If I asked you to close your eyes and picture someone with an eating disorder, who would you see?
Most people conjure an image of a younger person, maybe in high school or college. Yet this is hardly the whole story.
The assumption is that individuals struggle with their body image as they undergo the changes that come with puberty, and that these issues will subside with age. While younger people are at a higher risk for developing eating disorders, others across the age spectrum are not immune. In fact, women over the age of 45 account for almost 25% of hospital admissions for eating disorders.
Risk Factors in Middle Age
There are a variety of social, emotional, and biological stressors that may lead to body dissatisfaction or changes in eating behavior later in adulthood.
This distinct set of environmental and physical factors includes, for example:
- Career or other role transitions
- Divorce or separation
- Experiences of grief or loss
- Physical/personal illness or injury
- Body shape and/or weight changes during perimenopause and menopause
During menopause, women may experience a redistribution of fat throughout the body, weight changes, sleep disruption, and mood fluctuations. These and other effects of menopause start during a period of perimenopause. They are a result of hormonal changes, namely in estrogen levels. Scientific research indicates that this transition is associated with an increased risk of negative body image, and eating disorders.
In fact, the life and physical changes experienced during middle age may be equally significant to those experienced during adolescence. Many women experience a worsening of body satisfaction during menopause. For some, this can become associated with extreme or unhealthy changes in eating behavior and exercise, or overconcern with weight and/or body shape.
Unique Challenges and Consequences of Eating Disorders in Older Adults
As described elsewhere on The Feed, eating disorders take a toll on the body at any age. Insufficient nutrition can lead to nutrient deficiencies, loss of bone density, hormone changes, challenges to heart health and brain health, and effects on oral health. Fortunately, most of these physical effects reverse with renourishment and recovery.
The notable exception to this is bone health. Younger people with a history of low weight who have since recovered can experience consequences to their bones nonetheless, especially relative to their peers.
Conversely, for everyone, bone density decreases as a normal part of the aging process. Postmenopausal women, and men over 70, are already at risk for osteoporosis and osteopenia. When the expected decline in bone density intersects with the additional insult of significant nutrient deficiency and weight loss, injury and osteoporosis risk can increase exponentially.
Other bodily systems are also less resilient with age. This may mean, for example, that the cardiac effects of malnutrition or purging behaviors can become even more dangerous for older adults. Poor nutrition is also associated with dermatological effects. Poor skin health – including the development or deepening of wrinkles or the inability for wounds to heal – can be more extreme in older individuals with anorexia nervosa.
In sum, eating disorders do not discriminate by age. Left untreated, eating disorders in middle age can be especially dangerous. More research is needed to better understand the experiences of older individuals with eating disorders. And more education is needed to help providers remember to screen for these problems across the lifespan.
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