Content warning: disordered eating.

If you think you left behind your eating disorder in your teens or made it out of your 20s without worrying about your weight or body image, you might be in for a rude – and dangerous – surprise in midlife.

Do a quick search for "body image in menopause" and you’ll come across comments like the following:

“Half the time I'm feeling bloated and gross and really resenting the weight I've gained these past few months. The other half I'm making excuses to have another candy or treat. I knew getting older meant not being able to burn off calories like before, but this is really awful… And yes, I did have an eating disorder as a teen, just typing all this out and I can see that old thinking coming back.”

“I have always been slim, not skinny, and as I've aged I've had to watch what I eat, etc. If the past had been facing a small challenge to be slim and healthy then the menopause is Mount Everest. No matter how 'good' I am I can't lose a single pound and I put them on so easily I'd win Olympic gold at weight gaining.”

“I feel like in my 20's I could just stop eating junk food and the pounds came off. now it seems no matter what I do I can’t lose weight and it's all in my middle :(“

If these statements sound familiar, you’re not alone. And that doesn’t mean this sort of thinking is necessarily healthy.

(Take caution: pro-eating disorder forums or websites (e.g. Pro Ana, referring to Pro Anorexia Nervosa behaviors, and Pro Mia, referring to Pro Bulimia behaviors) are sometimes disguised as support.)

Leslie (not her real name) doesn’t consider herself as having an eating disorder, but she’s no stranger to extreme dieting.

Extreme dieting is considered a type of disordered eating, defined as “a ‘very strict diet’ or ‘hardly eating anything at all’ in order to influence their weight or shape.”

Although Leslie's mom had diabetes, and three of her siblings have had heart attacks, Leslie’s concern has always been less about health and more about her physical appearance. Before midlife, Leslie was always thin. As a teenager, she led crowds in cheers with her baton and skimpy outfits as a majorette in her high school marching band.

However, after two children and then menopause, she grew more and more self-conscious of the stubborn fat around her midsection. She calls it her “roll.”

To lose the midlife bulge, Leslie followed a plan that restricted food intake to alternating days of consuming around 500 calories worth of dairy or vegetables. To combat hunger pangs, she would rub ball bearings taped behind her ears ("acupressure points") every hour, on the hour.

While Leslie stopped once she hit her goal weight, she falls back on this method whenever she feels uncomfortable with her “roll.” She calls it “going back on the beads.”

If you need help with eating disorders in midlife, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.

What do eating disorders look like in midlife?

Leslie’s story is all too common.

Eating disorders and body dissatisfaction affect up to 13 percent of women aged 50 and older, with risk factors that correlate to eating disorders in younger women – compounded with additional anxiety around the aging process. 

While 13 percent represents the percentage of women in midlife with a diagnosable eating disorder, 60 percent report that their body image has a negative impact on their life, and 70 percent report trying to lose weight or belly fat. 

With such a high percentage of women suffering, you may not need a reminder of the various types of eating disorders, but just to be clear, we’re talking about all of the following here:

• Anorexia Nervosa: Starvation or compulsive exercise to reduce calorie intake, though it can also involve binging and purging (consciously throwing up or taking laxatives)
• Bulimia Nervosa: Binge eating (eating to excess) and then purging.
• Binge Eating Disorder: Eating to the point of feeling sick, without purging, accompanied by feelings of guilt or shame.
• Orthorexia: an obsession with healthy eating to an extent that impacts well-being.
• Other specified feeding or eating disorder (OSFED): eating disorders, like Leslie’s, that don’t meet the diagnostic criteria for the above but still cause significant medical problems.

In midlife, eating disorders generally look like binge eating, bulimia, or other specified feeding or eating disorders. Anorexia rates typically plateau around age 26, but binge eating levels out at age 47, and purging can last until a woman is in her 70s. Women who have never married or had children are more likely to experience anorexia or bulimia in midlife.

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Eating disorders are dangerous on their own, representing the highest mortality rate of any mental illness. They bring even more health challenges in midlife, as our bodies are more prone to injury and illness than in adolescence and we feel the effects more strongly. For example, bone density is already a concern as we enter menopause, and eating disorders compound our likelihood of a compound fracture. 

Hospitalizations for eating disorders increased among all age groups between 1999 and 2009, but hospitalizations for the 45-65 demographic rose the most: 88 percent. People over 45 saw the highest increase in purging. 

We’ve written before about why women in midlife are so prone to disordered eating. It comes down to hormonal shifts that lead us to binge eat or fall back into harmful dietary patterns, stressful big life changes (like kids going off to college or taking care of aging parents) that make it harder to eat healthily, and societal pressure to be thin when your body wants to gain and hold on to weight – and sadly, weight discrimination, perceived or otherwise, is prevalent in our society. 

For some women, it’s a new thing. Others relapse into old patterns. And some women finally realize that they’ve had problems with food for decades when their children receive treatment for an eating disorder. 

Get help

Consider this: you owe it to both yourself and the next generation to break the cycle of dieting and self body-shaming. Your children (or grandchildren, nieces, or nephews) are watching your actions and will model their own body image around yours.

If you recognize any of the symptoms of an eating disorder in yourself or feel you have an unhealthy relationship with food or exercise, talk to your doctor or schedule a phone conversation with one of ours. 

Awareness of eating disorders in midlife is increasing, but some women still find that their practitioner of choice will brush off their concerns, believing that only teenagers can have an eating disorder. Consider seeing another provider if this happens to you, particularly one who specializes in eating disorders.

Experts suggest that treatment for perimenopausal and menopausal individuals with eating disorders focus on behavioral and cognitive symptoms. In addition, they advise addressing the specific challenges of midlife, whether they be the physical aspect of aging, reflection upon choices made during reproductive and career-building years, and, for women who have long struggled with their eating disorder, acceptance around relationships and accomplishments that may have turned out otherwise without it.

Don’t fight Mother Nature

Consider focusing on being healthy instead of being thin.  After all, none of us will ever get to (have to) be in our 20s again. 

For most of us, this means that gone are the days of crying at 3 AM after too much tequila, sleeping on a futon because we’re saving up for a real bed, sharing an apartment we can barely afford (despite having a roommate or two), and having our hearts broken by one-night stands. And, hey, even if you can still party until dawn or your back can handle a futon, you’ve at least left behind that pesky late-adolescent angst. 

We’ve left our 20-something mindset in the past; we can leave our 20-something bodies there as well. There's more to come... let's get after it!

Your insights and experiences are valuable... and shareable! Click over to the Gennev Community Forums to ask questions, clarify, and process your experience of midlife, menopause, perimenopause, and health. We'd love it if you'd join us.