\u009D that this is something with which she will always have to contend: I started thinking, \u00E2\u0080\u009CGod, I'm obsessed\u00E2\u0080\u009D\u00E2\u0080\u00A6because I don\u00E2\u0080\u0099t think it's gonna go away. I honestly can't imagine what I would do. I don\u00E2\u0080\u0099t think any amount of therapy, medication [will help]. I know that I will always have to watch my weight\u00E2\u0080\u00A6I think I am a very good candidate for your study. This is a problem. I have a problem. I feel like I'm in an AA meeting, you know? This is sort of like my Waterloo in a way\u00E2\u0080\u00A6talking about it here with you, I think, \u00E2\u0080\u009COh my God, really? Get a grip on this.\u00E2\u0080\u009D But I don\u00E2\u0080\u0099t think I will. I think this is me. I just turned 65 and I don\u00E2\u0080\u0099t imagine this going anywhere\u00E2\u0080\u00A6and maybe in that there's a little bit of self-acceptance that this is just something I have. This is just part of my make-up. I will always have a mild obsession and I have to work away on it. Sense of Pressure to Conform To varying degrees, all of the women in this study acknowledged feeling a sense of pressure to conform to beauty- and body-related cultural \u00E2\u0080\u009Cideals,\u00E2\u0080\u009D in particular thinness/lower weight and a \u00E2\u0080\u009Cyouthful\u00E2\u0080\u009D appearance. The participants discussed perceived pressure via media, noting how cultural imagery depicting beauty- and body-related ideals continues to have a negative impact on their sense of self, as well as their perceptions of, and feelings about, their own bodies. The women also discussed perceived pressure from close others, typically family members and intimate partners, to change their eating habits and/or alter their bodies by losing 147##weight. Importantly, the women reported feeling increased pressure in mid-life \u00E2\u0080\u0093 reflecting on how they believed body-related ideals were harder to attain during mid-life, in light of the normative weight gain and other signs of the aging process that they all experienced with advancing age (e.g., wrinkled skin, greying hair, cellulite, varicose veins). The participants talked about feeling a sense of pressure to conform to cultural notions of \u00E2\u0080\u009Cattractiveness\u00E2\u0080\u009D and \u00E2\u0080\u009Cdesirability.\u00E2\u0080\u009D Most commonly, they made reference to the \u00E2\u0080\u009Cideal\u00E2\u0080\u009D female figure that is often presented in media \u00E2\u0080\u0093 typically noted as the current \u00E2\u0080\u009Cstandard\u00E2\u0080\u009D for female beauty in North American culture (i.e., images of young, thin, sexualized women). Given the \u00E2\u0080\u009Cimpossibility\u00E2\u0080\u009D of achieving or maintaining this standard, particularly in middle-age, the women experienced heightened degrees of body dissatisfaction and self-consciousness when comparing their own bodies to the bodies of women they believed more closely reflect the ideal. Relatedly, one of the participants who identified as Latina discussed the frustration she experienced with having a body type that differs from the ideal figure in her culture: \u00E2\u0080\u00A6and being Latina, you\u00E2\u0080\u0099ve got to be beautiful. You have a big butt, you know, big boobs, whatever. And you have to have that [outgoing] personality. And it's difficult to follow that especially since not a lot of us are like that. And a lot of Latina women, especially from Central America, are very tiny. Like, they're very small, petite, and I'm not. Like, I'm medium framed. I have the big hips and the big shoulders, and I'm never going to look like that. But it's difficult to accept that because everybody else looks like that. And that\u00E2\u0080\u0099s the standard. Importantly, some of the women discussed paradoxically turning to food to cope with their perceptions of not living up to these cultural \u00E2\u0080\u009Cstandards,\u00E2\u0080\u009D and the shame that they experienced about their bodies, as a result. 148## Beyond weight and shape, some of the participants commented on feeling pressured to emulate a youthful appearance, reflected in the \u00E2\u0080\u009Cyouth-oriented\u00E2\u0080\u009D North American cultural standards for beauty. For example, one woman reflected on the pressure she felt to get Botox injections, to minimize the visible signs of aging on her face by paralyzing her facial muscles, despite her desire and choice to age naturally: \u00E2\u0080\u00A6I\u00E2\u0080\u0099m not my mom. I\u00E2\u0080\u0099m not in my 80s and I\u00E2\u0080\u0099m only in my 50s. But I don\u00E2\u0080\u0099t want to be pressured into doing the Botox\u00E2\u0080\u00A6and I thought Oprah had a really good line that has resonated with me for the last little while. And she says, \u00E2\u0080\u009CTo deny your age is to deny your life.\u00E2\u0080\u009D And I thought to myself, \u00E2\u0080\u009CWow,\u00E2\u0080\u009D you know, \u00E2\u0080\u0098cause I always say I\u00E2\u0080\u0099ve got memories. I\u00E2\u0080\u0099ve earned every one of those lines...I\u00E2\u0080\u0099ve experienced life. I\u00E2\u0080\u0099ve gone out there and seen this world\u00E2\u0080\u00A6Why do I want to look like a Barbie doll, you know what I mean? Take me for who I am. Take me as I am. Accept that there\u00E2\u0080\u0099s nothing wrong with women. The pressures that the women felt to retain \u00E2\u0080\u009Cyouthfulness,\u00E2\u0080\u009D conceal their aging bodies, and achieve or maintain a desirable weight often had an impact on the women\u00E2\u0080\u0099s relationships with food and their bodies. Specifically, cultural pressures appeared to contribute to the women\u00E2\u0080\u0099s experiences of low self-esteem, body dissatisfaction, and an overall sense of insecurity and self-consciousness about their bodies. For some of the women, the pressures were experienced as an added stressor in their daily lives, which they sometimes tried to cope with by turning to food for comfort. In particular, some of the women described turning to food as a way of coping with the exasperation they felt in response to these pressures. Specifically, when the women felt particularly unable to resemble cultural ideals, they sometimes turned to food in an act of \u00E2\u0080\u009Cgiving up\u00E2\u0080\u009D in the face of what they perceived as the \u00E2\u0080\u009Cpointless,\u00E2\u0080\u009D relentless struggle with their weight and appearance. In the words of one participant, eating also served to create a \u00E2\u0080\u009Cbreak from the 149##pressures of expectations.\u00E2\u0080\u009D At times, these pressures also served as motivation for the women to carry out their weight loss goals. For example, one participant in her sixties commented on how she turned to dieting throughout her life, in response to the pervasiveness of cultural pressures centred on \u00E2\u0080\u009Cbeauty\u00E2\u0080\u009D and appearance: \u00E2\u0080\u00A6when I was in my 20s and 30s there was that whole marketing thing - looks and make-up. And all of a sudden, it\u00E2\u0080\u0099s like malls sprang up everywhere because they wanted us to spend money on clothes and looks and all of that \u00E2\u0080\u0093 and diet books and gym memberships. And it was always women, you know? It\u00E2\u0080\u0099s really focused on women. So, therefore food was the biggest obsession \u00E2\u0080\u0093 counting calories \u00E2\u0080\u0093 and as we\u00E2\u0080\u0099ve gotten older the food thing is still there, and I think there\u00E2\u0080\u0099s probably a lot of us like me that that are dealing with it all the time. Importantly, the women described a powerful battle that they waged between their strong desire to accept their bodies as they are, and the pressures they felt to achieve a lower weight. This sentiment is most clearly expressed in the following words of one participant who felt less shame about her eating behaviour when she felt more accepting of her body: And I waffle between, \u00E2\u0080\u009CYeah, I\u00E2\u0080\u0099m going to do it. [I\u00E2\u0080\u0099m going to stop fighting with my weight]. I\u00E2\u0080\u0099ve always been fat. I\u00E2\u0080\u0099m going to be fat all my life. Why am I putting myself through this hassle? Just stop the insanity. Learn to live in the body you\u00E2\u0080\u0099ve been given, even if it\u00E2\u0080\u0099s [bigger] than what you want. As long as you\u00E2\u0080\u0099re healthy and you\u00E2\u0080\u0099re active and you\u00E2\u0080\u0099re happy, who gives a crap?\u00E2\u0080\u009D So, that\u00E2\u0080\u0099s my excuse. \u00E2\u0080\u009COkay, so you\u00E2\u0080\u0099re going to live like that? Okay, have your bag of chips, that\u00E2\u0080\u0099s fine.\u00E2\u0080\u009D All of the women experienced and spoke about the pressures to conform to cultural standards of beauty and desirability throughout their lives. They typically became aware of, and 150##internalized, these standards at a young age, and carried these ideals with them throughout their lives. The potency and power of the pressure to conform to body-related ideals was poignantly captured in the words of one participant who discussed her mother\u00E2\u0080\u0099s struggle with her own weight, and her elderly mother\u00E2\u0080\u0099s delight in eventually losing weight after becoming ill: The main thing for me is not to be heavy, no matter how old I am. And I remember my mom - this is so sad. My mom was bedridden at the end. She weighed about 80 pounds, and she was just skeletal. And I remember her telling me that she was happy finally to be thin. You know, that\u00E2\u0080\u0099s a kind of heartbreaker, so she obviously had the same thing and maybe sort of subtly passed that on, because she was slim as a young woman, got heavy during midlife and probably was about 30 pounds overweight in her 70's, and then she got sick. And she was happy to be thin, even though she looked like skin and bones\u00E2\u0080\u00A6How can we be so hard on ourselves and have such a poor capacity to look at ourselves? My mother preferred the way she looked at 80 when she was skeletal than when she was 70 and was maybe 20 pounds overweight and healthy. She preferred the wasted look to a healthy look and I thought, \u00E2\u0080\u009COh gosh. I don\u00E2\u0080\u0099t know if I'll be the same when I get there too. I don\u00E2\u0080\u0099t know.\u00E2\u0080\u009D Notably, the degree to which the women expressed feeling pressure to conform varied significantly between participants. In fact, one of the women in this study explained how she felt less pressure to conform as she entered her sixties \u00E2\u0080\u0093 a developmental stage that she believed granted her \u00E2\u0080\u009Cpermission\u00E2\u0080\u009D to \u00E2\u0080\u009Cbe more relaxed\u00E2\u0080\u009D about her appearance, and more accepting of her wrinkles, grey hair, and weight gain. Perceived Pressure via Media. The majority of the participants in this study made reference to the role of the media in perpetually portraying cultural imagery depicting unrealistic 151##and largely unattainable beauty- and body-related ideals for women. The women expressed \u00E2\u0080\u009Cknowing\u00E2\u0080\u009D that the \u00E2\u0080\u009Cideal\u00E2\u0080\u009D body weight/shape commonly presented in media imagery is largely \u00E2\u0080\u009Cimpossible\u00E2\u0080\u009D to attain, particularly in mid-life, and were aware that such images are often distorted and unrealistic (i.e., airbrushed). Irrespective of that knowledge, the participants noted that they still sometimes compared their own bodies to the \u00E2\u0080\u009Cideal\u00E2\u0080\u009D \u00E2\u0080\u0093 comparisons that typically had a negative impact on their sense of self and their body image. Some of the women discussed believing that the media operates by preying on the \u00E2\u0080\u009Cenvy\u00E2\u0080\u009D of the consumer \u00E2\u0080\u0093 engendering a sense of inferiority and insecurity among women, about our bodies. The women explained that they took away one consistent message from popular media imagery: that women are somehow not acceptable as we are. This sentiment is concisely captured in the words of one participant who expressed wanting women to \u00E2\u0080\u009Cembrace who [we] are\u00E2\u0080\u009D and \u00E2\u0080\u009Crealize [we] are loveable,\u00E2\u0080\u009D contrary to the messages she believes are conveyed in the media: Somewhere along the line we have believed and bought the story that we are less than, and that we have to do something to fix ourselves - that we\u00E2\u0080\u0099re not good enough the way we are\u00E2\u0080\u00A6You have to be perfect. Not just succeed: you have to be the best. The thinnest. The prettiest. The blondest. Many of the women talked about the inescapability, and \u00E2\u0080\u009Cbombardment\u00E2\u0080\u009D of cultural imagery depicting unrealistic and youthful body-related ideals (e.g., via billboard/magazine advertisements, television, movies, commercials). In some cases, the women believed that the ubiquitous nature of media imagery served to sensitize them to such images. At the same time, the women also talked about the \u00E2\u0080\u009Cinsidious\u00E2\u0080\u009D nature of media imagery and marketing, and how easy it was to blindly accept these standards, sometimes with little awareness: I love Dove. Because this campaign for real beauty, they actually have older women with 152## grey hair, you know? Awesome, with wrinkles, awesome. Everybody is beautiful in their own way. Just stop looking past the media bullshit and you can see it...There\u00E2\u0080\u0099s something about that person. They have wrinkles, that shows you what they\u00E2\u0080\u0099ve done in their life. That\u00E2\u0080\u0099s their beauty; their inner beauty shines out. So, how dare you tell me that I have to devalue that person just because they\u00E2\u0080\u0099re a little heavy or they\u00E2\u0080\u0099re old or they\u00E2\u0080\u0099re not white. Like, how dare you? But you still buy into it. In a moment of weakness, you\u00E2\u0080\u0099re sitting on the sky train and these ads are flipping by or there\u00E2\u0080\u0099s something on a magazine, and you read it and you don\u00E2\u0080\u0099t even know that you\u00E2\u0080\u0099ve read it\u00E2\u0080\u00A6And it\u00E2\u0080\u0099s there - that if you\u00E2\u0080\u0099re not a size 2 you fail. Fail, fail! You know? And it\u00E2\u0080\u0099s so insidious. Like, without us even realising it\u00E2\u0080\u0099s there. It\u00E2\u0080\u0099s there. Thus, subsequent to viewing such imagery, the women typically felt worse about their mid-life bodies, and they believed that such imagery undermined their sense of self and contributed to their challenges with body image. Relatedly, the women discussed how they felt that there was no room for them to embrace normative physiological and body-related changes that naturally occur during the developmental period of mid-life (e.g., aging, menopause, weight gain), in the face of cultural beauty- and body-related pressures. In the words of one participant: I\u00E2\u0080\u0099ll be entering through perimenopause and then menopause and those things are a natural part of a woman\u00E2\u0080\u0099s life but it just seems like you\u00E2\u0080\u0099re not allowed to have that in your life because you gotta look this way - look the way the media portrays you. Overall, the pressures that the women experienced via popular media sometimes made the process of accepting age-related physical changes significantly more difficult. Some of the women expressed being \u00E2\u0080\u009Cangered\u00E2\u0080\u009D by the \u00E2\u0080\u009Cdouble standard\u00E2\u0080\u009D that exists 153##regarding standards of attractiveness for women versus men, which they believed are highlighted in the media. Broadly speaking, this sentiment is expressed in the words of one woman who commented on the ever-changing ideals that are directed at women, and how she feels men are held to a less stringent standard, particularly in terms of body weight: Because back then Marilyn Monroe was a size 16. So, you know, everybody was curvy. And after the war and after The Depression, if you had 5, 10 pounds on you, you were healthy. Your husband was doing well. That was a sign of prosperity. Now that\u00E2\u0080\u0099s completely flipped. That has absolutely nothing to do with it. And the double standards \u00E2\u0080\u0093 when you hit middle age, if your husband has a little bit of a paunch, \u00E2\u0080\u009COh, he\u00E2\u0080\u0099s done well.\u00E2\u0080\u009D But if you get a little paunch, \u00E2\u0080\u009COh, you\u00E2\u0080\u0099ve let yourself go.\u00E2\u0080\u009D Similarly, another participant expressed \u00E2\u0080\u009Canger\u00E2\u0080\u009D at feeling compelled to succumb to the pressure to embody characteristics of the \u00E2\u0080\u009Cideal\u00E2\u0080\u009D woman, which ultimately felt confining and restraining for her, as reflected in the following quote: I guess it has made me angry at some point because of the fact that women at 40 have to go through this, you know, with the media and the expectations. And it's - you just can't live your life. You have to live by the expectations\u00E2\u0080\u00A6I think it's unfair that women have these expectations placed upon them for beauty and men don\u00E2\u0080\u0099t\u00E2\u0080\u00A6Like, why do we have to have different expectations than men? Why is it, you know? It's 2013, and we still have that same old mentality that women are supposed to be perfect. That\u00E2\u0080\u0099s not fair. Thus, the women described being keenly aware of what women \u00E2\u0080\u009Cshould\u00E2\u0080\u009D look like, and how their own bodies differed from cultural ideals. Importantly, a heightened awareness of cultural pressures centered on weight and beauty sometimes served to motivate the women to stick to their dieting behaviour; however, at the same time, such pressures also acted as contextual 154##stressors which sometimes led to eating in an effort to cope. Interestingly, almost all of the women in this study who were in their fifties and sixties commented on the generational differences and changes they have observed in media imagery and marketing, and the overall sense of pressure they felt to conform to beauty- and body-related ideals, which increased over time. For example, one participant commented on the proliferation of women\u00E2\u0080\u0099s magazines and what she perceives as their role in instilling a sense of inferiority and self-consciousness among women: There might\u00E2\u0080\u0099ve been The National Enquirer back then, and maybe one other rag mag. Better Homes and Gardens: they\u00E2\u0080\u0099ll teach you how to do a better home and garden. Canadian Living, how to be a good Canadian. And that was about it. Now there\u00E2\u0080\u0099s all sorts of other magazines out there that tell you how bad you are, how badly you\u00E2\u0080\u0099re feeling, and what you need to do to fix it. Instead of just saying, you know what? You\u00E2\u0080\u0099re pretty good the way you are. These women also highlighted female figures that marked the body-related ideals of different eras, such as Marilyn Monroe \u00E2\u0080\u009Cwho was a size 16\u00E2\u0080\u009D in the 1950s, and a decade later, Twiggy, who emerged as a cultural icon \u00E2\u0080\u009Cwho was pathetically skinny, and now outweighs most of the models that model our clothes.\u00E2\u0080\u009D Commenting on the constantly changing and decreasing body size/weight/shape of female models symbolizing the ideal, one participant in her 60s noted that she believed she came of age in a more \u00E2\u0080\u009Cbenign environment around weight\u00E2\u0080\u009D and that she has experienced increased pressure to attain/maintain a slim physique as she has aged: \u00E2\u0080\u00A6the thing that always struck me is that the weight differential between a runway model and the average woman in the 50's was about ten pounds. And it's now about 60. So, I think I grew up in a more benign environment around weight. 155##Another participant discussed the emergence of the diet and exercise industries in the 70s, and the impact of marketing, which she believed was wholly directed at women and solely focused on weight and appearance: ...when I got into my 20s \u00E2\u0080\u0093 we were a generation of opportunities to get out and work. We weren\u00E2\u0080\u0099t the ones just to grow up, get married, and have babies and stay home...we were really the first generation that were marketed to. Appearance became something...that\u00E2\u0080\u0099s when we got hit with the diets and the Jane Fonda work out videos, No Pain No Gain. So, it became a constant battle...and you were always obsessed about food and food became \u00E2\u0080\u009Cgood\u00E2\u0080\u009D or \u00E2\u0080\u009Cbad\u00E2\u0080\u009D...you\u00E2\u0080\u0099d be consuming 500 calories a day and then exercising like crazy\u00E2\u0080\u00A6Like, that\u00E2\u0080\u0099s a disorder, I think. But that\u00E2\u0080\u0099s what we were marketed to believe - no pain, no gain, you know? And you gained the weight, you beat yourself up, and then you go on the next fad diet. We were marketed to for something my mother wasn\u00E2\u0080\u0099t marketed to or my grandmother. These women experienced cultural pressures as worsening throughout their adult lives \u00E2\u0080\u0093 particularly in recent years, as the standards for mid-life and older women have become increasingly difficult to attain. Such pressures were thus described as prominent, underlying contextual stressors which added to the sense of shame they felt about their bodies and weight, and which bolstered their desire to engage in weight loss behaviours (e.g., exercise, dieting). Overall, for many of the women, the impact of cultural pressures via popular media imagery had a deeply negative impact on their sense of self, as well as their relationships with their bodies and with food. For example, the women discussed how beauty- and body-related ideals promoted in the media served to undermine their self-confidence, and heighten their challenges with self- and body-esteem and self-consciousness. This sentiment is captured in the 156##words of one participant who powerfully commented on her desire to become the kind of \u00E2\u0080\u009Cbeautiful\u00E2\u0080\u009D that is featured in popular media: Well, it\u00E2\u0080\u0099s probably just what you see in the media \u00E2\u0080\u0093 the look of people, what beautiful looks like. I guess that\u00E2\u0080\u0099s something I\u00E2\u0080\u0099ve observed over the course of working with my naturopath is that it\u00E2\u0080\u0099s not so much increased vitality or increased mobility that I was looking for. It was that I wanted to be beautiful in my sense of what beautiful is...I was so happy with the weight loss, and yet I would look in the mirror and still tell myself, \u00E2\u0080\u009CGreat, you lost the weight, but you\u00E2\u0080\u0099re still not beautiful!\u00E2\u0080\u009D Importantly, the only woman in this study who has daughters expressed her \u00E2\u0080\u009Canger\u00E2\u0080\u009D at the promotion of beauty- and body-related ideals in the media that are often sexualized in nature. As reflected in the following quote, she described wanting her daughters to resist cultural imagery, as well as the difficulty she faced in facilitating this process, in light of her own challenges with body image and eating: I think my anger has grown [about media imagery and expectations placed on women] because it just seems that I don\u00E2\u0080\u0099t want the same for my daughters, you know? But they're exposed to it, and how do I get them out of it? I don\u00E2\u0080\u0099t want them to be feeling guilty about what they're eating. I don\u00E2\u0080\u0099t want them to feel fat. I don\u00E2\u0080\u0099t want them to feel ugly or have low self-esteem. But how do I do that if I'm having that issue myself, you know? The women in this study described the media pressure to conform to unrealistic body ideals as an aspect of their experience that they were confronted with repeatedly throughout their daily lives. Importantly, however, despite the ubiquitous nature of the pressure that all of the women felt, and its impact on their relationships with their bodies and with food, a limited number of these women felt better able to be critical of cultural messages and images that glorify 157##thinness as they progressed through mid-life: By the same token, I\u00E2\u0080\u0099m recognizing that in my mid-life wisdom, I\u00E2\u0080\u0099m old enough to be like, \u00E2\u0080\u009CWell, screw [the media]!\u00E2\u0080\u009D you know? I\u00E2\u0080\u0099m also old enough to know that you don\u00E2\u0080\u0099t have to worry so much about what other people think. So, it\u00E2\u0080\u0099s kind of a balance but there\u00E2\u0080\u0099s definitely still that element of shame and insecurity [that I feel when I see media images]. Perceived Pressure from Close Others. Four of the women in this study explicitly discussed experiencing pressure in mid-life from significant others \u00E2\u0080\u0093 typically family members and partners \u00E2\u0080\u0093 to alter their eating habits and/or lose weight. In some cases the pressure was delivered through direct comments or suggestions, whereas in others the pressure was more implicit and less overt. Many of the women in this study noted that family members paid close attention to, and frequently commented on, their weight and eating habits when they were girls and young women. Sadly, for some of the women, this pattern continued into mid-life. For example, one participant explained that her family, including her in-laws, frequently made comments about, and suggestions for her to change her eating behaviour. She noted how these \u00E2\u0080\u009Cpainful\u00E2\u0080\u009D and \u00E2\u0080\u009Cmean\u00E2\u0080\u009D judgements actually pushed her toward, rather than away from, food: \u00E2\u0080\u00A6my father in law, a couple of years ago, suggested to me that I might be morbidly obese\u00E2\u0080\u00A6it was hard to hear him say that, you know?...I also think he sometimes says things hoping for an effect, hoping for a shock. So, if I shock her into thinking she\u00E2\u0080\u0099s terminal then maybe she\u00E2\u0080\u0099ll do something about it. And it\u00E2\u0080\u0099s just a lot of pressure, you know?! So, I find when he\u00E2\u0080\u0099s tried to intervene with my eating habits or lifestyle, then that\u00E2\u0080\u0099s really made me want to go and eat. 158##Thus, direct pressures exerted upon women to alter their eating habits and weight often served to further complicate the women\u00E2\u0080\u0099s relationships with food. Importantly, the women described turning to food in an effort to cope with the ongoing pressures they experienced from close others, and the challenging emotions that arose in response to such pressures (e.g., guilt and shame). For example, one participant commented on how others\u00E2\u0080\u0099 comments about her body and eating have reinforced her own self-criticism and the self-consciousness she feels about her appearance, which sometimes led to a process of \u00E2\u0080\u009Cself-sabotaging\u00E2\u0080\u009D herself by paradoxically turning to food to cope: \u00E2\u0080\u00A6the ones who make the comments who have the most effect on me are the ones who are saying things that I\u00E2\u0080\u0099ve doubted in myself. You know, if I\u00E2\u0080\u0099ve had those thoughts myself, then they just reinforce it and they bring it to the surface. And sometimes it\u00E2\u0080\u0099s something that I hadn\u00E2\u0080\u0099t even realized I was thinking and then I go, \u00E2\u0080\u009CYeah! I\u00E2\u0080\u0099m worried about that. I am worried about getting fat again!\u00E2\u0080\u009D Often the pressures that the women felt from close others served to increase the shame and self-consciousness that they felt about their bodies. For example, one participant noted that her husband has made direct comments about her body and weight, which has caused her to feel more \u00E2\u0080\u009Cinsecure\u00E2\u0080\u009D about her mid-life body. She expressed that she feels her husband sometimes quietly disapproves of her eating habits and current weight, and expressed concern that he may become less attracted to her as a result of her recent weight gain: I felt that there was some sort of judgement from my husband because I was a lot bigger than what he was used to, you know? And he made just little comments like, \u00E2\u0080\u009CHey, let's join a gym.\u00E2\u0080\u009D And I'd be like, \u00E2\u0080\u009CWhy don\u00E2\u0080\u0099t you join the gym.\u00E2\u0080\u009D...sometimes I feel like he's judging me, especially if I'm eating something that he doesn\u00E2\u0080\u0099t approve of. He won't say it 159## because he knows that I'll tell him where to go. But I can tell by the look on his face that something's going on. I don\u00E2\u0080\u0099t know if I'm assuming it or maybe I'm reading too much into it. But that\u00E2\u0080\u0099s what I feel. Similarly, another participant also talked about being painfully aware of her husband\u00E2\u0080\u0099s \u00E2\u0080\u0093 and in the past, her father\u00E2\u0080\u0099s \u00E2\u0080\u0093 preference for thinness, which she experienced as an indirect form of pressure for her to be mindful of her weight and appearance: I don\u00E2\u0080\u0099t know how much [my husband] cares\u00E2\u0080\u00A6for his age and stage he's unbelievably fit\u00E2\u0080\u00A6And when we married, I was probably 18 pounds less than now. So, I'm not one of these women that just totally ballooned up\u00E2\u0080\u00A6 he doesn't say much, which is nice, but I know he's happier when I'm thin, but he's never really been at me. You know, my dad was much fussier about weight and I don\u00E2\u0080\u0099t remember him saying a lot to me, but it was just understood in the family that thin was better, fit was good, but not a, \u00E2\u0080\u009CYou gotta do this or don\u00E2\u0080\u0099t eat that.\u00E2\u0080\u009D It was just this sense I had that thin was good. The women ultimately experienced pressure from close others as shaming, which engendered negative feelings about their bodies and their eating behaviour, and often had a negative impact on their sense of self. In response to such pressure, some of the women described a heightened commitment to dieting, in order to manage their weight \u00E2\u0080\u0093 in an attempt to avoid further pressures and comments from others, and the resulting shame. Importantly, some of the women expressed how even \u00E2\u0080\u009Cpositive\u00E2\u0080\u009D comments about their weight, and weight loss, served to increase their self-consciousness about their bodies, as well as the pressure they felt to maintain an \u00E2\u0080\u009Cattractive\u00E2\u0080\u009D appearance. This sentiment was expressed in the words of one participant who reflected on distant and more recent past experiences of being praised for her weight loss: 160## I was finding that I had pressure when people would say, \u00E2\u0080\u009COh, you\u00E2\u0080\u0099re so thin! You\u00E2\u0080\u0099re looking really good! You\u00E2\u0080\u0099ve lost a lot of weight!\u00E2\u0080\u009D And I find that\u00E2\u0080\u0099s pressure for me! I can remember when I lost weight in my early twenties, then one woman came up behind me and said, \u00E2\u0080\u009CYou\u00E2\u0080\u0099re so skinny!\u00E2\u0080\u009D And for me\u00E2\u0080\u00A6it\u00E2\u0080\u0099s like pressure to stay that way or a comment validating that I wasn\u00E2\u0080\u0099t right before. Another participant reflected on how praise for her weight loss served to reinforce her desire to lose weight, and as motivation to adhere to her weight-loss behaviours: I noticed that because I started cutting down on [eating meat] the pounds started to come off...and people would say, \u00E2\u0080\u009CHoly, you're not eating meat. Oh my God, you\u00E2\u0080\u0099ve lost so much weight!\u00E2\u0080\u009D I thought, \u00E2\u0080\u009COh, okay.\u00E2\u0080\u009D [And it was reinforcing]. A lot of people actually say, \u00E2\u0080\u009COh my god. You look so good.\u00E2\u0080\u009D I think I lost about 10 pounds, maybe. And so it's like, \u00E2\u0080\u009CWell, okay. Point taken. No meat, lose weight. Okay.\u00E2\u0080\u009D Importantly, receiving praise for weight loss did not engender positive feelings among the women, yet rather such comments reinforced the women\u00E2\u0080\u0099s challenges with body image, and also strengthened their commitment to dieting. Thus, explicit and implicit pressure put on the women to lose weight and/or alter their eating behaviours was sometimes experienced as unwanted, intrusive, and painful. Such pressure also heightened the sense of shame they felt about their bodies and eating patterns, and reinforced their fear of weight gain, self-criticisms, and insecurities. Notably, only one of the participants explicitly commented on how she felt \u00E2\u0080\u009Clucky\u00E2\u0080\u009D to have her husband\u00E2\u0080\u0099s support, and how he has never exerted any degree of pressure for her to alter her appearance. She felt that the lack of pressure she experienced from her spouse to alter her body, as central to her lack of desire to change her eating behaviours, as reflected in the following quote: 161## I guess I\u00E2\u0080\u0099m not self-critical enough [about my body] to make the changes to my relationship with food. Like, if I felt like my husband was judging me or if I cared what the other moms were thinking or saying, then there might be the motivation. Increased Pressure in Mid-life. The women in this study discussed feeling increased pressure to attain or maintain a slimmer figure and lower weight during mid-life, at a developmental point in their lives when losing weight became more challenging, and the onset of the aging process more apparent. Overall, the women commented on how \u00E2\u0080\u009Cit gets harder to maintain an ideal that\u00E2\u0080\u0099s not necessarily realistic for someone of a different demographic.\u00E2\u0080\u009D As discussed earlier in this chapter, all of the women lamented how much harder it was for them to manage their weight in mid-life, which served to increase the pressure they felt to lose weight: There\u00E2\u0080\u0099s more pressure. And it\u00E2\u0080\u0099s harder to lose weight at this age. It really is! And your metabolism is [slower], and then you\u00E2\u0080\u0099re trying to exercise but there\u00E2\u0080\u0099s a lot more aches and pains involved, you know?! And so then you beat yourself up and then you\u00E2\u0080\u0099re looking for comfort. Well, the best comfort I find is in food. Thus, some of the women in this study described turning to food to cope with the increased pressures they felt to manage their weight in mid-life. However, at other times, the pressures that the women felt \u00E2\u0080\u0093 combined with the reality that weight loss was harder to achieve in mid-life \u00E2\u0080\u0093 strengthened their adherence to dieting, and in some cases, served as motivation to engage in even more restrictive eating patterns: There\u00E2\u0080\u0099s got to be other women that have been through some of the same kinds of things \u00E2\u0080\u0093 working our way and really battling, because we\u00E2\u0080\u0099re still battling those issues with food. That was pumped into us back in our 20s and 30s, and 40s and 50s. And we still look at our plate, and you can you can have your 1200 calories but that doesn\u00E2\u0080\u0099t mean that you\u00E2\u0080\u0099re 162## going to drop those pounds \u00E2\u0080\u009Clike that\u00E2\u0080\u009D \u00E2\u0080\u0093 where you can give those same 1200 calories to [a younger] age group and boom there [the weight] goes, you know? So, therefore it becomes a struggle. And how much less do you eat? Some of the women noted how middle-aged models and actresses have become increasingly thin in recent years, which they believe has propelled the notion that being thin and \u00E2\u0080\u009Cfit\u00E2\u0080\u009D in mid-life is attainable. For example, in speaking about the \u00E2\u0080\u009Cideal\u00E2\u0080\u009D body weight/shape that is portrayed in the media, one participant discussed her experience of feeling unable to \u00E2\u0080\u009Creach that standard\u00E2\u0080\u009D in mid-life, which increased her dissatisfaction with her weight and appearance, and exacerbated her dieting tendencies: ...like if you go to Sears, right, and you see the postings they have for these creams, you know, for wrinkles. And they have this girl who barely looks like she's 16. And I'm thinking, \u00E2\u0080\u009CWhy are they doing that? Like, what kind of image are they trying to like portray to us?\u00E2\u0080\u009D And then they have cellulite cream, and they have this girl - I'm sure she's never had cellulite on her body - or they have some really good make-up artist, and it's like what are they trying to do? They're definitely trying to sell products, but they don\u00E2\u0080\u0099t know what is happening to women. Especially because what seems to be on television, women who are 40 don\u00E2\u0080\u0099t look like they're 40. They look like they're 20 or 30, you know? And a lot of us can\u00E2\u0080\u0099t reach that standard. Relatedly, another participant discussed how she felt that the pressure put on women to aspire to the ideal becomes \u00E2\u0080\u009Cworse\u00E2\u0080\u009D in mid-life, as women are bombarded with a whole new set of impossible-to-achieve appearance-related ideals centered on youthfulness: Yeah, just makes me angry because so many people are conditioned to view that as the ideal woman and I just think that\u00E2\u0080\u0099s sad for everybody\u00E2\u0080\u00A6getting to mid-life, it\u00E2\u0080\u0099s even 163## worse. It\u00E2\u0080\u0099s even worse, \u00E2\u0080\u0098cause it\u00E2\u0080\u0099s just all about wrinkles and good hair and it\u00E2\u0080\u0099s just like non-stop. Yeah, I think there is an element of shame in all that stuff. Like, if you don\u00E2\u0080\u0099t look this way, you\u00E2\u0080\u0099re not going to be good enough. So, that plays a factor for sure. The women described an increased sense of self-consciousness about their bodies as they entered mid-life, in light of physical age-related changes they experienced, as expressed in the words of one participants who noted feeling increased pressure to retain a youthful appearance as she entered mid-life: I wasn\u00E2\u0080\u0099t that worried about aging until about 40. Thirty I was fine. And I thought, \u00E2\u0080\u009COh, I'm going to age gracefully.\u00E2\u0080\u009D And then I started realizing, \u00E2\u0080\u009COh, what's that?\u00E2\u0080\u009D You know? Sagging here and there. It's like, \u00E2\u0080\u009COh.\u00E2\u0080\u009D And all my friends who are a little bit older than me and they're like, \u00E2\u0080\u009COh, I don\u00E2\u0080\u0099t want to get old. Oh, I have more wrinkles.\u00E2\u0080\u009D And they're all touching themselves. And I'm thinking, \u00E2\u0080\u009CWow, you know, is that what it's going to be like when I'm 50?\u00E2\u0080\u009D You know? And then everybody says, \u00E2\u0080\u009COh, 40 is the new 30.\u00E2\u0080\u009D Not if you look 40! So just more pressure\u00E2\u0080\u00A6more of how society values beauty and youth. When the women felt unable to live up to these unrealistic expectations, the women sometimes gave up on their diet goals and turned to food for comfort, which in turn, often increased the shame they felt about overeating. In addition, the majority of the single women in this study expressed feeling more self-conscious about their bodies as they contemplated entering into new romantic and sexual relationships in mid-life. Broadly speaking, these women expressed concern that prospective partners might be put off by their mid-life bodies \u00E2\u0080\u0093 that they won\u00E2\u0080\u0099t be \u00E2\u0080\u009Cdesirable\u00E2\u0080\u009D and \u00E2\u0080\u009Cattractive,\u00E2\u0080\u009D and that their bodies wouldn\u00E2\u0080\u0099t be assessed as \u00E2\u0080\u009Cgood enough\u00E2\u0080\u009D in terms of sexual desirability. This sentiment is captured in the words of one participant who recently ended a 164##serious romantic relationship, and expressed feeling \u00E2\u0080\u009Cinsecure\u00E2\u0080\u009D about her body and wondering how it will be perceived by prospective intimate partners: \u00E2\u0080\u00A6I was very conscious of my body from a very early age and it just became my identity, I guess, for self-worth. That\u00E2\u0080\u0099s where I got my self-worth was by having a nice figure and a nice face\u00E2\u0080\u00A6I figured that was the only way to get attention and approval. And I guess obviously that\u00E2\u0080\u0099s still comes into play for sure as I get older and being single, too. I want to be in a relationship, and I figure, \u00E2\u0080\u009CGod, what if I\u00E2\u0080\u0099m not good enough physically?\u00E2\u0080\u009D So, there\u00E2\u0080\u0099s definitely the aging thing, right?...it makes me feel insecure about myself. It makes me feel like I won\u00E2\u0080\u0099t be wanted or desired. And I guess maybe I\u00E2\u0080\u0099m feeling that more now because I haven\u00E2\u0080\u0099t been in a relationship for a few months. I just feel, \u00E2\u0080\u009CAm I going to be good enough? Am I going to be attractive?\u00E2\u0080\u009D, not mention that men tend to be attracted to women who are a lot younger than them, and that\u00E2\u0080\u0099s definitely a factor. Importantly, despite the increased pressure that the women experienced in mid-life to manage their weight and appearance, none of the participants actually expected to be able to embody the physical characteristics of the \u00E2\u0080\u009Cideal body\u00E2\u0080\u009D in mid-life. This sentiment is expressed in the words of one participant who discussed being impacted by the \u00E2\u0080\u009Cstandard\u00E2\u0080\u009D of thinness presented in media imagery, even though she didn\u00E2\u0080\u0099t \u00E2\u0080\u009Cexpect to look like a 17 year old fashion model\u00E2\u0080\u009D: And I guess I often thought that affects younger women more, but that's not true. I mean I look at fashion magazines and I look at what's the standard and that's still [there]. You know, I don\u00E2\u0080\u0099t expect to look like a 17 year old fashion model, but I look at women that are slim with great admiration and envy. I'm very conscious when I walk around on the street\u00E2\u0080\u00A6everyone that I judge to be attractive as an older woman was thin. 165##Thus, the women expressed that their goal wasn\u00E2\u0080\u0099t to be \u00E2\u0080\u009Cskinny,\u00E2\u0080\u009D but to aim to \u00E2\u0080\u009Cweigh less\u00E2\u0080\u009D and \u00E2\u0080\u009Clook as attractive [as possible]\u00E2\u0080\u009D in their mid-life bodies. Sense of Loss of Social Power and Visibility All of the women in this study discussed experiencing a sense of loss in various ways throughout mid-life. For example, the women spoke of the many losses associated with divorce and the end of romantic relationships, the loss of significant others to illness and death, the loss of community and relationships that came with geographical moves, the loss of the dream of motherhood due to infertility, and as one participant noted, \u00E2\u0080\u009Cthe loss of some dreams you may have had\u00E2\u0080\u009D as a younger person. Most notably, however, a sense of loss of social power and visibility was a prominent common theme in the women\u00E2\u0080\u0099s narratives, and an aspect of their lived experiences that began in mid-life. Interestingly, this theme was the only theme to emerge in this study that did not break down further into sub-themes. Overall, the women related the lessening of their social power and visibility to the age-related bodily/physical changes that they experienced (i.e., in terms of weight and appearance), and to being resultantly perceived as \u00E2\u0080\u009Colder\u00E2\u0080\u009D by society, which typically had a negative impact on the women\u00E2\u0080\u0099s sense of self and served to heighten body dissatisfaction with their mid-life bodies. The majority of the women in this study described their experience of feeling increasingly less visible in society, and relatedly, as losing some degree of social power as they entered, and advanced through, mid-life. The women appeared to make sense of this experience by pointing to the ways in which the larger society typically perceives \u00E2\u0080\u009Colder\u00E2\u0080\u009D women \u00E2\u0080\u0093 as less attractive, less sexual, less powerful, and ultimately less \u00E2\u0080\u009Crelevant.\u00E2\u0080\u009D This experience is perhaps most astutely captured in the words of one woman in her late-fifties who talked about struggling with ageism, with being perceived as \u00E2\u0080\u009Cpast her prime,\u00E2\u0080\u009D and with being \u00E2\u0080\u009Ctreated differently\u00E2\u0080\u009D in 166##mid-life in than she was in younger years: \u00E2\u0080\u00A6a lot of it has to do with our body changes, like your hormone levels, but it\u00E2\u0080\u0099s also in how we\u00E2\u0080\u0099re treated. You know, we bust our butts to make some achievements and trying to have that good self-esteem and we\u00E2\u0080\u0099re doing battles still, and yet there\u00E2\u0080\u0099s a kind of a stigma or judgment\u00E2\u0080\u00A6you know? You\u00E2\u0080\u0099re \u00E2\u0080\u009Cpast your prime.\u00E2\u0080\u009D Like, even nowadays if you enter a gym or something at the age that I\u00E2\u0080\u0099m at, you don\u00E2\u0080\u0099t get treated quite the same, you don\u00E2\u0080\u0099t get taken quite as seriously. But you get that young athlete that\u00E2\u0080\u0099s walking in and they\u00E2\u0080\u0099re buff and everything else and boom \u00E2\u0080\u0093 that\u00E2\u0080\u0099s where the focus goes\u00E2\u0080\u00A6and so therefore it affects your self-esteem. Also related to age-related \u00E2\u0080\u009Cstigma,\u00E2\u0080\u009D one participant commented on how she experienced the \u00E2\u0080\u009Closs of [her] whole value system\u00E2\u0080\u009D after having great difficulty securing employment in mid-life, despite impeccable grades and qualifications, and ultimately feeling discriminated against on the basis of her age and weight: \u00E2\u0080\u00A6almost a loss of my whole value system, because I\u00E2\u0080\u0099ve always been raised to believe that it\u00E2\u0080\u0099s more important as to who you are, what your substance is as a person, and what you can give to a job. Not something as shallow as well, you\u00E2\u0080\u0099re too old or you\u00E2\u0080\u0099re too fat. Like, what does that have to do with my ability to do the job? Some of the women also described their experience of feeling \u00E2\u0080\u009Creplaced\u00E2\u0080\u009D by a younger generation of women whom they believed were ultimately more visible and more powerful in society based on their youthful appearance. These sentiments are captured in the words of one participant who expressed \u00E2\u0080\u009Cbattling\u00E2\u0080\u009D the \u00E2\u0080\u009Cfeeling of still being relevant\u00E2\u0080\u009D in a culture that reveres youthful female beauty: And now we\u00E2\u0080\u0099re feeling we are older and chances are we\u00E2\u0080\u0099ve got screwed up metabolisms 167## because of everything that we\u00E2\u0080\u0099ve been through and our bodies are like \u00E2\u0080\u0093 we\u00E2\u0080\u0099re being looked at differently, too. We\u00E2\u0080\u0099re being replaced...I think some of us are struggling for that identity or the feeling of still being relevant\u00E2\u0080\u00A6Like, there\u00E2\u0080\u0099s still stigmas about men can mature, and grey will look distinguished on men and whatever. But it\u00E2\u0080\u0099s not the same for us. And I think we\u00E2\u0080\u0099re still battling it. Consistent with this sense of invisibility, one participant in her fifties discussed the futility of striving toward beauty- and body-related \u00E2\u0080\u009Cideals\u00E2\u0080\u009D throughout her life, only to feel \u00E2\u0080\u009Cpassed over\u00E2\u0080\u009D as she entered mid-life: \u00E2\u0080\u00A6but we still are that first generation of still trying to figure it out. And what have we done to our bodies? And therefore what we\u00E2\u0080\u0099re dealing with now, and what I\u00E2\u0080\u0099m dealing with now, even though [I\u00E2\u0080\u0099m still struggling with my eating], it\u00E2\u0080\u0099s being processed differently\u00E2\u0080\u00A6Because my body doesn\u00E2\u0080\u0099t necessarily respond \u00E2\u0080\u0093 or you start to think, \u00E2\u0080\u009CWhy bother?\u00E2\u0080\u009D Or you have those times where, like in a way, it\u00E2\u0080\u0099s like feeling sorry for yourself because you know what - we bought the books, we followed those diets and yet you know what - I\u00E2\u0080\u0099m still 58 years old and I\u00E2\u0080\u0099m being passed over. Importantly, the sense of invisibility and perceived loss of social power that the women experienced in mid-life increased the shame that they felt about their bodies, and sometimes led to a process of turning to food to cope with these challenging feelings, as they negotiated the aging process. For example, one participant verbalized her experience of overeating in order to cope with self-deprecating sentiments and feelings of low self-esteem, stemming from being perceived in mid-life as being \u00E2\u0080\u009Colder\u00E2\u0080\u009D: \u00E2\u0080\u00A6you beat yourself up\u00E2\u0080\u00A6it becomes kind of like, if you\u00E2\u0080\u0099re being perceived as old you might as well justify it\u00E2\u0080\u00A6It\u00E2\u0080\u0099s all self-inflicted because they say nobody can make you feel 168## bad unless you allow them to. Well, I don\u00E2\u0080\u0099t have to allow it because I can make myself feel bad enough. So, then I think, \u00E2\u0080\u009CUgh, I don\u00E2\u0080\u0099t care. Food is comfort. Food doesn\u00E2\u0080\u0099t judge me. And I\u00E2\u0080\u0099m not worthy anyway, [so] I might as well eat this!\u00E2\u0080\u009D Overall, the women described feeling a loss of social power in mid-life, given their prevailing belief that society \u00E2\u0080\u009Crevolves around\u00E2\u0080\u009D youth and young adults. This experience is concisely reflected in the words of one participant who commented on society\u00E2\u0080\u0099s role in granting power to women under the age of 40: So, we\u00E2\u0080\u0099re caught in the middle, particularly in middle age because society seems to revolve around \u00E2\u0080\u0093 let me guess, probably 35 to 40 and under. That\u00E2\u0080\u0099s what drives the society. That\u00E2\u0080\u0099s the demographic that the ads go after, is that age group. Because once you pass 40 they still think in their head that you have no buying power, that you don\u00E2\u0080\u0099t have any power. Similarly, another participant commented on how she believes that the larger society perceives women over 40 as \u00E2\u0080\u009Cno longer productive\u00E2\u0080\u009D and somehow \u00E2\u0080\u009Cdone,\u00E2\u0080\u009D particularly as women move farther way from the \u00E2\u0080\u009Cideal\u00E2\u0080\u009D body type that is promoted in the media: \u00E2\u0080\u00A6I understand that [celebrities] spend a lot of their time exercising, and they have the money to go get massaged and rubbed and tucked, but I don\u00E2\u0080\u0099t. And men want that. They don\u00E2\u0080\u0099t want normal people. And I think that\u00E2\u0080\u0099s one of the reasons why it's a lot of single women - older single women [struggle], because it seems that as soon as a woman reaches 40, she's no longer a productive part of society\u00E2\u0080\u00A6it's like, \u00E2\u0080\u009COkay. She's done.\u00E2\u0080\u009D The women expressed being pained by their experience of feeling less powerful and visible in society. These experiences of feeling less relevant, less productive, and less powerful in mid-life increased the women\u00E2\u0080\u0099s dissatisfaction with their bodies, fueled their discontent with the aging 169##process, and served as a contextual stressor which bolstered the women\u00E2\u0080\u0099s use of food as a coping mechanism. Importantly, the crux of the women\u00E2\u0080\u0099s experiences of losing social power and visibility in mid-life appeared to be centered on the ways in which their appearance changed as they aged \u00E2\u0080\u0093 that is, as they began to overtly carry and display visible signs of aging, as their physical weight, shape, and size began to change with the onset of normative weight gain, and other physiological processes during mid-life (e.g., menopause and hormonal changes). As one participant noted, it was increasingly difficult for her to have a \u00E2\u0080\u009Cproud body\u00E2\u0080\u009D as she aged, in light of the often unwelcome changes that occur with the aging process, including how \u00E2\u0080\u009Ceverything starts to change and sag and wrinkle.\u00E2\u0080\u009D Thus, in their narratives, the women described \u00E2\u0080\u009Cmoving further away from that ideal\u00E2\u0080\u009D as a \u00E2\u0080\u009Closs.\u00E2\u0080\u009D For example, one participant described the loss she felt with no longer feeling like she was in the \u00E2\u0080\u009Cdesirable group of females,\u00E2\u0080\u009D which exacerbated her struggles with her eating behaviour and weight: I think the problem started mostly when I noticed when I turned 40. My metabolism slowed down, whereas I used to be able to exercise for like two weeks and I would lose weight, or cut down on my eating and lose weight. Now that I'm 41, everything seems to have totally slowed down. And things don\u00E2\u0080\u0099t react quite as they used to. And I find that, you know, just with the media and seeing everybody always so concerned about getting old, all my friends are like, \u00E2\u0080\u009COh my God. Wrinkles! Blah, blah, blah.\u00E2\u0080\u009D And it's just the stress of realizing that you're no longer in that desirable group of females has made [my eating challenges worse] and more of a problem for me. In addition, some of the women felt that being \u00E2\u0080\u009Cattractive\u00E2\u0080\u009D and \u00E2\u0080\u009Cdesirable\u00E2\u0080\u009D and revered for their appearance was a source of power for them in younger years. As they entered mid-life, 170##and as their physical appearance changed, the women reported feeling a decreased sense of power associated with their mid-life bodies. For example, one participant discussed struggling with the loss of attention she experienced in mid-life, and the loss of power that resulted from having a body that was reportedly perceived as \u00E2\u0080\u009Cless attractive\u00E2\u0080\u009D in mid-life: \u00E2\u0080\u00A6I'm the outgoing type. So, [my husband] would take me to the clubs to meet people. And I'd meet people in the bathroom, talk, and have quite the social circle. And I was the \u00E2\u0080\u009Chot babe,\u00E2\u0080\u009D you know? Because I was thin. I dressed well. And then we [moved] here, and I go to work and I look like this, you know? So, it's kind of that transition, as well, as it's been a little bit hard to deal with. Importantly, the loss of power that the women experienced in relation to their changing bodies \u00E2\u0080\u0093 and their experience of \u00E2\u0080\u009Cbeing unhappy with the way [they] look\u00E2\u0080\u009D \u00E2\u0080\u0093 sometimes contributed to the women\u00E2\u0080\u0099s tendency to engaging in eating in an effort to cope. For example, in the words of one participant: \u00E2\u0080\u009CSo, if I'm feeling down [about my body or aging], I'll eat and that changes my body [because I gain weight]. So, it\u00E2\u0080\u0099s just like a chain reaction.\u00E2\u0080\u009D At the same time, as the women began to lose control over their bodies in mid-life, in light of weight gain and other age-related physical changes, they became \u00E2\u0080\u009Cmore proactive\u00E2\u0080\u009D about dieting and exercising, given that the methods they employed to achieve weight loss in younger years were no longer as effective in mid-life, in part due to \u00E2\u0080\u009Cslower metabolisms\u00E2\u0080\u009D (e.g., restricting calories, \u00E2\u0080\u009Ccrash\u00E2\u0080\u009D diets). Thus, in sum, the women described struggling with a sense of loss associated with a lessening of visibility and social power as they aged \u00E2\u0080\u0093 an ultimately distressing experience that the participants grappled with, and one that was difficult to reconcile. Importantly, the loss of social power and visibility typically had a negative impact on the women\u00E2\u0080\u0099s feelings about their own bodies and the aging process, and their relationships with food. 171## Chapter 5: Discussion Using a hermeneutic phenomenological methodology, the purpose of this study was to explore women\u00E2\u0080\u0099s lived experiences of having a problematic relationship with food in mid-life. In this final chapter, I first outline contextual considerations for interpreting the research findings. Next, I discuss the study findings within the context of research that has demonstrated similarities and differences in the eating challenges of younger versus mid-life women. Each of the major findings/themes that emerged in this study are then discussed within the context of the large body of extant research conducted with younger women living with eating challenges, as well as the small, but growing, literature focused on eating challenges among women in mid-life. Subsequently, the implications of the findings for theory, counselling, and future research are presented. Finally, this chapter ends with a brief personal statement about my experiences of conducting this study. Contextual Considerations for Interpreting the Findings The participant sample for this study was primarily comprised of Canadian women who identified as White, with European ancestry. Additionally, one participant identified as Latina, and two participants indicated \u00E2\u0080\u009Cmixed\u00E2\u0080\u009D racial identity, including First Nations ancestry. Only two of the participants in this study, who identified as Lebanese and with First Nations ancestry respectively, spontaneously spoke about how their ethnic and racial cultures shaped their relationships with food, particularly as children. Interestingly, one of the participants who identified with First Nations ancestry believed that her relationship with food may have been healthier if she had retained her culture\u00E2\u0080\u0099s teachings and practices regarding food and eating, rather than adopting the practices of the dominant White culture. In addition, the majority of the participants identified as able-bodied, heterosexual, and 172##educated, with the exception of one participant who believed her \u00E2\u0080\u009Cage, weight, and sex\u00E2\u0080\u009D were \u00E2\u0080\u009Cdisabilities.\u00E2\u0080\u009D As a result of the apparent lack of diversity among the women in this study, it seems plausible that the study findings may be less resonant for women identifying with diverse racial identities (e.g., Taylor et al., 2007, Nasser & Malson, 2009), sexual minority identities (e.g., see Boisvert & Harrell, 2013; Davids & Green, 2011), and women who are differently-abled (e.g., Cicmil & Eli, 2014; Gross, Ireys, & Kinsman, 2000). Importantly, the results of one study suggest that ethnicity, urbanicity, socioeconomic status, and education may not be strongly associated with the epidemiology of eating disorders (EDs) (Mitchison & Hay, 2014). However, at present, we do not yet know the extent to which these variables may impact the lived experience of eating challenges among mid-life women, thereby suggesting caution in the extent to which these findings may reflect, or resonate with, the food/eating challenges of mid-life women with different demographic profiles. Given that participation in this research was voluntary, and that purposive sampling was utilized to create the participant sample, a self-selection bias may have impacted the results (Robinson, 2014). For example, as noted by Robinson, the intimate self-disclosure that is often warranted when participating in qualitative research interviews may appeal to women \u00E2\u0080\u009Cwho are more open, more patient and more interested in the [research] topic\u00E2\u0080\u009D (p. 36). Furthermore, the women who participated in this study may have demonstrated more self-awareness about their eating challenges, and an increased tolerance for the often emotional process of sharing their experiences with a researcher (i.e., a stranger). Since the majority of the women in this study expressed that their primary motivation for participating in this research was to help other mid-life women who may be struggling in their relationships with food, perhaps they felt more confident that their stories could have a positive impact on others. It is possible that all of these 173##factors may have influenced the results of this study, thereby limiting the extent to which the findings may resonate with the experiences of other mid-life women. The research question that guided this research was: \u00E2\u0080\u009CWhat is the meaning and experience of having a problematic relationship with food for women in mid-life?\u00E2\u0080\u009D It is important to note that the participants\u00E2\u0080\u0099 narratives may have differed if the research question had been centered on their experiences of having an \u00E2\u0080\u009Ceating disorder\u00E2\u0080\u009D or experiencing \u00E2\u0080\u009Cdisordered eating,\u00E2\u0080\u009D as opposed to living with a \u00E2\u0080\u009Cproblematic relationship with food,\u00E2\u0080\u009D which was the focus of this research. Although this latter phrasing was more congruent with the research methodology (e.g., non-pathologizing, open to interpretation by the women), and with the purpose of this study, it is possible that this languaging may have impacted those who responded to the recruitment notices, and shaped the particular experiences that the women shared, and therefore, the findings. Relatedly, feminist research principles guided the facilitation of this research from its inception, to the writing and validation of the results. Specifically, in the current study, women\u00E2\u0080\u0099s voices and experiences were prioritized, privileged, and documented. In addition, the participants were included in the validation of the research findings, and the overall research relationship was characterized by collaboration, mutual respect, safety, and an acknowledgement of power dynamics. Thus, given the influence of feminist research principles and the use of a bottom-up, phenomenological methodology for the current project, including potentially pathologizing diagnostic information (e.g., DSM-IV eating disorder diagnoses) as inclusion/exclusion criteria for this study seemed incompatible with a feminist approach (e.g., see Brown, 1991; Brown, 1997). Moreover, feminist theory on EDs and women\u00E2\u0080\u0099s development \u00E2\u0080\u0093 and their attention to the social context and the developmental realities of women\u00E2\u0080\u0099s lives \u00E2\u0080\u0093 informed the current project. 174##Such a theoretical grounding and perspective, and research approach, may have unduly shaped the interview process, and eventual findings. Similarities and Differences in the Eating Challenges of Mid-life vs. Younger Women A small body of extant research has explored similarities and differences between younger women and women in mid-life who struggle with \u00E2\u0080\u009Cdisordered eating\u00E2\u0080\u009D (DE) and clinically diagnosable \u00E2\u0080\u009Ceating disorders\u00E2\u0080\u009D (EDs). Broadly speaking, similarities have been found among these different groups of women in terms of risk and etiological factors (e.g., body image disturbance, sociocultural pressures toward thinness, perfectionism, low self-esteem, family of origin challenges), and comorbidities demonstrated for DE and EDs (e.g., mood disorders, substance abuse, sexual abuse/trauma histories) (e.g., Cumella & Kally, 2008a; Forman & Davis, 2005; Gadalla, 2008; Kally & Cumella, 2008; Midlarsky & Nitzburg, 2008). Consistent with this body of research, the women in this study described how many of these traits, characteristics, and experiences contributed to the development and maintenance of their eating challenges, both as younger women and in mid-life. Most notably, body dissatisfaction, sociocultural pressures toward thinness, perfectionism, low self-esteem, family of origin challenges and a history of traumatic experiences (e.g., physical, verbal, sexual abuse; neglect; therapeutic abortion; traumatic losses/deaths) were particularly salient for the women in this study as they described their challenges with food and eating. In addition, both of the women in this study who identified as having \u00E2\u0080\u009Ceating disorders\u00E2\u0080\u009D discussed how they believed that they used food to cope with \u00E2\u0080\u009Canxiety.\u00E2\u0080\u009D Additionally, the clinical presentation and primary features of DE and EDs have also been found to be strikingly similar across different cohorts of women (e.g., Ackard, Richter, Frisch, Mangham, & Cronemeyer, 2013; Forman & Davis, 2005). With the exception of one 175##theme that emerged in this study \u00E2\u0080\u0093 the sense of loss of social power and visibility \u00E2\u0080\u0093 all of the remaining themes found in the stories of the mid-life women in this study strongly converge with the large body of research conducted with younger women with DE and EDs (e.g., using food as a coping mechanism, needing control, guilt and shame, drive for thinness, body dissatisfaction, etc.) (e.g., Coker & Abraham, 2014; Fairburn, Shafran, & Cooper, 1999; Oluyori, 2013; Polivy & Herman, 2002). Areas of convergence between the current findings and the large body of literature documenting central features of DE and EDs will be further discussed below. Consistent with extant research conducted with younger women, the women in this study talked about deeply struggling with a high degree of body dissatisfaction in mid-life (Allaz et al., 1998; Brandsma, 2007; Gagne et al., 2012; Grippo & Hill, 2008; Mangweth-Maztek et al., 2006; Rodin, Silberstein, & Striegel-Moore, 1984; Runfola et al, 2013; Saucier, 2004; Zerbe & Domnitei, 2004; Webster & Tiggeman, 2003). Consistent with the literature, the women in this study reflected on experiencing dissatisfaction with their bodies at various points, and to varying degrees, throughout their lives (e.g., Pruis & Janowsky, 2010; Webster & Tiggeman). However, they universally noted an increase in their dissatisfaction with their bodies and increasing challenges to maintain control over their eating and their weight, as they struggled with normative weight gain, difficulty losing weight, and noticeable signs of the aging process during mid-life. Consistent with available research conducted with mid-life women, some of the older women in this study felt that in recent years, more pressure has been placed on mid-life women to attain or maintain a slim, toned physique (Allaz et al., 1998; Midlarsky & Nitzburg, 2008) \u00E2\u0080\u0093 in contrast to the experience of younger women who, based on their age and average body size, more closely resemble the \u00E2\u0080\u009Cideal.\u00E2\u0080\u009D Several theorists and researchers have commented on the 176##reality that our culture\u00E2\u0080\u0099s unrealistic expectations for \u00E2\u0080\u009Cbeauty,\u00E2\u0080\u009D particularly a youthful appearance and thin physique, have been increasingly promoted by corporate industries as attainable and desirable for mid-life and older women (e.g., Bulik, 2013; Hesse-Biber, 2007; Marshall, Lengyel, & Utioh, 2011; Winterich, 2007; Wolf, 1990). Recent research has also demonstrated that increased media exposure \u00E2\u0080\u0093 especially exposure to mid-life models and actresses who closely resemble younger beauty- and body-related \u00E2\u0080\u009Cideals\u00E2\u0080\u009D \u00E2\u0080\u0093 is positively correlated with body dissatisfaction and eating symptomatology among mid-life women (Hefner, Woodward, Figge, Bevan, Santora, & Baloch, 2014; Slevec & Tiggemann, 2011). Coined after a popular television show depicting thin and \u00E2\u0080\u009Cattractive\u00E2\u0080\u009D mid-life women, the \u00E2\u0080\u009CDesperate Housewives effect\u00E2\u0080\u009D has been discussed in recent literature, capturing the increased pressure felt by today\u00E2\u0080\u0099s women in their 30s, 40s, and 50s to achieve an unrealistic standard for thinness (Hefner et al., p. 186). Indeed, some of the women in this study commented on the unrealistic standard set by today\u00E2\u0080\u0099s increasingly thin and \u00E2\u0080\u009Cfit\u00E2\u0080\u009D mid-life actresses, which perpetuated their experience of viewing their own bodies as unattractive and undesirable. These women experienced increased pressures to look youthful and maintain a \u00E2\u0080\u009Cdesirable\u00E2\u0080\u009D weight and shape, at a time in their lives when the aging process made both of these outcomes increasingly difficult, if not impossible, to attain (Calasanti, 2005; Saucier, 2004). In the face of ageist beauty norms, the women in this study exhibited difficulties perceiving and evaluating themselves in a positive light (Hurd, 2000). Overall, the women in this study reported that perceived pressures from the media and close others to approximate cultural notions of beauty had a negative impact on their sense of self, and their relationships with food and their bodies. Thus, the current findings highlight an important and significant difference between the eating challenges of younger versus mid-life women \u00E2\u0080\u0093 the developmental and contextual factors 177##that lead to the onset and maintenance of eating problems \u00E2\u0080\u0093 which differ significantly between these two demographic groups of women. The context of the mid-life women\u00E2\u0080\u0099s lives who participated in this study differed drastically from the developmental tasks and realities of adolescent girls and young adult women. For example, the women in this study described how various developmental stressors (e.g., parenting, work-related stress and significant career changes, deaths of loved ones, the dissolution of serious romantic partnerships and marriages) exacerbated their eating challenges \u00E2\u0080\u0093 particularly their tendency to turn to food for comfort and use food as a means of coping with stress and overwhelming emotions. Importantly, many of the women in this study noted that their problems with food, eating, and body image significantly worsened in mid-life in response to new and varied stressors, and many of them discussed the onset of new DE practices in mid-life (e.g., purging, laxative use, highly restrictive diets) \u00E2\u0080\u0093 closely paralleling DE practices observed in younger women. To be sure, the current findings converge with extant literature demonstrating the use of a wide range of DE practices and weight loss strategies among mid-life women (e.g., Bedford & Johnson, 2006; de Freitas, Appolinario, de Moura Souza, & Sichieri, 2008; Gallada, 2008; Gagne et al., 2012; McLaren & Kuh, 2004; Mangweth-Maztek et al., 2006; Marcus, Bromberger, Wei, Brown, & Kravitz, 2007). As such, the current findings provide support for research demonstrating that developmental stressors in mid-life (e.g., family challenges, health issues, aging, infidelity, divorce, parenting, financial concerns, trauma and abuse, deaths of loved ones) may serve as triggers for the onset or exacerbation of eating challenges among mid-life women (Bulik, 2013; Cosford & Arnold, 1992; Harris & Cumella, 2006; Kally & Cumella, 2008; Keith & Midlarsky, 2004; Midlarsky & Nitzburg, 2004; Peat, Peyerl, & Muehelenkamp, 2008; Zerbe, 2008). Relatedly, Bulik (2013) discusses several developmental and contextual differences in the 178##lives of middle-aged adults that differ significantly from younger populations, and exacerbate eating challenges among older adults. For example, she notes how marketing strategies have changed over time \u00E2\u0080\u0093 shifting from a focus on material possessions to targeting the personal being of the consumer \u00E2\u0080\u0093 creating a \u00E2\u0080\u009Cculture of discontent\u00E2\u0080\u009D (p. 7), subjecting today\u00E2\u0080\u0099s mid-life adults to a barrage of media designed to make them feel inferior and discontented about various aspects of self, including appearance (e.g., weight gain, age spots, wrinkled skin, varicose veins, cellulite). As previously noted, the women in this study discussed the increased pressure they felt to attain beauty- and body-related ideals promoted in the media (i.e., slim figure, youthful appearance), and noted that media consumption typically had a negative impact on their sense of self and body image. In contrast to younger girls and women who are in the care of parents/caregivers, mid-life women have more money, and are afforded the freedom and self-reliance to make their own choices about their eating behaviour, which makes it easier to engage in harmful eating practices, and access harmful substances (e.g., laxatives) (Bulik). In particular, the single women in this study who lived alone were afforded even greater ease in engaging in DE behaviours (e.g., bingeing, purging, dieting) without the fear of being interrupted, chastised, or outed by others. Bulik also discusses how food production has vastly changed in recent years, subjecting today\u00E2\u0080\u0099s middle-aged adults to a strikingly different social context that promotes dysregulated eating, in contrast to the eating norms and habits they grew up with (e.g., increase in processed foods; increase in availability of unhealthy/fast foods; increase in food portion sizes; eating out more at restaurants). Indeed, some of the older women in this study commented on changes they have observed in eating habits/norms of the dominant culture and food production (e.g., greater availability of processed and fast foods) over the course of their lives, which have negatively impacted their eating behaviour. For example, some of the women discussed how the ubiquitous 179##nature of tempting, unhealthy foods has made sticking to their diet and making positive changes to their eating habits more challenging. Other women in this study discussed how the wide availability of unhealthy foods has made procuring foods for a binge less conspicuous and easier, in comparison to their younger years when they needed to extend more care to engage in \u00E2\u0080\u009Csneak eating.\u00E2\u0080\u009D Additional differences have been demonstrated between the eating challenges of younger versus mid-life women. Given that the majority of mid-life women who struggle in their relationships with food have likely done so for years (Kally & Cumella, 2008; Forman & Davis, 2005; Scholtz, Hill, & Lacey, 2010; Zerbe & Domnitei, 2004), some studies have found a lengthier duration of eating challenges among mid-life women, in comparison to younger women (e.g., Ackard et al., 2013). Indeed, all of the women in this study discussed how they have been struggling in their relationships with food since they were adolescents or young adult women. In addition, among women who meet criteria for an ED there is some evidence to suggest that mid-life women may present for treatment with more severe clinical presentations (Cumella & Kally, 2008a), although findings to the contrary also exist (Cumella & Kally, 2008b). Of note, the women in this study exhibited a range of different DE practices that varied in severity among participants. Importantly, as noted above, as a result of the methodology utilized to conduct this study, and the strong influence of feminist theory and research principles that guided this work, diagnostic information was not gathered for the women in this study. As such, it is impossible to comment upon the possible presence of full-blown, diagnosable EDs among the women who participated in this study, and therefore the current findings are not suited to corroborate and/or extend specific research findings that have highlighted the first onset of clinically diagnosable EDs in mid-life, as well the predominance of certain ED diagnoses among women in this 180##demographic group (e.g., Brandsma, 2007; Cumella & Kally, 2008b; Forman & Davis, 2005; Joughin, Crisp, Gowers, & Bhat, 1991; Mangweth-Maztek et al., 2014). Significant Findings In the current study, six prominent themes emerged: sense of food as comfort and a means of coping, sense of guilt and shame, sense of needing control, sense of food and eating as addiction, sense of pressure to conform, and sense of loss of social power and visibility. These findings have further elucidated the lived experience of having a problematic relationship with food among women during mid-life. In this section, I will discuss each of these significant findings within the context of the extant literature. Sense of Food as Comfort and a Means of Coping The women in this study poignantly described their experiences of turning to food, and engaging in eating, in order to cope with a variety of different stressors, including overwhelming emotions. In the extant literature, there is agreement that both younger and mid-life women use food and eating \u00E2\u0080\u009Cto cope with developmental challenges, identity issues, and distress\u00E2\u0080\u009D (Cumella & Kally, 2008a, p. 183), although these development issues clearly differ depending on the woman\u00E2\u0080\u0099s age and life stage. Consistent with this understanding, participants in the current study unanimously described the powerful role of food as a comfort in their lives, especially during times of stress. Within the first few minutes of the data collection interviews, many of the participants discussed their experience of \u00E2\u0080\u009Cfood as comfort,\u00E2\u0080\u009D emphasizing the salience of this experience/relationship for these women. Interestingly, the experience of \u00E2\u0080\u009Cfood as comfort,\u00E2\u0080\u009D and \u00E2\u0080\u009Ceating to manage negative affect\u00E2\u0080\u009D emerged in other qualitative studies exploring younger and mid-life women\u00E2\u0080\u0099s experiences of living with EDs (Kemp, Bui, & Grier, 2013; Starkman & Tosone, 2005). 181## Participants in this study also described turning to food and eating as a means of coping with internal distress caused by the onset of stress and challenging emotions. Among younger and older women prone to DE practices involving overeating and binge eating, \u00E2\u0080\u009Cemotional eating\u00E2\u0080\u009D is often employed as a primary method of managing stress and emotions (e.g., Crowther, Snaftner, Bonifazi, Shepherd, 2001; Starkman & Tosone, 2005; Sulkowski, Dempsey, & Dempsey, 2011). As noted by Polivy and Herman (2002), \u00E2\u0080\u009Cby refocusing one\u00E2\u0080\u0099s attention onto weight, shape, and eating, one enters a domain in which one can gain some emotional control\u00E2\u0080\u009D (p. 196). Certainly, for the women in this study, preoccupation with weight and food, and engaging in eating, were powerful coping mechanisms for managing affect \u00E2\u0080\u0093 in particular, negative or distressing feelings. Sense of Guilt and Shame A poignant finding in the current study was the overwhelming sense of shame and guilt that the participants felt about their eating behaviour and their bodies. For the women in this study, feelings of shame and guilt appeared to serve as motivation for them to keep their eating challenges a secret, and contributed to the dissatisfaction they felt about their mid-life bodies, particularly when they felt at fault for causing weight gain. Interestingly, the experience of self-criticism \u00E2\u0080\u0093 a powerful experience described by the women in this study \u00E2\u0080\u0093 appears to be mediated through the experience of shame among younger and mid-life women (Kelly & Carter, 2013). For the women in this study, the onset of feelings of shame and guilt primarily occurred after eating, especially after engaging in binge eating or overeating. Interestingly, the loss of control that often accompanies a binge has been implicated in the onset of feelings of self-disgust and guilt among younger women (e.g., Fairburn, 1981). Additionally, consistent with the findings of the current study, extant research has determined that younger and mid-life women living with 182##an ED are especially prone to experience shame and guilt about their bodies, particularly in eating contexts (Burney & Irwin, 2000; Frank, 1991). Relatedly, younger women who binge eat have also been found to experience higher levels of guilt and shame, and greater fluctuations in these emotions, overall (Sanftner & Crowther, 1998). The results of one qualitative study exploring the role of guilt and shame among mothers\u00E2\u0080\u0099 experiences of living with an ED bear a striking resemblance to the experiences of mothers in the current study (Rortveit, Astrom, & Severinsson, 2010). In their study, Rortveit, Astrom and Severinssson found that participants in their study deeply struggled with feelings of guilt and shame, tried to hide such feelings and their eating difficulties from their children, and expressed concern about the possibility of their children developing an ED. Indeed, the women in the current study expressed a profound desire to keep their eating challenges a secret from their children, and to refrain from \u00E2\u0080\u009Cpassing on\u00E2\u0080\u009D such challenges to their children. The women in this study expressed a desire to keep their eating challenges, and their eating behaviours, a secret from not just their children, but from everyone in their lives \u00E2\u0080\u0093 often going great lengths to conceal their eating problems from others. Indeed, self-concealment, secrecy, and denial have been described as hallmarks of EDs at all life stages, particularly as DE practices and behaviours become more entrenched and habitual (e.g., Barth, 2008; Fairburn, 2008; Masuda, Boone, & Timko, 2011; Vandereycken &Van Humbeeck, 2008). Importantly, some of the women in this study expressed reluctance to seek treatment based on the shame they felt about living with eating challenges, particularly given their age and life-stage \u00E2\u0080\u0093 embracing a belief that at this stage in life they should have it \u00E2\u0080\u009Ctogether\u00E2\u0080\u009D in terms of their relationships with food. Consistent with this finding, researchers have demonstrated that a fear of stigma surrounding DE and EDs impedes disclosure and is a significant barrier to treatment-seeking 183##among women of all ages (e.g., Evans et al., 2011; Reyes-Rodriquez, Ramirez, Davis, Patrice, & Bulik, 2013). Indeed, as was evident in the current findings, mid-life women often go to great lengths to conceal their eating challenges, often precluding efforts to seek treatment (Zerbe, 2013). The current findings also appear to corroborate the hypothesis that mid-life women may experience more shame and embarrassment about living with eating challenges, in comparison to younger women, which may impede treatment seeking (Cumella & Kally, 2008a). The finding that many of the women in this study had never sought out or received treatment for their eating challenges may provide support for the finding that EDs and other eating problems are likely underreported and underdiagnosed among mid-life women (Hall & Driscoll, 1993; Lewis & Cachelin, 2001; Zerbe, 2008). Overall, the current findings appear to concur with the literature on younger cohorts, in underscoring the central and complex role of guilt and shame, in the experiences of women who struggle in their relationships with food and in their reluctance to seek help with these challenges (e.g., Burney & Irwin, 2000; Oluyori, 2013; Rortveit, Astrom, & Severinsson, 2010). Sense of Needing Control The women in this study discussed several ways in which a need for control manifested in their relationship with food. Broadly speaking, engaging in a wide range of dieting practices was discussed as a primary method they employed to exert control over food, eating, and their weight. The participants also noted engaging in a variety of DE practices (e.g., overeating, purging, food restriction) as a means of more broadly establishing control in their lives. Importantly, these findings offer further support for extant EDs literature that has highlighted the need for control as an important facet in DE and EDs for younger women. For example, theory on EDs has long assigned a prominent role to the need for control among women who struggle 184##with EDs (e.g., Bruch, 1973). Indeed, a need for control is considered to be a prominent feature in EDs, particularly in anorexia nervosa (e.g., Fairburn, Shafran, & Cooper, 1999; Oluyori, 2013; Lawrence, 1979; Polivy & Herman, 2002). Among younger and older women who struggle in their relationships with food, establishing control over food, eating and weight may be particularly prominent for those who have experienced violations to their bodies (e.g., sexual abuse), thereby affecting their sense of control and efficacy (Waller, 1998). Of note, one participant in the current study discussed how she first attempted to control her eating and body weight after experiencing sexual abuse as a young girl. Importantly, the women in this study described their attempts at establishing control over food and eating as fallible, given that they continually experienced a pattern of failing to abide by their diet rules, and subsequently reinstating these rules. Of note, dieters have been found to struggle in their attempts to sustain restrictive control over their eating, often resulting in a cycle where eating and weight goals are set and commitments are made but not adhered to, resulting in a sense of failure (e.g., Polivy & Herman, 1985). Indeed, this \u00E2\u0080\u009Cvicious cycle\u00E2\u0080\u009D that partly characterized the participants\u00E2\u0080\u0099 relationship with food was described as one of the more difficult aspects of their experience of living with eating challenges. In addition, dieting has also been found to be a risk factor for binge eating, irrespective of age and life stage (see Polivy & Herman, 2002), which is characterized, in part, by episodic loss of control while eating (e.g., Lilenfeld, Marino, Schmid, & Bowman, 2014). The women in this study described experiences where they felt completely out of control in their relationships with food for discrete periods of time. In particular, feeling that they were unable to stop themselves from eating was described as troubling, and at times, frightening. These experiences appear to overlap with current knowledge about, and extant descriptions of, binge episodes and binge eating for younger and older 185##populations (APA, 2000). Sense of Food and Eating as Addiction A relatively recent development in the literature on EDs is the conceptualization of EDs as addictive disorders (see Wilson, 2002). In particular, among both younger and mid-life women, binge eating and binge eating disorder (BED) appear to share similarities with other addictive behaviours (i.e., substance abuse), in terms of cravings to consume a substance, loss of control over the use of a substance, and using a substance to cope with stress and regulate emotion (Davis, 2009; Gearhardt, White, & Potenza, 2011; Wilson). These experiences were discussed by the participants in the current study, as they reflected on their relationships with food and in particular, foods that they deemed to be \u00E2\u0080\u009Cforbidden.\u00E2\u0080\u009D Importantly, and relevant to the current study, addiction to food has also been demonstrated in younger and middle-aged individuals who do not meet criteria for BED (Curtis & Davis, 2014). There has been a recent surge of research exploring the phenomenon of \u00E2\u0080\u009Cfood addiction\u00E2\u0080\u009D (FA), particularly in younger adults (e.g., Granero et al., 2014), and interest in this construct appears to be growing. The FA hypothesis suggests that some problematic eating behaviours (i.e., binge eating) are related to an underlying addiction to certain foods \u00E2\u0080\u0093 typically processed foods high in fat, salt, and sugar (see Gearhardt, White, Masheb, & Grilo, 2013). Interestingly, the women in the current study unanimously described seeking out such foods to cope with distress, regulate affect, and improve mood. In one study exploring FA among younger and mid-life women, the construct of FA has been demonstrated to differentiate between women with EDs and controls (Granero et al.). In two empirical studies exploring FA among younger and mid-life women diagnosed with BED, roughly half of the participant samples met a \u00E2\u0080\u009Cdiagnosis\u00E2\u0080\u009D for FA based on a self-report measure designed to assess this construct (Gearhardt, White, 186##Masheb, Morgan, Crosby, & Grilo, 2012; Gearhardt, White, Masheb, & Grilo). In fact, the content items for the Yale Food Addiction Scale (Gearhardt, Corbin, & Brownell, 2009) appear consistent with many of the experiences that were shared by the women in this study (e.g., eating past the point of fullness, going to great lengths to obtain certain foods, experiencing negative emotion after eating, etc.). Furthermore, compulsive overeating has also been conceptualized as an addictive disorder (Davis & Carter, 2009). However, it is important to note that the addiction model of EDs is controversial in the field, and some experts remain skeptical about its usefulness, pointing toward the lack of empirical support and conceptual weaknesses inherent in this conceptualization (Wilson, 2002). Nonetheless, some researchers have highlighted anecdotal evidence for an addiction hypothesis, including the fact that some individuals living with DE and EDs refer to themselves as \u00E2\u0080\u009Cfood addicts\u00E2\u0080\u009D and understand their eating challenges, in part, as a form of addiction (Davis, 2009). Indeed, this was the case for some of the participants in this study. In addition, the degree to which the participants in this study spoke of needing to accept and continually negotiate their eating challenges in their daily lives appeared to be strikingly similar to how aspects of the \u00E2\u0080\u009Crecovery\u00E2\u0080\u009D process from non-food-related addictions is often described, irrespective of age and life stage. Interestingly, the importance of maintenance factors, sustained effort toward recovery over time, and viewing recovery as a dynamic process (and less as an end state and goal) have been regarded as an integral part of the recovery process from addictions to non-food-related substances (e.g., see Humphreys, Moos & Finney, 1995; Snow, Prochaska, & Rossi, 1994; White, 2007). Sense of Pressure to Conform Younger and older women have been found to be equally susceptible to sociocultural 187##pressures toward thinness (Cumella & Kally, 2008a; Marshall, Lengyel, & Utioh, 2011; Midlarsky & Nitzburg, 2008), and to experience preoccupation with thinness (e.g., Gupta & Schork, 1993; Martin, 2007), and body dissatisfaction (e.g., Allaz, Bernstein, Rouget, Archinard, & Morabia, 1998; Tiggemann, 2004; Tiggeman & Lynch, 2001). Consistent with this research, the women in this study unanimously expressed feeling pressure to conform to sociocultural definitions of beauty (i.e., centered on a thin, fit body and youthful appearance), which they perceived as having a negative impact on their perceptions of their bodies, their relationships with food, and their self-esteem. In contrast to research that has demonstrated the decreasing importance of appearance among aging mid-life and older women (e.g., Hurd, 2000; see Hurd Clarke & Korotchenko, 2011), the women in the current study expressed a high degree of dissatisfaction with their bodies, and the aging process, that remained consistent and ever-present. All of the women in this study reported struggling in their relationships with food and their bodies since they were adolescents or young adult women, and noted that their eating challenges worsened and improved at different points throughout their lives. This finding provides further support for the contention that many mid-life women who live with eating challenges have likely been struggling in their relationships with food for years (e.g., Kally & Cumella, 2008; Forman & Davis, 2005; Scholtz, Hill, & Lacey, 2010; Zerbe & Domnitei, 2004). In contrast to the experiences of younger women, the findings of this study highlight important developmental, contextual, and sociocultural factors that are likely specific to mid-life women (e.g., normative weight gain, physical changes accompanying aging, menopause), that the participants in this study identified as negatively impacting their body image and eating behaviour. For example, the participants in this study perceived themselves as moving farther away from cultural notions of \u00E2\u0080\u009Cbeauty\u00E2\u0080\u009D in mid-life, which was experienced as a loss and added to 188##the pressure they felt to conform to beauty- and body-related ideals. They also reported feeling increased pressure in mid-life to achieve a lower weight than was realistic and to look \u00E2\u0080\u009Cattractive,\u00E2\u0080\u009D at a point in their lives when losing weight was more difficult and the signs of aging were more apparent. Furthermore, the participants expressed a high degree of body dissatisfaction that for many began when they were younger, but typically ramped up in mid-life, increasing their motivation to find ways to try to control and manage their weight (e.g., dieting, purging, exercise). For these women, the primary motivation to lose weight was to alter their physical appearance, as opposed to improving their health (see Hurd Clarke, 2002b). Historical and more recent perceived pressures placed upon the participants by partners and significant others to lose weight and alter their eating behaviours merely served to exacerbate their challenges with eating and body image. Such experiences are consistent with extant research demonstrating the negative impact of pressures and body-related \u00E2\u0080\u009Cteasing\u00E2\u0080\u009D from family, peers, and partners on the development and maintenance of EDs among women of all ages (e.g., Haines & Neumark-Sztainer, 2006; see Polivy & Herman, 2002; Murray, Touyz, & Beumont, 1995; Sweetingham & Waller, 2008). Sense of Loss of Social Power and Visibility In contrast to the experience of younger women, a noteworthy finding in this study was that participants reported feeling less visible, and less socially powerful, as they entered and advanced throughout mid-life, which they believed had a powerful impact on their relationships with food and their bodies. Of note, the women in this study believed that the loss of visibility and social power they experienced in mid-life revolved around physical changes to their aging bodies (i.e., moving further away from cultural body-related \u00E2\u0080\u009Cideals). They highlighted their belief that the dominant culture perceives their mid-life bodies \u00E2\u0080\u0093 and consequently, their entire 189##being \u00E2\u0080\u0093 as less relevant, less sexual, less powerful, and less attractive, which further contributed to their experience of body dissatisfaction. Indeed, as noted above, younger women certainly feel pressure to conform to cultural beauty- and body-related ideals. However, in contrast to mid-life and older women, younger women are inherently more youthful and are typically perceived in a sexual way \u00E2\u0080\u0093 if their bodies meet cultural criteria for \u00E2\u0080\u009Cthinness\u00E2\u0080\u009D or not. As such, younger women more closely resemble cultural notions of desirability and attractiveness, given their age and developmental life stage. Importantly, the women in this study discussed being increasingly aware of youthfulness as a critical cultural currency, as they entered and advanced throughout mid-life. Indeed, mid-life and older women have been found to equate physical attractiveness with a youthful appearance and slim figure (e.g., Hurd Clarke, 2002a). Thus, consistent with the findings of the current study, the aging process has been found to trigger feelings of loss and invisibility among women (Hurd Clarke, 2001), and as women age, they appear to become more aware of losing social power, and of their changing social presence (Banister, 2000; Calasanti, 2005). Importantly, research has demonstrated that women increasingly attend to their appearance, and engage in beauty work, in their mid-life and older years, in part to \u00E2\u0080\u009Cfight against [the] invisibility\u00E2\u0080\u009D that accompanies a body displaying signs of the aging process (Hurd Clarke & Griffin, 2008, p. 653). Although women of all ages have been found to make disparaging comments about their body weight and shape (i.e., \u00E2\u0080\u009Cfat talk\u00E2\u0080\u009D), as women age they may be more susceptible to making negative comments about their aging bodies and their \u00E2\u0080\u009Cold\u00E2\u0080\u009D appearance (i.e., \u00E2\u0080\u009Cold talk\u00E2\u0080\u009D), further contributing to their experience of body dissatisfaction (Becker, Diedrichs, Jankowsi, & Werchan, 2013). As noted by Rice (2014), \u00E2\u0080\u009Cthe search for visibility and self-acceptance can be daunting, especially for those on the cultural margins of \u00E2\u0080\u0098beauty\u00E2\u0080\u0099\u00E2\u0080\u009D (book insert) \u00E2\u0080\u0093 a primary experience of the mid-life women in the current 190##study. Importantly, investment in one\u00E2\u0080\u0099s physical appearance has been found to be a significant risk factor for the development of eating challenges among younger women, as well as mid-life and older women (Keith & Midlarsky, 2004). Implications To the best of my knowledge and based on a thorough review of the literature, the current study is the first to explore women\u00E2\u0080\u0099s lived experiences of having a problematic relationship with food in mid-life, using a hermeneutic phenomenological approach. Additionally, it is one of the relatively few qualitative studies that have been conducted in the vast body of ED research dominated by quantitative approaches. In this next section, I will summarize the implications of the study findings for theory, counselling practice, and future research. Implications for Theory in Eating Disorders Research Despite an \u00E2\u0080\u009Calarming trend\u00E2\u0080\u009D toward viewing eating disorders (EDs) as disorders of the brain (see Harris & Steele, 2014), the prevailing theory on the etiology of EDs is the biopsychosocial model (see Polivy & Herman, 2002). This theoretical model posits that biological, psychological, and sociocultural factors converge to create vulnerability and risk toward the development of eating problems (e.g., dieting, bingeing), which may lead to the onset of clinically diagnosable EDs. Although the methodology utilized for the current study precludes any comment on biological correlates for the etiology of eating problems, the findings appear to support the theory that psychological and sociocultural factors may be implicated in the development and maintenance of eating challenges among mid-life women. Specifically, regarding psychological factors, the women in this study spoke about a complex interplay between their relationship with food and their personality traits (e.g., perfectionism), psychological experiences (e.g., difficulty regulating emotion, anxiety, stress, negative mood, 191##low self-esteem), and interpersonal experiences (e.g., relational trauma and abuse, teasing, perceived criticism from partners and significant others), all of which have been implicated as risk factors in the development and maintenance of eating challenges (Polivy & Herman). Several of the current findings support a sociocultural, etiological perspective on the development of eating challenges (see Smolak & Chun-Kennedy, 2013). The women in this study noted that they internalized unrealistic beauty- and body-related ideals from a very young age, which had an impact on their sense of self, eating behaviours, and body image, throughout their lives. The participants also discussed feeling pressured to conform to cultural notions of \u00E2\u0080\u009Cbeauty\u00E2\u0080\u009D as younger girls and women, and in mid-life, which they perceived as inextricably related to their longstanding and ongoing attempts to lose weight (e.g., by dieting, exercising). Supporting extant sociocultural theory, these women also discussed how various sociocultural influences (e.g., perceived pressures from family, significant others/peers, and media to lose weight and change their eating patterns), had a negative impact on their body image and eating behaviours (Thompson et al., 1999; Shroff & Thompson, 2006). In addition, one of the more central findings in this study \u00E2\u0080\u0093 a sense of loss of social power and visibility \u00E2\u0080\u0093 was an experience that reportedly emerged in mid-life for the participants, as they moved further and further away from beauty- and body-related cultural ideals commonly depicted in popular media (i.e., images of young, thin, sexualized women). Moreover, when the women in this study felt that their weight didn\u00E2\u0080\u0099t live up to cultural expectations for attractiveness and desirability, they felt shame about \u00E2\u0080\u0093 and a desire to hide \u00E2\u0080\u0093 their bodies. Not surprisingly, these women experienced a relentless dissatisfaction with their bodies in mid-life, which motivated them to engage in various weight control strategies (e.g., dieting, exercising, purging). For these women, such strategies usually failed, leading to weight gain and self-punishing thoughts and emotions, which 192##subsequently led to a re-instatement and strengthening of their weight loss plan \u00E2\u0080\u0093 thereby perpetuating the \u00E2\u0080\u009Cvicious\u00E2\u0080\u009D eating cycle that these women discussed. Importantly, dieting and body dissatisfaction are posited as central factors in the development of eating problems among women (e.g., Stice, 2001). Many of the women in this study increasingly turned to dieting and other weight loss strategies in an effort to control their weight and bodies in mid-life, in response to the normative weight gain and other physical changes characteristic of the aging process (e.g., \u00E2\u0080\u009Csagging\u00E2\u0080\u009D body parts, wrinkled skin). As such, these women experienced an increased pressure in mid-life to achieve and maintain an \u00E2\u0080\u009Cattractive\u00E2\u0080\u009D appearance. Notably, as previously discussed, many of the women in this study felt that social pressures toward thinness and youthfulness increased throughout their adult years. As Maine and Bunnell (2010) stated, \u00E2\u0080\u009Cas the social changes accelerate, many women seek solace and mastery by controlling their bodies\u00E2\u0080\u009D (p. 3). Indeed, this was the experience of many of the participants in this study. In fact, as the women began to notice the physical signs of the aging process (e.g., wrinkles, normative weight gain, greying hair), and as they experienced being treated differently as \u00E2\u0080\u009Colder\u00E2\u0080\u009D women, they became acutely aware of how society views aging women \u00E2\u0080\u0093 as less relevant, less sexual, less attractive, and less productive. For many of the women in this study, this had a significant impact on their self-esteem, and their relationships with their bodies and with food. Importantly, dieting and a drive for thinness, as a response to the aging process, have been found to be important factors in the development of DE and EDs among mid-life and older women (Gupta, 1995). Thus, the findings of the current study appear to highlight aspects of the sociocultural context that may render mid-life women especially vulnerable to developing, or experiencing the reemergence of, eating challenges in mid-life. Indeed, in the current North American cultural climate, female gender 193##remains the primary risk factor toward the development of EDs at all life stages (Maine & Bunnell). Thus, the current findings provide support for ED theory that includes a sociocultural perspective, and highlight the importance of attending to, and including, developmental and contextual factors in the development of ED theory centered on mid-life women. Interestingly, the transition to mid-life has been regarded as a \u00E2\u0080\u009Cwindow of vulnerability\u00E2\u0080\u009D (Mangweth-Maztek et al., 2013, p. 609) for the development of eating problems among mid-life women. In addition, the social and biological changes often experienced during the developmental phase of puberty have been equated with those experienced by menopausal women (Crisp, 1980, as cited in Cosford & Arnold, 1992; Lewis & Cachelin, 2001). Importantly, the developmental tasks associated with the menopausal transition (e.g., hormonal changes, changes in reproductive status, changing conceptualizations of womanhood and identity) have been regarded by some as likely to increase the risk for psychiatric difficulties among mid-life women, including EDs (Mangweth-Maztek et al.). In their study, Mangweth-Maztek et al. set out to examine the possible impact of menopausal status on EDs and body image among 715 mid-life women between the ages of 40 and 60. Participants in this study filled out an anonymous survey, and results indicated that perimenopausal women evidenced higher rates of EDs and body dissatisfaction, in comparison to premenopausal women, after controlling for age and body mass index (Mangweth-Maztek et al.). Certainly, the women in the current study reported struggling, and feeling out of control with, their bodies as they dealt with the symptoms of menopause (e.g., the hormonal fluctuations, weight gain, desire to eat) and aging \u00E2\u0080\u0093 all of which they perceived as having a negative impact on their relationships with food and their bodies. Interestingly, it is important to note that such hormonal and physiological changes occur within a social context where puberty is associated with the sexualization of younger women, and 194##inversely, menopause is linked with the desexualization of mid-life women \u00E2\u0080\u0093 perhaps pointing toward the need for further examining sociocultural factors in the study of EDs, and including developmental and contextual considerations in ED theory. However, that the biological and psychological changes characteristic to both puberty and menopause may create a vulnerability toward the development of eating problems is an interesting theoretical hypothesis, and yet at present, remains speculative. One of the more interesting findings in this study is that the participants perceived aspects of their relationship with food as reminiscent of \u00E2\u0080\u009Caddiction.\u00E2\u0080\u009D The women in this study discussed parallels between their eating challenges and \u00E2\u0080\u009Cfood addiction,\u00E2\u0080\u009D to addictions to drug, alcohol and other compulsive behaviours (e.g., sexual addictions). Specifically, they spoke of the addictive nature of some foods, the overwhelming urge to consume certain foods, and the sometimes frightening experience of losing control over food and eating. Additionally, one of the more significant parallels to the addiction model is the finding that the participants used food and eating as a primary method of coping with stress and emotions. Relatedly, the \u00E2\u0080\u009Cvicious cycle\u00E2\u0080\u009D that characterized the participants\u00E2\u0080\u0099 eating pattern is also reminiscent of addictions. The women in this study discussed a \u00E2\u0080\u009Cvicious cycle\u00E2\u0080\u009D of trying to control their food intake (i.e., abide by their diet goals), eventually overindulging in \u00E2\u0080\u009Ctempting\u00E2\u0080\u009D foods in the face of stress, experiencing shame and guilt about their transgression, and subsequently reinstating their diet goals \u00E2\u0080\u0093 until the next time they felt overwhelmed and a desire to turn to food for comfort and a means of coping. Taken as a whole, such findings may provide support for the theoretical conceptualization of DE and EDs, particularly binge eating and Binge Eating Disorder, as forms of addiction. In addition, as noted above, the way in which the women in this study discussed their resignation to living with eating and body image challenges was strikingly similar to how the life-long recovery 195##process from addictions is typically conceptualized. The finding that participants felt resigned to their challenges with body image and eating, and believed they would always live with, have to manage, and be vigilant to such challenges also supports theory and literature which conceptualizes recovery from an ED as a process \u00E2\u0080\u0093 and not final, static state (e.g., see Federici & Kaplan, 2007). To the best of my knowledge, this is the first phenomenological study to explore mid-life women\u00E2\u0080\u0099s challenges in their relationship with food. Although there is much overlap with the current findings and the extant literature on EDs, particularly literature exploring central features of EDs (e.g., using food to cope, secrecy, guilt and shame, self-criticism, pressure toward thinness, etc.), the study findings also highlight the importance of the developmental and contextual realities of mid-life women\u00E2\u0080\u0099s lives and the resulting impact on women\u00E2\u0080\u0099s relationships with food, their bodies, and themselves. Thus, the findings of this study may begin to inform theory development with this population \u00E2\u0080\u0093 theory which acknowledges and examines the centrality of developmental life stage and social context in the onset, maintenance and treatment of DE. As the literature on mid-life women\u00E2\u0080\u0099s eating challenges grows, it will be interesting to see how theorizing about this important phenomenon is advanced. Implications for Counselling Psychology/Psychologists and Clinical Practice The results of this study have important implications for mental health clinicians, including Counselling Psychologists, who are tasked with treating mid-life women presenting with eating challenges4 (e.g., dieting, purging, bingeing). Overall, as previously discussed, there is a high degree of convergence between the findings of this study and the extant literature on ######################################## ####################4#Given#the#shame#and#embarrassment#that#that#mid9life#women#may#feel#about#their#eating#challenges#(Zerbe,#2008),#as#well#as#the#secrecy#they#may#try#to#maintain,#it#is#important#for#clinicians#to#assess#for#eating#problems#among#this#demographic#of#women,#even#when#such#problems#are#not#readily#disclosed#(Mangweth9Maztek#et#al,#2014).##196##common features of EDs (e.g., using food as a means of coping, difficulty coping with emotions, guilt and shame, self-criticism, secrecy and isolation, needing control). Given the complexity of the challenging, interrelated experiences summarized in the study findings, a flexible and multifaceted treatment approach appears to be warranted for mid-life women presenting with eating problems. Such an approach is typically the mainstay for EDs treatment, particularly for women seeking treatment in higher levels of care (e.g., Joy, Wilson, & Varechok, 2003; Stein, Saelens, Dounchis, Lewcyzk, Swenson, & Wilfley, 2001; see Stewart & Williamson, 2004, for an example; Weiner, 1999). At a minimum, Counselling Psychologists would do well to assist their mid-life clients to enhance self-regulation and develop healthier coping strategies (i.e., aside from turning to food) (e.g., Troop, Holbrey, Trowler, & Treasure, 1994), learn to better tolerate and regulate their emotions (e.g., Wisniewski, Safer, & Chen, 2007), challenge harmful thought patterns that serve to maintain their problematic eating patterns (i.e., self-criticism) (e.g., Fairburn, 2008), and process and work through their feelings of guilt and shame (e.g., Troop, Allan, Serpell, & Treasure, 2008). In particular, it may be fruitful for Counselling Psychologists to address the shame that women may feel about living with eating challenges in mid-life \u00E2\u0080\u0093 a problem the women in this study felt they \u00E2\u0080\u009Cshould\u00E2\u0080\u009D have been able to control at their age and life stage. However, each of the study findings are rife with possibilities for intervention, and offer counsellors points of reference for engaging mid-life women in a process of therapeutic change. Consistent with the findings of Marcus et al. (2007), many of the mid-life women in this study reported past traumatic experiences (e.g., physical, sexual, and emotional abuse) and difficulties with mood (e.g., anxiety and depression). These results suggest the importance of assessing for trauma and mood-related difficulties, and planning treatment accordingly, for mid-life women presenting for counselling to address eating challenges. In addition, given that eating 197##problems can wreak havoc on physical health (see Herzog & Eddy, 2007), coupled with the reality that mid-life women are increasingly vulnerable to a variety of health problems including nutritional deficiencies (see Allaz et al., 1998; Lewis & Cachelin, 2001), Counselling Psychologists would do well to assist their mid-life clients to seek a medical assessment for any physical complications that may result from dysregulated eating patterns, and harmful eating practices (e.g., bingeing, purging, restrictive eating). Also, in light of the finding that the participants experienced their eating challenges as a form of \u00E2\u0080\u009Caddiction,\u00E2\u0080\u009D it seems fitting that addiction treatment models, including relapse prevention work, may prove useful for women who are engaged in a treatment process (e.g., Larimer, Palmer & Marlatt, 1999). Important for treatment contexts was the finding that the women in this study acknowledged their inability to practice abstinence from their \u00E2\u0080\u009Caddiction\u00E2\u0080\u009D to certain foods, given the necessity of food for survival \u00E2\u0080\u0093 in contrast to addictions to other substances (e.g., drugs, alcohol) where abstinence and sobriety are central to the recovery process. In light of this finding, counsellors would do well to assist their clients to carefully arrange their personal surroundings to minimize the risk of engaging in binge eating (e.g., not keeping certain foods in the house), and to learn ways to manage temptations in the external world, where food imagery and messages are ubiquitous and constant (Bulik, 2013). Similarly, given that the participants experienced eating as a habitual and cyclical pattern, it would seem useful for Counselling Psychologists to assist mid-life women to devise, and eventually implement, methods designed to interrupt the \u00E2\u0080\u009Cvicious cycle\u00E2\u0080\u009D that characterizes their eating, at each point along this cycle (e.g., learning different ways to cope with stress, using cognitive behavioural techniques to interrupt self-critical thoughts, employing self-soothing strategies to cope with painful emotions). Unfortunately, given that research exploring mid-life women\u00E2\u0080\u0099s experiences of eating 198##challenges is still in its nascence, the field has not yet heeded the call for developmentally and contextually relevant treatments for this population (e.g., Zerbe, 2003). However, the results of this study highlight some of the developmental and contextual realities of the lives of mid-life women, and the impact of these realities on their eating challenges, which may help to inform more developmentally-appropriate treatments for this demographic of women. In particular, Counselling Psychologists need to be sensitive to and address women\u00E2\u0080\u0099s perceived loss of social power and visibility, as well as the very real societal pressures on women to meet unrealistic and largely unattainable standards of weight, shape and youthful appearance. Such issues may be addressed by Counselling Psychologists in therapy by engaging clients in feminist therapy approaches and techniques (e.g., attending to the impact of gender, openly discussing the influence of social context, focusing on empowering clients who face systemic oppression, exploring ways to resist dominant cultural messages), facilitating self-compassion and self-acceptance (particularly regarding the inevitable physical changes that accompany aging), exploring and highlighting personal strengths (to widen indicators of self-worth, beyond weight and shape), and engaging in social justice work and advocacy (within and outside the treatment context) (e.g., see Ballou, Hill, & West, 2008; Brown, 2009). The majority of the women in this study experienced significant life changes throughout mid-life (e.g., deaths of loved ones, geographical moves, divorce, career changes, going back to school). Entering mid-life was also perceived as a difficult transition for some of the women in this study. For one of the participants, the developmental transition to mid-life was particularly challenging, as she grieved the loss of her younger years, experienced the dissolution of a serious romantic relationship, and took stock of her current life. The women in this study reported turning to food to cope with these developmental challenges, and for those who had experienced 199##the death of loved ones, food was central to coping with their grief. Such findings may lend credence to the hypothesis that mid-life women who experience difficulty mourning losses, and making smooth developmental transitions, may be more vulnerable to developing/experiencing problems with their eating (Zerbe). As such, the recommendation to include a specific focus on loss and grief within the treatment process may be warranted for this population (Forman & Davis, 2005; Zerbe), particularly for those mid-life women who experience significant life changes and experiences that require a grieving process (e.g., divorce, geographical moves, deaths of loved ones, infertility). In addition, given the high degree of ambivalence and loathing that the women in this study felt about their aging bodies and the aging process, it would be prudent for Counselling Psychologists to facilitate a grieving process around the loss of their youth, work toward the acceptance of the inevitability of aging, and to assist clients with the potentially difficult process of looking forward to the latter half of their lives (Zerbe, 2008). Given that body image problems were so central to the participants\u00E2\u0080\u0099 experiences, Counselling Psychologists would do well to explore mid-life women\u00E2\u0080\u0099s relationships with their bodies; to foster and enhance mid-life women\u00E2\u0080\u0099s self-acceptance, self-love, and self-compassion toward their changing bodies (e.g., see Stewart, 2004); and to engage mid-life women in interventions designed to improve body image, overall (e.g., psychoeducation, skills to cope with emotions stemming from body image problems, learning to refute harmful appearance assumptions and body-related \u00E2\u0080\u009Ccognitive disortions,\u00E2\u0080\u009D exposure and response prevention for avoidant behaviours related to body image disturbance, facilitating a positive relationship with the body) (e.g., see Cash, 2002; Cash, 2008). In addition, it seems possible that a focus on positive, functional experiences that mid-life women have had in relation to their bodies (e.g., birthing children, surviving illness) may increase their body-related pride and allow for a shift 200##away from a preoccupation with appearance and weight, and from viewing their bodies as deficient objects that need to be altered (Calogero, Davis, & Thompson, 2005). From a feminist counselling perspective, the results of this study indicate the importance of addressing the social context \u00E2\u0080\u0093 most notably, the impact of gender \u00E2\u0080\u0093 that creates vulnerability toward, and sustains, mid-life women\u00E2\u0080\u0099s eating challenges (see Maine & Bunnell, 2010). As noted above, several key findings specific to this study lend credence to the value of exploring the impact of sociocultural factors in therapy, including gender role socialization. As Maine and Bunnell state, \u00E2\u0080\u009Cpsychotherapy must help patients make sense of the biopsychosocial storm that led to their ED, through explicit discussion of what it means to be a woman with all its associated values, dreams, aspirations, hopes, fears, and anxieties\u00E2\u0080\u009D (p. 12). It is therefore essential for Counselling Psychologists to be mindful of the developmental and contextual realities of mid-life women\u00E2\u0080\u0099s lives, and incorporate such knowledge into case conceptualization and treatment planning. This focus on development and context \u00E2\u0080\u0093 so central to a counselling psychology approach \u00E2\u0080\u0093 might be the piece that is missing in existing treatments for EDs, particularly dominant \u00E2\u0080\u009Cevidence-based\u00E2\u0080\u009D approaches, which are largely focused on the reduction of eating-related symptomatology, to the exclusion of contextual factors. Importantly, the results of the current study highlight the centrality of developmental and contextual factors in the development and maintenance of mid-life women\u00E2\u0080\u0099s eating challenges. Based on the current findings, ignoring these factors in treatment \u00E2\u0080\u0093 particularly the finding that the participants felt a sense of loss of social power and visibility with advancing age \u00E2\u0080\u0093 would be a disservice to mid-life women presenting with eating problems, and would deprive them of the opportunity to engage in significant and important therapeutic work. Thus, a treatment approach with a non-pathologizing Counselling Psychology perspective that includes development and social context 201##in its approach, may render the counselling process more useful, effective and targeted for mid-life women presenting with eating challenges. Importantly, one participant in this study discussed a \u00E2\u0080\u009Charmful\u00E2\u0080\u009D experience she had in a therapeutic group for women with EDs. In this group, she was the only mid-life woman, and the only \u00E2\u0080\u009Cobese\u00E2\u0080\u009D woman who struggled with bingeing and purging, among a majority of younger women who presented with \u00E2\u0080\u009Crestrictive\u00E2\u0080\u009D eating problems. This participant reported that she felt unsafe, out-of-place, and not well understood, resulting in an increased sense of shame in this particular treatment group. In contrast, she also reported attending a different therapeutic EDs group where she was accompanied by other mid-life women, which felt safer, and in which she felt better able to engage in therapeutic work. Counselling Psychologists facilitating group-based treatment approaches should carefully consider creating groups specifically for mid-life and older women, targeting the specific needs of this demographic group. Of note, homogeneity among participants in therapeutic groups is known to help facilitate cohesion among group members (Spitz & Spitz, 1999; Yalom, 1985). In this setting, Counselling Psychologists would be able to incorporate developmental and contextual considerations into their group-based treatment goals specifically relevant to the biopsychosocial realities and pressures affecting the lives of mid-life women. Two related findings that emerged from the participants\u00E2\u0080\u0099 narratives seem particularly important to address in a counselling context. First, based on the study findings, it seems important for Counselling Psychologists to address the role of food in mid-life women\u00E2\u0080\u0099s lives. All of the participants in this study discussed the role of food as a source of \u00E2\u0080\u009Cemotional comfort,\u00E2\u0080\u009D and consequently attended less to the role of food in sustaining life and ensuring proper nutrition. One insightful participant perceived this to be the crux of her problematic relationship with food 202##that needed to be dismantled before she could entertain the idea of a healthier relationship with food. As women begin to learn to manage their emotions in healthier ways through counselling, they may need assistance in mourning the losses associated with perceiving food as a coping mechanism, and with granting food a positive role in their lives (e.g., \u00E2\u0080\u009Cfriend,\u00E2\u0080\u009D \u00E2\u0080\u009Creward,\u00E2\u0080\u009D \u00E2\u0080\u009Ctreat,\u00E2\u0080\u009D and \u00E2\u0080\u009Ccomfort\u00E2\u0080\u009D). Importantly, many clients presenting with eating challenges experience ambivalence about the loss of a relationship with food that has been familiar and comforting, as well as self-destructive and self-harming (Leavey, Valliantou, Johnson-Sabine, Rae, & Gunputh, 2011). Indeed, the women in this study discussed a paradoxical relationship with food, characterized by positive and negative experiences, meanings and attachments. As an overarching goal of the treatment process, it would seem fitting for counsellors to assist mid-life women to process, and eventually let go of, both the pleasurable and painful aspects inherent in their relationship with food \u00E2\u0080\u0093 and to look toward developing a new relationship with food. Talking with mid-life women in counselling about their \u00E2\u0080\u009Crelationship with food\u00E2\u0080\u009D \u00E2\u0080\u0093 as opposed to their eating-related \u00E2\u0080\u009Csymptoms,\u00E2\u0080\u009D \u00E2\u0080\u009Cdisordered eating\u00E2\u0080\u009D habits, and/or their \u00E2\u0080\u009Ceating disorder\u00E2\u0080\u009D \u00E2\u0080\u0093 is less pathologizing and therefore less threatening for some clients, and may lead to a more in-depth discussion about the role and meaning of food in their lives. This approach may allow deeper exploration of, and insight into, the ways in which eating problems manifest in mid-life women\u00E2\u0080\u0099s lives, how they are perpetuated, and how they may be changed. Of note, in their search for greater understanding of their eating challenges, some of the participants in this study discussed feeling pathologized and confused by DSM diagnoses for EDs, as well as clinical terms for eating behaviours that they weren\u00E2\u0080\u0099t ready to acknowledge or accept (e.g., \u00E2\u0080\u009Cdieting,\u00E2\u0080\u009D \u00E2\u0080\u009Cpurging,\u00E2\u0080\u009D \u00E2\u0080\u009Cbingeing\u00E2\u0080\u009D). These women\u00E2\u0080\u0099s experiences speak to the importance of carefully attending to the use of language when working with women presenting the eating 203##problems in therapeutic contexts. Lastly, it is important to note that only five of the participants in this study sought out assistance for their eating challenges and body image concerns throughout their lives (e.g., twelve step programs, therapeutic groups, professional counselling). However, many of these women discussed feeling apprehensive to seek professional help for their eating challenges in mid-life, in part due to the shame they felt about living with eating problems at their age and life stage. As a case in point, only one of these women reported specifically seeking out professional counselling for her eating challenges in mid-life. In addition, another participant commented on how, despite the fact that she has attended counselling numerous times throughout her life, she never discussed her eating challenges as part of her therapeutic process/journey. These findings suggest that Counselling Psychologists would do well to reflect on how we, as a field, can make counselling services more accessible to this population. As a starting point, it seems possible that bringing more public awareness and attention to the reality that mid-life women experience challenges in their relationships with food may begin to shift public perception of eating problems as a younger women\u00E2\u0080\u0099s issue \u00E2\u0080\u0093 thereby reducing stigma about, and shame related to, this phenomenon. In addition, counsellors would do well to assess for and explore eating challenges among our mid-life clients, in an attempt to open up space for mid-life women to discuss their eating problems in a therapeutic context. Exploring how to reduce barriers to mid-life women seeking counselling for eating challenges would be a fruitful area for future research. Implications for Future Research The extant literature exploring eating challenges among mid-life women is growing, yet still very limited, and research in this area is in its infancy. As a result, there remains much to learn about this important phenomenon. However, the current study is the first to illuminate the 204##lived experiences of the participants who have had a problematic relationship with food during mid-life. To build on this work, qualitative research centered on furthering our understanding of mid-life women\u00E2\u0080\u0099s experiences with eating challenges would likely provide more of a foundation toward the development of more targeted, efficacious, developmentally-appropriate treatments for this demographic of women. Once a more solid understanding of this phenomenon grows, researchers and clinicians alike would do well to develop treatments for mid-life women struggling in their relationships with food. Subsequently, the field would benefit from quantitative research designed to assess and evaluate newly developed programs for this population. The women in this study discussed various developmental and contextual stressors that influenced their relationship with food (e.g., career, parenting, transitioning to mid-life, normative weight gain, aging), which they felt had a negative impact on their sense of self, body image and eating behaviours. In addition, despite the ability to be more critical of media imagery depicting beauty- and body-related ideals in mid-life, the participants expressed that media consumption still had a negative impact on their relationships with food and their bodies. Based on the results of this study, the developmental and contextual realities of mid-life women\u00E2\u0080\u0099s lives \u00E2\u0080\u0093 and their impact on women\u00E2\u0080\u0099s eating and body image \u00E2\u0080\u0093 appear to be the most important difference that sets apart mid-life women\u00E2\u0080\u0099s experiences of eating challenges from that of younger women. As such, researchers would do well to further explore the impact of these unique stressors on mid-life women\u00E2\u0080\u0099s eating challenges, particularly how developmental and contextual factors serve as triggers for the onset, and maintenance, of eating challenges among this demographic of women. For example, qualitative work exploring how mid-life women negotiate their eating problems, and the recovery process from EDs, while trying to balance developmental 205##tasks and transitions (e.g., parenting, work, partnerships, menopause) would assist researchers and clinicians alike with developing more targeted ways to assist mid-life women in therapy. In addition, a critical ethnography exploring the social context within which mid-life women develop and experience eating challenges would be of benefit for furthering our understanding of the complex interplay between eating problems and social/contextual factors. Regarding the finding that the women in this study expressed a desire to maintain a sense of secrecy about their eating behaviours, and their struggles with eating, more broadly, it may be helpful for future research to explore how the drive for secrecy may affect the work, relational, and familial contexts of mid-life women\u00E2\u0080\u0099s lives; their experiences of social supports; and their willingness or reluctance to seek treatment. Relatedly, as noted above, the mothers in this study discussed their desire to not \u00E2\u0080\u009Cpass on\u00E2\u0080\u009D their eating challenges to their children. Future research may do well to explore mid-life women\u00E2\u0080\u0099s tendency to hide their eating challenges from their children, and its possible impact on parenting, parent-child relationships, and the likelihood of transmitting eating problems across generations (e.g., Rodgers, Faure & Chabrol, 2009). As previously discussed, all of the women in this study noted that their challenges with body image and eating began in childhood or adolescence, and worsened and improved at various points throughout their lives. Importantly, many of the women described how their eating challenges significantly worsened as they entered their mid-life years. To better understand fluctuations in women\u00E2\u0080\u0099s relationships with food, and the potential difficulties women may face with their eating in mid-life, it may prove useful for researchers to conduct longitudinal research, following women from their youth into their mid-life years (see Keel, Gravener, Joiner, & Haedt, 2010). Relatedly, it seems prudent for researchers to target future research on how potential vulnerabilities (e.g., childhood trauma, high need for control, perfectionism) may lead 206##to the development or re-emergence of eating challenges among women in their mid-life years \u00E2\u0080\u0093 especially mid-life women whose eating challenges are long-standing (i.e., since childhood and adolescence). As is the case for the majority of the research that has been conducted in the area of EDs (Talleyrand, 2012), this study had a primarily White, relatively homogeneous sample. It will be important for future research to explore eating challenges among mid-life women occupying diverse social locations and identities in order to increase our understanding of this apparently increasing phenomenon, and to determine the extent to which the findings of the current study resonate with, and differ from, the experiences of culturally diverse mid-life women. Additionally, although EDs are more often experienced by women (e.g., Maine & Bunnell, 2010), men of all ages are not immune the development of eating problems (e.g., Robinson, Mountford, & Sperlinger, 2013; Strother, Lemberg, Stanford, & Turberville, 2012). As such, it would be useful for researchers to explore eating challenges among middle-aged men, including prevalence rates and epidemiology, etiological correlates and prognosis, as well as their lived experiences, in part, to determine if there are gender-based differences in the experience of mid-life adults who live with eating problems, which has important implications for theory and treatment. Four of the women in this study explicitly stated that they felt pressure from close others, including their male partners, to lose weight and/or change their eating habits/behaviours. These women discussed how overt and subtle pressures from male partners often increased the shame they felt about their bodies and eating behavior, and the anxiety they felt about their weight gain in mid-life, and served to further complicate their relationships with food. Importantly, these negative consequences occurred whether or not the women perceived their partners as having 207##good intentions (i.e., trying to help the participants in their struggles with food). Notably, one of the participants expressed feeling grateful that her husband was accepting of her at any weight, and has never exerted pressure on her to make changes to her body or eating behaviour, which she believed reduced the degree to which she engaged in weight loss behaviours (e.g., dieting). In light of these findings, future research exploring how couples negotiate mid-life women\u00E2\u0080\u0099s eating challenges within their relationships, could make a significant contribution to the literature. In addition, although recent research has explored the role of intimate partners in supporting younger women\u00E2\u0080\u0099s recovery from an ED (Hughes-Jones, 2015), researchers would do well to explore how intimate partners can better support mid-life women who struggle in their relationships with food. Lastly, the finding that that the women in this study perceived their eating challenges as reminiscent of \u00E2\u0080\u009Caddiction,\u00E2\u0080\u009D and discussed several parallels between their eating problems and non-food-related addictions (e.g., drugs, alcohol), appears to warrant further investigation. Given the relatively recent conceptualization of EDs as forms of addiction, future research exploring \u00E2\u0080\u009Cfood addiction\u00E2\u0080\u009D and the possible role of addiction in EDs is needed. Such research may be especially warranted given the contentious nature of the addiction hypothesis in EDs research and theory (e.g., Wilson, 2002). Overall, future research in this area appears to have potentially important implications for theory and treatment of EDs. Personal Statement and Researcher Reflections Facilitating this research project has undoubtedly been one of the highlights of my academic career, to date. At times, the research process has been exhilarating and exciting, and it was truly a delight to be able to immerse myself into my passion for studying women\u00E2\u0080\u0099s eating challenges. The human connection between myself and each of the participants was core to the 208##interview and research processes, which enthused the work with purpose, humanness, and liveliness. Speaking with the women about the results of the study, and sharing in their excitement about this research, was undoubtedly one of the highlights of the entire process. In various ways, I learned how difficult it can be to conduct this kind of qualitative work \u00E2\u0080\u0093 which was, in fact, a gift. At other times, the process of conducting this research was challenging and trying. In the best way possible, I felt highly accountable to these women \u00E2\u0080\u0093 as I should have \u00E2\u0080\u0093 and representing the sensitive nature of these women\u00E2\u0080\u0099s experiences was a serious undertaking. In addition, given the difficult nature of the subject matter central to the research inquiry, the immersion process that was required was an emotional process \u00E2\u0080\u0093 one that demanded continual reflexivity and self-introspection. Indeed, I learned first-hand that food and body image challenges are not solely the domain of the younger woman, as many (would perhaps like to) believe. The harsh reality that women of all ages struggle in their relationships with food and their bodies was sometimes disheartening, angering, triggering, and saddening. At the same time, the participants\u00E2\u0080\u0099 strength and resilience in the face of their challenges with food and body image was inspiring. These women longed for personal and sociocultural change. To be sure, their voices have been heard, and they have made a difference to me personally, and to those whose work might be informed by this study. Ultimately, I am grateful for the teachings that were bestowed upon me by both the positive and painful aspects of the research process, and I believe that I have grown as a researcher and a clinician, and have furthered my own process of personal development, as a result of completing this piece of work. Importantly, without the women who participated in this study, this project could not have been realized. It was an absolute privilege to hear the 209##participants\u00E2\u0080\u0099 stories, and to listen and bear witness to some of the more painful aspects of their lived experience of negotiating their relationships with food. As I have shared with them many times, I will be forever grateful to these women for sharing their experiences, offering their time and feedback, and their enthusiasm for this research. I will carry these women\u00E2\u0080\u0099s voices with me long after the completion of this project, and it is my great hope that their experiences, courage and resilience will inspire and be of assistance and interest to many other mid-life women who have experienced a problematic relationship with food \u00E2\u0080\u0093 and to those who care for/about them. 210## References Ackard, D.M., Richter, S., Egan, A., & Cronemeyer, C. (2014). Poor outcome and death among youth, young adults, and midlife adults with eating disorders: An investigation of risk factors by age at assessment. International Journal of Eating Disorders, 47, 825-835. Ackard, D.M., Richter, S., Frisch, M.J., Mangham, D., & Cronemeyer, C. (2013). 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Primary Psychiatry, 10, 80-82. Zerbe, K. (2008). Middle and later life. In Integrated treatment of eating disorders: Beyond the body betrayed (pp. 192-220). New York, NY: W.W. Norton & Company. Zerbe, K. (2013). Late life eating disorders. Eating Disorders Review, 24, 6. Zerbe, K., & Domnitei, D. (2004). Eating disorders at middle age, part 1. Eating Disorders Review, 15, 1-3. 238## Appendix A: Descriptions of Eating Disorders & A Working Definition of \u00E2\u0080\u009CDisordered Eating\u00E2\u0080\u009D The fourth edition of the Diagnostic and Statistical Manual (DSM-IV) (APA, 2000) outlines three diagnostic categories, and one provisional diagnosis, for eating disorders. Each are described below. ANOREXIA NERVOSA (AN) Anorexia Nervosa (AN) is typically characterized by: \u00E2\u0096\u00AA extremely low body weight (i.e., at or below that expected for weight and height) \u00E2\u0096\u00AA intense fear of gaining weight or becoming fat \u00E2\u0096\u00AA body image disturbance \u00E2\u0096\u00AA self-evaluation heavily influenced by body weight and shape \u00E2\u0096\u00AA amenorrhea (i.e., absence of at least three consecutive menstrual cycles) in postmenarcheal females There are two types of AN \u00E2\u0080\u0093 restricting type and binge-eating/purging type. In contrast to the former type, the latter type involves regular engagement in binge-eating and purging behaviours. BULIMIA NERVOSA (BN) Bulimia Nervosa (BN) is typically characterized by: \u00E2\u0096\u00AA recurrent episodes of binge eating \u00E2\u0096\u00AA recurrent compensatory behaviours (e.g., vomiting, laxative abuse, excessive exercise) \u00E2\u0096\u00AA self-evaluation heavily influenced by body weight and shape \u00E2\u0096\u00AA binge-eating and compensatory behaviors must occur at least twice a week for 3 months There are two types of BN \u00E2\u0080\u0093 purging type and nonpurging type. The purging type is characterized by the use of self-induced vomiting, diuretics, laxatives or enemas. The non-purging type is characterized by the use of other inappropriate compensatory behaviours (e.g., fasting or excessive exercise). EATING DISORDER NOT OTHERWISE SPECIFIED (EDNOS) The diagnostic category Eating Disorder Not Otherwise Specified (EDNOS) includes any disorder that does not meet criteria for any specific eating disorder, including AN and BN. Some examples include: \u00E2\u0096\u00AA repeatedly chewing and spitting out large amounts of food \u00E2\u0096\u00AA use of compensatory behaviours among individuals eating small amounts of food \u00E2\u0096\u00AA all criteria met for AN except amenorrhea \u00E2\u0096\u00AA all criteria met for BN except frequency and duration of bingeing/purging behaviour BINGE EATING DISORDER (BED) Binge Eating Disorder (BED) is currently a provisional diagnosis that is located under the larger EDNOS diagnostic category. It is typically characterized by: \u00E2\u0096\u00AA recurrent episodes of binge eating in the absence of compensatory behaviours (e.g., as seen in BN) \u00E2\u0096\u00AA marked distress regarding binge eating 239## \u00E2\u0096\u00AA binge eating occurs at least two days a week for 6 months According to the National Eating Disorders Information Centre, \u00E2\u0080\u009Cdisordered eating\u00E2\u0080\u009D includes: \u00E2\u0096\u00AA a wide range of abnormal eating patterns and behaviours, including those seen in EDs such as AN, BN \u00E2\u0080\u0093 for example: \u00E2\u0096\u00AA irregular, chaotic eating patterns \u00E2\u0096\u00AA restricting food intake \u00E2\u0096\u00AA the elimination of certain foods and food groups from one\u00E2\u0080\u0099s diet \u00E2\u0096\u00AA preoccupation with food and weight \u00E2\u0096\u00AA eating large amounts of food in one sitting (i.e., binge eating) \u00E2\u0096\u00AA chewing and spitting, without swallowing, foods \u00E2\u0096\u00AA engaging in bodily altering practices such as: \u00E2\u0096\u00AA self-induced vomiting \u00E2\u0096\u00AA use of diet pills or laxatives \u00E2\u0096\u00AA excessive exercise \u00E2\u0096\u00AA chronic restrained eating, compulsive eating, and habitual dieting \u00E2\u0096\u00AA physical hunger and satiety are often ignored \u00E2\u0096\u00AA counting calories, fats, carbohydrates or other nutritional aspects of food with the intent of screening foods for consumption 240## Appendix B: Recruitment Poster ####If you said \u00E2\u0080\u009Cyes\u00E2\u0080\u009D to the questions above and are interested in helping us learn more about the growing number of mid-life women who struggle in their relationships with food, please contact Ashley Palandra, a doctoral student at UBC. This study is being supervised by Judith Daniluk, Ph.D., Professor of Counselling Psychology at UBC. Participation in this study involves 1 confidential interview (approx. 1 \u00E2\u0080\u0093 2 hrs) and one brief follow-up interview (approx. 30 \u00E2\u0080\u0093 60 mins). For more information about this study, please contact: Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx Ashley Palandra XXX-XXX-XXXX xxxxx@xxxxx.xxx ! Are you a woman between the ages of 40 and 65? ! Do you have a complicated relationship with food (e.g. dieting, overeating, purging, restrictive eating, preoccupation with food)? ! Are you willing to share your story with a UBC researcher? #\u00E2\u0080\u009CIT\u00E2\u0080\u0099S COMPLICATED\u00E2\u0080\u009D: A UBC STUDY ABOUT WOMEN\u00E2\u0080\u0099S RELATIONSHIPS WITH FOOD 241## Appendix C: Online and Social Media Recruitment Notice \"It's complicated\": A UBC study about mid-life women's relationships with food Description -Are you a woman between the ages of 40 and 65? -Have you had a complicated relationship with food (e.g., dieting, overeating, purging, preoccupation with food?) -Are you willing to share your story with a UBC researcher? If you said \u00E2\u0080\u009Cyes\u00E2\u0080\u009D to the questions above and are interested in helping us learn more about the growing number of mid-life women who struggle in their relationships with food, please contact Ashley Palandra, a doctoral student at UBC. This study is being supervised by Judith Daniluk, Ph.D., Professor of Counselling Psychology at UBC. Participation in this study involves 1 confidential interview (approx. 1 \u00E2\u0080\u0093 2 hrs) and one brief follow-up interview (approx. 30 \u00E2\u0080\u0093 60 mins). For more information about this study, contact Ashley Palandra: XXX-XXX-XXXX xxxxxx.xxxxxxxx@x.xxx 242## Appendix D: Telephone Screening Form \u00E2\u0096\u00AA \u00E2\u0080\u009CThank you for calling. My name is Ashley Palandra and I am a doctoral student in the Department of Counselling Psychology at the University of Brititish Columbia. This research study is being conducted in partial fulfillment of the requirements for my doctoral dissertation. My supervisor is Dr. Judith Daniluk.\u00E2\u0080\u009D \u00E2\u0096\u00AA \u00E2\u0080\u009CBefore we begin, I need to ask you a few questions to clarify whether or not you meet the criteria for participating in this study. 1. What is your current age? 2. During mid-life, and within the past 5 years, did you have a problematic relationship with food (such as dieting, restricted or excessive eating, self-induced vomiting, use of laxatives or diet pills, etc.)? 3. Did those eating behaviors continue for a period of a year of more? 4. In the past, have you ever been diagnosed with an eating disorder such as anorexia or bulimia? If the person is between 40 and 65 years of age I will proceed to question 2. If the person answers \u00E2\u0080\u009Cyes\u00E2\u0080\u009D to question 2 I will proceed by asking question 3. If the person answers \u00E2\u0080\u009Cyes\u00E2\u0080\u009D to question 3 I will proceed to ask question 4. If the person answers \u00E2\u0080\u009Cno\u00E2\u0080\u009D to question 4, I will proceed to describe the research purpose and process. If the person answers \u00E2\u0080\u009Cno\u00E2\u0080\u009D to either question 2, 3 or \u00E2\u0080\u009Cyes\u00E2\u0080\u009D to question 4, or is not between 40 and 65 years of age, I will thank them for their interest and tell them they don\u00E2\u0080\u0099t meet the criteria for the study. \u00E2\u0096\u00AA \u00E2\u0080\u009CIn order to help you to decide whether or not you are still interested in participating in this study, I\u00E2\u0080\u0099ll review the purposes and requirements of this research. You are welcome to ask questions at any time.\u00E2\u0080\u009D \u00E2\u0096\u00AA \u00E2\u0080\u009CThe purpose of this study is to learn about your experiences of having a problematic relationship with food during mid-life. We have lots of information about eating problems among younger girls and women \u00E2\u0080\u0093 particularly eating disorders such as anorexia \u00E2\u0080\u0093 but we have very little information about women in mid-life who have experienced problems with their eating, something that seems to be occurring more frequently in recent years. By beginning to understand your experience of having a problematic relationship with food \u00E2\u0080\u0093 what you feel triggered your eating challenges, what those challenges were like for you, and how you may have overcome those challenges \u00E2\u0080\u0093 other women and professionals will be able to learn from your stories and experiences.\u00E2\u0080\u009D \u00E2\u0096\u00AA \u00E2\u0080\u009CThe study will involve one confidential tape-recorded interview, lasting approximately 1.5 - 2 hours, at your home or at a private space on the UBC Campus in the Department of Counselling Psychology or another mutually agreed upon suitable location. During this interview, you will 243##have the opportunity to tell your story, in your own words, about having lived with the challenges of experiencing a problematic relationship with food.\u00E2\u0080\u009D \u00E2\u0096\u00AA \u00E2\u0080\u009CAfter I\u00E2\u0080\u0099ve completed the interviews, I will attempt to identify the common threads in the stories of the women in the study. I\u00E2\u0080\u0099ll then send you a copy of these common themes to read and review. A few weeks later we\u00E2\u0080\u0099ll meet again for a brief interview, during which time I would like to hear from you whether the common themes I\u00E2\u0080\u0099ve identified have accurately captured your experiences.\u00E2\u0080\u009D \u00E2\u0096\u00AA \u00E2\u0080\u009CYour participation in this study is voluntary and confidential. You can choose not to answer questions which you aren\u00E2\u0080\u0099t comfortable answering during the interview.\u00E2\u0080\u009D \u00E2\u0096\u00AA \u00E2\u0080\u009CDo you have any questions?\u00E2\u0080\u009D \u00E2\u0096\u00AA \u00E2\u0080\u009CAre you still interested in participating in this study? If so, I will send you a copy of the consent form either by mail or e-mail so you have time to read and review it before we meet. I will be happy to answer any questions you have about the consent form at that time. Can we now set up a time for the first interview?\u00E2\u0080\u009D 244## Appendix E: Informed Consent ## Faculty(of(Education#Vancouver#Campus#Educational#&#Counselling#Psychology,##And#Special#Education#2125#Main#Mall#Vancouver,#B.C.#Canada##V6T#1Z4##Phone#604982290242#Fax#604982293302#www.ecps.educ.ubc.ca##WOMEN\u00E2\u0080\u0099S EXPERIENCES OF HAVING A PROBLEMATIC RELATIONSHIP WITH FOOD DURING MID-LIFE Principal Investigator: Dr. Judith Daniluk, Professor (Supervisor) Department of Counselling Psychology University of British Columbia (604) 822-5259; judith.daniluk@ubc.ca Co-Investigator: Ashley Palandra, PhD Student Department of Counselling Psychology University of British Columbia (XXX) XXX-XXXX; xxxxx@xxx.xxx Purpose: This study is being conducted to explore the meaning and experience of having a problematic relationship with food for women in mid-life (i.e., between the ages of 40 and 65). The research is being conducted for Ashley Palandra\u00E2\u0080\u0099s doctoral dissertation. Study Procedures: This study will involve approximately 2 to 3 hours of your time: 1. Ashley will meet with you for one individual interview, and one validation interview totalling approximately two to three hours. You will have an opportunity to share your experiences of having a problematic relationship with food during mid-life. These confidential interviews will be tape-recorded. 2. After transcription, analysis, and interpretation of the confidential interviews, the co-investigator, Ashley, will identify and describe common themes that emerged from the interviews with all participants. Ashley will meet with you to discuss the results of the study during which time you will have an opportunity to review the common themes and provide feedback. Confidentiality: Any information resulting from this research will be kept strictly confidential. Both Dr. Judith Daniluk (supervisor) and Ashley Palandra (co-investigator) will have access to the research interviews. All transcribed interviews will be assigned a code number and kept in a locked filing cabinet. You will be assured confidentiality by having a specific code for your name. You will not be identified by the use of your own name or initials and your identity will be kept strictly confidential in any publication resulting from this research. The recordings and transcripts will 245##be destroyed five years after the research has been completed. You will be given a written copy of both the initial findings, and final write-up once the study has been completed. Potential Risks/Benefits: You may find that your participation in this study is a positive experience for you. Participants in this type of research study often appreciate the opportunity to tell their story \u00E2\u0080\u0093 without feeling judged. You may have a feeling of satisfaction in knowing that your involvement in the study may help other women who have had a problematic relationship with food, by increasing the understanding of mental health professionals working with mid-life women. It is also possible that recalling and reflecting on your experiences of having a problematic relationship with food may bring up some uncomfortable emotions. Should that happen during or following the interview, the co-investigator, Ashley, will be happy to provide the names of mental health professionals with whom you can speak. Renumeration/Compensation: There will be no monetary compensation for your participation. Contact for Information About the Study: If you have any questions or would like further information with respect to this study, you may contact Dr. Judith Daniluk at the Department of Counselling Psychology at (604) 822-5259. Contact for Concerns About the Rights of Research Subjects: If you have any concerns about your treatment or rights as a research subject, you may contact the Research Subject Information Line at the UBC Office of Research Services at (604) 822-8598. Consent: You have read the above information, and have had an opportunity to ask questions. Your participation in this study is entirely voluntary and you may refuse to participate or withdraw at any time without negative consequences. Your signature below indicates that you consent to participate in this study, and acknowledge receipt of a copy of this form. ______________________________________ ________________________ Signature of Participant Date ######246## Appendix F: Orienting Statement The following statement will be read by the researcher to all participants at the beginning of the first interview, after the consent form has been read, reviewed, and signed. The tape-recording will now be turned on\u00E2\u0080\u00A6 The purpose of this study is to learn about your experiences of having a problematic relationship with food during mid-life. We have lots of information about eating problems among younger girls and women \u00E2\u0080\u0093 particularly eating disorders such as anorexia \u00E2\u0080\u0093 but we have very little information about women in mid-life who have experienced problems with their eating, something that seems to be occurring more frequently in recent years. By beginning to understand your experience of having problematic relationship with food \u00E2\u0080\u0093 what you feel triggered your eating challenges, what those challenges were like for you, and how you may have overcome those challenges \u00E2\u0080\u0093 other women and professionals will be able to learn from your stories and experiences. In conducting this research, I am specifically interested in learning about your experiences of having a problematic relationship with food during mid-life, as well as how you understand and make sense of your experiences. The main question I would like to ask you is: \u00E2\u0080\u009CWhat was your experience of having a problematic relationship with food like for you and as look back now, how do you make sense of that experience?\u00E2\u0080\u009D You can begin anywhere you like in telling me about your experiences. Some people find it easier to tell it like a story with a beginning, middle and end. Please begin whenever you\u00E2\u0080\u0099re ready\u00E2\u0080\u00A6 247## Appendix G: Sample Interview Questions General Research Question \u00E2\u0080\u00A2 What is the meaning and experience of having a problematic relationship with food for women in mid-life? Opening/Ice Breaker Questions \u00E2\u0080\u00A2 Tell me a little about yourself so I can get to know you a little before we start talking about your experiences. Principal Interview Questions \u00E2\u0080\u00A2 What was your experience of having a problematic relationship like for you and as you look back now, how do you make sense of that experience? (Tell me your story about experiencing a problematic relationship with food.) Additional Interview Questions \u00E2\u0080\u0093 to be used to help deepen exploration if these topics are raised by the participants \u00E2\u0080\u00A2 How would you describe your relationship with food throughout your life and currently? \u00E2\u0080\u00A2 How does your experience of having a problematic relationship with food in mid-life compare to experiencing problems with your eating at an earlier life stage? \u00E2\u0080\u00A2 Based upon your experiences, how do you define a \u00E2\u0080\u009Cproblematic\u00E2\u0080\u009D relationship with food? (Probe: How do you know when you are experiencing a problematic relationship with food?) \u00E2\u0080\u00A2 What kinds of behaviours, thoughts, and feelings do you experience when you are experiencing a problematic relationship with food? \u00E2\u0080\u00A2 Looking back now, can you describe the time at which you remember starting to become aware of issues related to your body/food? (Probe: What was going on in your life at that time?) \u00E2\u0080\u00A2 Looking back now, how do you understand how you came to develop a problematic relationship with food during mid-life? \u00E2\u0080\u00A2 How did your experiences with having a problematic relationship with food affect your life \u00E2\u0080\u0093 in terms of your feelings about yourself, your relationships with others, etc.? \u00E2\u0080\u00A2 Can you identify any triggers that had an impact on your relationship with food or eating behaviours? \u00E2\u0080\u00A2 What were the most challenging aspects of experiencing a problematic relationship with food? \u00E2\u0080\u00A2 How would you describe your relationship with your body when you were experiencing a problematic relationship with food? 248##\u00E2\u0080\u00A2 How would you describe your relationship with your body/food now? \u00E2\u0080\u00A2 Can you describe a time when you had a less problematic relationship with your body/food? (Probe: What was going on in your life at that time?) \u00E2\u0080\u00A2 How would you describe the process you went through in returning to what feels like more \u00E2\u0080\u009Cnormal\u00E2\u0080\u009D eating and a less challenging relationship with food? \u00E2\u0080\u00A2 If you were to describe your experience with having a problematic relationship with food as a metaphor, what would that metaphor be? What would your metaphor be for your relationship with food now? (Same set of questions for relationship with the body). \u00E2\u0080\u00A2 In your opinion, how do you feel your relationship with food compares to other mid-life women you know? Questions Addressing Cultural Variables \u00E2\u0080\u00A2 How do you think aspects of your identity or culture (e.g., gender, race, ethnicity, religion, sexual orientation, disability) affected the development and your experience of having a problematic relationship with food? \u00E2\u0080\u00A2 How do you feel your experience of having a problematic relationship with food was impacted by your age and life stage? \u00E2\u0080\u00A2 How do you understand the role of culture in your experience of having a problematic relationship with food? (societal influences) \u00E2\u0080\u00A2 Do you think your relationship with food would be different if you were a man? Questions Addressing van Manen\u00E2\u0080\u0099s Existentials \u00E2\u0096\u00AA How were your relationships impacted by your experience of having a problematic relationship with food? (Lived human relation) \u00E2\u0096\u00AA In reflecting on your experiences with having a problematic relationship with food, were certain spaces/places important in your experience and if so, how were they important? (Lived space) \u00E2\u0096\u00AA Over the course of your experience with having a problematic relationship with food, were there changes in your experience over time? (Lived time) \u00E2\u0096\u00AA Looking back now, how did your body (and your relationship with your body) factor into your experiences of having a problematic relationship with food? (Lived body) Process Questions \u00E2\u0080\u00A2 What was this interview process like for you? \u00E2\u0080\u00A2 Is there something I didn\u00E2\u0080\u0099t ask you that I should have? 249##\u00E2\u0080\u00A2 If you were speaking to another mid-life woman who was experiencing having complicated relationship with food what advice would you give her based on your experiences? 250## Appendix H: Transcription Confidentiality Agreement Transcript Divas Canada: Transcription Confidentiality Agreement. THIS AGREEMENT (the \"Agreement\u00E2\u0080\u009D) is entered into on this ____day of ___________ by and between _________________( the \u00E2\u0080\u009CDiscloser\u00E2\u0080\u009D or \u00E2\u0080\u009D Disclosing Party\u00E2\u0080\u009D), and Andrew Dodson doing business as Transcript Divas Canada (the \u00E2\u0080\u009CRecipient\u00E2\u0080\u009D or the \u00E2\u0080\u009CReceiving Party\u00E2\u0080\u009D). The Disclosing Party have agreed to provide the Receiving Party with information which the Discloser considers to be confidential in nature (the \u00E2\u0080\u009CConfidential Information\u00E2\u0080\u009D) to enable the Receiving Party to provide transcription related services (the \u00E2\u0080\u009CPurpose\u00E2\u0080\u009D) to the Discloser. Confidential information includes but is not limited to information contained in audio and video recordings, as well as the transcriptions of audio and video recordings, originating from the Discloser or related parties and provided to the Receiving Party. In accordance with providing transcription services the Receiving Party agrees to: i. limit disclosure of any Confidential Information to its directors, officers, employees, agents or representatives (collectively \u00E2\u0080\u009CRepresentatives\u00E2\u0080\u009D) who have a need to know such Confidential Information in connection with providing the transcription services to which this Agreement relates, and only for that purpose; ii. advise its Representatives of the extremely private and confidential nature of the Confidential Information and of the obligations set forth in this Agreement and require such Representatives to sign similar legally binding confidentiality agreements. iii. not, during the term of the contracts, or after their completion, for any reason unless expressly authorised by the Discloser, or required by law, disclose to any unauthorized person, nor use, any Confidential Information relating to or received from the Discloser, its staff, or other related parties. The obligations of confidentiality and non-use will not apply with respect to any of the following: i. information which is generally available to the public; ii. information already known to the party at the time of disclosure; iii. information which is subsequently disclosed by third parties having no obligations of confidentiality; iv. information which is or becomes generally available to the public in printed publications in general circulation Internationally or in Canada through no act or default on the part of the parties or their agents, employees or professional advisers. The Receiving Party understands that the use and disclosure of all information about identifiable living individuals is governed by Canadian law. The Receiving Party will not use any personal 251##data acquired during work for any purpose that is or may be incompatible with the purposes specified in this agreement. That is the transcription of audio and video files into a typed format for the Discloser. The Receiving Party understands that it is required to keep all confidential and personal data securely. This means ensuring all electronic information is password protected by passwords only in use by the signatories\u00E2\u0080\u0099 of this agreement. The Receiving Party hereby undertake to ensure that all records provided or created for the purposes of this agreement, including any backup records, are passed back to the recipient or permanently deleted. Once the Receiving Party have received confirmation that the work the Receiving Party was contracted to do has been satisfactorily completed and all the required information has been provided in accordance with the Discloser wishes all remaining records will be deleted / and or destroyed. The Receiving Party understands that the discloser reserves the right to take legal action against any breach of confidence. The rights, duties and obligations of the parties and the validity, interpretation, performance and legal effect of this agreement shall be governed and determined by the laws of Canada and the parties hereby submit to the nonexclusive jurisdiction of the Canadian Courts. Miscellaneous: (a) This Agreement constitutes the entire understanding between the parties and supersedes any and all prior or contemporaneous understandings and agreements, whether oral or written, between the parties, with respect to the subject matter hereof. This Agreement can only be modified by a written amendment signed by the party against whom enforcement of such modification is sought. (b) The validity, construction and performance of this Agreement shall be governed and construed in accordance with the laws of Ontario (state) applicable to contracts made and to be wholly performed within such state, without giving effect to any conflict of laws provisions thereof. The Federal and state courts located in Ontario (state) shall have sole and exclusive jurisdiction over any disputes arising under the terms of this Agreement. (c) Any failure by either party to enforce the other party\u00E2\u0080\u0099s strict performance of any provision of this Agreement will not constitute a waiver of its right to subsequently enforce such provision or any other provision of this Agreement. (d) Although the restrictions contained in this Agreement are considered by the parties to be reasonable for the purpose of protecting the Confidential Information, if any such restriction is found by a court of competent jurisdiction to be unenforceable, such provision will be modified, rewritten or interpreted to include as much of its nature and scope as will render it enforceable. If it cannot be so modified, rewritten or interpreted to be enforceable in any respect, it will not be given effect, and the remainder of the Agreement will be enforced as if such provision was not included. 252##(e) Any notices or communications required or permitted to be given hereunder may be delivered by hand, deposited with a nationally recognized overnight carrier, electronic mail, or mailed by certified mail, return receipt requested, postage prepaid, in each case, to the address of the other party first indicated above (or such other addressee as may be furnished by a party in accordance with this paragraph). (f) Paragraph headings used in this Agreement are for reference only and shall not be used or relied upon in the interpretation of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first above written. Disclosing Party By (Signature): Printed Name: Title: Date: Receiving Party By (Signature): Printed Name: Title: Date: 253## Appendix I: Referral List If you feel you may require further support following participation in this research study, various community resources are available for you to access. Below is a list of some of the resources that may be of interest. 1) Oak Counselling http://oakcounselling.org/ 2) Family Services of Greater Vancouver http://www.fsgv.ca/programpages/counsellingsupportservices/counsellingprogram.html 3) New Westminster Counselling Centre http://ecps.educ.ubc.ca/cnps/new-westminster-counselling-clinic 5) Kelty Mental Health Resource Centre www.keltymentalhealth.ca 5) British Columbia Clinical Counsellors\u00E2\u0080\u0099 Association www.bc-counsellors.org "@en . "Thesis/Dissertation"@en . "2015-05"@en . "10.14288/1.0166151"@en . "eng"@en . "Counselling Psychology"@en . "Vancouver : University of British Columbia Library"@en . "University of British Columbia"@en . "Attribution-NonCommercial-NoDerivs 2.5 Canada"@en . "http://creativecommons.org/licenses/by-nc-nd/2.5/ca/"@en . "Graduate"@en . "A phenomenological analysis of mid-life women\u00E2\u0080\u0099s challenges in their relationships with food"@en . "Text"@en . "http://hdl.handle.net/2429/52717"@en .