Anorexia and other eating disorders can manifest in middle-aged individuals with signs that are easily missed, even by medical professionals, according to a medical expert. These conditions are often not recognized because they do not fit the stereotypical image of a teenage patient in a hospital bed.
A study published in 2017, which interviewed over 5,500 women in midlife, found that more than 15 percent met the criteria for an eating disorder at some point, with nearly 4 percent being ill within the previous year. Among those currently unwell, over 40 percent developed their illness in middle age, often triggered by life events such as divorce, bereavement, children leaving home, or caring for elderly parents.
Despite the prevalence, fewer than 30 percent of these women sought or received help, and only about 8 percent mentioned their condition to their general practitioner. For many, the interviews conducted for the study were the first time they had spoken about their struggles to anyone.
Barriers to Diagnosis
A significant reason for missed diagnoses is that these cases do not align with traditional diagnostic criteria, which were largely developed with younger patients in mind. Historically, some specialist services even had weight thresholds that prevented individuals from being referred, despite experiencing significant distress from an eating disorder.
Recent findings, including a national survey in England last November, indicated that not a single adult identified as having an eating disorder fell into the underweight category. This data supports guidance from the National Institute for Health and Care Excellence, which advises against using single measures like weight or duration of illness as sole determinants for treatment, although some services continue to do so.
Recognizing Subtle Signs
Experts suggest several subtle behavioral indicators to look out for in individuals who may be struggling with an eating disorder in midlife. These can include a pattern of claiming to have already eaten elsewhere, an excessive focus on ‘healthy eating’ or ‘clean eating’ that appears obsessive, exercising even when ill, exhausted, or on holiday, becoming distressed by changes to plans involving meals, and quietly withdrawing from social situations that center around eating.
Approaching someone suspected of having an eating disorder requires sensitivity. It is advised not to comment on their weight or scrutinize their food intake, as this can increase their anxiety. Instead, focusing on observed behaviors and expressing concern kindly, with patience for repeated conversations, may be more effective.
The charity Beat offers support through its eating disorders helpline at 0808 801 0677. For individuals struggling, experts emphasize that it is never too late to seek help, regardless of age or weight, and that recovery is possible even for those who believe it is unattainable.