Body Image Issues In Older Women

Body Image Issues in Older Women

Post-Menopause Weight Problems Might Trigger Eating Disorders


Alexis Peraino, M.D.

Eating disorders aren’t just a young woman’s problem. Older women suffer from similar body image issues. Read on for expert advice on eating disorders in menopause and beyond…Think eating disorders, and the image of a young woman or teen leaps to mind. But such body image issues aren’t just a problem of weight-obsessed youths.Women 50 and older also suffer from eating disorders and body image problems, according to a 2012 University of North Carolina survey published in the International Journal of Eating Disorders. Of the 1,849 women questioned online, 13% said they struggle with eating disorders. Symptoms include binge eating, purging (getting rid of food through vomiting), excessive exercising and over-dieting. About 35% said they spent at least half of their time on a diet over the last half-decade.So why do older women worry about having skinny waistlines? The reasons vary, but social pressure tops the list, says Alexis Peraino, M.D., faculty physician at Cedars-Sinai Center for Weight Loss in Los Angeles.“Society has laid unrealistic expectations of what the aging process is,” she explains.
The bar is set high, because older women are measuring themselves against glam goddesses like supermodel Gisele Bundchen and Angelina Jolie. Plus, as women age, they’re more rigid about dieting, Dr. Peraino explains.“They tend to be very detailed and almost obsessive-compulsive about what they’re eating,” she says.In this exclusive Lifescript interview, Dr. Peraino weighs in on eating-disorder red flags in older women and has tips about how to regain a healthy body image.What kind of body image issues do older women face?
First, there are women who have a poor self-image even though they aren’t considered overweight according to their Body Mass Index (BMI); second are those who have a poor self-image and are overweight.[Editor’s note: The BMI compares your height with your weight to determine weight status. Calculate your BMI here.][A third category would be] women who are just unhappy with their current weight. They battle it and can’t get themselves to a weight at which they’re happy and healthy.
At what age does this occur in older women?
They start struggling with weight loss at menopause. It’s been said that women who aren’t at their ideal weight before menopause endure a harder fight to reach that ideal weight later in life.
What factors contribute to that problem?
Many biological factors are involved, but psycho-behavioral factors [also play a role], because women have developed many unhealthy habits in terms of diet and physical activity by that point. Furthermore, they now undergo hormonal changes that make it more difficult to lose weight than previously.

How do eating disorders differ in older and younger women?
For both younger and older women, it’s often [based on] caloric restriction. How they achieve that differs.

[Older women] tend to track their food intake and follow recommended guidelines. [They convince themselves and others] that they’re doing it to improve their health. That’s different from teenage girls or younger women. Their focus often is solely based on appearance.

Are older women with eating disorders more likely to have had a history of it?

It used to be that if you didn’t have an eating disorder when you reached your 20s or 30s, the chance of developing one was pretty much nil. You crossed the critical mark. We now know that women in their 40s, 50s and into their 60s can develop an eating disorder even if they didn’t have one earlier. 

Why the change?
It has a lot to do with a sense of control, but also the emphasis [society] puts on slowing the aging process. Also, [older women] want to feel the way they felt 10 or 20 years ago.Is there more pressure today to look younger?
Society has unrealistic expectations of aging. It’s not realistic to think that you won’t age. As you get older, you lose lean body mass and strength. You add more fat to your body than when you’re younger.[Editor’s note: Lean body mass is your body weight minus fat – including muscle, bones and nonfat tissue.]
Maintaining the weight you were at 20 years old is difficult when you’re 50. [Many women] have a difficult time accepting what’s a healthy weight for them versus what’s in their mind.
What psychological factors contribute to women’s body image issues?
Women may have done lots of dieting, been committed to exercise and increasing their strength and lean body mass for most of their lives. They come to view weight as a number on the scale that they want. When they actually see what they look in the mirror, they don’t [like it].That’s because their percent of body fat is high, but their BMI is normal. When that happens, it’s referred to as skinny fat.How can women change their mindset?
Don’t work so hard to change the number on the scale. Rather, change the way you diet and exercise. That way, you can improve muscle mass and decrease fat mass. That’s [a better] approach to health and fitness than just weight.
Do most older women know how to eat nutritiously?
A lot of them know the right things to eat and not eat. For the most part, they try to abide by that, but other habits sometimes intervene. Binge eating is a common disorder, particularly in relationship to emotional and stress eating. These women generally do well [with their diets], but they sometimes come to me and say, “I did really well, except that I binged several times over the week.” That negates any of the benefits from being compliant and restrictive with their dietary intake.Do older women suffer other health problems from body image issues and eating disorders?
Anorexia, regardless of age, can significantly impact women’s health. Overall, as women age there’s less body mass reserve. So sometimes the impact on their overall lean body mass can be substantial. That’s where you end up with that skinny fat. It also impacts bone health.Do younger or older women suffer worse health effects from eating disorders?I’m not sure that [the health effects are] any worse in one age than another. Probably the ability to [treat] it – if and when you recover – is difficult if you’re older because [options are fewer].
Do weight problems or trauma in your early teen and adult years impact body image later in life?
There is a connection – not in every case, but in a large percentage of them. It usually stems from a control issue. For example, if someone was sexually, verbally or physically abused, they [may have] sought comfort with food. When they get older – particularly when stressful events occur–they return to [the habit]. There’s a common link between emotional events and stress eating.Who’s more secretive about their eating disorders, younger or older women?
I’m not sure if it’s more prevalent in one age or another. When children and adolescents face pressure about what they’re eating and their weight, it commonly triggers [behaviors like] eating by themselves, eating when others aren’t looking or hiding food in their rooms. That can carry on into adulthood.
How do you treat an eating disorder?
The first step is identifying it–having the patient recognize that what they’re doing could be unhealthy for them. Then they start to make behavioral changes, while simultaneously working with a therapist, psychologist or attending group therapy. That allows [the patient] to develop better coping skills for handling stresses in their life. We try to shift women who use food for comfort [away from the habit]. That’s an important skill to develop, so they no longer need to depend on food for stress relief.Therapy is fundamental for addressing how to cope with these body image issues, plus working with a dietitian to learn how to eat appropriately. All these together are important in treatment.How can family members recognize the problem and intervene?
It can be difficult for family and sometimes an individual to recognize the problem. I usually ask people to keep a log about how they feel when they’re eating. This might bring it to their attention.
It’s important for a family member to say, “You know, I’m really concerned. I know you’re stressed out.” But it can be touchy. You have to be cautious about asking them, even when [you have the] best intentions. It’s great for physicians to ask about it, particularly when they’re trying to help patients with weight loss.


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