Eating disorders an increasing problem in older women

Eating disorders long have been considered a problem of the young. But during the past decade, some health professionals say they increasingly have been diagnosing the conditions among older adults.

“Fifteen years ago, it was very rare to have a patient with an eating disorder at midlife,” said Ann Kearney-Cooke, PhD, a Cincinnati psychologist who specializes in eating disorders. “Now, half my patients are women 35 to 70.”

The problem is affecting older women nationwide, according to a study of 1,849 women 50 and older published online June 21 in the International Journal of Eating Disorders. The study shows that 62% of respondents said their weight or shape negatively impacts their life, and 64% think about their weight at least once a day.

The research, based on an anonymous online survey conducted between September 2010 and January 2011, found that 13.3% of women 50 and older exhibited eating disorder symptoms. To put that figure in perspective, senior study author Cynthia M. Bulik, PhD, said 8.3% of the U.S. population has diabetes.

“Most people I talk to think this number [of adults with eating disorder symptoms] is huge,” she said.

The Renfrew Center, which cares for women with eating disorders and other behavioral health issues, has noticed a similar change. The center says there has been a 42% increase during the past decade in the number of women older than 35 seeking treatment at its clinics nationwide.

Some older women with an eating disorder probably had the condition when they were young, or at least struggled with their weight, and those issues resurfaced later in life. Other women develop an eating disorder at an advanced age, health professionals say.

Driving the increase is an unrealistic societal expectation that women should be fit and thin in middle age, eating disorder experts say. Also contributing to the problem are the mounting responsibilities older women face, which often leave them with little time for themselves and can lead to binge eating and other unhealthy eating habits, Kearney-Cooke said. Such responsibilities include juggling the demands of a full-time job with the pressures of caring for children, grandchildren and ill parents.

Norristown, Pa., internist Charles Cutler, MD, attributes the rise in adults with eating disorders to health professionals identifying the conditions more frequently due to greater awareness that the disorders can extend beyond teens and young adults.

“I think more discussions are taking place between doctors like myself and their older patients about eating disorders,” Dr. Cutler said. “I’m probably looking for it more.”

Regardless of what’s causing the uptick, health professionals agree that primary care physicians need to look for eating disorders in all their patients. When a problem is suspected, physicians should talk to patients about it and take steps to treat the condition, which could include referring the individual to a specialist, said Bulik, a professor of eating disorders in the Dept. of Psychiatry at the University of North Carolina School of Medicine.

“We know very little about how women 50 [and older] feel about their bodies. An unfortunate assumption is that they grow out of body dissatisfaction and eating disorders,” she said.

Identifying symptoms

Eight percent of women reported purging in the last five years, and 3.5% said they binge-ate in the past month, according to the International Journal of Eating Disorders study. Those behaviors were most prevalent among women in their early 50s, but they also occurred in women older than 75.

Participants reported using a variety of unhealthy methods to change their body, including diet pills (7.5%), excessive exercise (7%), diuretics (2.5%), laxatives (2.2%) and vomiting (1.2%).

While eating disorders can negatively affect the health of people of all ages, the impact can be particularly severe in older adults, whose bones and immune systems are weakened by age, Bulik said. She often sees severe osteoporosis, cardiovascular problems and gastroesophageal reflux disease in older patients with eating disorders.

Bulik urges physicians to remember that eating disorders “occur across a person’s life span.” When working with overweight patients to improve their health, she recommends that doctors talk to them about binge eating, which could contribute to their weight problem. She also encourages doctors to help such patients focus on lowering their blood pressure and cholesterol, rather than just stressing the importance of losing weight.

Kearney-Cooke encourages physicians to watch for eating problems in patients who experience a major loss, such as a death in their family or a divorce. Some people dramatically restrict what they eat to gain a sense of control during a time of loss, while others binge-eat for comfort, she said.

But even if a physician identifies an eating disorder, treating the condition appropriately can be even more challenging, Dr. Cutler said.

“It might be more difficult for doctors to help older patients with eating disorders [than young patients] because they’re trying to break a lifelong habit,” he said.

Dr. Cutler supports increasing physician knowledge on the subject through medical conventions, journal articles or continued medical education training.

“The more this information gets out there, the better prepared physicians will be to look for eating disorders [in older patients] and to ask the right questions, so in the end, the patient will be helped,” he said.