Eating disorder symptoms and weight and shape concerns in a large web‐based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study

Over 53 million women in the United States are over age 50, comprising approximately 17.2% of the total population.1 Despite their growing influence in our society, little is known about disordered eating behaviors and attitudes of women in this age range. By assessing current and past disordered eating behaviors in women over 50, the current study aimed to gain a greater understanding of the nature and magnitude of weight and shape concerns of women in this age group to assist with service planning, if required. Population-based studies in the United States and Europe have reported reduced risk for eating disorders as women mature.2, 3 In a study of European women, Preti and colleagues 3 reported lower lifetime risk of anorexia nervosa (AN; 0.17% vs. 0.58%), bulimia nervosa (BN; 0.21% vs. 0.55%), and binge eating disorder (BED; 0.61% vs. 1.07%) in women ages 45 years and over compared with women between 30 and 44 years of age. Similarly, in the United States, women ages 18 to 59 were significantly more likely than women ages 60 and over to suffer from BN and BED, but not AN.2 In both the European and the American samples, age was inversely related to lifetime risk for eating disorders.2, 3 However, inconsistencies in the age stratification of samples (e.g., stratification by decade, combining all women over 45 in a comparison group) may have obscured differences in the risk of eating disorders within these age groups. Prevalence estimates of eating disorders in women over 50 are lacking, resulting in an incomplete picture of eating disorders in this age group. In contrast to population-based statistics, clinical investigations report the presence of late-onset eating disorders4, 5 and reveal increasing inpatient admissions for eating disorder treatment in women ages 35 and over.6 Emerging epidemiologic and clinical reports of women during mid-life suggest that eating disorders present in one of three ways—either a chronic presentation of an earlier-onset disorder without a period of recovery; a relapse of a remitted disorder that occurred earlier in life; or, a late-onset presentation with no past history.5, 7-11 The prevalence of late-onset eating disorders in clinical samples of women with eating disorders at midlife (over age 40) appears to be quite modest. 5, 11, 12 However, a recent review of forty-eight case studies of eating disorders in individuals over the age of fifty reported that 69% (i.e., thirty-three studies) had late onset eating disorders.12 A fuller understanding of these contrasting patterns of presentation necessitates further study. Limited research has followed women with histories of eating disorders as they age. In a 20-year longitudinal study of men and women from late adolescence (age 20 ± 2 years) to mid-life (40 ± 2 years), Keel et al.13 reported that 75% of women who met criteria for BN and eating disorders not otherwise specified (EDNOS) in late adolescence were in remission at mid-life. Yet, the estimated point prevalence of BN and EDNOS in mid-life women was 4.5%.13 As a critical starting point, the expansion of this line of research will increase our knowledge of the trajectory or trajectories of eating disorders in mid-life and beyond. Several community studies have explored disordered eating behaviors among women during mid-life.14-16 Of 475 Austrian women ages 60 to 70 years, 3.8% met diagnostic criteria for an eating disorder (e.g., AN, BN or EDNOS) and 4.4% endorsed a current single symptom of an eating disorder (e.g., binge eating, laxative/diuretic use, or vomiting).14 A multiethnic sample of slightly younger women ages 42 to 55 years revealed that 11% of women endorsed binge eating at least two to three times a month.15 Dieting behaviors and weight and shape concerns, such as fear of weight gain and preoccupation with food, were also reported in community samples of women during mid-life and late adulthood,14, 15, 17-19 even in women reporting a body mass index (BMI) in the healthy range.17, 20 Mid-life women report greater disordered eating behaviors and concerns, including drive for thinness and disinhibited eating, compared with older women in the same samples suggesting either a decrease in disordered eating behaviors and concerns between mid-life and older adulthood or a cohort effect, given that these were not longitudinal investigations.18, 20, 21 Body dissatisfaction is also a pertinent concern among mid-life women. Collectively, studies indicate that overall body dissatisfaction is somewhat stable across the lifespan,22, 23 with mid-life and older adult women reporting body dissatisfaction similar to that of younger women.21, 24-26 In addition, greater body dissatisfaction is associated with higher BMI in mid-life women.14, 18, 20, 21, 27, 28 BMI increases through middle age, levels off, and then begins to decrease around age 60 years.29 During this transition from mid-life to older adulthood, other physiological changes occur as well (e.g., skin changes, fat redistribution). A major limitation of the current literature on body dissatisfaction among mid-life women is the reliance on figure-rating scales and questionnaires that fail to assess dissatisfaction with features of the body associated with the aging process (e.g., skin, face, and abdomen). One small study30 of 55 women found the prevalence of dissatisfaction for ten different body parts was similar across age (young, middle, old), with the stomach, hips, and thighs rated most negatively. However, this study did not assess dissatisfaction with skin, a key feature of the body influenced by aging, and may have lacked adequate power to detect differences; thus larger studies are needed to replicate and extend these findings. To increase knowledge of disordered eating behaviors and associated attitudes in this demographic group, the present study surveyed a large sample of adult women ages 50 and over. The aims of the study were to: 1) estimate the prevalence of current and past core eating disorder symptoms, weight control and body checking behaviors, and weight and shape concerns in a large sample of women ages 50 and above; 2) document differences on these dimensions across age and BMI categories; and 3) compare responses across three groups: women who endorse current core eating disorder symptoms (currentEDS), women who endorse a history of core eating disorder symptoms but no current symptoms (pastEDS), and women who report no history of core eating disorder symptoms (noEDS). The third aim was directed toward understanding whether eating disorder symptoms in the past were associated with persistent disordered eating behaviors and attitudes in later adulthood.