Spin classes on repeat, obsessing over a new weight-tracking app, or intermittent fasting may seem like harmless health and fitness fads, but the line between self-care and going too far can get fuzzy. And what’s alarming is that eating disorders among the soccer-mom set has spiked in the past decade. In one study done by The University of North Carolina Chapel Hill, three out of four women in their 40s reported some kind of disordered eating. When we think about eating disorders, we usually think of teenage girls, but they’re just as prevalent in middle age women—and all too often, they’re not receiving treatment, according to an article in Current Opinion in Psychiatry.

The Reason for the Rise

There are a few factors to explain the spike in midlife eating disorders.

Basic Biology

Ask anyone who is over 40 and has made the New Year’s resolution to lose five pounds, and they’ll tell you, it’s a lot harder than when they were in their 20s. As metabolism starts to slow down, you can’t even maintain your weight with the same eating and exercise habits that worked in the past. Hormone levels are part of the problem. They’re—to use a scientific term—all over the place. Spikes in cortisol and dips in testosterone not only make you bloated, but you get the double-whammy of having no energy to workout. And what starts as a diet or new workout routine can spiral out of control.

Midlife Stressors

Major transitions like divorce or having an empty nest for the first time can cause vulnerability and that can trigger an eating disorder according to Sharon Zarabi, RD, director of the weight loss program at Lenox Hill Hospital in New York City. When life feels out of control, strict adherence to a diet and to counting calories can morph into an eating disorder.

A Boomerang Effect

It’s not uncommon for an eating disorder to recur. Some women may have had anorexia or bulimia when they were teenagers or young adults, but then it was resolved and they had a long period of good health, according to Graham Redgrave, MD, assistant director of the Johns Hopkins Eating Disorders program in Baltimore. But during perimenopause and menopause—with all the physical and emotional changes—the eating disorder may return.

Body Image Anxiety

Body image becomes more complex with age, but the pressure to look a certain way (cue the flat stomach), persists. In a study published in the Journal of Women & Aging, women reported feeling “blindsided” by the changes in their body—almost like they were their younger selves trapped in an old body. One woman from the study summed it up well, “You wake up one morning and your face is sagging. You developed an inner tube around your middle that wasn’t there before. Your earlobes get longer, and your nose gets bigger…” This kind of body dissatisfaction can be a predictor to an eating disorder.

Widespread Denial

For women in this age range, especially those who may have fluctuated in weight after having children, there’s a reward system around being thin. And once they become preoccupied with their shape and their weight, it’s easy to normalize eating disorder symptoms. Things like the intermittent fasting diet can perpetuate the problem. Not only can the strict rules trigger an eating disorder, but they also distort what’s normal or can be used as a cover for a disordered eating.

It’s Often Undetected

Since these women don’t fit the stereotype, even doctors often miss the warning signs; and friends and family misjudge the symptoms. When a woman in her 30s or 40s develops an eating disorder, she may be caring for children, holding down a job, and maybe even caring for elderly parents. With so much going on, she can get away to some degree with having an eating disorder and no one will notice until it becomes severe says Dr. Redgrave. Some women themselves only realize they have a problem when they get treatment for their child.

Recognizing the Warning Signs

Of the four types of eating disorders—anorexia nervosa, bulimia, binge-eating disorder, and avoidant restrictive food intake disorder—binge eating is most common. To be diagnosed with this condition, you must have at least one binge eating episode per week for at least three months. Less frequent binge eating episodes may signal disordered eating.

In addition to being significantly underweight for your height and age, symptoms can include brittle nails, hair loss, a skin pallor, sunken eyes, being cold all the time, and being irritable says Zarabi.

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How to Get Help

The treatment for an eating disorder is usually outpatient, unless the person has lost a lot of weight, and then there may be an inpatient component. The first and most important step is to make the diagnosis. “From there, you need to interrupt problem behaviors like over-exercise or vomiting to reduce weight,” says Dr. Redgrave. This can be tricky since many people with an eating disorder think looking thin is attractive. “An eating disorder is not treated in a few sessions; it’s a lifelong therapy,” says Zarabi. And, the treatment is holistic so any co-occurring psychiatric conditions such as obsessive-compulsive disorder and depression are treated as well.

If you want to seek help for a loved one with an eating disorder, two good resources are the Alliance for Eating Disorders Awareness, which offers referrals to medical providers as well as  other resources, and the National Eating Disorders Association, which has a helpline and information about various aspects of eating disorders.

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Last Updated: Dec 5, 2019