We need to talk about eating disorders in older women
When you think of eating disorders, the image that springs to mind for most is someone white, in their teens, and a perfectionist or high achiever. Or, maybe someone who has been through a stressful life event, or a traumatic experience. While these are two groups of people who are indeed vulnerable to eating disorders, this stereotype is damaging.
Many people have worked hard to draw attention to other at-risk groups, through writing and activism. Ramadan can be an extremely difficult time for Muslim women with issues surrounding food. Black women, often entirely overlooked in the conversation around mental illness, are not immune. Fat, or overweight, women, can also have eating disorders – just because someone isn’t visibly underweight, it doesn’t mean they don’t have anorexia, bulimia, or binge eating disorder. Men, too, can have eating disorders, and numbers are rising.
A group that still seems to be left out of the conversation, however, is older women. It is a reflection of society’s beauty standards that if you are female and look past a certain age you are deemed no longer relevant. With the pressure on older women, as well as younger women, to carry on looking like skinny teenagers forever, it is no wonder that this can translate into rising numbers of eating disorders among that age group.
“We used to see very few older women with eating disorders,” says Dr William Rhys Jones, consultant psychiatrist & clinical lead at the West Yorkshire and Harrogate Adult Eating Disorders Service. “But numbers tend to be rising.” There are two groups, he explains: those who have had an eating disorder for many years, “early onset”, and those who have the first presentation beyond the age of 30-35. “This used to be unusual,” he says, “but now we see it more and more often.”
Difficulties getting treatment
However, developing issues with food around this time comes with its own set of problems. For one, as conditions such as bulimia and anorexia are viewed as a teenager’s illness, it can be hard to access help, or even consider yourself as being ill. Stressful events, or changing physical health, or even the onset of menopause can all be huge triggers, and with eating disorders then emerging almost as a secondary symptom of these, it can be hard to realise what is happening until the disorder is deeply entrenched. On top of this, the stigma surrounding eating disorders only increases the older you get.
“I remember being assessed and the psychiatrists couldn’t believe I had never had any food or weight issues prior to the age of 44. It was almost as if everyone was thinking I should know better. Rightly or wrongly I felt judged by everyone.”
Julie Spinks, a 49-year-old retail merchandiser, is one woman who found it harder to get help due to the comparably late onset of her eating disorder. She was diagnosed with anorexia when she was 44, but had never previously had any issues at all with regards to food, weight, or body image.
“I think my eating disorder was with me a couple of years before diagnosis,” she says. “The problem with this illness is that it doesn’t suddenly happen, it creeps in. Mine was due to bullying at work, and that led to depression, loss of appetite, and eventually left me feeling that I did not deserve to eat.”
While Julie doesn’t think her eating disorder is related to her age, she does think that many don’t realise anyone of any age or gender can develop one. “Many people, including my loved ones, believe it is not an illness,” she says. “I believe people think that anyone suffering with an eating disorder is being silly, stubborn, or even ridiculous for not being able to eat without guilt or shame.”
When it came to getting help for her condition, Julie definitely thinks her age made it harder. “I remember being assessed and the psychiatrists couldn’t believe I had never had any food or weight issues prior to the age of 44,” she recalls. “It was almost as if everyone was thinking I should know better. Rightly or wrongly I felt judged by everyone.”
“I think older women finding it hard to get help is something that we hear that is sadly quite common,” says Dr. Jones. “I think there is a lot of stigma generally, which has improved over the past five or ten years as there has been more awareness, but it is still very much there. The only answer is raising awareness among patients and individuals, as well as clinicians, particularly GPs, and knowing that eating disorders can present in older people.”
Eating disorders during menopause
Another under-reported factor is the role menopause can play. “Eating disorders in menopausal women have actually increased in frequency over the past decade or so,” writes menopause specialist Dr. Louise Newson. “Some women find that having menopausal symptoms leads to an eating disorder that has been successfully managed in the past recurring. Other women suffer with eating disorders for the first time during their menopause.”
The reasons for this are manifold, and the effects, both physical and mental, can be devastating. Older women experience more comorbidities as a result of their eating disorder, and if someone is underweight, and therefore low in hormones, during a phase of life when their hormone levels are fluctuating anyway, this can be a dangerous combination. But how exactly can menopause bring on an eating disorder, or make a previous one reemerge?
“I think with moving from youth to another phase in your life, the body changes that happen to women as they grow older, and your fertility coming to an end, psychologically, menopause can be a particularly challenging time for people, and could trigger dieting, which is, in turn, the main catalyst for eating disorders.”
One study looking at eating disorders in mid-life found the triggers seemed to be the same as those for young people – pressure from society, perfectionism, and found little link between concerns about ageing and onset of eating disorders.
However, along with societal pressure, fluctuating hormone levels have actually been suggested to play a part. Some researchers believe that eating disorders can be triggered by a hypersensitivity to oestrogen levels, which, when combined with societal pressure, can lead to a “perfect storm” of risk factors.
The same study reports that the prevalence of anorexia and bulimia nervosa in midlife women is approximately 4%. When binge-eating disorders are factored in, this figure rises to 10%. In one review of 48 adults aged over 50, 69% had no prior symptoms of an eating disorder when they were younger.
Speaking to Medscape, lead author Dr. Baker said, “We see that the risk for eating disorders increases exponentially during puberty, when another period of significant reproductive and oestrogen change is happening. There has been some research in the young adulthood literature showing that oestrogen might play a key role in turning on the genes responsible for eating disorders.”
Dr Jones adds that not only do changes in hormone levels impact mood, but also identity. “I think with moving from youth to another phase in your life, the body changes that happen to women as they grow older, and your fertility coming to an end, psychologically, menopause can be a particularly challenging time for people, and could trigger dieting, which is, in turn, the main catalyst for eating disorders.”
Indeed, a further study highlighted the menopause period as being a “window of vulnerability”. A questionnaire was sent to a sample of women aged 40-60, and women entering menopause reported a greater prevalence of eating disorders compared to premenopausal women, alongside significantly higher ratings of “feeling fat”.
So, what is the solution? “The body image we are constantly presented with is unrealistic, and in this culture of what you look like being more important than who you are, that is a big risk factor, especially if you add genetic predisposition, history of trauma, and anxiety to the cocktail,” says Dr. Jones. “In terms of interventions, on a grand scale it is education around that, that is doesn’t matter that much what you look like, and we overemphasise looks at the detriment of what is really important.”
Given that ageing itself doesn’t necessarily seem to be a huge factor in the development of eating disorders, it is all the more important that we recognise that, nonetheless, older women are still affected by all the same socio-cultural pressures as younger women, meaning that they, too, are at risk.
If you are suffering difficulties surrounding food, there is support available, and your GP can also refer you to appropriate services.