Eating Disorders in Midlife and Onwards

Despite the stereotype that eating disorders only affect adolescents and young women, the truth is that an eating disorder is a serious mental illness which can affect people of any gender, age or ethnic background.

Often stressful events that occur in midlife serve as potential triggers in the development of an eating disorder. These events may cause a relapse in some, while others may be experience eating disorder symptoms for the first time. Midlife eating disorders can have an effect on parenting, work capabilities and personal relationships, and can be accompanied by negative emotions such as low self esteem, depression and anxiety.

People who experience an eating disorder during midlife are at greater risk of developing serious issues with their gastrointestinal and musculoskeletal system. As such, it is important to seek professional help as soon as possible. The physical consequences that result from an eating disorder, such as malnutrition and nutrient deficiency, are particularly dangerous for older people as their bodies cannot sustain the same levels of physical strain as they could when they were younger. Older people are more at risk of developing or experiencing diabetes and osteoporosis, conditions which can be severely exacerbated by an eating disorder.

The common risk factors for the development of an eating disorder, such as a perfectionistic personality type, low self esteem, external stress and a desire to gain control over certain aspects of life are prevalent for people of all ages.

There are also some unique life stressors that occur in midlife and are potential risk factors for the development or recurrence of an eating disorder:

• A loss or trauma such as the death of a loved one, a relationship ending, divorce or life-threatening disease.
• Increased stress associated with caring for ageing parents as well as children and possibly grandchildren.
• Menopause
• Heightened body dissatisfaction resulting from the ageing process when the body’s metabolism slows, wrinkles appear and hair greys. This can leave people feeling self- conscious as their appearance naturally moves away from Western ideals of beauty, such as slimness and youth.
• Lifestyle changes which can lead to weight gain and body dissatisfaction. These may include less regular exercise (sometimes due to physical health problems) or a change in diet (e.g. eating at restaurants more frequently or consuming more pre-prepared meals).
• Changes in family structure. Many parents feel lonely when their children leave home, or as their own parents age.
• Stress associated with financing retirement.
• A loss of identity as people exit the workforce and enter retirement; resulting in feelings of low self esteem, boredom and worthlessness.

Disordered eating in older adults

Many older adults experience problems with eating which may be classified as ‘disordered eating’ or ‘eating distress’. It is not uncommon for older people to experience a loss in appetite due to physical health concerns. If this occurs without psychological factors such as a pursuit of thinness, avoidance of normal weight or body image distortion, it is unlikely to be classified as an eating disorder. Below are a few reasons why a decrease in appetite may occur:

• An undiscovered illness or infection can cause loss of appetite – reflux, gastrointestinal problems.
• Some medications cause loss of appetite, others cause stomach upset or pain that discourages eating.
• Poor dental health and missing teeth make it difficult to eat; similarly, poorly fitting dentures may cause pain and difficulty with eating.
• Poor memory may lead to confusion over whether one has eaten and result in missed meals.
• Lack of energy and/or motivation for grocery shopping and food preparation can discourage eating.
• Financial stress may limit a person’s ability to buy adequate amounts of nutritious food.
• Depression is often associated with decreased appetite, as are associated feelings of loneliness and lack of meaningful connections with other people.

Although some decrease in appetite is a normal part of the aging process, it is important to identify and treat any issues as there are many physical, mental and emotional consequences of malnutrition in the elderly. Please consult your GP if you are concerned.

Getting help for an eating disorder

Self-care tips for recovery

Recommended reading: Midlife Eating Disorders, Cynthia M. Bulik