Eating Disorders in Older Adults
By: Masha Sardari MS, RD, LDN
Published: May 7, 2024

Yes, they happen, and if you’re struggling with one, it’s important to seek help

There’s a long-standing perception in our society that people over 40 don’t struggle with or aren’t susceptible to eating disorders (EDs).

These adults are more likely to be afflicted with other conditions—depression, heart disease, increased cancer risk, the list is endless—but not EDs. It’s young people who get EDs, especially young, white, women.

Or so goes the public perception.

But that perception is inaccurate. It’s also damaging and dangerous.

Why? Because for many older adults who are struggling with EDs, their diagnosis gets missed, and they’re left to suffer without proper treatment. Sometimes for years, during which their condition worsens.

Time for some perception-slaying.

The real deal on later-onset EDs

First of all, it is true that most EDs occur in younger people. In a large cohort study published in JAMA Network Open in 2019, the average age of onset was 21 for both men and women, and 95 percent of first-time cases occurred by age 25.

That said, a significant number of people do get EDs later in life. Some appear for the first time, while others may recur many years after initial onset.

Later-onset ED diagnoses can be elusive

We’re realizing only in the last few years that a significant number of older people may’ve had EDs, we just weren’t paying attention. Clinicians were missing it, society was missing it, and no surprise the people with the EDs themselves were missing it.

Part of this major miss was a selection bias based on who came to treatment.

Here’s how that played out: Many eating disorder clinics required insurance, which meant the people who showed up tended to be younger women who had the benefit of being on their parents’ insurance plans.

Older, less affluent people were less likely to be insured, so they had limited access to treatment.

The result? Clinicians would be less likely come in contact with the latter group (older people), which in many cases gave clinicians a skewed view of who had EDs.

This view was naturally picked up by ED researchers, whose data and study findings became similarly skewed. When the media reported on those study findings, that influenced public opinion. At which point public perception solidified into: Only young people get EDs.

That then signaled to over-40 Americans that they must not have an ED, it must be something else. Yes, their thoughts and behaviors around food and body image were disordered and obsessive, but they couldn’t have an ED and therefore didn’t need ED treatment. Only young women went to ED treatment.

That’s largely where we are today, with potentially millions of older Americans not thinking they have an ED when in fact they do—and need treatment for it.

A final point on this “missing the diagnosis” phenomenon: It happened not only with older adults, but anyone who didn’t fit the young, white stereotype.

This meant minorities, men, people living in larger bodies—essentially anyone who didn’t fit the mold—had limited access to ED treatment.

Why EDs arrive later in life

EDs occur in older adults for the same reasons they occur in young adults. One of the key triggers is a difficult, highly anxiety-producing life transition.

With young people, that means transitions like the onset of puberty. For others, it’s the transition from high school to college, or simply moving to another city or state.

For older adults, a common triggering transition is when women go through menopause. Or when the kids leave “the nest.” Or when people retire.

Those later-in-life situations often engender a large amount of angst because people feel a loss of control or status (in the case of retirement). Or they feel like they’ve lost their identity and have a hard time establishing a new one.

For women even more than men, there can be intense pressure—both internally and externally driven—to look a certain way. Our youth-obsessed culture demands that you meet certain body ideals as you age.

Risk factors for later-onset EDs

  • Perfectionist or OCD tendencies. Those along with a history of depression or anxiety are all possible triggers for later-onset EDs.
  • Health issues. Conditions such as acid reflux, decreased bowel function, and other gastro-intestinal issues can drastically alter a person’s relationship with food.
  • Medication use. Older people tend to take more medications than younger people, and some cause nausea, stomach distress, and other side effects that may alter eating habits or digestion.
  • Social isolation. When people retire, for example, that can immediately shrink their social network. Eating disorders tend to thrive in isolation.

What I see

A difference I sometimes notice in older adults who come to us, versus younger adults, is they have less hope about getting better. Maybe because they’ve been struggling with it for so long, older residents sometimes think treatment isn’t going to work for them. Or they just don’t have the energy for it. Or they’re convinced there must be something wrong with them that can’t be fixed.

With these residents, we try to instill the hope they’re having trouble mustering on their own. We ask them to consider the possibility that their assessment of their situation may be faulty, and to consider alternative explanations.

In these instances, as in all ED cases regardless of the resident’s age, it’s vital to separate the person from the ED. We make it clear that their negative thinking, and their hopelessness, may well be the ED speaking, not them.

When that ED voice shows up, we suggest ways the resident can respond to it, rather than automatically believing it. We sometimes fact check the resident, and together we’re then able to dismiss some of that faulty thinking.

Final thoughts

One of the biggest challenges that people with later-onset EDs face is their complex personal and medical histories.

Some have struggled with their ED for decades or have long-standing co-occurring conditions that complicate their treatment. Others are dealing with health problems or the side effects from their medications.

And the sad fact is, many older Americans have spent decades being pummeled by our powerful diet culture that tells them … your body is too big, you’re not slim enough, you’re not attractive enough, and by the way, you need to look younger.

In fact, they do not need to look younger. They just need to be themselves.

At our clinic, once our older residents are stabilized and feeling stronger through therapy and other treatment modalities, they begin finding their way back to good mental and physical health.

Bottom line: Anyone can get an eating disorder, regardless of age, gender, race, ethnicity, body size, or cultural history.

Likewise, everyone can recover from an ED. In my experience, the great majority do just that.

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