Eating Disorders in Middle Age: Signs, Triggers, and How to Get Help

By Sarah Brown, LMFT, Certified Eating Disorder Specialist 

When people “picture” eating disorders, an unfortunate stigma persists. The image is one of a white, emaciated teenage girl standing in front of a mirror. This stigma is incredibly harmful, in that eating disorders do not discriminate with gender, body size, ethnicity, or—as we will discuss in this blog—age. When we exclude men and women in mid-life and beyond from the picture, we miss an entire group of people who are needing support and competent care. There are many factors that can contribute to a new or resurgent eating disorder in mid-life. Consider the amount of change that is happening in this stage of life—health concerns, body changes, empty nesting, retirement, and additional stressors; all of these and more can contribute to an eating disorder.

Historically, the focus of eating disorder research and treatment has done a poor job of including this group, resulting in minimal research and refined understanding of specific needs, lack of screening measures that can aid in identification and proper treatment, and ultimately, lack of care. The purpose of this blog is to highlight the prevalence of eating disorders in mid-life, identify triggers and risks, and explore treatment considerations specific to this population. Whether the eating disorder is a new component in mid-life or the resurgence of an old one, there is hope for recovery at any stage of life. 

The Prevalence of Eating Disorders in Middle Aged Men and Women

            While many people are not talking about eating disorders in mid-life and beyond, it is not due to a lack of need. According to a 2019 article in the BMC Medicine Journal, women in their 40s and 50s had a 3.6% prevalence rate for an eating disorder. Keep in mind that researching this information was difficult in that there are not nearly enough studies on this topic. It is important to consider the dated information (2019) in addition to poor screening and stigma that can prevent a realistic number being reported. For comparison, The National Institute of Mental Health reports a 12-month prevalence of Generalized Anxiety Disorder for women in mid-life to be 3.4%. While prevalence rates for middle aged men are lower, one must again consider poor screening measures and stigma to be barriers of reported eating disorders. Again, eating disorders do not discriminate, yet men (and marginalized groups) are consistently left out of research, screening measures, and treatment considerations.

What Triggers Eating Disorders in Mid-life?

Like any developmental stage, mid-life comes with its own stressors and difficulties.

·      Body changes: It goes without saying that our bodies change as we age. However, we live in a society that is actively in denial of this fact; consider weight stigma and aging—the wellness and anti-aging industries that thrive on telling people that an aging body is less valuable. Women in particular are told—implicitly and explicitly—that their value is in their body and desirability. Eating disorders triggered by menopause and other bodily shifts are common, as it can become very difficult to remain accepting—or even neutral—about one’s body. 

·      Life transitions: For many men and women in their 40s, 50s, and beyond, there are events that create a need for a major shift in outlook or activity, including but not limited to, becoming empty-nesters and retiring. While this can be an exciting time, it is not without stress or discomfort. For many, they find that the transition they have been eagerly awaiting is more difficult than anticipated.  An increased focus on food and/or body can bring a sense of structure to major transitions.

·      Grief/loss: In addition to the grief and loss that can accompany both body changes and life transitions, there is potential grief and loss in both identity and relationships. Caring for sick parents, losing long-time friends, or loss of identity and sense of purpose in work changes can create a profound sense of grief that some may cope with through food. 

While most people have the assumption that eating disorders only start in adolescence, there are factors in mid-life mental health that can contribute to an eating disorder later in life. For those who have recovered from an eating disorder earlier in life, some experience a lapse or relapse in symptoms in middle age. Eating disorders are not disorders of vanity; they often at first feel like legitimate safety nets to cope when life feels unmanageable or painful. 

How Eating Disorders Look Different in Middle Age

Eating disorder symptoms in adults may look similar to others in different age groups struggling. However, when considering physiology, it is important to acknowledge the increased risk of adverse health consequences that can be faced. One particular area of concern is bone density. Restrictive eating disorders in adults can lead to loss of bone density (osteopenia and osteoporosis) in a time where bone loss is already a concern. Cardiac health is another topic of concern that needs to be monitored. It is crucial to be regularly seeing one’s primary care physician to be discussing such matters to prevent adverse medical events. 

Why Eating Disorders in Adults Go Unnoticed- And Undiagnosed

Unfortunately, there are several factors that contribute to eating disorders in adults going unnoticed or unsupported. It is important to highlight said factors to challenge the systems in place and enact change.

            One potential reason that adults with eating disorders go undiagnosed is lack of screening. Therapists and doctors are given minimal education surrounding eating disorders in their schooling, and screening can be overlooked due to stigma, bias, misinformation, or more.

            In addition to lack of screening for eating disorders or disordered eating symptoms, it is possible that some symptoms can be mistaken for another medical concern. For example, weight changes can be common in men and women in their 40s and 50s, leading doctors to rule out other potential medical issues (which they should). However, this issue is compounded further if the individual experiences shame for struggling with an eating disorder or minimizes their experience.  Because there is not enough discussion of eating disorders being a struggle for adults in later life, those struggling often belittle their struggles, thinking that they are “too old” for an eating disorder.

Lastly, cultural sensitivity is a necessity in identifying and treating eating disorders at any age, including mid-life and beyond. Unfortunately (again), this is not a common occurrence. As mentioned earlier in the blog, today’s society often ignores or minimizes the struggles of aging women. It is a known fact that research on women’s issues significantly trails that of men’s, and aging women is no exception to this. Because there is less research and less value that our society places on aging, women can go unseen in their struggles. 

For the sake of all the men and women in mid-life who are struggling, we must do better. Ending the stigma means talking about these topics on a regular basis to raise awareness and build support.

The Path to Getting Help for an Eating Disorder in Later Adulthood 

            If you are struggling with an eating disorder as an adult, first and foremost, there is hope and there is a path forward. Here are three things to consider in seeking support:

·      Your concerns deserve competent care from providers who know what symptoms to look for and how to best come alongside you. You have every right to “screen” your providers, asking them of their experience in working with adults with eating disorders. Ask questions such as “How do you work differently with those in their 40s, 50s, or 60s with eating disorders compared to those who are in their teens or twenties?” 

·      Know what works. Treating an eating disorder takes a team approach, often involving at least a therapist, dietitian, and medical doctor. Individual and/or group therapy need to be able to address the needs and concerns of those in mid-life. Unfortunately, I often hear frustration from adults in mid-life, as most group therapy settings cater to teens and young adults, who have much different needs and life experience, making it difficult to connect or feel understood. Common modalities that are helpful in therapy for adults with eating disorders include Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Acceptance Commitment Therapy.

·      Include your support system. Whether you participate in family therapy or not, it is important to include your support system into the process. This will look different for everyone but including at least one trusted individual and letting them know specifically how they can support you will help when the recovery process feels more arduous.  

A Note to Loved Ones

You may be reading this, finding yourself concerned for a loved one. You have noticed concerning signs—a shift in eating habits, increased secrecy, weight fluctuations, a change in mood—and you’re not sure what to do or say. While it can be a sensitive topic, you can speak up. Ask questions with curiosity. A helpful way to start may sound like, “I’ve noticed you have seemed down lately. Can we talk about it?” 

When having conversations with your loved one, there are a few “don’ts” to keep in mind. It is important to remember not to comment on your loved one’s weight. Even well-intended comments about your loved one’s body may inadvertently be triggering or unhelpful.  Eating disorders are about so much more than food and body but making body-based comments has the potential to reinforce unhelpful beliefs that the eating disorder has about body shape and size. Another important reminder is that you cannot fix your loved one, as much as you may want them feeling better. When you find yourself getting the urge to “fix it”, take a step back and ask yourself what is coming up for you (likely worry) and consider how to engage in self-care.

As mentioned previously, self-care is important for loved ones of those struggling with eating disorders. The eating disorder does not exist in a vacuum, and you deserve to get support as well. Whether it is from individual therapy or support groups like the Alliance for Eating Disorders, it is important to talk about the emotions that come up for you with people who can understand and support you. 

Recovery is Possible at Any Age

For adults struggling with food and body concerns, the path to healing can feel overwhelming. Recovery from eating disorders and disordered eating is possible—no matter your age. It’s time to end the stigma. Reach out today if you or someone you know would benefit from therapeutic support. If you are looking for support groups, I encourage you to check out the Alliance for Eating Disorders. They have a support group for adults in mid-life and beyond. 

Sarah Brown, MA, LMFT, CEDS is an eating disorder specialist with over a decade of experience in varying levels of care. She co-founded Brown Family Counseling with her husband and therapy dog and strives to provide competent care to people of all ages who are struggling with eating disorders.

Micali, N., Martini, M.G., Thomas, J.J., Eddy, K.T., Kothari, R., Russell, E., Bulik, C.M., Treasure, J. (2017). Lifetime and 12-Month Prevalence of Eating Disorders Amongst Women in Mid-Life: A Population-Based Study of Diagnoses and Risk Factors. BMC Medicine, 15 (12). https://doi.org/10.1186/s12916-016-0766-4.

National Institute of Mental Health. (n.d.). Generalized Anxiety Disorder. U.S. Department of Health and Human Services, National Institute of Health. https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder#:~:text=on%20anxiety%20disorders.-,Prevalence%20of%20Generalized%20Anxiety%20Disorder%20Among%20Adults,Figure%202