In Canada, it’s estimated that 1.7 million people suffer from an eating disorder.

And not all of them are teen girls. In fact, as many as 29 percent of women in perimeno­pause (the roughly four­ to eight­-year window that typically falls in a woman’s 40s) could be experiencing specific symptoms of an eating disorder. Between the crazy hormones, crush­ing stress, body changes and pressure to look forever young, no wonder so many of us are fighting with our food.

What is disordered eating?

Although different types of eating disorders have distinct symptoms, each condition involves a hyper­ focus on food and eating, which is associated with distressing thoughts and emotions. A few of the most common eating disor­ders include anorexia nervosa, which is characterized by intense periods of restrictive eating; binge eating disorder which involves eating large quantities of food and then experiencing shame, distress, or guilt; and bulimia nervosa which involves binge eating fol­lowed by purging. Eating disorders also tend to occur alongside other mental health issues like mood and anxiety disorders, obsessive­ compulsive disorder, and alcohol and substance disorders. It’s esti­mated that 50 percent of people with eating disorders also meet the criteria for depression.

At its core, an eating disorder is a coping mechanism, says Heather Noble, a registered dietitian specializing in eating disorders at Cleveland Clinic Canada. “This is a way that individuals can seek comfort, a safety net, a way to feel in control,” she says. An eating disorder can be triggered by a major life change or traumatic event, such as loss of a loved one, a divorce, or a serious illness. Eating disorders can also develop in response to a drastic physical change, like puberty, pregnancy, or the hormonal shifts that come with the onset of menopause.

Why are we seeing a surge in eating disorders in women over 40?

One theory is that this group has simply gone mostly unnoticed until now. “Women over 40 are still often overlooked,” says Emily Tam, a registered dietitian with the University Health Network’s National Eating Disorder Information Centre in Toronto. “Eat­ ing disorders continue to be widely perceived as conditions that mostly affect teens and young adults and, as a result, women (and people of all genders) in their 40s or older often aren’t screened for them and the disorders go undetected,” she says.

The stereotypical patient with anorexia nervosa, for example, is imagined as young, white and painfully thin. However, we know that none of those things are nec­ essarily true. In fact, atypical anorexia nervosa (which shares all of the symptoms aside from being underweight) is actually much more common. Research also shows that eating disorders are as prevalent among Black, Indigenous and other racialized groups as with white women.

“Eating disorders don’t discrimi- nate against age, sex, gender, size, racial and ethnic backgrounds, sexual orientation or socioeco- nomic statuses,” says Noble.

Perhaps most persistent is
the idea that women with disor- dered eating are all very young. “I’ve had many middle-aged patients describe a feeling of imposter syndrome around being older and struggling with these symptoms,” says Noble. But research shows that while rates of anorexia nervosa do plateau for women around age 26, rates of bulimia nervosa actually peak closer to age 47.

In some ways, midlife can be a perfect storm of physical, mental, and emotional stressors that’s not dissimilar from the teen years. The highs and lows of the perimenopausal hormonal rollercoaster, coupled with peak career stress and the demands of the sandwich generation, may help to explain a spike in 40-something women seeking treatment for either new or existing struggles with food. Plus, underlying issues such as low self-esteem, relationship and interpersonal issues, and perfectionism can all play a part. “For some women, these issues may become particularly prominent during midlife,” says Tam. Then, to top it all off, there’s the unre­ lenting cultural pressure to stay thin and youthful.

Does that mean that a woman in her 40s, or beyond, could experience an eating disorder for the very first time? It’s possible. “Research findings indicate that most midlife women with eating disorders have either experienced a persistent struggle with disordered eating since adolescence or have experienced a relapse after recovering from disordered eating,” says Tam. “In some cases, however, the eating disorder simply develops in midlife, even in the absence of a history of symptoms.”

Treating eating disordered in older women

No matter a woman’s age, living with an eating disorder has the potential to impact physical and mental health—and sometimes the damage can be significant.

A lack of proper nourishment can lower blood pressure and damage the heart. Frequent purging can disrupt the digestive system, contribute to bone loss, and damage teeth. And as we age, our bodies don’t bounce back like we used to from muscle loss or a slowed metabolic rate. That’s why it’s so important for women to be able to seek treatment.

Eating disorders can be diagnosed by a primary physician, nurse practitioner, or a psychologist. Treatment typically includes a mix of specific types of talk therapy, medical monitoring, medications to treat the disorder directly or to address underlying mental health issues that might be impacting the eating disorder, such as anxiety or depression, in addition to nutrition education.

And while a multipronged approach does work best, even personalized treatment plans are not always tailored with midlife in mind, says Tam, because many of the evidence-based go-to treatments were developed from research with young women. “Continued research into approaches that prioritize quality of life, such as enhancing life enjoyment and fulfillment alongside symptom management, may offer meaningful benefits for women in midlife and older age,” she says.

“What makes this population unique is typically they have lived many years struggling with food and weight and reach a point where they don’t want to do it anymore,” says Noble. These women have decided to finally stand up to their disordered eat- ing, which is both very scary and very brave. “I get to witness them taking back control from the eating disorder—it’s incredibly rewarding,” she says.

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