Eating Disorders in Midlife

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Eating disorders are most often thought of as afflicting teenage girls and young women. In reality, this is not the case. Many women and men don't stop worrying about weight and shape as they age. The fact is that eating disorders are equal opportunity offenders, crossing cultural boundaries and leaping the borders of age and gender.

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.

Risk of midlife eating disorders
Verywell / JR Bee

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 people 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 every year, around 3.6% of women aged 40 to 50 years experience an eating disorder. 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 treatment
  • Those who had an eating disorder as a teen or young adult and recovered, only to relapse in midlife
  • Those who develop an eating disorder for the first time in midlife

Grishkat says that the majority of midlife women who struggle with later-life eating disorders have actually had an eating disorder their entire lives, followed by those who had an eating disorder when they were young.

Many people with eating disorders tend to suffer in silence, making it difficult for researchers to estimate how many people are affected by these disorders.

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) feeling 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 spouse
  • Retirement or loss of a job
  • Empty-nest syndrome
  • Caring for aging parents
  • Lacking adequate savings for retirement
  • Grief (including that brought on by the death of a parent, adult child, or friend)
  • Dealing with increased illness
  • Lack of enthusiasm for life
  • Attempts to get attention from family members
  • Growing 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:

  • Osteoporosis
  • Increased risk of high blood pressure
  • Increased risk of diabetes
  • Heart problems such as arrhythmias, heart disease, and heart failure
  • Anemia
  • Cognitive problems
  • Electrolyte abnormalities
  • Kidney 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 allows 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.

Because eating disorders are mental illnesses, your treatment team should include a mental health professional such as a psychologist or psychiatrist, as well as a primary care physician and registered dietitian.

Getting Help

People in midlife living with an eating disorder may find that there are 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 to be “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.

If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237. 

For more mental health resources, see our National Helpline Database.

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.

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.

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