When Margaret Maine returned from summer vacation years ago, a friend greeted her: “It looks like you’ve lost some weight. You look great!” the pal praised. “I wish I could.”
Maine wasn’t going back to high school, college or even back to work in middle age. Rather, she was in her late 70s at the time and returning to her assisted living facility in West Hartford, Connecticut. The woman envying Maine’s weight loss — which was due to health problems — was already thin, not to mention nearing 90.
“We think body image concerns and dieting is something more recent, but women have been living with this pressure to look a certain way and to be in control of their bodies for over a century,” says Maine’s daughter, Margo Maine, a clinical psychologist in West Hartford who recalled the scenario that transpired about 20 years ago.
[See: The Eating Disorder Spectrum — From Pregorexia to Drunkorexia.]
Eating disorders including anorexia nervosa, bulimia nervosa and binge eating disorder are psychiatric illnesses marked by extreme feelings and behaviors around weight and food that can have life-threatening physical and mental consequences, according to the National Eating Disorders Association. While the conditions most commonly emerge in adolescence and early adulthood, middle-aged and older adults aren’t immune, particularly if they didn’t resolve body image issues earlier in life, experts say. One 2012 survey found that 13 percent of women age 50 and older experienced eating disorder symptoms over the prior five years. More than 70 percent were attempting to lose weight, and 62 percent felt their weight or shape negatively affected their lives.
Much like body changes during adolescence, geographic changes during early adulthood, and career and family changes during middle-age, common older-age transitions like retirement, increased caretaking responsibilities and deaths among family and friends can spike eating disorder prevalence in older age, Maine reasons. “By the time women are … going through the psychological stressors of that time period … there’s a renewed desire to have something to control,” says Maine, author of “Pursuing Perfection: Eating Disorders, Body Myths, and Women at Midlife and Beyond.” “The body is the way that we do that.”
But eating disorders in older adults are difficult to identify because many more common age-related conditions like taste bud decline, dementia and lack of access to food can cause eating problems. What’s more, few clinicians who work with older adults have the training or awareness to consider eating disorders a potential cause for general symptoms like weakness, dizziness or dehydration, says Dr. Evelyn Attia, professor of psychiatry at Columbia University Medical Center who directs the Columbia Center for Eating Disorders. “There’s an assumption in the evaluation of an older person that these kinds of difficulties are likely associated with anything but an eating disorder,” she says.
Recognizing eating disorders in older age is critical since treating them is a lot different than treating other age-related eating problems, although the consequences of nutritional deficits in that population — a weak immune system, poor recovery from wounds, anxiety, cognitive impairment, weakened muscles and bones, and an increased risk of falls — are the same.
“You can’t neglect [good nutrition] at any point in life, and no less so as we enter older adult ages,” says Dr. James Powers, a geriatrician and professor in the Vanderbilt University School of Medicine. If you’re concerned about the eating habits of an older adult in your life, consider these experts tips:
1. Don’t jump to conclusions.
Don’t assume an older adult’s unexplained weight loss or restrictive eating habits are due to an eating disorder before digging deeper, experts say. “When an older person is struggling to eat, it almost always has an underlying medical cause,” says Dr. Laura Hanson, a professor in geriatric medicine at the University of North Carolina School of Medicine, where she directs the palliative care program. For example, medication side effects, dulled taste buds, physical limitations, economic barriers, dementia and depression can all make healthy eating difficult, unenjoyable or both. Some older adults, too, may naturally eat less as they become less active, which can be a healthy and effective weight-maintenance strategy, Hanson adds.
[See: The Best Ways for Nursing Home Residents to Stay Active.]
On the other hand, don’t assume overweight older adults can’t have eating disorders or nutrition problems. “If somebody looks frail, doctors, family members and friends are going to be alerted and concerned,” Hanson says. “But we see many older adults who are heavyset and yet in nutritional decline.”
2. Approach with care.
The best way to determine the cause of weight loss is by going directly to the source. Try, for instance, joining the person for a meal and observing potential barriers, says Angela Ginn-Meadow, a registered dietitian in Baltimore who works with patients of all ages. “You’ll get a lot of ideas of what’s going on,” she says, whether it’s difficulty preparing food, disinterest in eating or a fear of becoming fat. Just keep in mind that many older adults are too proud to admit they no longer have the finances or energy to grocery shop, for example, Hanson says. “Eventually, we see them in health care, and it’s up to the physician to recognize this isn’t just an infection.”
3. Know that treatment is available — and works.
Depending on the cause of weight loss or nutritional decline, you can teach an older adult new strategies that will help. If, for instance, food just doesn’t taste as good as it used to, experimenting with different spices can help make it enjoyable again. If older adults aren’t eating well because they’re depressed or have dementia, treating those conditions can lead to improved eating patterns. If access is the issue, meal delivery services such as Mom’s Meals or Meals on Wheels can step in. And, if physically cooking is more difficult, switching to more premade foods or investing in special stools or other equipment can help, Ginn-Meadow says.
[See: 8 Healthy Ways to Gain Weight.]
If it is an eating disorder? Seek treatment from a mental health professional through a referral from a primary care doctor or an organization like the National Eating Disorders Association. Treatments like cognitive behavioral therapy can be effective at all ages, experts say. In her work with older women with eating disorders, for example, Maine first helps them learn that their conditions are illnesses, not character flaws, and then works with them to understand and shift how they view their bodies. Education about the human body is key, too, she says, since many women don’t realize, for instance, that the belly fat that tends to emerge around menopause is a protective adaptation that helps replace some of the estrogen they’re losing. “They are experts in themselves, and I’m an expert in eating disorders,” she tells them. “Together, we can make a real difference.”
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Can Older People Have Eating Disorders? originally appeared on usnews.com
