Despite this, very little research has been done to better understand eating disorders in midlife (commonly defined as the period between 35 and 55 years). While the symptoms of each eating disorder may not differ much by age, the context in which people in midlife experience them is quite unique.
Prevalence
There are more midlife adults with symptoms of eating disorders than those with an official eating disorder diagnosis, as is the case for other age groups. But research specifically dedicated to disordered eating behaviors and eating disorders in midlife is significantly lacking compared to younger populations.
Eating Disorders in Midlife Women
It’s only been in recent years that eating disorder research has included women in midlife. Research shows that around 3.6% of women aged 40 to 50 years experience an eating disorder every year. Based on DSM-5 criteria, other specified feeding and eating disorders (OSFED; 1.7%) is the most common eating disorder found in this age group, followed by binge-eating disorder (BED; 1%), bulimia nervosa (0.4%), and anorexia nervosa (0.2%). According to midlife eating disorder specialist Dr. Holly Grishkat, midlife or older women living with eating disorders essentially fall into three categories:
Those who have struggled with an eating disorder for years without seeking treatmentThose who had an eating disorder as a teen or young adult and recovered, only to relapse in midlifeThose who develop an eating disorder for the first time in midlife
Grishkat says that most midlife women who struggle with later-life eating disorders actually had an eating disorder their entire lives, followed by those who had an eating disorder when they were young.
Eating Disorders in Midlife Men
Historically, studies have examined eating disorders from an entirely female focus, neglecting men entirely. Because of this, very little is known about the prevalence of midlife eating disorders in men. Lifetime prevalence rates for 45- to 59-year-old men based on supplemental data from the U.S. National Comorbidity survey were 0%, 1.3%, and 2.7% for anorexia nervosa, bulimia nervosa, and BED, respectively. The 12-month prevalence rate for eating disorders in midlife for older males was estimated between 0.2% and 1.6%. Among young males, a version of muscle dysmorphia tends to be more common than anorexia—it appears to be the same with middle-aged men, too. One study of middle-aged men with eating disorders showed a significant percentage engaged in excessive exercise, which can be very risky in this population because it can contribute to falls and fractures.
Causes
The causes of eating disorders in older adults are not well-documented or understood. The main reason being that there is a general misconception that eating disorders only affect teenage girls. However, there is growing evidence to show that eating disorders aren’t exclusive to people under the age of 30. Research has found that eating disorders can be triggered by periods of reproductive hormone change, such as puberty. Like puberty, perimenopause is also a time characterized by shifts in hormone levels. Because of this, some researchers hypothesize that the hormone fluctuations that occur in perimenopause could also be a risk factor for the development or maintenance of eating disorders in midlife in women. Additionally, body image issues, a common feature of eating disorders, seem to become more complex with age, particularly in cultures in which youth is often presented as a standard of beauty. Age-related weight gain and changes in body composition—including an increase in body fat, reduced skin firmness, fat redistribution and changing body shape, and decreased metabolism—can also cause many women (and presumably men, too) to feel dissatisfied with their appearance, which can lead to unhealthy eating habits. In addition to the hormonal changes, there are also some definite stressors unique to midlife that can prompt the emergence (or re-emergence) of an eating disorder:
Relationship problems (such as divorce or infidelity)The death of a partner or spouseRetirement or loss of a jobEmpty-nest syndromeCaring for aging parentsLacking adequate savings for retirementGrief (including that brought on by the death of a parent, adult child, or friend)Dealing with increased illnessLack of enthusiasm for lifeAttempts to get attention from family membersGrowing old/facing death
Risks
The older you get, the tougher it is for your body to bounce back from the devastating effects of eating disorders, making them even more dangerous to older adults. And for those who have been chronically ill with an eating disorder for many years, the effects may be heightened. The full range of potential medical consequences associated with eating disorders include:
OsteoporosisIncreased risk of high blood pressureIncreased risk of diabetesHeart problems such as arrhythmias, heart disease, and heart failureAnemiaCognitive problemsElectrolyte abnormalitiesKidney issues
Treatment
There is a great lack of research on the treatment of eating disorders in midlife patients. One study showed that only 27% of midlife women who met the criteria for an eating disorder diagnosis received any treatment. Given the similarity in presentation and course between eating disorders in midlife and young adulthood, there is a good reason to believe that the treatments developed in younger populations would be effective in older populations. They include:
Cognitive-behavioral therapy (CBT): Often considered a first-line treatment for eating disorders, CBT challenges unrealistic thoughts about food and appearance and helps you develop more productive thought patterns. In particular, CBT-oriented interventions that address age-related changes to the body, self-worth, body acceptance, and self-care have some basis in research for effectiveness in treating eating disorders. Group therapy: Working in a group setting, making connections, and sharing experiences allow someone struggling with an eating disorder in midlife to see that they are not alone. When used in combination with individual therapy, group therapy can be an excellent source of treatment and support for those with bulimia or binge-eating disorder. Family-based treatment (FBT): Sometimes referred to as the Maudsley method, FBT is designed to aid recovery from an eating disorder with the help of family and loved ones, including parents, partners, and children—often as a supplement to and in conjunction with individual therapy. Two popular FBT programs for adults are Uniting Couples in the Treatment of Anorexia Nervosa (UCAN) and Neurobiologically Enhanced With Family/Friends Eating Disorder Trait Response (NEW FED TR). Both are designed to treat midlife adults with anorexia nervosa. Interpersonal therapy: This type of psychotherapy can help you gain insight into issues such as role transitions, loss, and unresolved relationships that may underlie disordered eating and an excessive focus on body image. Nutritional therapy: A registered dietitian can help you learn (or relearn) the components of a healthy diet and motivate you to make the needed changes.
Getting Help
People in midlife living with an eating disorder may find added barriers to treatment and recovery both internally and externally. A middle-aged person may be more reluctant to acknowledge and seek help due to the misbelief that older people do not (or should not) get eating disorders. There may even be added shame and embarrassment related to experiencing what is often mistakenly perceived as “an adolescent problem.” Additionally, diagnosis may not be as prompt among providers who are not used to seeing eating disorders in this age group, but help is available, and recovery is possible.
A Word From Verywell
If you or a loved one is experienced an eating disorder in midlife, it’s important to know that you’re not alone. There are others just like you struggling with eating disorder symptoms in all stages of recovery. For more mental health resources, see our National Helpline Database. While recovery can be a physical and mental challenge, it is possible with the right support. If you or someone you know is experiencing some or all of the symptoms of any eating disorder, please consult with a physician, dietitian, or mental health professional for assessment and treatment.
