Eating Disorders in Midlife

We don't typically think of perimenopausal women when we talk about eating disorders, but middle age can be a high-risk time for developing one. More than one in 10 women over the age of 50 engage in eating disorder behaviors, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD).

There are a few similarities between adolescence and perimenopause that make it easier to understand why women in midlife may be susceptible. Both are stressful times of transition to a new stage of life that we may feel ambivalent about or afraid of. In addition, a characteristic of both is that our bodies seem to have minds of their own and change in ways we may not like.

That is related to a third and particularly interesting (to me) similarity: fluctuating hormones, especially estrogen.

Research shows that reproductive hormones play a role in the development of eating disorders in adolescence, and evidence suggests that the same may be true for women in perimenopause. The time around menopause is a unique "window of vulnerability" for getting an eating disorder.

Eating orders are complicated things, and there is not one thing that causes them. I've often heard that genetics load the gun and the environment pulls the trigger. If you or other people in your family have had eating disorders, you're more susceptible. In midlife, things like the loss of a spouse or feeling lonely or powerless or poor self-esteem may trigger an eating disorder.

According to ANAD, the biggest sign to look for is a preoccupation with food, calories and exercise. How much time do you spend thinking about food and calories? How much time do you spend exercising? Does it interfere with other activities?

If you think you might have an eating disorder, talk to your doctor or another health care professional. Eating disorders have the highest mortality rate of any mental illness. They can affect bone density, the kidneys and the heart—and middle-age bodies are less resilient than young ones. As with other illnesses, the earlier you catch it and address it, the easier it is to treat.

Barb DePree, MD, has been a gynecologist for 30 years, specializing in menopause care for the past 10. Dr. DePree was named the Certified Menopause Practitioner of the Year in 2013 by the North American Menopause Society. The award particularly recognized the outreach, communication and education she does through MiddlesexMD, a website she founded and where this blog first appeared. She also is director of the Women's Midlife Services at Holland Hospital, Holland, Michigan.