When you think of someone with an eating disorder, what does that person look like? If you’re like most of us, you think of eating disorders as happening primarily among young, white, thin women and girls. That misconception can be dangerous.

Eating disorders affect a much wider range of people, including up to 13 percent of women in midlife. Hormonal shifts, major changes in our lives, and societal pressures can all contribute to women over 40 engaging in unhealthy behaviors around eating, exercising, and occupying their own bodies.

Disordered eating has the highest fatality rate of all mental health issues, so it’s important to understand where this disease comes from, what it looks like, and how to combat it to get or stay healthy. To learn more, we turned to nutrition therapist and eating disorder specialist Julie Duffy Dillon.

What does an eating disorder look like?

There are several kinds of eating disorders, including anorexia nervosa, in which people restrict their calories and the types of food they eat and may engage in excessive exercise; bulimia, which is characterized by binging on large amounts of food then purging via self-induced vomiting or other methods; and, by far the most common among women in midlife, binge eating disorder (BED). Sufferers of BED generally eat large volumes of food, rapidly, to the point of discomfort, even when they’re not hungry. Feelings of self-disgust, shame, guilt and embarrassment are common.

But according to Julie, disordered eating doesn’t have to mean eating to the point of sickness multiple times a week to be a concern and bad for our health. Often, the beginning stages are marked by withdrawal – something as small as not attending the Friday family pizza and game night because we don’t trust ourselves around pizza.

If, says Julie, concerns about eating and body image are keeping us from taking part in activities we enjoy, if we’re starting to “check out” of our normal lives, then there’s a problem we need to address.

Why are eating disorders common at midlife?

According to Julie, there are a few reasons women in midlife are particularly vulnerable.

Hormonal shifts. As estrogen and serotonin decline in our bodies around menopause, women who are sensitive to the shifts in levels become more susceptible to binge eating, in particular. This estrogen sensitivity pre-dates any eating disorder behavior, meaning women who had issues with eating disorders in the hormonal chaos of adolescence may find themselves confronting the problem again in midlife.

Life changes. According to Julie, if you’re susceptible to disordered eating, times of transition are the most vulnerable periods of our lives. Midlife is marked by huge transitions: in addition to the hormonal shifts of menopause, women are often contending with a newly empty nest, aging parents, divorce, etc. Being constantly under stress can drown out our body’s natural signals that help us eat healthfully.

Societal pressures. Our culture values thinness (not necessarily healthiness, mind you: thinness), and women over 40 feel the pressure every bit as much as their younger sisters. But during menopause, research shows most women gain around 15 pounds, much of it in “central adiposity” (belly fat). That’s just part of the natural process. But most of us feel the pressure to be thin, to have a flat tummy regardless of age or child bearing. Raise your hand if you’ve heard someone say of a mature woman that “she’s let herself go.” Argh argh argh.

Fighting our body’s natural inclination during this transition is counter-productive, Julie says, because fat, particularly in the midsection, holds on to estrogen. Even when a woman is no longer ovulating and producing regular estrogen, that fat allows the body to have a release of estrogen that can help alleviate menopause symptoms.

“So many women I know are seeking out ways to help with symptoms
and side effects, but if they weren’t fighting their bodies so hard,
their bodies could take care of some of it, or maybe even all of it!”

It’s a kind of cultural toxicity, Julie says. We’re told that to be seen, to get a promotion, to keep a romantic partner’s interest, we have to be thin and trim. That pressure ends up being a far greater risk factor for disordered eating than are estrogen and serotonin sensitivity – and they affect a far greater number of women.

Poor information. The idea that gaining weight, particularly in the midsection, can be beneficial, seems radical, Julie says, but it’s true. We’re told that belly fat increases inflammation, leads to higher risk of heart disease, etc., but we really need to look deeper. There’s a weight bias at work in our culture that limits our access to information such as the protective qualities of some belly fat gain.

How do we get back to healthful eating?

It really is “getting back” to healthful eating, Julie says. We’re all born with an innate knowledge of how to feed ourselves and move our bodies for optimal health. But we’re taught to distrust our own instincts – starting as far back as when a parent demands we clean our plate or only take one helping, for example. But we can relearn how to read our body’s signals … and trust them.

This “Food Peace Journey,” as Julie calls it,
is an untangling of the societal and cultural cues about how we “should” eat
and what we “should” look like, and reconnect with our bodies.

“Every woman is expert on her own body,” says Julie. “She’s the only one that’s been there the whole time! We know metabolism starts to slow down, and we shouldn’t be scared of that or fight it. When we stay in our bodies, our bodies let us know what to do. Hunger and fullness cues are still reliable during this transition, just as they were in our 20s or 30s or 40s. For women who have learned not to trust their bodies, it can take some time to learn the cues. But all the information is there and can be trusted. When you tune in, you realize eating certain foods makes you feel more energized while others make you sluggish. If we stay connected, our bodies will lead us to make choices that are health promoting.”

So what’s a woman in midlife to do?

From Julie: Don’t fight your body. That fight is distancing you from the healthy body you’re craving. Yes, society is going to send you mixed messages, like a grocery store full of food that shunts you through an alley of magazines of glamorous women at the checkout. But the key is to reshape the messages for yourself: acknowledge that the food in your cart is there to nourish you, that you’re making the choices that are right for you. Respect your body; enjoy your autonomy; do and eat what makes you feel good and energized. Learn the skills to hear your body’s messages and then make informed decisions about your food.

To get more great information from Julie, visit her website, check out her blog, take a listen to her podcast. Then stay tuned, because we’re going to host Julie on our podcast! So if you have questions for her, please add them to the comments below, or give us a shout on Facebook or Twitter.