Eating disorders are usually associated with teenagers and young adults, but new research finds that they’re also a problem in older women.
The study, which was published in the journal Menopause, analyzed data from more than 35 participants who participated in a larger clinical trial. The researchers found that body dissatisfaction—both shape and weight—was a big reason why the women, who were 45 to 61, developed disordered eating habits.
The researchers also discovered that women going through perimenopause (the phase before menopause) and women who were just past menopause were more likely to say that they were afraid to gain weight or felt that they were losing control of their eating habits.
Betsy Brenner, author of The Longest Match: Rallying to Defeat an Eating Disorder in Mid-Life, knows this fear first-hand. Brenner says she was diagnosed with anorexia in her mid-40s after asthma made her constantly sidelined from playing tennis.
“It was the perfect storm,” she says. “I was diagnosed with pretty severe asthma and it felt out of control.” Brenner, who played Division I tennis in college, says she had recently gotten back into playing the sport. “I developed this intense fear of gaining weight and my asthma would take me off the court—it created a lot of anxiety.”
But it wasn’t until her doctor noticed that she had lost about 10 pounds off her already small frame that she underwent further testing that resulted in a diagnosis of anorexia. “I was consumed by thoughts about food and exercise all day, every day,” recalls Brenner. “But I was very functional. I didn’t realize I was headed down a dangerous path.”
Brenner says she was “shocked” by her diagnosis. “I remember thinking, I’m in my 40s. How can I have anorexia?” Brenner ended up learning more about the condition and its connection with her mental health. She started seeing a registered dietitian for nutritional therapy, along with a therapist for cognitive behavioral therapy who specializes in eating disorders. “I had several years of having that safe space to allow myself to be vulnerable,” she says.
Brenner says she’s now “able to be fully present,” adding that she’s “worked really hard to disconnect food and exercise.” She also volunteers with the National Association of Anorexia Nervosa and Associated Disorders (ANAD) to help others going through a similar journey.
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Unfortunately, Brenner isn’t alone. Research shows that about 3.5 percent of women over the age of 40 have an eating disorder. However, real numbers may be even higher: One study published in BMC Medicine found that about 15 percent of 5,500 women surveyed met the criteria for an eating disorder in midlife. “It’s a group of people we see frequently clinically and that are underrepresented in research and discussion about eating disorders,” says Rebecca Boswell, Ph.D., supervising psychologist for the Penn Medicine Princeton Center for Eating Disorders.
Experts break down what’s behind this—and how to spot the signs of disordered eating in yourself.
It’s difficult to say why any one person may develop an eating disorder in midlife, but experts say there are a few elements that could be at play. One is expectations on how women should look in middle age. “Middle-aged women often face societal pressures related to beauty standards and aging,” says Sanam Hafeez, Psy.D., a neuropsychologist and director of Comprehend the Mind. “The emphasis on youthfulness and a particular body image can lead to body dissatisfaction and an increased risk of developing eating disorders.”
Women who are perimenopausal and menopausal may also face changes to their bodies that they’re uncomfortable with, says Deborah Cohen, R.D.N., an associate professor in the department of clinical and preventive nutrition sciences at Rutgers University School of Health Professions. “The hormonal changes that occur between perimenopause and post-menopause can cause significant changes in weight, body composition, and body fat distribution.”
Doctors may also just be picking up on the signs of disordered eating more, Boswell says. “Our ability as providers—including eating disorder specialists and generalists—to assess and diagnose eating disorders has greatly improved over the past several decades,” she says. “Our understanding of eating disorders has also expanded to include a variety of disordered behaviors—restriction, binge eating, compensatory behaviors—and alterations in thinking—fear of weight gain, fear around eating—which has the effect of helping more people get diagnoses and appropriate treatment.”
Seeing fit celebrities like Jennifer Lopez and Halle Berry breeze through mid-life with six-pack abs also doesn’t help, says Debra Benfield, R.D.N., a nutritionist and body coach. “We have increased pressure about how we perceive aging women’s bodies,” she says. “We’re subject to more criticism and pressure to stay the same over time.”
There are a lot of different eating disorders, and the symptoms for each can be slightly different. In general, Boswell says that the symptoms of eating disorders tend to be consistent between younger and older women.
“Someone with an eating disorder may have obsessive thoughts related to their body shape, weight, and food, in addition to an impaired ability to function due to extremes with calorie intake, binging, purging, and exercising,” Cohen says.
But treatment may be different for older women versus their younger counterparts. “Many people with eating disorders in middle age have struggled with their eating disorder for a long time and have had multiple previous treatment episodes,” Boswell says. “With children and teenagers, eating disorder treatment aims to be very aggressive to help their growing brains and bodies be appropriately nourished for their time-sensitive developmental needs. For middle-aged adults, sometimes treatment is individualized based on their clinical history, specific treatment goals, and aims to improve quality of life.”
It can be difficult to spot the signs of an eating disorder in yourself, but Benfield says there are a few things to have on your radar:
- You have obsessive thoughts about food
- You’re irritable
- You feel edgy
- You feel colder than usual
- Your appetite is off
Acknowledging that you’re struggling with an eating disorder can be hard, but Cohen says it’s crucial to seek help quickly. “Early intervention and treatment are crucial,” she says. “Inpatient facilities are few and far between and very expensive—the average runs about $30,000 to $40,000 a month. Outpatient facilities are more feasible for most folks and much less expensive—about $7,000 to $10,000 a month—but treatment availability largely depends on geographic location.”
Boswell recommends reaching out to a professional for guidance, and that can start with your primary care physician. “People with eating disorders benefit most from the support of a specialized eating disorder treatment team composed of a medical provider, a therapist, and a dietitian,” she says. “Starting with one team member can help you figure out the level of support you might benefit from.”
It is always possible to recover from an eating disorder. “It’s never too late to be a work in progress,” Brenner stresses. “You can move forward and continue to become healthier in mind, body, and spirit.”
Before you go, check out these motivational quotes to reshape your mindset about food.
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