Eating Disorders and the Aging Adult. How Adults often fall through the cracks with this diagnosis (April 2014)

Eating disorders do not discriminate against sex, cause, whether the person is predisposed, or their age. I have observed in my private practice that once an older adult is referred to me for his or her eating disorder they are at a stage of needing significant help.

Perhaps the doctor assumes the eating disorder was a disease that adolescents have or that the only eating disorders that they currently see are patients with binge eating disorder. By getting to know my clients on a very intimate level I have learned that many of their practitioners don’t always ask the correct questions which could be why the patient has gotten to where they are at today especially the older adult who has anorexia nervosa.

According to the June 2012 International Journal of Eating Disorders Cynthia Bulik, Ph.D reports that “13% of American women 50 years old or old experience symptoms of an eating disorder, 60% report that they have concerns about weight and shape which negatively affects their lives. Finally “70% of 50 year old women are trying to lose weight”.

Many of these aging adults have developed eating disorders due to depression, losing a spouse, becoming an empty nester, financial stressors and following a special diet throughout their life with now learning how to liberalize is a scary thought. For example one woman that I am seeing has been raised watching her cholesterol and now her M.D. asked her to forget about her cholesterol before he referred her to me and eat whatever fat she wanted with any quantities as this has been seen as a “forbidden food”. At the same time she has other food rules and is on medications that have altered her taste buds. She sees herself as fat.

What is one supposed to do? Both men and women who have eaten a certain way throughout their life and as their life has started to unravel, they have developed an eating disorder that has been the coping mechanism which has evolved. When client X has now reached perimenopause she has started to see her body change as well as other aspects of her life change (or certainly in other times of her life). I hear women share with me that they now develop hips, back fat and curves that they never had on their body before. This results in them often times developing food rules and the fear of food. According to my colleague Jessica Setnick, MS, RD, CEDRD she reports that “research shows that perimenopausal women have more eating disorders than premenopausal women”. “Boomers who make disparaging comments about aging have higher eating pathology than those who only engage in negative comments about weight”.

With aging men observing the need to lose weight or becoming addicted to exercise (since they appear rather health conscious) is often how the eating disorder begins. When the patient visits their primary care physician their vitals need to be assessed by identifying if his body temperature is warm enough, and his blood pressure is coming down excessively.

It is also important to identify if he is eating adequate calories. Also if the aging male has bulimia nervosa it is important to not discuss his weight as this can be a triggering mechanism for the patient whether they are overweight, normal weight or underweight.

These clients certainly require additional support not only from a registered dietitian who is skilled working with eating disorders but also seeking out the guidance/support of a psychologist or a therapist. It is important for him/her to have a team to get through this difficult time in his/her life. The registered dietitian can help facilitate a team for these patients to help work through these psychological challenges especially as some of these clients may have always had an eating disorder which just reappeared during these stressful times. As I mentioned before the client had a safe and routine way of eating throughout his/her life and now the individual has had some perceived loss, lack of purpose, or other stressful circumstance that has caused him/her to be required to liberalize their nutritional intake.

References:

1. ADA Pocket Guide to Eating Disorders by Jessica Setnick, MS, RD, CSSD
2. Food & Nutrition Magazine, “Eating Disorders: An Ageless Affliction” January/February 2014 (26/27).
3. Eating Disorders: Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders by the Academy for Eating Disorders Medical Care Standards Task Force.
4. Today’s Dietitian “Eating Disorders in Older Men- Research Indicates Prevalence May Be on the Rise” Mike Bassett, Vol 15, No. 10. P. 22