Eating Disorders & Older Women

Woman binge eating food

Anorexia, bulimia nervosa and binge-eating disorder (BED) cases go beyond afflicting females during their teens and young adulthood. These collective eating disorders (EDs) are becoming more surprisingly commonplace among older women in midlife, according to some reports:

  • The Renfrew Center, which specializes in treating EDs, recently noted a 42% increase within a decade in women 35+ years pursuing treatment.
  • A 2012 study in the International Journal of Eating Disorders estimates that 13% of U.S. women 50+ have eating disorder symptoms, slightly more than the percentage diagnosed with breast cancer.
  • Research shows though rates of anorexia peak at about age 26, the rates of bulimia don’t become the highest until nearly age 47 and rates of BED don’t achieve highest level of incidence until women are in their 70s.
  • research shows up to 15% of midlife women have an ED.
  • Eating disorders are among the deadliest mental illnesses, second only to opioid overdose.
  • 10,200 deaths each year are the direct result of an ED —that’s 1 death every 52 minutes.
  • About 26% of those with EDs attempt suicide.
  • EDs have the highest mortality rates of any psychiatric illness, yet research points out only 27% of those afflicted seek professional help.

These findings may be attributed to several factors:

  • First and foremost, older women face many stresses and pressures that derive from varying fronts: in the workplace where youthful appearances may be associated with competitiveness and job capability; on the family frontline where many older women act as dual-generation caregivers to both aging parents and their young adult children, which then may induce changes within their marital and family relationships.
  • Another factor affecting ED in women could be everchanging hormones accompanied by physical changes and natural aging progression women experience from childbearing to and beyond menopausal years.
  • And lastly, emphasis on societal and cultural messages which depict desire for youth and vitality through repeated representations of thinness and physical beauty.

Add to these pressures those associated with the COVID-19 pandemic:

new survey of people with eating disorders in the U.S. and the Netherlands disclose a sharp increase in food restriction among those with anorexia and anxiety about finding foods consistent with prescribed meal plans. Those experiencing bulimia and BED reported noted increase in bingeing food behaviors.

These pressures, coupled with feelings of stigma and embarrassment to seek treatment due to age, makes ED diagnosis and subsequent treatment among older women a legitimate health concern nationwide.

March 2 through March 8 is designated National Eating Disorders Awareness Week. Your Capital Women’s Care team wishes to share important information about symptoms and behaviors associated with eating disorders pertaining to older women and how these conditions can jeopardize both physical and mental health during women’s adult years.

Eating Disorders at Midlife

Eating disorders are mental health conditions that usually require treatment. They can also be damaging to the body if left untreated.

Like younger women, older women can become afflicted with the primary eating disorders:

However, women during midlife are prone to experiencing differing behaviors often associated with the 3 primary eating disorders, blurring the lines for distinctive diagnoses.

The most frequently seen eating disorder in adult women is otherwise specified feeding and eating disorder (OSFED), which is a combination affliction of anorexic symptoms and bulimia.

Another indicative ED affecting midlife women is atypical anorexia, where women restrict food intake for days. This ED type can drastically slow the body’s metabolic rate, which occurs to protect the body and ward off and ultimately defend it against starvation.

A Lingering Health Issue

Data suggests only about 5% to 10% of women who develop an eating issue are afflicted for the first time as adults, meaning ED has been a potential health issue for years or even decades in afflicted older women.

Studies suggest most women with EDs were in treatment during adolescents, exhibited slight ED symptoms not medically addressed previously or had ED issues resurface after treatment during subsequent adult years. Many older women suffer ED symptoms for years, suffering persistent illness and low, but not alarming, bodyweight; off and on yo-yo dieting; compulsive eating, calorie counting and/or compulsive exercise behaviors; and nuanced, unnoticed intermittent ED behaviors they determine not to address with their healthcare professionals.

ED Contributing Factors

There are some eye-opening statistics concerning ED risks as they pertain to older women. A study by Gagne et al., 2012 notes these following statistics:

  • on average a woman is most dissatisfied with her body at age 54.
  • 79% of women age 50+ may feel body weight/shape plays a moderate to extreme role in self-perception.

Common genetic and cultural factors make some older women more susceptible to ED just as young women within their teens or 20s who also become afflicted.

The physiological and psychological changes that happen during menopause seem to echo similar changes which occur at puberty, sparking depression and anxiety (both of which sharply increase ED risk) which may make menopause with its potential accompanying hormonal shifts a high-risk period for the development of new EDs or  reemergence of a previous ED health issue in older women. A 2013 Austrian study in the International Journal of Eating Disorders found that women in perimenopause—the roughly 4- to 8-year window that typically occurs during a woman’s 40s—were more likely than either premenopausal or postmenopausal women to succumb to EDs.

According to scientific data, personality traits of perfectionism and sensitivity account for more than 50% of increased ED risk. Experts state 28% to 74% of risk for EDs is through genetic heritability.

While factors such as media, relationships, and cultural expectations may change with age, they can still be enormous sources of stress and contribute to body dissatisfaction and disordered eating. Environmental factors like obsessive messages promoting thinness and youth or enduring personal crises and shifting responsibilities and their subsequent resulting stresses can also increase ED risk.

These factors combine with renewed concerns about weight and appearance frequently emerge alongside stressors unique to the 50+ age bracket:

  • As more women have positions of power and visibility within the workplace, the effects of aging are on full display. Appearing youthful and thin can seem critical to staying competitive on the job.
  • Their parents begin to age, requiring them to move in with adult children or nursing facility.
  • The aging body (metabolic changes, skin changes and changes in fat distribution) within a society idealizing youthfulness and thinness.
  • The societal expectation older women should care for others before taking care of themselves.
  • Divorce/separation and the fear of being alone, while messages from the media tell women that being thin is the road leading to love and success.
  • The empty nest (when children leave the home) and the struggle to redefine identity; when no longer in the clearly defined role of “mother,” women may turn to health or appearance to initiate a new sense of identity and purpose.
  • The death of a parent and the struggle to manage grief, feelings of shock and new responsibilities.
  • Unexpected or chronic illnesses and changes in the body that can impair self and perceived body image.

Older women, including those into their 70s and 80s, may become afflicted. Causes may include:

  • lack of acceptance of aging
  • isolation or loneliness
  • depression
  • or not being in control of personal choices due to required nursing home care or having to live with adult children due to economic reasons.

EDs Severely Impact Overall Health

Experts state a lifetime of ED issues, especially if left untreated, can have severe impact on both physical and mental health as well as longevity and quality of life.

EDs affect all the body’s organs and systems, from the heart to hormones.

Lack of proper nourishment lowers blood pressure, sometimes to dangerous levels, and estrogen, which can trigger bone loss, thus increasing risk of osteoporosis.

As the brain consumes up to one-fifth of the body’s calories, simple thinking processes and concentration can suffer.

Purging can lower the body’s electrolytes, leading to heart arrhythmias and even heart failure.

Older women with eating disorders may have even more problems:

Left untreated, ED is dangerous especially to those who are older, as it can lead to or worsen:

Most important, ED can be a true threat to your life. One report found between 2008 and 2009, people age 45+ accounted for 25%, or a full one-quarter, of overall ED hospitalizations.

Recognizing EDs

EDs may go unrecognized within older female populations because it’s most obvious symptom of weight loss can indicate several health issues. In addition to weight loss, women may be embarrassed to discuss potential ED issues with their healthcare provider, thus avoid voicing concern.

Other recognized symptoms of ED include:

  • dramatic weight fluctuations – also called weight cycling, where an individual loses weight and gains it back repeatedly.
  • constant dieting, weight fixation and problems eating in front of others. Some may outright refuse to eat certain food groups or with others at mealtimes, often by making excuses for not joining in for meals.
  • other mental health issues, such as depression or anxiety. These issues can magnify each other and contribute to isolation, which is another exacerbating factor contributing to ED affliction.

Treatment Options

Many middle-aged and older women may be ambivalent or unsure about seeking help due to stigmas surrounding EDs occurring later in life. ED recovery is always possible, especially in a treatment program addressing the specific needs and challenges uniquely faced by older women.

Treatment for eating disorders among middle-aged and older women usually involves:

  • nutrition education
  • in-patient/outpatient treatment facility
  • psychotherapy
  • therapy with their significant other -- educates couples about ED recovery process and teaches effective communication skills so they can be on the same page regarding goals.
  • psychoeducation
  • and acceptance.

In therapy, women learn about the aging process, such as metabolic changes occurring in women throughout their lifetime. Therapy also supports older women to identify the ED source and redirect attention toward personal inner growth, including learning to prioritize the practice of self-care and identification of positive personal achievements. Ultimately, therapy for EDs in older women strives to develop within those women afflicted a deep sense of acceptance for the varying changes occurring to their body throughout their lifetime.

Organizations like ANAD and NEDA also offer helplines and resources to figure a way forward, including NEDA’s online screening tool.

If you think you may have an ED or are experiencing ED symptoms, contact your local Capital Women’s Care team for a confidential evaluation and treatment initiation plan. Our caring, empathetic family of healthcare professionals are there for you with comprehensive care and expertise spanning all treatment disciplines to devise a cohesive, individualized plan to help you achieve optimal health and quality of life.

Sources:

https://www.prevention.com/health/health-conditions/a34634228/eating-dis...
https://balancedtx.com/blog/eating-disorders-in-older-women
https://www.cdc.gov/aging/pdf/mental_health.pdf
Gagne DA, Von Holle A, Brownley KA, et al. Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: results of the Gender and Body Image (GABI) study. Int J Eat Disord. 2012;45:832-844.
https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.22030
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