When I tell people I research eating disorders I generally get one of three reactions:
- They ask me how I got into this research
- They tell me a story about themselves or a friend/family member suffering from an eating disorder
- They share some knowledge they’ve gleaned at some point about what it looks like to have an eating disorder (often, “aren’t eating disorders most common in teenagers?”)
Those are without question the most common responses I get, ignoring the really horrible outliers. The last item reminds me that there are still extremely pervasive myths about what “having an eating disorder” looks like. Perhaps in an earnest effort to counter such myths, I am always scouring the literature for studies revealing the particularities of eating disorders amongst diverse individuals.
One such group, and one that has been getting more “press” of late is women in midlife. To scan the more recent news fascinations, you might find that (gasp!) women in midlife also get eating disorders.
This is not news to everyone, however. Tetyana wrote about the characteristics of women with midlife-onset eating disorders here, and many eating disorder researchers have taken up the subject in recent years. For example, in 2010, McLean, Paxton & Wertheim examined developmental factors that contribute to body dissatisfaction and disordered eating amongst women aged 35-65.
STUDY DESIGN
McLean and colleagues ground their work in a body of literature that has revealed a high prevalence of body image concerns and disordered eating behaviors amongst middle-aged women (e.g. Hay et al., 2008). They looked at the links between body dissatisfaction and disordered eating symptoms in relation to the importance of body function and appearance, self-care, BMI, age, and cognitive reappraisal (altering one’s expectations about appearance during times of change).
The study took place in Australia, and the researchers recruited 200 women aged 35-65 (mean age 49). These women were assessed using a number of self-report questionnaires:
- The Eating Disorder Examination Questionnaire (Fairburn & Beglin, 1994)(a standard measure often used to assess eating disorder/disordered eating status) with an additional question addressing reasons for engaging in exercise was used to measure body dissatisfaction and disordered eating behaviours
- The Self-Objectification Questionnaire (Noll & Fredrickson, 1998) was used to measure how important bodily appearance and function was to the women; filling out this scale involves ranking how important bodily attributes (e.g. “firm/toned muscles”) are to one’s sense of self
- The authors developed a scale to measure cognitive reappraisal, specifically designed to determine how much and how participants adjusted their bodily expectations with age
Example item: “When I worry about the effects of age-related changes to my appearance, it helps to find a different way of looking at things”
- They also developed a scale to assess body-related self-care, and had participants select the number of times they engaged in behaviours
Example items: “eat healthily”; “pamper yourself”
THE MAIN RESULTS
Using the EDE-Q, the authors determined that 17% of their sample (34 of the 200 women) were “probably eating disorder cases.” Comparing women falling into the probable eating disorder case group to those in a “non-case” group, the authors found that in general, the women in the probable ED category:
- Had higher BMIs
- Felt that body appearance was more important to their self-concept
- Felt that body function was more important to their self-concept
- Reported less self-care (both body-related/physical self care behaviours and attitude toward self care)
- Had more difficulty adjusting their expectations of their body with age (lower scores on cognitive appraisal scale)
Looking at how these variables interact, the authors note that:
- As appearance importance increased, so did concerns about weight, shape, and eating, and dietary restraint
- As body function importance increased, so did shape concern
- To a slightly lesser extent, as cognitive appraisal increased, disordered eating and body dissatisfaction decreased
When the authors broke their sample down by age, they found that the importance of appearance did not vary with age, unlike prior similar studies indicating that appearance becomes less important with age.
Physical and attitudinal self care had slightly different relationships with the other variables:
- As physical (body-related) self care increased, there was a decrease in both disordered eating and body dissatisfaction
- As attitude toward self care increased, there was a decrease in weight, shape, and eating concern, as well as a slight decrease in dietary restraint
The authors also note a potentially surprising finding: as body-related self care increased, dietary restraint actually increased, rather than decreasing or remaining static, as one might expect. In thinking about this, I don’t know how surprising it really is.
It is possible that measuring body-related self care may capture a certain degree of preoccupation with bodily behaviours including but not limited to eating. That is, it may be that some women perceive “watching what they eat” (which may turn up on a measure as “dietary restraint”) to be “self-care.” I am thinking that this might be especially true of women in the mid-life age group, who are continually implored to be careful with their aging bodies from the media and other sources.
Going off on somewhat of a tangent, this makes me think about the proliferation of advertisements specifically geared toward this demographic. We tend to think about the dangers of advertising for children and adolescents, but take a look at your average magazine and you’ll find smiling women eating 0% yogurt and anti-aging creams galore.
While the media is obviously not the only contributing factor in the development of disordered eating/eating disorders, if you couple this kind of body-management pressure with other socio-contextual factors in women’s lives (e.g. marriage strain or divorce, children leaving home, hormonal shifts associated with menopause, etc.) you can begin to see how this kind of environment might pull the proverbial trigger in sparking disordered eating behaviours. As the authors note, midlife is a time at which women are faced with more responsibilities and less time to themselves; they may also feel social pressure related to the need to put others’ needs first.
Most participants (90%) also found body function to be important to how they felt about themselves, though to varying degrees. As the authors suggest, expanding the measurement to include domains beyond health, fitness and strength, such as physical pleasure in movement and ability to engage in life might help to deconstruct these results and reveal more about what aspects of body function matter to women in mid-life.
The authors suggest that the results of their study hold implications for therapy; namely, that self-care, including attitudes toward self-care, might be more explicitly addressed in eating disorder programs. In what is perhaps an obvious observation, I would also suggest that this study highlights the need to tailor treatment more specifically to life stage and developmental challenges.
What works for an adolescent will not likely be appropriate for an individual in mid-life, who is faced with an extremely different set of challenges. If we are focused on developing and evaluating treatment using primarily adolescent and young adult samples, we may be missing key elements of treatment that would attend more closely to the unique needs of women in mid-life.
References
McLean, S., Paxton, S., & Wertheim, E. (2010). Factors associated with body dissatisfaction and disordered eating in women in midlife International Journal of Eating Disorders, 43 (6), 527-536 DOI: 10.1002/eat.20737
