Middle-Aged Women and Eating Disorders

Stereotype of Eating Disorders

Eating disorders are commonly stereotyped, depicted to affect primarily young, adolescent females.  However, nothing could be farther from the truth as the eating disorder shadow knows no boundaries or limitations.  In reality, eating disorders can impact individuals across the life cycle, including males and females, young and old and everyone in between.  Largely in part to the media’s role in our society, eating disorders have long been portrayed as something that is partial to teenage females, but the truth of the matter is that eating disorders do not play favoritism when it comes to selecting their victims.  Eating disorders are not partial to any age, race, or ethnicity, as we have observed these diseases unfold.

One population in particular that seems to suffer silently in the shadows is women who are in their middle-aged to older years.  Women in this age range experience vulnerabilities in life just as adolescents and can be even more prone to developing an eating disorder as a coping mechanism through any of life’s difficulties.

A study from the University Of North Carolina School Of Medicine revealed the severity of this reality.  In a research effort that reached almost 1,900 women from the across the U.S. , researchers found that in women aged 50 and over, 3.5% reported binge eating, nearly 8% reported purging, and more than 70% were attempting to lose weight [1].  The study also discovered that a startling 62% of women had claimed that their weight or shape negatively affected their life, and two-thirds of the women reported being unhappy with their overall appearance [1].  Participants in this study had an average age of 59 years old.

These statistics exemplify the realism of eating disorders and the ability of these diseases to strike at any point in a man or woman’s life.  What can be said or done about information such as this?

Lead researcher of this study, Dr. Cynthia Bulik, noted the need for greater attention and focus on women in this age range stating, “The bottom line is that eating disorders and weight and shape concerns don’t discriminate on the basis of age.  Health care providers should remain alert for eating disorder symptoms and weight and shape concerns that may adversely influence women’s physical and psychological wellbeing as they mature.”

It is crucial that as a society, we break the stereotypes that circulate about eating disorders.  The truth of the matter is that many individuals are suffering with these terrible diseases, and every person, regardless of gender, age, race, or ethnicity, is needing and deserving of the treatment and resources required to discover healing and recovery.  When we begin to break these types of stereotypes, we break down walls that may have been preventing someone from reaching out for help.

Risk Factors for Middle-Aged Women

In general, an eating disorder is rarely the result of one isolated event or life situation. Certain factors can contribute to the development of an eating disorder, such as genetics, dieting, perfectionism, trauma, or the influence of media. However, the development, re-appearance or escalation of an eating disorder in midlife is thought to be triggered by drastic or unexpected life transitions. These catalysts can include:

• Divorce/Separation:  Divorce or separation, regardless of the whys behind it, is a difficult transition time. Women may struggle with fears of spending the remainder of their lives alone. Returning to the world of dating may cause extreme anxiety and insecurity. After all, everyday women are confronted with media messages telling them that females must be rail thin to achieve success and receive love. Under such an onslaught, a woman’s self-esteem diminishes, while her body dissatisfaction escalates. In order to achieve a younger, thinner, and more desirable body, she may turn to extreme measures to lose weight. Her dieting and/or exercising could easily get out of control.
• Aging body:  Clearly, the American culture is obsessed with youth, which places extreme pressure on women as they age. Fountain of youth fixes such Botox injections, fillers, and cosmetic surgery are a multi-million dollar industry. Remaining slender is part of this youth obsession, even though it’s abnormal for women over 30 to have the same bodies as they did at 18. The necessity to maintain a certain weight is particularly critical when a woman’s identity and self-esteem is wrapped up in her appearance. This may galvanize her to seek a thin, youthful body through unhealthy behaviors, such as food restriction, diet pills, extreme exercise, illicit drugs, laxatives, or even purging.
• Empty Nest:  Children leaving home can prove highly traumatic for some mothers. This is especially true when a woman is defined by her children and her primary identity is that of being a mother. Without children to validate her role as a mother, she may feel worthless. Focusing on appearance, diets, health, and exercise can fill that empty space and provide new identity.
• Parent’s Death:  The illness or death of a parent has a profound effect on adult women especially when the death is sudden and the woman is not prepared for the loss. Some women may feel unable to manage the feelings of sadness, grief or shock. Some may feel unable to meet the demands of adulthood in the midst of their loss. For predisposed women, an eating disorder may develop or re-emerge as a means to cope with the intense feelings associated with the death of a loved one. Eating disorders may also provide these women a way to escape from real-life responsibilities, which persist in the face of life’s ups and downs.
• Unexpected Illness:  No one is immune to illness. A disease such as breast cancer can result in a drastically impaired body image and difficulty accepting an altered shape. A woman may turn to extraordinary weight loss to reclaim lost youth or reshape her body.

 

How Does Body Image Affect Women

In general, body image and eating issues are perceived to be the preserve of younger women; however, recent research suggests that this is not the case. Indeed, it has been shown that fifty-four is, in fact, the age at which the average woman is least satisfied with her body [2].

Most women in midlife rate their ideal figure as smaller than their actual size and want to be thinner even when they are within the healthy weight range.  The literature suggests that appearance is just as important to “self-concept” – or how women view themselves and their worth – in 35 to 65-year-olds as it is to those in younger age groups [2].

Given that women in midlife experience significant alterations in their bodies, including an average weight gain of 5-10lbs, skin changes such as sagging and wrinkling, and changes in fat distribution, it is perhaps not so surprising that so many develop body image concerns at this stage or that inpatient admissions for eating disorder treatment in women aged 35 and over are increasing [3,4].

How Prevalent Are Body Image Concerns in the Middle-Aged Population?

One large study showed a very high prevalence of body image dissatisfaction amongst women aged 50 and over [4]. Of the participants:

• 71% were currently trying to lose weight
• 79% felt that weight or shape played a “moderate” to “the most important” role in their self-concept
• 70% were dissatisfied with their weight and shape compared to when they were younger
• 84% were specifically dissatisfied with their stomachs [4]

Those with a high body mass index had greater weight dissatisfaction whilst those with a low body mass index expressed a greater dissatisfaction with their skin [4].

Other research has found that obese women have endorsed the greatest body image dissatisfaction and disordered eating compared to normal weight and overweight midlife women, with overweight and obese women in their midlife being subjected to increased societal prejudices.  

Compared to normal weight midlife women, overweight and obese women are often perceived to be further from Western society’s thin ideal female body.  

Common forms of disordered eating among midlife women include but are not limited to food restriction, calorie counting, chronic dieting, extreme exercise and more.  

In biologically susceptible women, disordered eating can lead to the development of a pathological and chronic eating disorder, such as anorexia, bulimia and/or binge eating disorder.

What Makes One Woman Develop Body Dissatisfaction Whilst Another Does Not?

Not all middle aged women are dissatisfied with their bodies, however. Factors which are protective include:

• Being in a consistent relationship
• Being in a Long-term relationship
• Having children
• Having job security [2]

It has been suggested that these factors combine to divert women’s attention from their body image and reduce the pressure which they perceive to attain the “thin ideal” [2].

This is in contrast to a woman in midlife who has not yet found a partner, for example, and who therefore feels compelled to stay thin and, by social extension, attractive. Furthermore, a factor referred to as “cognitive control,” or “The ability to accept circumstances as they are and adjust the self to fit in with the environment has been identified as being important [2].”  A woman who has high cognitive control is able to reappraise and accept her changing body as she enters middle age.

The Importance of Self-Care

Self-care has also been shown to be an important indicator of whether a middle-aged woman will experience body image concerns. For example, women who make time for themselves regularly, and take care of their own needs without feeling guilt have lower levels of body image concern and less disordered eating than women who do not take time to care for themselves [2].

Caring for the body may be incompatible with body dissatisfaction which often leads to food deprivation. It turns out that low self-care is associated with a higher body mass index, which may explain why body image issues are a greater problem in this group of middle aged women [2].

Societal expectations that a middle aged woman will look after others before attending to her own needs may contribute to this phenomenon [1].  Many women are accustomed to putting their own physical, mental, emotional and spiritual needs on the backburner to care for other family members, which can contribute to overall poor self-care.  Adapting self-care skills in midlife may feel difficult for a woman who has not prioritized her own needs; however, this is an important step toward building better body image.  

How Do Eating Disorders Present in Women Who Are Middle Aged?

When women in midlife present with eating disorders, they may have a chronic illness which has begun in earlier life, a relapse of a disorder which has been in remission, or a late-onset illness with no prior history [4].  In one review, 69% of those presenting over the age of 50 had a late-onset eating disorder, a fact which could be attributed to changes which occur around the menopause [4].

It has been suggested that, in mid-life, the eating disorder is a focus which takes away the need to face up to major life changes:

• Parents aging
• Children leaving home
• Career transitions
• Divorce from a long-term relationship
• Or that it is a “defense against mortality” – an over-reaction to the health risks associated with obesity [3].  

Women in midlife will also experiences physical changes in their body that can be triggering, especially to a woman who is simultaneously going through a major life change, as described above.  

For example, the process of menopause can influence many physical changes in the body, some which may be uncomfortable and difficult to adapt to.  

While weight gain may be a normal physiological response to hormonal changes in the body, a woman may find it overwhelming and challenging to adjust to these fluctuations within herself.  This can trigger more extreme behaviors as a means of “controlling” something that suddenly seems unmanageable.

In midlife eating disorders, excessive exercise is a common reaction to normal weight gain, whilst resorting to plastic surgery is one response to skin changes [3].  One study showed that when eating disordered inpatients aged forty or older were compared with younger inpatients, more had anorexia rather than bulimia, the severity of the eating disorder was greater, but there was actually less body image distortion [5].

The older patients also tended to have more concomitant affective disorders and suicidal ideation, and there was a trend amongst them towards substance misuse [5].

This suggests that middle-aged people with eating disorders severe enough to require inpatient treatment have very specific needs which must be addressed by the multidisciplinary team.  Many middle-aged women may hesitate to ask for the help needed to recover or admit the struggles they are facing, many times due to the stigma that surrounds eating disorders in older populations.  

Eating disorders are often stereotyped to occur in young, adolescent white females, but the reality is that eating disorders do not discriminate against age.  Eating disorders occur across the age spectrum, including during middle age.

How Can Body Image Be Improved in Middle-Aged Women?

Although they are two different populations, the principles behind improving body image in middle-aged people who have a diagnosed eating disorder and those who do not are the same.  Psycho-education is the cornerstone of inpatient treatment and emphasizes the facts about the normal aging process, such as that the degree of thinness enjoyed by young women may be unrealistic for more mature women because of metabolic and hormonal shifts [3].  Awareness should also be raised about this process in the general population.

In therapy, in patients are helped to find the source of their eating disorder, such as unresolved conflict; in the community, women should be helped to shift the locus of their self-worth from external appearance to internal personal growth [3].

Middle-aged women with eating disorders or body image concerns should be challenged to ask themselves why staying youthful is so important to them and should be helped to value the functional bodies which they do have [1].

All women in this age bracket should be encouraged to engage actively in self-care as a protective measure, and to embrace the positive achievements of their lives to date, such as the development of good friendships, and their inner beauty [2,3]. In this last sense, an element of spirituality may help women to come to terms with changes in her physical state.

Acceptance

In summary, women experience incredible changes in their bodies as they pass through middle age. Body image concerns are ubiquitous and can lead to disordered eating behaviors or clinical anorexia, bulimia or binge eating disorder.

Some women are more susceptible than others but, by engaging in good self-care and learning to embrace the change as it occurs, all women can make themselves less vulnerable to the psychological and physical damage which body dissatisfaction can incur.  Seeking out appropriate help and support is also a necessary and important part of facing the many transitions that might occur during a woman’s midlife.

Treatment Options for Middle-Aged Women

With the increased recognition of eating disorders in middle to older age women, treatment options are becoming readily available and can be tailored to meet the unique needs of this population.

If you or your loved one is struggling with an eating disorder, remember that it is never too late to seek the appropriate help you need and begin your journey to recovery at an eating disorders treatment center.

---

References:

[1] “Eating disorder behaviors and weight concerns are common in women over 50”.  UNC Health care and UNC School of Medicine Newsroom.  http://news.unchealthcare.org/news/ Accessed 22 July 2013

[2] McLean, S et al: Factors associated with body dissatisfaction and disordered eating in women in midlife. International Journal of Eating Disorders 2010;43:527-536
[3] Zerbe, K and Domnitei, BS: Eating disorders and middle age: part two. Eating Disorders Review 2004;15:3
[4] Gagne, DA 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. International Journal of Eating Disorders 2012;45:832-844
[5] Cumella, EJ and Kally, Z: Comparison of middle-age and young women inpatients with eating disorders. Eat Weight Disorder 2008;13:183-190

---

Older Women and Eating Disorders Articles

• There is a large percentage of middle-aged women that are unhappy with their body image. 70% or more women 50 years of age or older are currently trying to lose weight, believe weight or shape play a role in their self-concept, are unhappy with their weight and shape compared to when they were younger, or are especially disappointed with their stomachs. A poor body image is no longer considered to be a young girl’s issue.
• Most attention about eating disorders is prominently placed on young women. It is found that 95% of people struggling with an eating disorder are between the ages of 12 to 25. However, there is growing evidence that women aged 30 and above are increasingly struggling with disordered eating. This is an alarming trend that is on the rise. Read more about middle aged eating disorders.
• Eating disorders are stereotypically thought to occur in younger adolescents, but the truth is that middle-aged women are just as likely to develop and struggle with an eating disorder. A combination of factors can contribute to the onset of eating disorders during this life-stage.  If you or someone you love has been suffering from an eating disorder, read this article to learn more about the unique needs of middle-aged women fighting eating disorders.
• Just as the onset of an eating disorder in a man or woman in their later years may be complex and intricate, so is the treatment involved in healing from this illness.  Men and women who may develop an eating disorder at the later stages of their lives often have unique challenges compared to adolescents.  No matter the differences though, treatment of eating disorders in mid-life is just as crucial.  Read more about the differing needs and challenges treating an eating disorder in mid-life in this article.

---

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on April 24, 2012
Edited And Updated By: Crystal Karges, MS, RDN, IBCLC
Contributor:  Sharon McConville, MB, BCh, BAO
Reviewed And Updated By:  Jacquelyn Ekern, MS, LPC on April 16, 2019.