Older women with eating disorders are often overlooked because many still presume the mental health condition only affects younger people. However, this couldn’t be further from the truth. Experts explain why they believe more and more women are struggling with an eating disorder and how menopausal hormone changes can play a part in it.
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Eating disorders don’t have an age limit. While they’re often associated with teenagers and young women, they can emerge for the first time in midlife or resurface after years of recovery.
Though research is still very new, epidemiological research in 2023 suggests that around 2% to 7.7% of older women may meet the criteria for an eating disorder, including anorexia nervosa, bulimia nervosa and binge-eating disorder.
For some women, the hormonal shifts of perimenopause and menopause, changing body image and major life transitions can make this stage of life particularly challenging.
As an eating disorder dietitian, Caroline Young, founder of Whole Self Nutrition, regularly works with middle-aged women experiencing a range of eating disorders. One of the most common presentations she sees is bulimia nervosa, which involves recurrent episodes of binge-eating followed by compensatory behaviours, such as self-induced vomiting or excessive exercise.
How menopause and hormonal changes can play a part
“It’s important to remember that eating disorders are a maladaptive coping mechanism that often come with an underlying emotional function or means of emotional survival,” she explained. “In my clients, I’ve noticed that purging is a way to release hard feelings and to feel a sense of relief from emotional overwhelm. Of course, it’s a dangerous way of coping, however, it helps to understand why it’s happening.”
As for what she believes is contributing to the growing rise of midlife women with eating disorders, Caroline points to hormones, unsurprisingly, playing a part, alongside other factors.
“Women in midlife are often dealing with a mix of physical and emotional changes that can contribute to eating disorder development or relapse. Hormonal shifts in perimenopause and menopause is one major factor that can make it a vulnerable time, along with harmful societal pressures to look young (which often includes thinness). Life transitions that are common in mid-life, like divorce, aging parents, and perhaps kids leaving home can also contribute to disordered eating behaviors.”
Why some women don’t realise they have an eating disorder
Another eating disorder specialist, Ali Spotts-De Lazer, of Live Your Full Story, often sees patients in her clinic who don’t realise the severity of their eating disorder.
“Here’s what I see in clinical practice: Some older women have been practicing disordered eating or even living with an eating disorder without realizing the level of severity – or even that they have a clinical eating disorder at all,” she explained.
“They feel worn out from all the weight cycling, diets, and such. Some start to question: Am I simply ‘failing’ at my eating, health, or weight goals, or is there something more going on? They finally seek help to find more peace in their relationship with food and eating.
“We live in a society that tends to praise behaviors that can be eating disorder behaviors for many, so people often don’t realize they are ill. By our fifties, many of us want life to feel easier or better. I see that as another reason people seek help for eating issues in their later life.”
When it comes to the type of eating disorder Ali sees, it’s a combination of older women with anorexia nervosa, atypical anorexia nervosa (anorexia without being at a low weight), bulimia nervosa and binge-eating disorder.
“Though the causes of eating disorders are complex, we’ve seen – and research suggests – that times of hormonal change may be windows of vulnerability for developing or relapsing into an eating disorder among people who are already vulnerable,” she added.
“Menopause is certainly a time of hormonal change. Transitions can also create vulnerability if someone is biologically predisposed. I know of case examples of people who developed new eating disorders in their older years after experiencing significant health issues. There are many factors.”
When an eating disorder returns in midlife
Although many midlife women are developing eating disorders for the first time, some are also not new to them. The resurgence of an eating disorder in an adult who had it as a youngster is common, points out Francesca Emma, a psychotherapist who has specialised in the eating disorder population for the last 16 years and runs Francesca Emma LMHC.
“I think it is especially important to clarify that what we are seeing in mid-life women is not always a completely new eating disorder emerging for the first time.
“For many women, mid-life brings a resurgence of things that may have existed quietly for years, were never fully acknowledged, or had previously been in recovery. During this period of time there are body changes, menopause, growing of children, caring for elderly parents, questions around identity and these can all create a period of significant vulnerability. If someone used the manipulation of food and exercise as a way to cope in the past, the behaviours can re-emerge as a familiar way to cope, especially if they haven’t developed more adaptive ways along the way.
“There can also be a sense of, ‘Who am I now?’ Midlife often asks women to figure out who they are outside of motherhood, productivity, appearance, or taking care of everyone else. In a culture that places enormous value on youth and thinness, attempts to regain control or feel more like oneself can sometimes become focused on changing the body.”
The pressure to stay young and thin
In agreement is eating disorder specialist Kyla Fox, of Kyla Fox Centre, who says that whilst eating disorders are common at any age, the harm in midlife in particular is commonly in response to the changes that occur to women in this life stage.
“You have perimenopause/menopause, empty-nesting, shifting in career aspirations, more apparent signs of aging parallel to the pervasive anti-aging movement, the influence of diet and fitness culture, caregiving for sick parents and therefore a sharper focus on sickness and health, and now, the over-use and over-saturation of GLP-1s and thinness,” she explains.
“How can anyone ever feel comfortable about the inevitable evolution of time and what that means for how we look, if we are all bombarded with messaging/images around physical preservation at any cost and thinness as the ultimate privilege?
“What’s most important to remember, is that eating disorders are not about food and body, they become about food and body. What they are really about are the rooted issues, core beliefs, self-concept, life circumstances, emotional, psychological and relational experiences that shape and change us. At midlife, it’s facing all the challenges and changes that often spark the desire for control and/or feeling the lack thereof.”
Warning signs of an eating disorder in midlife
If you are concerned about a loved one with an eating disorder, Caroline Young advises looking out for the following signs and symptoms:
- Becoming unusually rigid about food, such as avoiding entire food groups or having strict rules about when or how much they eat.
- Frequently talking about calories, weight, dieting, “clean” eating or needing to compensate for eating.
- Skipping meals, eating very little around others or making excuses for not eating.
- Eating unusually large amounts of food privately, sometimes followed by shame or secrecy.
- Going to the bathroom immediately after meals or exercising intensely to “make up for” eating.
- Repeatedly checking their weight, body shape or appearance – or avoiding mirrors and weighing themselves.
- Noticeable changes in weight, although weight loss is not required for an eating disorder.
- Becoming withdrawn, irritable, anxious or preoccupied around meals.
- Changes in energy, concentration, sleep or physical health.
- Hiding food, buying unusually large quantities of food or becoming secretive about eating habits.
Where to seek help
It’s important for someone struggling with an eating disorder to reach out for professional help from a doctor, therapist and dietitian trained in eating disorders.
