Expert: Ryan Hale - 1/18/2010

Question
My mother-in=law, 84 years old, starting chewing her food and then spitting it out, claiming she couldn't swallow.  Every possible test has been done and there is no physical reason she can't swallow.  she has gone form 250 lbs to 85 lbs over 5 years.  Someone told us this is an eating disorder described as cupping.   Have you ever heard of this???  Is it an eating disorder??  Can you suggest any reading material??  Thank you, Nancy Enos

Answer
Nancy- the only form of "cupping" I am familiar with is a technique used as a form of therapy in holistic medicine and does not have anything to do with eating disorders.  I can say that eating disorders are on the rise in the elderly, especially if they are in a nursing home or hospital setting.  The most common form is simple food refusal, which spitting food out could be a form of.  Usually, the often cited reasons for an eating disorders such as body image, don't apply to the elderly.  Most often, the behavior is a plea for help or attention or is used as a form of protest (such as being placed in a nursing home).  

Some issues that are common to eating disorders for any age are depression or anxiety.  These should be considered in the older populations as well, as depression is very under-treated in the elderly.  Look into aspects of their psychosocial lives for clues, especially if there have been major life changes or loss of a partner in the past.

Chewing and spitting out food is common in eating disorders in younger individuals.  Older folks may claim to be full, not hungry, that they don't feel well, or that they forgot to eat.

Make sure they are seeing a geriatric specialist if possible rather than a generalist, as they may be more in tune with the processes of someone older.  Also, see about mental health services (especially someone specializing in the elderly).  Good luck with this.  Sorry I'm can't be more help.