On December 10^th, Monte Nido Director of Clinical Integrity Kate Craigen presented “Eating Disorders in Later Life: Clinical Considerations for Midlife and Older Adults,” focusing on the unique clinical considerations involved in treating eating disorders in midlife and older adulthood.  

Dr. Craigen highlighted how eating disorders appear across the lifespan through relapse, long-standing illness, or late-onset presentations. The session also reviewed contributing factors, screening and assessment recommendations, and treatment adaptations supported by existing research.

Clinical Presentation of Eating Disorders in Mid to Late Life

Eating disorders may emerge in midlife and later life - some individuals relapse after an earlier eating disorder, others have long-standing illnesses without significant recovery periods, and some develop an eating disorder for the first time in later adulthood. There are multiple studies documenting the persistence of eating disorder behaviors and body dissatisfaction well into older age for both women and men.

Who Has Eating Disorders in Midlife and Beyond?

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The presentation identifies three general clinical patterns:

• Eating disorder earlier in life that has lapsed or relapsed

• Long-standing eating disorder diagnosis without significant periods of recovery

• Eating disorder developing for the first time later in life

Prevalence and Body Dissatisfaction in Older Females

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Findings from several published studies examine the presence of dieting behaviors, binge eating, purging, and body dissatisfaction in women ages 42–80. These studies report a range of clinically meaningful symptoms, including strict dieting, preoccupation with food and weight, and depression associated with higher body dissatisfaction scores.

Documented findings include:

• Women over age 65 demonstrated three times the prevalence of strict dieting and fasting, two times the prevalence of binge eating, and four times the prevalence of purging compared to earlier data (Hay et al.).

• Women ages 65–80 were equally likely as young adult women to feel fat or concerned about shape (Pruis & Janowski, 2010).

• Among women ages 60–70, 3.8% met diagnostic criteria for an eating disorder, more than 80% controlled their weight, and more than 60% reported body dissatisfaction (Ackard et al., 2007).

• In women ages 42–52, 73% were dissatisfied with their weight, and greater body dissatisfaction was associated with higher depression scores (Jackson et al., 2014).

Prevalence of Eating Disorders in Older Males

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The research presented also showed meaningful prevalence of eating disorder symptoms and weight-related distress among men. Studies report objective binge eating, purging behaviors, and associations between aging symptoms and eating pathology.

Key findings include:

• 6.8% of men ages 40–75 reported at least one eating disorder symptom, and these individuals showed greater pathology on measures of eating behavior, exercise addiction, and satisfaction with body shape and weight (Mangweth-Matzek et al., 2016).

• Objective binge eating and purging behaviors occurred in 2.6%–4.1% of men (Mitchison et al.).

• 37% to 71% of men ages 20–40 expressed a desire to lose weight (Keel et al., 2007).

• Higher levels of aging symptoms were associated with higher levels of eating pathology and compensatory exercise (Kummer et al., 2018).

Impairment and Longitudinal Findings

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Research shows that impairment in psychosocial functioning does not significantly differ between males and females with full or partial anorexia nervosa or bulimia nervosa. Women reported greater distress associated with extreme dietary restriction, while men with binge eating or extreme dieting reported more days off work.

A 30-year longitudinal study (Brown et al., 2020) showed that the percentage of women meeting criteria for any eating disorder decreased from ages 20 to 30 and remained stable through age 50, while rates in men did not significantly change from ages 20 to 50. At age 50, 84% of women and 83% of men who had an eating disorder at age 20 had recovered, while 16% of women and 17% of men had relapsed. Most cases at age 50 were diagnosed with OSFED.

Eating Disorders in Mid–Late Life Men

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Research has noted specific characteristics observed in men, including:

• Greater parity in prevalence in BED, ARFID, and night eating syndrome

• Lower scores on eating disorder symptom measures

• Drive for muscularity

• Compulsive exercise

• Less likelihood of explicitly endorsing a desire to lose weight

• Presence of “double stigmatization”

Contributing and Maintaining Factors

The presentation outlined interpersonal, medical, cultural, hormonal, and body image–related factors that contribute to eating disorders in midlife and older adulthood. It is necessary to emphasize that these factors often overlap and may occur simultaneously.

Interpersonal Triggers

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There are several life events and transitions that may act as triggers:

• Death of a spouse or loved ones

• Infidelity

• Divorce

• Caretaking aging parents

• Parenting demands

• Empty nesting

• Young adults returning home

• Retirement

Medical Antecedents

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Medical contributors can include:

• Pregnancy

• Weight loss surgery

• Diabetes

• Chronic pain, autoimmune conditions, allergies

Research included in the presentation showed that post-bariatric surgery symptoms may involve objective binge eating, loss of control, night eating syndrome, grazing, picking, and nibbling (William-Kerver et al., 2021).  

Body Image and Cultural Influences in Adult Females

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Several factors were identified as relevant to body image concerns in older women, including social media, selfies, aging, involuntary body changes, and weight or shape changes associated with health conditions or medications. Slides also noted cultural emphasis on youth and beauty, marketing to older women, and societal forces that undermine self-esteem.

Hormonal Factors: Females and Males

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For females, the presentation noted that binge and emotional eating tend to be lowest when estrogen is high and progesterone is low, and that more severe menopausal symptoms are associated with greater body image concerns (Vincent et al., 2023).
For males, malnutrition or excessive exercise can lead to low testosterone, low luteinizing hormone, and low follicle-stimulating hormone, and several aging-related symptoms were noted (Kummer et al., 2019).

Body Image in Adult Males

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Key contributors include muscularity-oriented eating, compulsive or excessive exercise, RED-S, muscle dysmorphia, and use of performance-enhancing substances.

Assessment & Diagnosis of Eating Disorders in Midlife and Older Adults

Dr. Craigen highlighted the importance of age-sensitive tools and awareness of gender-specific symptom patterns. The presentation emphasized that eating disorders should be included in the differential diagnosis of unexplained weight gain or weight loss irrespective of age or gender.

Assessment Tools

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Appropriate assessment tools include:

• EDE-Q

• Grilo’s Model (Grilo, 2013)

• EAT-26

• Bazo Perez’s Model (Bazo Perez, 2023)

Eating Disorder Screening

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The Eating Disorder Screen for Primary Care includes five yes/no questions addressing satisfaction with eating patterns, secrecy around food, effect of weight on feelings about oneself, family history, and current or past eating disorders. (Cotton et al., 2003)

Additional Assessment Considerations

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Additional assessment considerations include:

• For males, clinicians may focus on EDE-Q questions rather than full-scale scores.

• The Binge Eating Scale is used to assess binge eating.

• The PARDI-AR-Q is used for ARFID.

• Post-bariatric surgery assessments should include subjective binge episodes and night eating frequency.

• Additional considerations include muscle dysmorphia and performance-enhancing substance use.

Eating Disorder Treatment Adaptations & Considerations for Older Adults

The presentation also focused on treatment approaches supported by research findings and considerations unique to older adults.

Medical Collaboration and Referral

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Recommendations include collaborating with:

• Primary care providers (Halbeison et al., 2025)

• Gerontologists

• Endocrinologists

• Menopause specialists (Pearce et al., 2014)

The deck also emphasized weight-inclusive care, willingness to spend time with patients, and monitoring for osteoporosis, osteopenia, and weight suppression.

Eating Disorder Treatment Outcomes for Midlife and Older Adults

• In anorexia nervosa, a multidimensional approach is recommended; 50% of older adults required hospitalization.

• For bulimia nervosa, CBT alone, medication alone, or CBT plus medication resulted in 80% of cases showing improvement.

Additional Treatment Literature

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Findings presented included:

• Prevalence of eating disorders is around 3.5% in older women and 1–2% in older men.

• CBT and ACT-based interventions are used.

• Treatment emphasizes the context of midlife and addresses age-related changes to appearance, self-worth, body acceptance, and self-care. (Mangweth-Matzek & Hoek, 2017)

Body Image Work

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Dissatisfaction and appreciation may coexist, and treatment may include education about unrealistic media ideals and decreasing internalization of those ideals. (Quittkat et al., 2019; Rubenstein & Foster, 2012)

Treatment for Men

Findings presented include delayed recognition of eating disorders in men, lack of information about eating disorders, minimization or ignorance of symptoms by PCPs, and men experiencing being a minority in treatment. Research also supports the role of designated tracks for men and the importance of addressing masculine gender socialization. (Richardson & Paslakis, 2020; Bunnell, 2021; Macneil et al., 2018)

Connecting Triggers to the Role of the Body

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Specific examples included fertility and infertility, empty nest transitions, and workplace wellness programs. (Maine & Kelly, 2016)

Family Work

• Education about eating disorders

• Defining support roles

• Recommending step-up in care

• Restructuring responsibilities to support treatment

The research and clinical insights shared in this presentation underscore a central message: effective care for midlife and older adults begins with accurate recognition and multidisciplinary support. By assessing symptoms without age or gender bias and attending to the medical and psychosocial factors that shape later-life presentations, clinicians can better identify needs and guide individuals toward appropriate treatment. This framework strengthens our collective ability to provide informed, sensitive, and comprehensive care.

For more information about Monte Nido please call 888.826.2320, visit our website and connect with us on Facebook, LinkedIn, and Instagram.

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Sources:  

Ackard, D. M., Richter, S., Frisch, M. J., Mangham, D., & Cronemeyer, C. L. (2013). Eating disorder treatment among women forty and older: Increases in prevalence over time and comparisons to young adult patients. Journal of Psychosomatic Research, 74(2), 175–178. https://doi.org/10.1016/j.jpsychores.2012.10.014

Bazo Perez, M., de Carvalho, P. H. B., & Frazier, L. D. (2025). Examining the factor structure and measurement invariance of the online-administered Eating Disorder Examination-Questionnaire and the Eating Attitudes Test-26 in young and middle-aged women. Eating and Weight Disorders: EWD. https://doi.org/10.1007/s40519-025-01802-8

Bazo Perez, M., Hayes, T. B., & Frazier, L. D. (2023). Beyond generalized anxiety: The association of anxiety sensitivity with disordered eating. Journal of Eating Disorders, 11(1), 173. https://doi.org/10.1186/s40337-023-00890-0

Brown, T. A., Forney, K. J., Klein, K. M., Grillot, C., & Keel, P. K. (2020). A 30-year longitudinal study of body weight, dieting, and eating pathology across women and men from late adolescence to later midlife. Journal of Abnormal Psychology, 129(4), 376–386. https://doi.org/10.1037/abn0000519

Bunnell (2021). Men with Eating Disorders: The Art and Science of Treatment Engagement, In Eating Disorders in Boys and Men, Nagata, J. M., Brown, T. A., Murray, S. B., & Lavender, J. M. (Eds.).  Springer.

Cotton, M.-A., Ball, C., & Robinson, P. (2003). Four simple questions can help screen for eating disorders. Journal of General Internal Medicine, 18(1), 53–56. https://doi.org/10.1046/j.1525-1497.2003.20374.x

Grilo, C. M., Henderson, K. E., Bell, R. L., & Crosby, R. D. (2013). Eating disorder examination-questionnaire factor structure and construct validity in bariatric surgery candidates. Obesity Surgery, 23(5), 657–662. https://doi.org/10.1007/s11695-012-0840-8

Hay, P. J., Mond, J., Buttner, P., & Darby, A. (2008). Eating Disorder Behaviors Are Increasing: Findings from Two Sequential Community Surveys in South Australia. PLOS ONE, 3(2), e1541. https://doi.org/10.1371/journal.pone.0001541

Kummer, K. K., Pope, H. G., Hudson, J. I., Kemmler, G., Pinggera, G.-M., & Mangweth-Matzek, B. (2019). Aging male symptomatology and eating behavior. The Aging Male, 22(1), 55–61. https://doi.org/10.1080/13685538.2018.1477931

Maine, M. M. & Kelly, J. (2016). Pursuing Perfection: Eating Disorders, Body Myths, and Women at Midlife and Beyond. Routledge. https://www.mwsg.org/pursingperfection

Mangweth-Matzek, B., & Hoek, H. W. (2017). Epidemiology and treatment of eating disorders in men and women of middle and older age. Current Opinion in Psychiatry, 30(6), 446–451. https://doi.org/10.1097/YCO.0000000000000356

Mangweth-Matzek, B., Kummer, K. K., & Pope, H. G. (2016). Eating disorder symptoms in middle-aged and older men. International Journal of Eating Disorders, 49(10), 953–957. https://doi.org/10.1002/eat.22550

Mitchison, D., & Mond, J. (2015). Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: A narrative review. Journal of Eating Disorders, 3(1), 20. https://doi.org/10.1186/s40337-015-0058-y

Mitchison, D., Mond, J., Slewa-Younan, S., & Hay, P. (2013). The prevalence and impact of eating disorder behaviours in Australian men. Journal of Eating Disorders, 1(1), O23. https://doi.org/10.1186/2050-2974-1-S1-O23

Pruis, T. A., & Janowsky, J. S. (2010). Assessment of body image in younger and older women. The Journal of General Psychology, 137(3), 225–238. https://doi.org/10.1080/00221309.2010.484446

Quittkat, H. L., Hartmann, A. S., Düsing, R., Buhlmann, U., & Vocks, S. (2019). Body Dissatisfaction, Importance of Appearance, and Body Appreciation in Men and Women Over the Lifespan. Frontiers in Psychiatry, 10, 864. https://doi.org/10.3389/fpsyt.2019.00864

Richardson, C., & Paslakis, G. (2021). Men’s experiences of eating disorder treatment: A qualitative systematic review of men-only studies. Journal of Psychiatric and Mental Health Nursing, 28(2), 237–250. https://doi.org/10.1111/jpm.12670

Vincent, C., Bodnaruc, A. M., Prud’homme, D., Olson, V., & Giroux, I. (2023). Associations between menopause and body image: A systematic review. Women’s Health (London, England), 19, 17455057231209536. https://doi.org/10.1177/17455057231209536

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