This is the first time the prevalence of eating disorders has been investigated in a population sample of women in the fourth and fifth decade of life and the researchers were surprised to find that eating disorders affected a significant amount of women aged 40-50 years. Around 15.3 per cent of women in the study reported having an eating disorder at some point in their life and 3.6 per cent reported an eating disorder in the past 12 months. Less than 30 per cent of women who had eating disorders said they had sought help or received treatment.
Dr Nadia Micali, lead author from the Department of Psychiatry at Icahn School of Medicine at Mount Sinai in New York and University College London, London said: “Our study shows that eating disorders are not just confined to earlier decades of life, and that both chronic and new onset disorders are apparent in mid-life. Many of the women who took part in this study told us this was the first time they had ever spoken about their eating difficulties, so we need to understand why many women did not seek help. It may be that there are some barriers women perceive in healthcare access or a lack of awareness among healthcare professionals.”
The researchers also assessed factors that may be associated with the onset of an eating disorder including childhood happiness; parental divorce or separation; life events; relationship with parents; and sexual abuse.
Dr Micali explained: “The early risk factors we assessed were associated with different eating disorders. Anorexia, bulimia, binge eating and purging disorder were all associated with childhood unhappiness, and parental separation or divorce during childhood seemed to increase the risk of bulimia, binge eating disorder and atypical anorexia. We also found that death of a carer could increase the likelihood of purging disorder and that sexual abuse during childhood, or a fear of social rejection, was associated with all eating disorders.”
In this study a woman’s risk of suffering from anorexia nervosa or bulimia nervosa, two of the most common eating disorders in the UK, was increased by 4-10 per cent per unit score of ‘unhappiness’ if they reported being unhappy during childhood. Higher interpersonal sensitivity – the ability to accurately assess others’ feelings – was associated with an increased risk of binge eating by 19 per cent per unit score of ‘sensitivity’. A good mother–daughter relationship was associated with a 20 per cent reduced chance of developing bulimia.
The study used data from women included in the University of Bristol’s Avon Longitudinal Study of Parents and Children cohort to assess how many women have or had an eating disorder at some point in their life. Women selected for the study were asked to complete a questionnaire where each eating disorder they had experienced in their life was recorded. Women who reported having ever had any symptoms of eating disorders, and an equal number of women who reported never having symptoms, were interviewed using standardised diagnostic interviews. Women who reported experiencing any eating disorder were asked if they had ever sought and/or received treatment for these.
This study was observational and longitudinal, so it can increase our understanding of possible links between early risk factors and eating disorders, but it cannot show cause and effect.
The data in this study covers the last 40 years and might reflect the past rather than the current lack of clinical awareness of eating disorders in the UK. The sample may also be limited as the cohort was made up of women who were pregnant at a specific point in time and from a defined region of the UK. Further studies are needed to better characterise eating disorders in mid-life and determine the different impact of the various risk factors that lead to mid-life eating disorders compared to those that occur earlier in life.
‘Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: a population-based study of diagnoses and risk factors’ by Nadia Micali, Maria Martini, Jennifer Thomas et al in BMC Medicine 2017.
University of Bristol