Eating disorders in middle age: a complex issue

Eating disorders are becoming more common among women and men who have reached middle age

Liam Kelly, 40, a teacher Diyafah International School in Abu Dhabi has recently shared his story with bulimia. Reem Mohammed / The National

There is little data to show the true extent, but recent research has found that growing numbers of middle-aged people are experiencing eating disorders.

In regards to women in particular, Dr Tara Wyne, a clinical psychologist and co-founder of The LightHouse mental health clinic in Dubai, says it has become "almost expected" in this age bracket, with low self-esteem and poor body image significant factors as people age.

"These women usually present with other primary problems such as anxiety, low mood, low self-confidence and self-worth issues, but talk predominantly about their insecurities and constant battles with weight and shape," she says. "It's a variable that they may conflate with their inner emotional pain and over-focus on as something that can be controlled and remedied, and which they believe will lead to improved mood and well-being."

Women in their forties and fifties often experience significant shifts in self-identity, she says. Having reached many of the milestones in their lives – including education, relationships, children and careers – they are at the stage of accepting the life they worked so hard to 'reach'. Dr Wyne says they sometimes don't end up in a very fulfilling place. "Basically, women entering midlife have some illusions beginning to shatter. Also, they may begin to experience stages of partnered relationships that are more mundane, less novel and exciting. Many marriages and relationships break down at this stage or suffer infidelities," she says.

Disillusion and disappointment can be tough. Self-worth is questioned and, in turn, so is body weight, shape and desirability. "Many women tell me they begin to feel invisible as they enter middle age – they don't get as much attention as they did in their twenties and thirties, and they feel the loss keenly. Women can often over-focus on their weight and shape and diet as a means of securing attention once again to bolster their self-worth."

Eating disorders are typically associated with the young, but new research led by University College London suggests more than three per cent of women in their forties and fifties have had a recent eating problem. The study, published in BMC Medicine, questioned 5,658 women in the UK and found 15 per cent had suffered disordered eating at one point, while 3.6 per cent had done so in the past year. "No previous studies have investigated the period or lifetime prevalence of eating disorders among women in the fourth and fifth decades of life, after most individuals would be considered to have passed through the primary window of risk," it states. The report says such issues are "common in midlife".

The issue is complex, triggered by many things changing concurrently. Children become more independent, relationships may stale and, suddenly, life might seem out of control. Dr Wyne says the loss of parents, which can happen around this time, cannot be underestimated, saying it can reduce psychological buffers. "Losing parents can also trigger complicated grief reactions, which bring up developmental traumas or reactivate our troubled early relationships," she says. "This pain may be manifested, again, by causing us to either restrict our food intake or overeat to self-soothe, obsess over healthy eating as ways to manage our internal pain and gain control and regulate our emotions."

It's not just women

It's not only women who are affected. Liam Kelly, 41, is a teacher in Abu Dhabi. He has been a lifelong sufferer of binge-eating and purging, also known as bulimia nervosa, and says it must be more widely understood that men struggle, too. He says schools and educators have a role to play. "I really feel that the school curriculum needs to change to take into account social media and eating disorders. It just seems that, as a society, we are still trying to brush it under the carpet and only celebrities can have eating disorders."

Nadia Brooker, a counselling psychologist at Priory Wellbeing Centre in Dubai, says binge-eating disorder, a related condition in which sufferers do not purge, is unique in that those affected can range in age from young adults to those in middle age and well beyond. "Preliminary research suggests equal prevalence among males and females for binge-eating disorder," with women focusing on weight loss issues and men on muscle mass loss. She says binge-eating appears to be more prominent in those of middle age – one factor in older women is hormonal changes.

"Research has shown that the perimenopause and menopause can increase a woman's risk and vulnerability in succumbing to the onset or relapse in eating disorders," she says. Other factors include psychosocial stressors such as divorce, widowhood, physical illnesses, age-related weight gain, parenting transitions and retirement. "These factors can all act as a 'trigger' in those who may already be predisposed to developing eating disorders." Maria Abi Hanna, a clinical dietitian and eating disorder practitioner in Dubai, says that for those in the older age group, eating disorders often go undiagnosed, and there is a lack of awareness in the medical community that these issues can affect people at any age. In particular, she says the rise of 'orthorexia', a condition in which patients become obsessed with 'healthy eating' to an extent it affects their mental health, social lives and relationships, cannot be ignored. "In this older age group, there are many potential triggers that could cause the extreme obsession with eating healthy food as this could become a coping mechanism for the triggers," says Hanna, who runs Keep Eat Real, a nutrition and lifestyle consultancy.

Considered a modern phenomenon, Dr Wyne believes orthorexia, considered a modern phenomenon, has legitimised obsessional rumination. "The clean eating movement is the perfect disguise for a disordered relationship with eating and our bodies," she says. "A new cross-section of women are beginning to struggle with eating disorder symptoms because their concept of what will nourish and respect their bodies narrows to wholly unrealistic levels." In turn, people deny themselves adequate nutrition as they become distrustful of more food.

Raising awareness is central to ensuring the trend does not keep rising, says Dr Wyne. "We do not support authentic ageing societally. In today's world, women appear ageless and often there are implicit expectations that we should remain youthful and graceful despite our age or health issues. When women are going through menopause, this is particularly acute and many women can become symptomatic at this stage. Their bodies are no longer acting as they did and changing irreversibly due to hormonal shifts."

In turn, diet and body image become magnified, she explains. “We are supposed to have outgrown such insecurities and, though I don’t believe it’s a taboo, there is little compassion offered to people struggling with body image or eating issues in today’s world. Either we are supposed to have more meaningful lives and not be hung up on our bodies or, conversely, we should be able to have the willpower to control our eating and the discipline to exercise enough to remain thin. This unconscious bias can make women simply suppress these issues into internal battles.”