Like many Americans, you may believe that eating disorders (EDs) are the exclusive territory of teenage girls and twentysomethings. But in fact, research shows that older women are just as preoccupied with food and weight as their younger counterparts.
A 2012 study published in the International Journal of Eating Disorders shows that 3.5 percent of women 50 and over report binge eating and nearly eight percent report purging. The research also revealed that about 70 percent of midlife women are trying to lose weight and 62 percent believe their weight or shape negatively affect their lives.
“One of the features of an eating disorder is that thinking around food and exercise becomes distorted,” says Melissa O’Neill, director of program development at Timberline Knolls Residential Treatment Center in the Chicago area. Other common hallmarks of women with EDs are depression, low self-esteem and perfectionism.
“People who are feeling depressed and bad about themselves often externalize that to their appearance, and then become hyper-focused on losing weight,” says eating disorder specialist Dr. Carolyn Coker Ross, author of "The Binge Eating and Compulsive Overeating Workbook."
Two key players: diet and hormonesAlthough some men struggle with binge eating disorder or bulimia, women are much more likely to suffer from an ED ( 10 million females versus 1 million males in the U.S.) partly because women feel societal pressure to be thin.
Ross, who has treated women as old as their late 60s, sees diets as one of the biggest culprits. “People go on a diet to lose 15 to 20 pounds and then can’t stop themselves,” she says. Women who are genetically predisposed towards an eating disorder “see this newfound change in their appearance as a way to boost their mood and to help them deal with some of the other things that are going on.”
Menopause can be another factor in the development of an ED. Evidence suggests that the fluctuations in estrogen that occur during this time may make women vulnerable to a new eating disorder or the re-emergence of an old one.
“The physiological and psychological changes that happen during menopause seem to echo changes at puberty,” another high-risk time for an eating disorder to emerge, the study’s lead researcher, Dr. Cynthia Bulik told AARP.
The role of loss and traumaMidlife EDs are often triggered by stressful life events such as divorce, the death of a spouse or the empty nest syndrome. Unresolved traumas such as previous sexual abuse or rape, sometimes triggered by a loss, are often a “huge underlying cause” for an eating disorder, says Ross.
According to O’Neill, a loss of human connection can “drive someone who was engaging into a little bit of disordered eating behavior” to lose control around eating. “In a perfect storm, an individual whose brain is predisposed to run with a maladaptive coping mechanism can become pretty compulsive pretty quickly.”
Women who are recovering from alcoholism may also be vulnerable to disordered eating. When alcoholics stop drinking they significantly reduce the amount of sugar they were consuming via alcohol, points out O’Neill. “What may begin as a craving for sweets can turn into a binge eating disorder or binging-purging cycle,” she says.
Recovering alcoholics or drug addicts are also susceptible to “whack-a-mole behavior”-- after achieving recovery from one substance, “up pops an eating disorder,” she says. “Very often they have struggled all their life to regulate emotions and they have taken to really fast methods… like drinking or drugs or eating disorders or self-harm.” If the treatment strategy does not deal with what lies underneath the ED, “it will just evolve into another behavior,” she says.
Greater health risksThe health effects of eating disorders in older women are more pronounced than in younger women. According to a 2015 study, while women of all ages experience the same types of medical complications from eating disorders, “the risk of death for cardiovascular, metabolic, gastric and bone disorders is considerably higher” in older women.
Two-thirds of binge eaters are obese, putting them at risk for obesity-related illnesses like diabetes, high cholesterol and heart attacks. If they have concurrent disorders like high blood pressure, they’re at even greater risk for heart problems, says Ross. The other one-third of binge eaters, who are not overweight, are still vulnerable to digestive problems and, occasionally, gastric rupture.
As for bulimics, the recurrent binge-and-purge cycles that mark their disease may damage teeth and affect the entire digestive system. Electrolyte and chemical imbalances can produce heart complications, especially purging is combined with if over-exercising, says Ross.
Anorexia is another serious ED, though not as common in older women as binge eating or bulimia. “We typically don’t see older women who are experiencing anorexia because it is such a deadly mental illness that often it takes the life of an individual or they achieve recovery-- one or the other--at an earlier age,” says O’Neill.
Even though eating disorders can damage a woman’s health and lead to isolation, shame and depression, most people do not view binging on donuts with the same seriousness as, say, a crack addiction. As O’Neill points out, “Eating disorders have a powerful way of insuring their own survival by convincing everyone that it’s not a problem.”
Signs of a distorted relationship with foodOne of the defining features of eating disorders is that they are often hidden. It’s not uncommon for women to stuff themselves with chocolate, ice cream and chips alone in their bedroom, only to eat chicken salad in front of friends and family. Still, despite the secretive nature of the disease, you can sometimes pick up on clues, such as the following, that suggest a problem.
- A sudden change in weight
- Compulsive exercising
- Refusal of dinner invitations
- Repeated diets, especially if they are at a normal weight
- Extreme preoccupation with food and/or body image
- Extreme mood changes
- Frequent trips to the bathroom after meals
- Stashes of junk food
Getting help with an eating disorderTo break free from an ED, women can explore several avenues, says Ross, who encourages women to seek help from an experienced team of experts (e.g, a dietitian, eating disorders specialist and therapist). Although talking to a primary care doctor can be an appropriate first step, Ross cautions that some primary care doctors “encourage women to lose weight, and then they get on that diet treadmill and can’t get off.”
Ross also notes that certain medications, such as Vynase, are also used to help treat women with eating disorders. “It won’t make people lose 100 pounds … but it helps give people a little freedom from binging,” she says.
Outpatient eating disorder programs can often be found at hospitals. Another alternative: residential treatment centers, where patients participate in a variety of therapies, including cognitive behavioral therapy, nutritional counseling, and peer support.
“Peer support groups with people who are active in recovery are a wonderful resource,” says O’Neill. They reduce “the shame of eating disorder behaviors, especially the binging behaviors, that we really are silent about.”
Katherine O'Brien is a freelance content writer and editor specializing in seniors’ health, senior care and aging. She’s covered a wide range of topics including dementia, seniors’ nutrition, advance care planning and emotional wellness. More of Katherine's writing can be found here.