Can Older Adults Develop an Eating Disorder?

An unsuspecting share of people who seek treatment are 45 and older

Kimberly Goad,

AARP

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Published December 05, 2024

conceptual illustration of an eating disorder

Elena Lacey (Getty 1)

Until not so long ago, people with eating disorders fit a pretty specific stereotype: thin, white, weight-obsessed females who were — and this part is key — young. In fact, research shows that until the 1980s, age figured prominently in the diagnosis of anorexia nervosa, one of the most common eating disorders.

You might’ve had all the symptoms of the condition — characterized by self-starvation and extreme weight loss — but if you were over age 30, you wouldn’t have met the criteria for an anorexia diagnosis, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association’s so-called bible for diagnosing mental health disorders. The prevailing wisdom: Only the young battle eating disorders.

Over the past decade, however, there’s been a shift. Clinics are seeing an increase in older adults seeking treatment for eating disorders, notes the National Council on Aging; not just anorexia, but other types, as well, most notably binge eating (consuming unusually large amounts of food in one sitting) and bulimia nervosa (binge eating followed by purging). A review of research published in Current Psychiatry Reports suggests that around 30 percent of people seeking treatment for an eating disorder are over the age of 45.

“Many people have the misconception that eating disorders are characterized by extreme thinness, primarily in younger women,” says Savannah Erwin, a postdoctoral fellow at the Center of Excellence for Eating Disorders at UNC School of Medicine. “In fact, eating disorders can affect people of any age, body size, gender, sexual orientation, race and socioeconomic status.”

For some older adults, it’s a continuation of an eating disorder they’ve had all their life. More commonly, though, it’s a long-ago eating disorder that’s been triggered by a stressful event — the loss of a partner, children leaving home, caring for aging parents, etc. — or another mental health condition, such as depression or anxiety.

Hormonal upheaval, like menopause, can also provoke an eating disorder. The authors of a 2023 research review, published in Current Opinion in Psychiatry, write that “what puberty is for eating disorders in adolescence and young age is menopausal transition for midlife women.” Research even suggests that the more severe a woman’s menopausal symptoms are, the worse an eating disorder can be.

And while women are far more likely than men to develop an eating disorder — 41 percent of women over 50 have current or previous eating disorder symptoms, according to the National Association of Anorexia Nervosa and Associated Disorders — that doesn’t mean men are immune. Around 10 percent of people with anorexia and bulimia and a third or more of those with binge eating disorder are male.

Genes, environment and other eating disorder risks

What’s known as “anorexia of aging,” a diminished appetite and/or reduced food intake among older people, is nothing new. Research suggests this particular form of anorexia affects around 25 to 30 percent of older men and women, more commonly in nursing homes and hospitals. What experts are seeing now — the uptick in eating disorders from middle-age on — is different. It has more in common with the disordered eating seen in younger people.

Although research on what causes eating disorders to emerge or re-emerge later in life is inconclusive, there’s plenty of evidence to suggest that genes play a significant role. If someone in your family has an eating disorder, that ups the likelihood that you’ll develop one, too.

One review of studies published in the Journal of Preventive Medicine and Hygiene suggests genetic factors predispose 41 to 57 percent to binge eating disorder, the most common type of disordered eating in older adults, especially among middle-aged men and women who struggle with their weight, says Tom Hildebrandt, director of the Eating and Weight Disorders Program at Icahn School of Medicine at Mount Sinai.

But genes don’t act alone; environment also plays a role. Pressure to diet, or weight loss related to a medical condition or life stressor, can open the door to an eating disorder. And for someone who is genetically predisposed, losing even five to 10 pounds can be like an invitation to continue. For some, the state of semi-starvation can then lead to binge eating, if not anorexia.

Some doctors and researchers have expressed concern that people who take GLP-1 drugs (like Ozempic, Wegovy, Mounjaro, Zepbound) may be at risk of developing an eating disorder for that very reason. These drugs — some of which are approved for diabetes, some for weight loss — have helped some people shed 10 to 20 percent of their body weight. Although it’s too soon to know for certain, the thinking is that could compel someone to further limit how much they’re eating.

Eating disorders later in life can be riskier for your health

Eating disorders do a number on overall health no matter the age. But the physical toll is even greater on an aging body.

“People with a weakened immune system, bone structure, or cardiac function are particularly vulnerable to health complications associated with eating disorders,” says Erwin.

Binge eating disorder is also associated with heart disease, diabetes, and hypertension (high blood pressure), she adds, while anorexia nervosa can cause anemia, bone loss (osteoporosis), arrhythmia and heart failure. Meanwhile, bulimia is associated with “significant dental problems and dangerous electrolyte imbalances,” says Erwin.

There’s also a cumulative effect of living with an eating disorder for many years. “The longer you suffer with an eating disorder, the greater the burden of symptom-related medical consequences,” says Hildebrandt. “This increases the risk and may coincide with an erosion of resources, including access to care" and insurance-based treatment options.

Do you know the warning signs of an eating disorder?

There’s no single telltale sign of an eating disorder, according to the American Psychiatric Association, but there are red flags. For instance, says Erwin, any of the following could be a warning sign that someone is struggling with their eating:

Marked weight loss or weight gain
Weakness, fatigue or fainting
Greater focus on “healthy eating” or a newfound fixation on food and calories
Eating in secret or hiding food
Excessive or rigid exercise patterns

Other symptoms can include:

Mood swings
Thinning hair or hair loss
Frequent bathroom breaks after eating
Unusual sweating or hot flashes
Withdrawing from friends or social activities

If you recognize these symptoms in yourself or a loved one, talk to a doctor. "It is important to seek treatment early for eating disorders," says the National Institute of Mental Health. Erwin also points to resources available from the National Eating Disorders Association and the National Center of Excellence for Eating Disorders.

The most effective treatments focus on helping people with an eating disorder normalize their eating and weight control behaviors. But much of the research is focused on what works in adolescents. “There remains little research on treatments for older patients, so there is less to guide clinical decisions,” says Hildebrandt.

Confoundingly, the same GLP-1 drugs that may raise the risk of an eating disorder, may be a potential treatment for binge eating, suggests early research. By suppressing appetite, the drugs reduce binge eating.

“GLP-1 (drugs) are amazing tools and can be very effective in increasing satiety and reducing food intake, which can certainly be helpful for people who struggle with overeating,” says Erwin. “However, research on their effectiveness in reducing binge eating in humans has showed mixed results.” What’s more, these drugs don’t target the cognitive mechanisms that enable an eating disorder, she adds.

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Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Prevention, Health and Reader's Digest.