An outline illustration of a woman shown from the waist up sitting on a made bed, What it's like coping with an eating disorder in midlife

(Illustration: iStock)

Content warning: This story describes experiences with eating disorders in detail.

When Ottawa writer and lawyer Sheri Segal Glick, 50, visited a psychologist six years ago to address what she thought were just lingering behaviours from a past eating disorder, she didn’t expect to hear that she still had one. Yes, she had had anorexia for years, but that was decades ago. Apart from a small relapse after the birth of her third child, she considered herself recovered.

Seeing her denial, the therapist offered up a challenge: if she no longer had a problem, then it should be easy to throw out her food scale and skip a couple of days on her elliptical trainer. That’s when the penny dropped. “She was right,” says Segal Glick, who was shocked by the revelation. “I couldn’t change any of those things because I was still so fully entrenched in my eating disorder.”

We typically picture teens and young adults when we think about eating disorders. But according to a 2023 press release from The Menopause Society, an organization that educates women about menopause and healthy aging, eating disorders can occur throughout someone’s lifespan, including midlife and beyond.

Eating disorders are complex mental health illnesses that involve extreme preoccuption with weight and food as well as eating behaviours that cause physical and mental harm. They encompass disorders like anorexia and bulimia, as well as binge-eating disorder, and otherwise specified feeding or eating disorder (OSFED), a catch-all term for disordered eating that may not meet all the criteria but still has a distressing and potentially life-threatening impact on a person’s life.

A large study out of the National Eating Disorders Information Centre (NEDIC) found that 17 percent of adults seeking eating disorder treatment were age 40 or older. But the figure could be much higher because eating disorders are vastly under-reported in older women, says Dr. Nina Mafrici, Ph.D., who co-runs an eating disorders clinic out of her Toronto psychology practice. And while disordered eating is more common than a full-blown eating disorder in this age group, one can slowly morph into the other. “It’s all a continuum,” says Dr. Karen Trollope-Kumar, family physician and chief medical officer at Body Brave, a Hamilton, Ont.-based eating disorder treatment centre that offers free and provincially covered programs and resources.

Midlife: a time of transition

When diagnosing eating disorders, Mafrici looks at biological, social and psychological factors. She cites midlife transitions as a common theme, calling them “points of trigger.” “It’s shifts in the day-to-day roles and responsibilities, shifts in career, shifts associated with biological changes,” she says. “With midlife women, those things together can lead women to cope in unhealthy ways, possibly resulting in the development of an eating disorder, especially if there’s a genetic predisposition to eating disorders or to other mood and anxiety disorders.”

Women, in particular, tend to use the body as a coping mechanism for underlying emotional stressors. Delisa Richardson, a 53-year-old mom of three from St. Louis, Missouri, first developed an eating disorder in middle school after experiencing childhood sexual assault. “I wanted to control the one thing I could control,” she says. Years later, as she began having children, she quickly returned to her regime of calorie restriction and over-exercising. This proved increasingly difficult after she was diagnosed with ulcerative colitis while pregnant with her third child, and over-exercising would routinely land her in bed for days. “I always had this picture of me at 24 that I needed to get back to,” she explains. “It didn’t matter that that picture of me at 24 was from under-eating, over-exercising and repressed trauma.”

Genes also play a role, says Trollope-Kumar. “If you’ve got someone in your family with an eating disorder or with a major mental illness, then you have a genetic set of cards that makes you more prone to developing an eating disorder,” she says. This doesn’t mean you are destined to develop one, she continues, “but if you go through a very difficult life transition, it can trigger an eating disorder in genetically predisposed people.” Segal Glick, who writes about her experience in The Skinny: My messy, hopeful fight for full recovery from anorexia, agrees that “the genetics component is huge”—making it, she says, even more critical to avoid any body talk around her kids.

Perimenopause heightens risk

Perimenopause is, according to the Menopause Society, “a particularly risky time for eating pathology.” Depression, fatigue and low mood are common to perimenopause, as is fear of weight gain, feeling overweight and body dissatisfaction. For some women, these factors can create a perfect storm. “People start to diet around the time their bodies naturally change,” says Mafrici, “and of course, that time is the years before, during and after menopause.” “Fear of aging is so prevalent in our society,” adds Trollope-Kumar. “There’s a lot of pressure on middle-aged women to make changes to their appearance, and they start to internalize that.”

As an actor and former fitness competitor, Richardson felt this keenly after she gained weight during perimenopause. “You feel so out of control when you’re in midlife,” she says, “especially when you don’t know what’s causing the issues in your body. You worry about feeling discarded.” Living with an autoimmune illness amid a pandemic only added to her stress. “I was essentially locked in my house for two years, fearing for my life,” she says. Binge eating became Richardson’s go-to for coping with the uncertainty of her high-risk status. “And then one day, I looked at myself in the mirror and thought, ‘I don’t know who this person is.’ ‘This is not me.’” she says. “I was very upset and unhappy, and it triggered all sorts of old feelings.”

Living alone can compound the problem, as can living with a partner who may not understand the issue or know what to look for. In fact, many women quietly struggle for decades. “There’s this presumption that people grow out of eating disorders,” says Segal Glick.

Mafrici notes that eating disorders often come to light when she’s working with an older woman and her adult children who have recently become parents themselves. They become increasingly aware of their own parents’ disrupted eating behaviours. “They’ll say, ‘Mom, this is not normal. You have a problem.’”

Diet culture disguised as wellness

When Gwyneth Paltrow waxed poetic about bone broth and intermittent fasting on The Art of Being Well podcast last March, she was accused of promoting disordered eating. Paltrow swiftly clapped back, reassuring critics that she is not, in fact, on a diet—she was merely sharing her “daily wellness routine.”

“If you talk to almost anyone, they’ll say, ‘Yeah, diets are harmful,” says Mafrici. These days it would be hard to get away with saying otherwise. Instead, diets are packaged up as something else: “wellness”—a disguise that carries an overwhelmingly positive connotation. “But regardless of what you call it, a meal plan that restricts calories still reinforces diet culture,” she says, “And as much as the wellness industry is trying to tell people, ‘confidence comes from within’ and ‘we want you to feel good within,’ it showcases this pronounced objectifying, evaluative gaze of your appearance.”

In her book, Segal Glick writes about the intersection of diet culture and what’s deemed healthy versus what is actually healthy. “You get a lot of accolades for disordered things,” she says, adding that ‘wellness’ isn’t usually about actually being well. “It’s usually about size and shape. If it were really about wellness, there would be a lot less emphasis on cutting things out and on looking a certain way. It would be what actually makes you feel well and whole and present.”

Mafrici’s clients often present with orthorexia—an obsession with health and wellness and healthy eating. “They’ll say, ‘I don’t see what’s wrong with it. I’m just watching my weight. I’m cutting out carbs.’”

It can be hard to draw a hard line between orthorexia and being health-conscious, says a source at NEDIC. One strategy is to reflect on what’s driving the behaviour: Is it the belief that people in smaller bodies are inherently healthier? Is the “interest in health” a desire to lose weight?

Comfort in social settings can also provide clues: Mafrici often asks clients if going out to dinner is stressful for them—to which many concede that, yes, it is because they don’t know what to expect, what to order, or how much to eat. “Then it’s having an impact on your life,” Mafrici tells them.

A diagnosis that’s easy to overlook

Eating disorders are linked to numerous physical complications, including osteoporosis, stress fractures and anemia—all health risks that are exacerbated by midlife. In cases of bulimia, gastrointestinal issues like chronic constipation or reflux are also common side effects, along with dental problems. As the first point of contact, family doctors play a crucial role for women seeking treatment: Doctors can refer patients to therapists and dietitians, hospital-based treatment programs and private facilities. Unfortunately, most doctors don’t get the necessary training to spot the signs of an eating disorder, in med school or beyond.

Looking back, Segal Glick can identify several symptoms of her eating disorder that have been present throughout her life that should have been red flags for her doctors—if they had asked the right questions. “Even though my weight was low, nobody thought to ask about my eating or exercise habits,” she says. “I had never had a natural period in my life and doctors didn’t seem to wonder why.”

Another problem is the weight bias that continues to exist in medical communities. Trollope-Kumar concedes that doctors still tend to view being overweight as a major risk factor for a variety of diseases. “And it’s true that if you are in a really large body, you are at risk for many different conditions,” she says. “But for many women, going on a diet is more harmful than beneficial.”

Trollope-Kumar calls dieting a “gateway to eating disorders.” She routinely hears from women who see their doctors for a non-weight-related issue only to be told that they should probably go on a diet as well. “And that really makes people feel not heard. Not seen.”

Richardson can relate. “It’s the fear of being judged; it’s the fear of being chastised that a lot of women have when they go to a doctor—especially in midlife,” she says. Richardson was at what she considered a healthy weight at the time and was physically active, but according to the BMI, at 5’4”, she was deemed overweight. “Every time I’d leave that office, I’d think, ‘I gotta lose weight, I gotta lose weight.’” As a gauge of health, the BMI is increasingly under fire because it doesn’t account for differences in muscle mass, fat distribution and bone density, nor does it consider gender or race.

The problem is pronounced for Black people, says Richardson, who is Black. “It takes longer to be diagnosed with any health issue,” she adds—but eating disorders in particular, especially if a person’s BMI puts them in the “overweight” category as it did with Richardson. As a result, many eating disorders go unrecognized.

Aging while female

It’s no secret we need a cultural overhaul of what it means to age. “You have the world at large telling you, ‘You should look like ‘x,’ or ‘This is what 50 looks like,’” says Richardson. “It’s easy to say, ‘Okay. I’m going to control this. I want to look this way so  badly for any number of reasons, and then the next thing you know, you’re in the throes of an eating disorder.”

In truth, it’s normal to gain weight as we get older; in fact, it comes with health benefits. “Women who are carrying a little bit of extra weight are much less likely to develop osteoporosis,” says Trollope-Kumar, adding that fat cells also provide a form of estrogen when the ovaries are no longer producing it.

But these changes shift the female body further away from the “young, thin” standard of female beauty so pervasive in Western culture. This, in turn, leads women to make harmful comparisons—both to social media and to a younger version of themselves. “The attention that you got when you were 20 or 25—and now people look right past you,” says Richardson. “It’s like, ‘Okay, I guess I’m not desirable anymore. I guess I’m invisible.’ It can be hard. But you have to take back the narrative—invisible to who?’”

Recovery: The road is rarely straight

Research shows that seeking help within the first three years of developing an eating disorder is linked to a high recovery rate. The longer an eating disorder goes unaddressed, the more difficult it is to treat because behaviours become entrenched and normalized. Women also have a hard time with self-compassion and self-care.

“It took a really long time to accept that I still had a problem and that I wanted to fix it,” says Segal Glick, who adds that she never felt quite sick enough to get help. “That’s a recurring theme in eating disorder recovery,” she says, “And it’s how you stay trapped.” Acknowledging you have a problem can be difficult, but the payoff is huge, says Trollope-Kumar. “I often tell people that one of the things they’ll notice is way more mental space to do other things they want to do: Concentration improves, memory improves, energy levels improve.”

But for recovery to begin, the cloak of secrecy has to come down. “There’s a lot of shame wrapped up in eating disorders,” says Segal Glick. For a long time, that shame kept her quiet. “People who knew that I was very ill when I was younger presumed I was better,” she says. “I wanted to keep up that charade.” She eventually confided in a close friend. “The way she reacted and responded made it possible for me to tell other people,” she says. On the advice of her then-therapist, she tried a local day hospital program but discovered it wasn’t a good fit for her. Eventually, she started working with an eating disorder recovery coach. “It’s kind of like a therapist, but you’re not doing traditional therapy,”’ she says. “You make recovery goals and stick to them—or try to stick to them as best you can—and talk about problems as they come up.” Recovery coaching is a relatively new field; the first certification program was established in 2013. Coaches don’t diagnose or treat eating disorders. Instead, they’re trained to work on the “here and now” with clients and assist them with day-to-day challenges.

For others, an important part of recovery is finding like-minded women in a group setting. “Some women are in their late 50s, early 60s, and have had an eating disorder for years,” says Trollope-Kumar, “And when they join a group, they’re so relieved to be able to talk about it and to realize, ‘Wow, other people are also struggling. I’m not alone.’” The Canadian Mental Health Association lists several eating disorders resources on its site, including Ontario Community Outreach Program for Eating Disorders, Bulimia & Anorexia Nervosa Association, in southwestern Ontario, Hopewell in eastern Ontario, and Kelty Eating Disorders in B.C.

One-on-one therapy can also be highly effective. After symptoms of repressed trauma started to resurface for Richardson, she returned to counselling and quickly discovered that food was an active, ongoing issue. Eating disorders in the Black community are “still very hush-hush,” she says. “It’s something that people don’t talk about. We’ve seen it—probably through generations—we’ve seen that uncle or that aunt or that grandma. Especially bingeing—you see it a lot. And you just kind of ignore it. Or someone who’s stopped eating. You don’t talk about it.” For Richardson, the guilt and shame of bingeing eventually proved too much. “It wasn’t how I wanted to live my life: Throwing food away before I get to the house—throwing away ‘evidence.’ I knew it wasn’t something I could sustain—and I didn’t want to.”

When broaching recovery, Mafrici tries to be transparent. “I’ll say, ‘It sounds very stressful to hop on the scale every single day and have the number you see determine how you feel the rest of the day.” By wording it that way, Mafrici helps clients see the link between their mood and their anxiety and their perpetual hypervigilance about food. “I tell them, ‘You can’t eat freely because you are very restrained in your body,” she says. “Knowing the source of the anxiety motivates them to try to work on that and change it.”

Understanding the role of perimenopause in her symptoms has been helpful for Richardson. By approaching recovery from a health perspective, she could take weight completely off the table. “I started listening to more people with a balanced approach to health,” she says. “Because I want to live my life. I want to eat the birthday cake I made for my son and grandson. And if the scale changes as a result, then the scale changes,” she says.

She also had to accept the limitations of living with an auto-immune illness or risk making herself sick. “I can’t go hard anymore like I used to,” she says of her former extreme fitness approach. “So it’s learning that, ‘Okay, the crazy beat-yourself-dead workout that you used to do isn’t going to help you.’” Now she does yoga and chair fitness and keeps a mini elliptical under her desk.

Once Segal Glick reframed her relationship to exercise, she had an epiphany. “I thought exercise made me feel good,” she says, “and at one point, I realized that it didn’t. It was just relieving the stress of not having exercised.” She doesn’t miss the elliptical machine. “It’s just so boring,” she says. As a former exercise addict, Segal Glick needed to switch lanes. She does yoga and adds weights for bone health but honours her “rest days” even when she’s craving a walk.

Recovery isn’t easy. “There’s no magic bullet,” says Segal Glick, who has found that being open about her struggles encourages others to do the same. At the beginning of her recovery, she discovered a sizable community on Instagram and developed relationships with other women—many moms like her—who would follow her journey online. “I was looking for a safe place to talk and to share.” That said, even today she’s selective about who she follows. “You have to make sure you’re following people who aren’t triggering to you,” she says. “We’re all so vulnerable to suggestions, especially in early recovery.”

Starting a conversation

The misconception about eating disorders is that women do it to themselves. “It’s not a choice to have an eating disorder,” says Mafrici. Validation is key when talking to a loved one about their relationship with food. Mafrici suggests approaching them as you would anyone with a mental health issue. “You could say, ‘I see that you’re struggling,’ or ‘It seems food is really stressful. I’d love to support you if that’s something that you want to talk about.’”

Trollope-Kumar echoes this strategy. “Communication skills are really important. Make it very open-ended: ‘I notice you seem tired. Is there something that you’re concerned about? Is there anything I can help you with?’” If they’re receptive, Trollope-Kumar suggests recommending a website like NEDIC, which has a private, highly responsive texting feature and phone line, and Sheena’s Place (for Ontario residents,) as good starting points. “Quite often, they start reading and think, ‘Oh, my gosh, this is totally me.’ And it might be quite a shock because they’ve been normalizing it in their own mind.” She points out that Body Brave doesn’t require a diagnosis or a referral. “If you’re not happy with your relationship with food, weight or body image, you’re welcome at Body Brave.”

For Richardson, one of the most critical tools is self-love. “I’m not 100 percent,” she says. “But it’s learning to sit with it: so what if the scale has gone up? That’s not connected to me as a person. It’s giving yourself that grace and that understanding that you are not that number on that scale.”