In this episode of Eat the Rules, I’m sharing a summary of what the research says about eating disorders and disordered eating in mid-life, and why this lifestage can make people more vulnerable to EDs and disordered eating.
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Transcript
Summer:
This is eat the rules, a podcast about body image self worth, anti dieting and intersectional feminism. I am your host. Summer innan, a professionally trained coach specializing in body image self worth and confidence, and the best selling author of body image remix, if you’re ready to break free of societal standards and stop living behind the number on your scale, then you have come to the right place. Welcome to the show.
This is episode 316 and I’m talking about eating disorders and disordered eating in midlife, and why this life stage can make us more vulnerable to relapsing with an eating disorder or engaging in disordered eating. You can find all the links and resources mentioned at summer Inn and in.com forward, slash, 316
I want to give a shout out to Laura a swim who left this review. I’ve been listening to summers podcast for a while. Be prepared for her to bring up a lot of feelings that are deep inside. It can lead you to a good cry every now and then, if you’re being real with yourself, as I’m turning 50, I’m trying to find a way to finally stop being so mean to myself and to start finding the courage to say that I’m enough. I feel like she’s speaking right to me. And between her podcasts and social media posts, she always manages to say just what I need to hear when I need to hear it. I’m not there yet on my journey, but summers a critical tool for the effort. Thank you so much. That’s so so kind of you. You can support the show financially, if you have the means to do so, for as little as $5 a month, you can go to KO fi.com forward slash summer in and in and make a monthly contribution, which will also give you access to my mini course conquering negative BodyTalk. You can always find that link in the show notes or in the information for the episode on whatever platform you’re using, and if you don’t have the financial means to support the show, it always means a lot when you subscribe and or leave a review. You can do that by going to Apple podcast, search for eat the rules, then click ratings and reviews and click to leave a review. There’s free resources for you on my website, at the body image coach.com you’ll find the 10 day body confidence makeover. And if you’re a professional who works with people who also have body image struggles, you’ll find our free body image coaching road map. It’s at summer Inn and com, forward slash road map.
Back in the fall, I completed the first part of my capstone research project, which will ultimately be a 40 to 50 page research paper, and I’ve chosen to do my research on eating disorders and disordered eating in midlife. The reason why I chose that I feel like, is pretty obvious, but obviously I’m really interested in body image and disordered eating and eating disorders. And personally, I have a real interest in mental health in in midlife. And originally I was going to do mental health and midlife and perimenopause and mental health, but it felt too broad. And to be honest with you, this just makes my life easier to like narrow it down to one particular issue. And so that’s why I’m going to do eating disorders and disordered eating in midlife. And so back in the fall, I had to do the first section of it, which was like a 15 page paper, and it was just the preliminary research, sort of looking at like the studies that have the most meat in them, and summarizing what they have to say a start of like, what will become a more comprehensive literature review, which, like, to be honest, I didn’t even know what that meant until now, but it’s when you review the literature, which seems kind of obvious when you say it, but I really didn’t know what it was. I had to google it. It’s been a while since I’ve been in school, right? And so I wanted to share some of the stuff that I learned, because I think that there’s a lot of people listening to this show who have perhaps had eating disorders in the past, or are still struggling with one, or are still, you know, struggling with disordered eating. And I know a lot of the people listening to the show are either in that midlife range or heading into that midlife range, which is defined as 40 to 60 years old. That’s the definition that I’m using for my paper. And so I wanted to cover it, because there’s some unique things that are happening, right? There’s these different factors that are happening during this time in our life that are unique to this age group as well, the manifestation of eating disorders looks a little different. And so this information is really important for people personally, because I think that if you’re struggling with these things, there can be this extra layer of stigma on top of it, because you feel like eating disorders are younger people’s problems, and if you’re a provider or professional, it’s really important.
To be screening for these things, because a lot of times they’re flying under the radar because disorder eating behaviors are so normalized, and especially when we look at a lot of the messaging around perimenopause and menopause and nutrition, a lot of the mainstream stuff promotes a disordered habits, and this idea that, like, you know, we have to, like, prevent any of the inevitable weight gain and and anything that might happen to our bodies, and I think that that additional pressure, plus the pressure of ageism in our culture, can make people a lot more vulnerable to slipping back into these ways, or re engaging with their eating disorder, or even just having it worsen, if you’re already struggling with it. So that’s what I’m going to talk about in this episode. And hopefully you find it as interesting as I did, I’m going to talk about the statistics. So you know, what percentage of people in midlife struggle with eating disorders, and how does it manifest in this demographic differently? What are some of the unique challenges that make people more vulnerable to eating disorders? And disorder eating in this in this stage of life, the role of hormone fluctuations in perimenopause and some of the barriers to treatment, and so let me just say, right from the get go, that all of the research looks at things through a very like binary lens. There’s very little research in general, on, you know, trans and non binary folks experiences with eating disorders. There’s more and more coming out more recently. But to look at that and then look at it in midlife, I haven’t extensively searched for it, but the majority of stuff that comes up is really centered around women. So that’s what I’m going to be talking about, because it was easier for me to just roll with that in my search terms and in my research, and look at it from that perspective, but I just wanted to call that out. And I am layering on different looking at like it from more of like an identity perspective. When I do my actual literature review, which I know what that means. Now, okay, so, so eating disorders are, you know, they’re pretty severe psychiatric disorders. There’s, there’s high levels of mortality associated with them, and they impact people across the lifespan. But I think for most of us, we associate eating disorders with with young women in particular, and we kind of have this vision of, like, this really frail, thin young woman. And there’s a lot of problems with that image, because it it then creates bias in eating disorder treatment. It results in a lot of people being misdiagnosed because they perhaps are fat or are non white, and in which case, like a lot of times, they’re not getting screened, there’s bias, and so age is also a factor here, because there’s so much association with it being like a younger person’s condition. But when we actually look at some of the research, and I would say these numbers are more trends instead of absolutes, but it’s the prevalence of eating disorders in midlife is estimated to be between 2.1 to 7.7%
and about 15% of midlife women will have struggled with it at any point in time in their life. And so now we’re seeing that admissions into eating disorder treatment facilities are they’ve gone up for older women in particular, so women over age 45 now account for a quarter of the admissions into eating disorder treatment facilities. And so it does account for, you know, a pretty significant portion of the population that is seeking treatment. One of the other things I’m going to talk about it is how there’s a lot of people that don’t seek treatment. The way that it manifests in midlife is you have people who have had a an eating disorder earlier on in their life, and then they like recovered or partially recovered, because fully recovered is oftentimes considered sort of a myth, but they they’ve partially recovered, or they’ve mostly recovered, and then what happens is, is they relapse during this phase of their life, then you have people who have subclinical eating disorder symptoms throughout their entire life, and they’ve just been undiagnosed until midlife, So they’ve been able to, kind of, like, maintain these disordered behaviors. Maybe they’re not severe enough, maybe they were misdiagnosed because their body size was bigger, and then they get diagnosed in midlife, and then you have people who’ve just had eating disorder, like full blown eating disorder their entire life. It’s called severe and enduring eating disorders. And.
And then finally, there’s just a tiny portion of people who would have onset in that time of life. So for most people like they are going to have this onset earlier on in their life, and it’s the midlife is where it might cause it to worsen or relapse or finally become problematic enough that they’re officially diagnosed. And so what’s interesting is that there’s different kinds of eating disorders. So I think most of us think of like anorexia and bulimia, but there’s a whole other category called other specified feeding or eating disorder, and that’s where atypical anorexia falls. And atypical anorexia is essentially anorexia, but you’re you don’t meet the weight requirement for anorexia, which is a very low BMI, and so people who aren’t considered like thin enough, quote, unquote, are now categorized as having like, atypical anorexia. But everything else is the same. All the other behaviors and symptoms are the same. It’s just like a body weight categorization, and it wasn’t even in the DSM, I think, until like 2014 so I feel like there’s probably still, I know there are still a lot of people who don’t get diagnosed properly because they’re, quote, unquote, like not thin enough. The reason why I’m talking about this is because the manifestation of eating disorders in midlife tends to be more atypical anorexia and binge eating disorder, so less like higher than like, say, younger populations. And so that’s important, right to recognize, I think, especially even as individuals, if we are engaging these behaviors and we don’t think we’re sick enough, because we’re not thin, or we’re not, you know, as thin as we think we should be to be classified as having an eating disorder. I know that was, that was my experience. And I was told by two or three doctors that I wasn’t they were like, You’re too big to have an eating disorder. That was before atypical anorexia was in the DSM. I don’t even know if that would have made a difference, because these were just like old school male doctors, but I think that’s important to just recognize, like, if you’re listening to this and you’re thinking about this like it, you know, it doesn’t matter your body size, you can have an eating disorder, and it’s more based around your behaviors and thoughts around food. And the other problem with having an eating disorder in midlife is that people then tend to have worse medical profiles, because the body is just less resistant, unable to rebound from the physical damage that happens as a result of these behaviors. And in addition to that, obviously there might be other risk factors, like, I don’t know, I’m thinking about, like some of the bone loss with perimenopause, or like the muscle mass loss and then so if you’re then restricting food on top of that, it’s going to have a more significant impact to your physical well being. And so when we think about eating disorders, we also have to think about disordered eating. And disordered eating is really just behavior that is like restricting food, counting calories, cutting out food groups, intermittent fasting, not eating enough food, feeling guilt and shame. I mean, the way that I kind of look at it is like, anytime your food behaviors are tied to your weight, then we’re really engaging in disorder eating behaviors. But clinically or academically, the definition of disordered eating is really suggesting that it means you’re somehow, like, lowering your energy intake intentionally, whether that be through, like, excessive exercise or caloric restriction, but you don’t meet the full criteria for a diagnosis of an eating disorder. And I think I’ve said this a million times, but the problem with disordered eating is that it’s celebrated and normalized. So a lot of people do it, thinking that that’s healthy, thinking it’s the right thing to do, when the reality is that it’s it’s damage. It’s also damaging to our health and well being and mental health. And so in midlife, the prevalence for disordered eating is anywhere from like three to 16% it’s kind of hard to measure, because they just have questionnaires that they’ve given to people in different settings. I wouldn’t be surprised if it’s towards the higher end there or even higher. It’s one of those things that we can just kind of look at at this as like a trend versus an absolute number. But what they did find, one of the pieces of research that was really interesting to me, is that they found that disordered eating was twice as high in the midlife range compared to other ages. So again, suggesting that, like, there’s this period of time here where we become more vulnerable to slipping back into those behaviors, or engaging in those behaviors. And so the last thing I wanted to mention around that.
Is that, yeah, just like, it’s hard, not a lot of people get treatment. Only 27% of all women with eating disorders sought help or received treatment for eating disorder at any point in their life. So that’s why these numbers are more trends, because we don’t even know, like, there’s just so many people that don’t get treatment, and it’s not their fault. It’s because the medical establishment, you know, normalizes weight loss and normalizes extreme measures to lose weight. And so a lot of people don’t even realize that they have an eating disorder or disordered eating, or they’re ashamed of it, so they don’t get help, or they just try to, like, work through it on their own. And so, and I’m absolutely one of those people as well, so we don’t even know really the the real numbers, the things that make midlife a more challenging time, and that make make people more vulnerable to having an eating disorder in this time. One of those things is the menopause transition, so perimenopause and the changes that can happen to our appearance. So I talked about this when I did the episode on perimenopause and body image, which I will link to in the show notes, but that was episode 294, in case you want to check it out. So I’m not going to go into too much stuff around that, because I talked about that a lot in that episode. But we have appearance changes, which is relates to our weight changing, or just like our the our weight distribution changing, or like the that sort of like tone of our body changing. We have more complex lives. We might be caring for elders. We might have illnesses ourselves. We might have family or friends that have passed away. We might be caring for children. We might be trying to save money to retire or funding our children’s education, like there’s just a lot of shit going on in this time in our lives, and that can make us more vulnerable, because we’re looking for something to control, right? And so controlling our food can be that coping mechanism to deal with all this stuff that’s happening. And then we have ageism entering the chat and saying, like, Oh my God, you’re starting to age everything’s gonna go wrong. You’ve gotta stop it. And people’s body dissatisfaction goes up, and body dissatisfaction is one of the biggest risk factors for eating disorders. And so that’s becoming more complex with age, because our Western society places such a huge value on youth. And then, you know, our faces are changing, our hair is changing, our skin tone is changing, and we’re just like, What the hell is happening to me. I don’t even recognize myself in the mirror anymore. And then we have the mental health changes that happen as a result of perimenopause, like anxiety and depression and sleep and stress and oh my god, doesn’t this sound so terrible, but really, not everyone is going to be affected this way. And I think that’s kind of the problem with social media, is that it makes us think that, like, oh my god, we’re all doomed. We’re all going to experience these awful things. That’s not really, not necessarily true, and there’s actually a lot of things that we can do to help ourselves with the mental health challenges and to make ourselves more resilient to some of these appearance related changes. That’s why I think, like body image work is so important and so good to do before you enter that phase as well, because then you’re just going to be so much more resilient to those changes and not freak out anyways. What happens is, is that we sort of freak out, right, because we see these changes as unacceptable, and then we need to control our bodies. And then, you know, hello, eating disorder, and disordered eating. And so that is, that can be a huge problem there.
So that’s kind of like, you know, I talked about body image and perimenopause, and perimenopause being the perfect storm for the development and exasperation of body image issues. And really, it’s the same thing with eating disorders and disordered eating, because they go hand in hand with body image struggles. The other piece I wanted to talk about was the biological aspect of it. So perimenopause menopause, which I talked about in that previous episode as well. But what happens is there’s changes to estrogen and progesterone, but specifically that change in estrogen can make us more vulnerable to eating disorders and disordered eating. And so there, there’s kind of more like hypotheses around this. And one of the hypotheses is that it’s the fluctuation in estrogen that can cause eating disorder symptoms to fluctuate, suggesting that people who are more sensitive to these estrogen fluctuations are going to be more sensitive than, or, sorry, more vulnerable to just engaging in disorder eating and eating disorders. But that’s more of like a hypothesis. There’s more research needed around that. And then.
And there’s another study that looked at the menopausal stage and showed that it was actually less important, but rather it was more the level of symptoms that people have that’s a better predictor of disturbances in eating and body image. So the more symptoms you have in that menopause transition in perimenopause, the more disturbances you might have in eating and body image. And so they found this correlation between menopausal symptoms and prevalence of disordered eating. And so therefore, knowing that is important as an individual. So if you’re experiencing a lot of these different perimenopausal symptoms, it might make a lot of sense that then you’re wanting to engage in disordered eating, you’re having more body image struggles. And there’s a lot of things that can be done, you know, to help with some of those symptoms of perimenopause, like hormone replacement therapy and other things which I’m, you know, I would suggest talking to a North American menopause society practitioner. There’s lots of doctors. If you go to the website the North American menopause society, you can find doctors or other practitioners that are specifically trained to work with people in that phase and can do different things, including hormone replacement therapy is one of the modalities. And the last thing I just wanted to talk about is the reason why eating disorders often go unrecognized, and disordered eating goes unrecognized in midlife is because, like I said, they’re considered diseases of the young, and so there’s a stigmatization that happens, and this can happen on behalf of the individual, so thinking like, well, like this can’t be happening to me, or it’s not that bad, or this is all normal. And then you have the stigmatization of the practitioners who think that their patient is perhaps too old to have an eating disorder or is maybe just really biased still and anti fat, and therefore promotes those behaviors to their clients to try to help mitigate some of the weight changes that might be happening in that period of life, because there’s a lot of anti fat bias amongst eating disorder professionals, and that can create that barrier. And like I said, because having a lower weight, which is would classify you for anorexia, is less prevalent in midlife, like, it’s more binge eating disorder. It’s more subclinical eating disorders, or what would be considered like disordered eating and atypical anorexia, where you’re at a like, a higher, not even higher weight, like, just you’re not, like, in the really low BMI that would classify you for anorexia, but you can be higher weight, you can be majority of weight ranges, except for, like, super thin, basically, would classify you for atypical anorexia. And so therefore people, again, don’t think they’re sick enough. Or clinicians are just sort of diagnosing people based on how they look, which is obviously usually problematic. And a lot of the research focuses around anorexia and bulimia. It’s so therefore, like treatment models and screening models are centered around those things, and so a lot of practitioners just don’t even know to screen for this. And the treatments are are ones that are based on younger populations. So do we even know if they’re effective with older populations, there’s just a lot that still needs to be looked into. And then there’s this belief that maybe we can’t change, maybe we don’t deserve treatment, and maybe we just accept that this is part of our identity, like it’s too hard to let it go, because maybe we’ve had this as part of our identity for 234, decades or more, and it’s too hard to let it go, and there might be shame around it, like it’s like, oh my god, like, I don’t want to, I don’t want to get treatment, because I’m going to be a bunch around a bunch of like, teenagers and 20 year olds and whatever. And so there’s this stigmatization and shame, and then there’s the other piece of identity. So depending on your identity and your proximity to privilege or marginalization, there are other factors that come into play. So LGBTQ, I A plus plus individuals tend to have a higher incidence of eating disorders and disorder eating behaviors, there’s a real lack of research on how eating disorders impact black and indigenous peoples as so much of the research has been conducted on white populations. We know that racial bias is a factor, and so there’s all of these different things that can also cause barriers to getting screened, assessed and and treated and so, so what? So? What do we do with this information? I think it’s important to note that if you are listening to this and you are thinking like, oh geez, maybe I am struggling with.
This, or maybe I’m going to be more vulnerable to this than seeking out support and seeking out support from someone who takes a like body liberation, that positive stance on these things, I think would be really, really important just noticing, like hormonal fluctuations and noticing how that might impact your feelings about your body and your behaviors around food, and for clinicians potentially listening to this, or providers being on the alert for disordered eating, and screening for that, and eating disorders and things like that. And I think that that should be integrated when we’re working with people who are in midlife, and so I hope you found that informative, or maybe you listen to that and fall asleep, in which case that’s good. You can use it to do that too. I find this stuff super interesting. If you have questions or want more information about it, let me know. I’m happy to share. I use 30 different references for this paper, and so I’ve sort of pulled from all of them to do this podcast episode, and I will be pulling from many more over the next few months as I do this project. So thank you so much for listening today. You can find the links mentioned at summer innan.com, forward, slash, 316,
and don’t forget, you can support the show if you have the financial means to do so for as little as $5 a month by going to K O, dash, F, i.com forward slash summer in and in, you can also just click the information for this episode to find that link or find it in the show notes. Thank you so much for being here today and listening. I really appreciate you. Rock on.
I’m Summer innanen, and I want to thank you for listening today. You can follow me on Instagram and Facebook at summer innan, and if you haven’t yet, go to Apple podcasts. Search, eat the rules and subscribe, rate and review this show I would be so grateful until next time rock on you.
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