Eating disorders are on the rise in older women—and menopause is playing a role

Eating disorders are quietly but steadily increasing among women in midlife and beyond. 

Doctors and specialists say they’ve seen a noticeable uptick in women ages 40 to 70 seeking help for disordered eating. And because these women don’t fit the stereotype of a person with an eating disorder—namely, they’re not teenage girls—they often experience missed diagnoses or delayed care.

“Nothing is more invalidating than being told by your doctor that you’re too old for an eating disorder,” says Cynthia Bulik, founding director of the University of North Carolina Center of Excellence for Eating Disorders. “Yet this is what countless women in the perimenopausal period report.” 

(Could this be the end of menopause as we know it?)

These observations have proven difficult to quantify. Some studies estimate that between two and seven percent of women over 40  meet the formal diagnostic criteria for an eating disorder. Other research suggests that some 13 percent of women over 50 struggle with some form of disordered eating. Still other research shows that these numbers may be the tip of the iceberg as “up to 30 percent of women in middle age may experience disordered eating symptoms,” says Elizabeth Wassenaar, a certified eating disorder specialist and regional medical director of the Eating Recovery Center in Colorado. “And we’ve definitely seen an increase.” 

Binge eating is the most prevalent eating disorder among women in their 40s, 50s, and 60s, followed by bulimia nervosa; “and we are also seeing higher rates of less discussed purging behaviors like laxative misuse in this age group,” adds Jason Nagata, a physician specializing in eating disorders at UCSF Benioff Children’s Hospital in San Francisco.  

Midlife women also experience anorexia nervosa—though at much lower rates—as well as a lesser-known condition called orthorexia that’s characterized by obsessive behaviors surrounding exercise and “clean” eating. This condition is sometimes associated with perimenopause specifically, Wassenaar says, and can “actually lead to malnutrition.”

In fact, symptoms of perimenopause and menopause are usually at the center of all midlife eating disorder diagnoses, as both introduce a cascade of physiological and psychological changes that intersect in complex ways. Here’s how these conditions heighten a woman’s risk of developing an eating disorder—plus what other factors may be at play. 

Hormones driving a change in body composition

Menopause may drive disordered eating in a similar way that puberty affects teenage girls. “Puberty and menopause are the reproductive and metabolic bookends of life,” explains Bulik.

During both puberty and menopause, women experience extended fluctuations in levels of estrogen. This hormone plays a crucial role in the production of serotonin, a neurotransmitter that influences mood. These shifts can affect a person’s happiness and feelings of self-worth—and they directly affect body composition.

(Girls are going through puberty much earlier. There may be several reasons why.)

“During perimenopause and menopause, women often experience an increase in total body fat, especially around the abdomen,” Nagata explains. “This is largely due to the drop in estrogen, which affects how the body stores fat and regulates appetite and mood.” 

Declining estrogen levels are also linked to a drop in resting metabolic rate—the amount of energy your body uses while at rest—resulting in fewer calories burned throughout the day. These hormonal shifts can also contribute to sarcopenia, a condition that leads to muscle loss and increased fat storage.

Both changes can also lower your energy levels—meaning you may become less active and, as a result, even more dissatisfied with a changing body.

Regaining a lost sense of control

Beyond hormone fluctuations, menopause often occurs during major life disruptions such as children leaving home, marital strain or divorce, career upheaval, and aging parents who require care—disruptions that have been shown to profoundly affect dietary choices.

Moreover, “women in midlife carry much of the burden of their families,” says Robyn Kievit, a Massachusetts-based nurse practitioner and certified eating disorder specialist. Amid such pressures, disordered eating behaviors can develop as a way “to regain a lost sense of control,” says Wassenaar.

This desire to reclaim a sense of agency or predictability “is a known psychological driver of eating disorders across all age groups, but it’s particularly salient in midlife,” adds Nagata.

As one patient told researchers in a 2009 study, “Controlling what I ate was one way of controlling at least part of my life… I felt that if I could control what went in and out and how much exercise I did then I could control other things in my life.”

The pressures of #SkinnyTok versus a changing body

Such factors coincide with a double bind that midlife women often face: cultural pressure to remain thin and youthful and an aging body that naturally shifts away from the proportions idealized in media. The pressures are so intense that research shows an overwhelming 73 percent of midlife women reporting weight dissatisfaction—making it clear these struggles are not just personal, they’re systemic.

This dynamic has only been intensified by the surge of weight-loss drugs like Ozempic and harmful diet trends promulgated on social media such as #SkinnyTok. “Asking a woman between the ages of 45 to 55 to be the size she was at 15 or 20 or even 30 is terrible advice,” says Kievit.

(The science behind why weight-shaming backfires.)

After all, women going through perimenopause and menopause are sure to experience “changes in shape, weight distribution, hair texture, bone density, and more,” says Bulik. This combination of changes often causes these women “to feel increasingly disconnected from the body they once knew—intensifying disordered eating as a coping mechanism,” adds Nagata.

A history of disordered eating, anxiety, and depression

Women who have a history of disordered eating in adolescence or young adulthood are at the highest risk of relapsing during menopause as that’s when similar feelings of body dissatisfaction or emotional upheaval often resurface. Indeed, “research shows that many women with eating disorders in midlife are not experiencing these issues for the first time,” says Nagata.

Jennifer Wildes, director of the Eating Disorders Program at the University of Chicago Medicine, says she’s seen the same among her patients: “Some were never treated, or symptoms went into remission—only to return with menopause.”

Sometimes other preexisting mental health conditions are also at play such as anxiety and depression—challenges that have been linked to driving disordered eating behaviors and making their symptoms worse. 

“Eating disorders are complex biological illnesses that involve our mental health and can co-occur with substance use disorders and other mental health diagnoses,” says Doreen Marshall, a psychologist and chief executive officer of the National Eating Disorders Association. 

How to recognize—and recover from—an eating disorder

Regardless of what triggers disordered eating, one of the biggest challenges in treating it among perimenopausal and menopausal women is helping them recognize there’s a problem to begin with. This can be tricky, especially since eating disorders can be masked by dieting, wellness trends, or aging.

While there are healthy ways to reduce weight under a doctor’s recommendation, red flags of going too far include an intense preoccupation with food or weight, frequent detoxes or “cleanses,” excessive calorie restrictions, avoiding social situations involving food, or resorting to any compensatory measures after eating such as excessive exercise, laxative use, spitting or purging, or skipping subsequent meals.

Recognizing the signs is essential because “eating disorders treated within their first six months of inception have the best chance at full recovery,” says Kievit.

And while many people think of disordered eating behaviors as a “phase” that will go away with time, “it is a myth that eating disorders resolve on their own,” says Bulik. “Eating disorders are neither choices nor stages—they are serious illnesses that require attention.”

The good news is that, once recognized and diagnosed, evidence-based treatments—including a wide variety of proven psychotherapies—can be highly effective. “There is every reason to believe that if menopausal women access treatment, their symptoms will improve,” says Wildes.

Women struggling with disordered eating at midlife can turn to trained therapists, dietitians, medical providers, and organizations like the National Eating Disorders Association, Project Heal, MEDA, and the National Alliance for Eating Disorders.

No matter where you turn for help, Wassenaar emphasizes a need to do so sooner rather than later. “It is never too late to seek treatment for disordered eating and to have a peaceful relationship with your body,” she offers. “Whether you’ve developed disordered eating behaviors for the first time or lived with them for decades, now is the time to seek and receive care.”