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Depression and Anxiety Special Report

Why Older Women Have Eating Disorders

Body dissatisfaction is not only a signature problem of youth. An increasing number of middle-aged and older women are developing eating disorders. In this Special Report, Johns Hopkins explores eating disorders -- an all-too-common condition.

Our cultural obsession with thinness as well as looking and feeling young may be contributing factors to a surge in eating disorders, leading women to fixate on dieting and exercise as a way to combat the signs of aging. Traumatic life events also may be a cause of eating disorders. The death of a spouse, the onset of menopause, a divorce, and children leaving home may lead midlife and older women to feel like they're losing control of their lives, sparking them to focus too much on things they can control, such as their eating habits and weight.

Even older men aren't immune to eating disorders, albeit in very small numbers. Only 10% of younger patients with eating disorders are male, usually from high-risk groups like dancers and athletes for whom excessive exercise is part of daily life. Eating disorders may often go undiagnosed by doctors, not only because they're unexpected but because weight loss and changes in appetite can also occur as a complication of another illness or medication use.

A recent Austrian study is among the first to investigate poor body image and eating disorders in older women. Investigators surveyed a random sample of 475 women ages 60-70 about their eating behaviors, weight history, and attitudes toward their bodies. Around 90% of the women said they felt very or moderately fat, and 60% reported being dissatisfied with their bodies. The majority of women had a body mass index (BMI) of 25, which is considered just slightly overweight, and wanted to have a normal-weight BMI of 23. Over 80% of the women made efforts to manage their weight.

Four percent of the women (18 total) met the diagnostic criteria for an eating disorder: One had anorexia nervosa, two had bulimia nervosa, and 15 had symptoms of an unspecified eating disorder that did not meet the criteria for anorexia or bulimia. In addition, another 4% of the women (21 overall) reported a single symptom of an eating disorder, such as using laxatives, diuretics, or vomiting to lose weight, or binge eating.

Eating Disorder Treatments: Cognitive behavioral therapy, which focuses on changing distorted thinking patterns and behaviors that lead to eating disorders, is often beneficial for patients with an eating disorder, as is nutritional counseling. Effective medications also have been developed to combat some eating disorder behaviors, most notably the selective serotonin reuptake inhibitors (SSRIs), including citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). These drugs can also treat the depression and anxiety that may often accompany eating disorders.

Eating Disorders Defined

  • Anorexia nervosa is a condition in which individuals starve themselves as a result of misperceptions about the way their bodies look. Symptoms include a refusal to eat, an abnormal fear of weight gain, and an altered body image. Health consequences can include fatigue, depression, an irregular heart rate, growth of baby-fine hair all over the body (known as lanugo), anemia (iron-poor blood), constipation, bloating, brittle nails and hair, and low blood pressure. This insidious disease is difficult to treat and can be life threatening if the individual's weight drops too low. It can also lead to heart disease, bone loss, and nerve damage.

  • Bulimia nervosa is characterized by a pattern of eating copious amounts and then purging the food by vomiting or abuse of laxatives to prevent weight gain. Many people with this eating disorder are of normal weight. Like anorexia, bulimia can cause serious health consequences, including fatigue; depression; dehydration; electrolyte abnormalities; constipation; damage to teeth, gums, and cheeks (from exposure to stomach acid during vomiting); and an irregular heartbeat.

  • Binge eating, which is not officially categorized as an eating disorder but may be more common than anorexia and bulimia combined, is diagnosed when someone repeatedly and excessively overeats at one sitting. Binge eaters typically feel like they can't stop eating, then they're ashamed or feel guilty afterwards. They may suffer from fatigue and joint pain and can develop high blood pressure and cholesterol levels, heart disease, type 2 diabetes, or gallbladder disease. They are usually overweight or obese and have a history of weight fluctuations.

Posted in Depression and Anxiety on January 13, 2010

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