Eating Disorders in Midlife and Beyond
Reviewed by Margo Maine, PhD, FAED, CEDS
There is no age limit to disordered eating. Despite the damaging stereotype that eating disorders are a “teenager’s problem,” research shows that rates of eating disorders and body dissatisfaction occurring later in life are on the rise.1,2,3,4 Studies have found that among older adults aged 40 and above between 2-7.7% of women and approximately 1% of men meet the diagnostic criteria for an eating disorder.5 These prevalence rates are even higher for individuals who are experiencing disordered eating and body image issues but do not meet the diagnostic criteria for an eating disorder. For example, studies have found that 13% of women 50 years old and above and 7% of men aged 40 and above experience at least one current symptom of an eating disorder.3,5,6 Another notable study found that 73% of midlife women experience dissatisfaction with their weight which is a significant risk factor for the development of an eating disorder.6 Although the exact symptoms of eating disorders do not differ much from eating disorders at a younger life stage, the context can be drastically different.
Some older adults who suffer from an eating disorder have struggled since youth and have never recovered; others have recovered at some point then relapsed later in life. Some have had food and body image issues for years but were never incapacitated by them until now. While others, faced with the challenges of aging in our youth-obsessed world, develop rituals related to diet, exercise, and appearance for the first time in their lives, which can lead down the slippery slope of an eating disorder.3,7
How Are Eating Disorders In Mid-Life And Beyond Different?
Triggers to eating disorders and body image issues in older adults tend to differ and are often correlated with life-stage-specific events. Risk factors for the development of eating disorders and body image issues in mid-life and beyond can include:
- Pregnancy and childbirth.3,6
- Divorce or other partner relationship issues (i.e. infidelity).6
- Menopause. Similar to puberty, the hormonal and physical changes (i.e. weight gain) that occur during menopause have been found to be a period of high risk for the recurrence of an eating disorder or the development of body dissatisfaction, disordered eating, and the initial onset of eating disorders.3,6
- Natural signs of aging and the resulting anxiety that aging can create due societal pressures which equate youthfulness with beauty have been found to increase the risk of body dissatisfaction and disordered eating.2,8
- Death of a loved one or widowhood.7
- Illness of a loved one.7
- Personal experience of illness.6
- Retirement.7
- Empty nest.6
- Becoming a grandparent.6
- Aging parents.6
- Moving residences.7
Despite the fact that eating disorders are largely experienced the same way regardless of age, there are some differences for people at mid-life and beyond. For example older adults often can experience:
- Shame and embarrassment for having a “teenager’s problem.”3,6
- Greater awareness of what they have lost due to their eating or body image issues.9
- After living with an eating disorder for many years of their life, older adults may come to think of their disorder as part of their identity and have more rigid or entrenched eating disorders.6
- More obstacles to treatment due to other responsibilities (i.e. being a caretaker of a child and an elderly parent).6
- Increased anxiety about appearance/ health due to the natural aging process9
- Multiple stressors and losses that accompany adult development.6
- The lack of awareness and screening for eating disorders in older adults by medical professionals.6
Age-Related Complications
Older bodies often have less ease in bouncing back from an eating disorder, and gastrointestinal, cardiac, bone and even dental effects of eating disorders can worsen as people mature. Furthermore, older adults who have a long history of eating disorders often experience more severe and enduring health consequences later in life. One unique health complication for older adults with eating disorders is the rapid decline of cognitive functioning due to restrictive dieting and weight loss. Indeed, studies have found that weight loss during midlife and beyond increases the rate of cognitive impairment and can be a key risk factor in helping to identify eating disorders in older adults. Given the prevalence and serious consequences of eating disorders during midlife, it is vital that clinicians and medical professionals be aware that eating disorders occur at any age, identify factors that increase the risk of developing an eating disorder during midlife and screen their patients regardless of their age.6
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Sources
[1]Jenkins, P. E., & Price, T. (2018). Eating pathology in midlife women: Similar or different to younger counterparts?. The International journal of eating disorders, 51(1), 3–9. https://doi.org/10.1002/eat.22810
[2] Goodman, E. L., Baker, J. H., Peat, C. M., Yilmaz, Z., Bulik, C. M., & Watson, H. J. (2018). Weight suppression and weight elevation are associated with eating disorder symptomatology in women age 50 and older: Results of the gender and body image study. The International journal of eating disorders, 51(8), 835–841. https://doi.org/10.1002/eat.22869
[3] Maine, M. (2016). Pursuing Perfection: Eating Disorders, Body Myths, and Women at Midlife and Beyond. London: Routledge.
[4] Maine, M. (2005).The Body Myth: Adult Women and the Pressure to be Perfect. New Jersey: Wiley.
[5]Mangweth-Matzek, B., Kummer, K. K., & Hoek, H. W. (2023). Update on the epidemiology and treatment of eating disorders among older people. Current opinion in psychiatry, 10.1097/YCO.0000000000000893. Advance online publication. https://doi.org/10.1097/YCO.0000000000000893
[6] Samuels, K. L., Maine, M. M., & Tantillo, M. (2019). Disordered Eating, Eating Disorders, and Body Image in Midlife and Older Women. Current psychiatry reports, 21(8), 70. https://doi.org/10.1007/s11920-019-1057-5
[7] Runfola, C., Baker , J., & Bulik , C. (2018). Midlife-onset eating disorders. In L. K. Anderson, W. H. Kaye, & S. B. Murray (Eds.), Clinical Handbook of Complex and atypical eating disorders (pp. 363–383). Oxford University Press.
[8] Carrard, I., Argyrides, M., Ioannou, X., Kvalem, I. L., Waldherr, K., Harcourt, D., & McArdle, S. (2021). Associations between body dissatisfaction, importance of appearance, and aging anxiety with depression, and appearance-related behaviors in women in mid-life. Journal of women & aging, 33(1), 70–83. https://doi.org/10.1080/08952841.2019.1681882
[9] Midlarsky, E., Marotta, A. K., Pirutinsky, S., Morin, R. T., & McGowan, J. C. (2018). Psychological predictors of eating pathology in older adult women. Journal of women & aging, 30(2), 145–157. https://doi.org/10.1080/08952841.2017.1295665
