February 24 - March 3, 2025, is National Eating Disorders Awareness Week.
Alice* can’t remember a time when she felt comfortable in her body.
Growing up, she developed a lot earlier than the other girls her age, and her school didn’t offer much in the way of education about women’s health. She felt alone, and her cannonball into womanhood made her a target for bullying. In high school, she was relentlessly teased by boys and pushed into lockers by girls who called her “slut.”
Alice thought that if she could just shrink her body — take up less space — maybe it would all go away.
She started restricting calories and the types of food she ate. If she did eat something “bad,” she’d make herself throw up, which helped her feel in control. Alice cycled through periods of restricted eating, binging and purging for years. She told herself that it didn’t rule her life or happen every day, so it wasn’t a problem. But when she got an invite to a class reunion, she realized her “non-problem” had been going on for decades.
The rise in eating disorders in midlife
For some women like Alice, eating disorders in midlife can be the result of an untreated pattern that started earlier on in life. But there are a lot of different reasons that eating disorders develop or reoccur in midlife.
“When you think about some of the things that we know about eating disorders — they're biologically based, they often co-occur with other mental health issues — the changes in midlife for women can create new stressors or bring on or exacerbate existing conditions,” said Doreen Marshall, Ph.D., CEO of the National Eating Disorders Association. “For women in midlife, there's often changes to their bodies that they're navigating. For many women, it's years of dealing with fertility or fertility issues or childbirth. It's also dealing with perimenopause.”
Although many people associate eating disorders with youth, research shows that rates of eating disorders among women in midlife have increased over the years. The statistics are alarming: One study found that 1 in 5 women have dealt with an eating disorder by age 40 — twice the number identified for women at age 21.
More than 1 in 10 women over 50 experience symptoms of an eating disorder, and a recent study found nearly 3 out of 4 women in midlife are not satisfied with their weight, which is a risk factor for developing an eating disorder.Risk factors for eating disorders in midlife
“Disorders do not discriminate based on age, gender, body type, socioeconomic status, race — no one is immune,” Marshall said.
But there are some factors that may increase the risk for developing an eating disorder in midlife. Body changes during perimenopause (the time period leading up to menopause) and menopause can contribute to the risk. Most people start perimenopause in their 40s and during this time, estrogen levels start to decline, which causes your metabolism to slow and can contribute to weight gain.
Marshall said hormonal changes paired with aging in general are all risk factors that come with this stage in life. Other risk factors can include:
- Death of a loved one
- Retirement
- Divorce
- Illness or caregiving for someone with an illness
“I think what's clear is that there's no one cause for an eating disorder, and that eating disorders are complex — they involve biology and environmental stressors or environmental exposure. And we're all impacted by things like weight loss culture and diet culture and beauty ideals ... Coupled with changes in midlife, that can really set someone [with vulnerabilities] up for development of an eating disorder,” Marshall said.
Common eating disorders in midlife
There are many different types of eating disorders, but the three most common eating disorders in midlife are:
- Anorexia nervosa: extreme food restriction
- Bulimia: binge eating and purging by vomiting or using laxatives
- Binge eating disorder: eating large quantities of food past the point of feeling full
The health-related impacts of eating disorders in midlife
It may come as a surprise to find out that eating disorders have the second highest death rate of any mental illness. And dealing with an eating disorder in midlife makes you more vulnerable to serious physical health conditions that happen with age.
These can include:
- Bone loss
- Heart conditions
- Lung problems
- Dental problems
Eating disorders that cause malnutrition can also contribute to cognitive functioning deficiencies For example, studies show that people with anorexia have poor decision-making skills.
Getting help for an eating disorder
For Alice, the realization that she did have a problem prompted her to start seeing a therapist. If you’re not sure if you have an eating disorder, consider taking the National Eating Disorders Association screening tool. It’s free and confidential and can give you information you need to bring to your healthcare provider — preferably one that has experience with treating eating disorders.
“Treatment for eating disorders often involves a mental health professional and it can involve a dietician and a medical doctor. So, I think it's just important that people reach out and that they start talking to their medical providers,” Marshall said. “These are illnesses that exist in silence and secrecy. And when someone takes a first step toward help, it’s a step toward bringing this into the light.”
Resources
National Eating Disorder Association
National Association of Anorexia Nervosa and Associated Disorders (ANAD)
National Institute of Mental Health
*Alice is not her real name.
- Eating Disorders ›
- Menopause and Eating Disorders ›
- Suffering in Silence: Middle-Aged Women and Eating Disorders ›
