Ask an Expert: Can people develop eating disorders in their 40s?

Q: “A friend in his 40s has become obsessed with dieting. He has lost so much weight that he’s starting to look too thin, yet he continues to diet. Is it possible to develop an eating disorder at that age? Should I say something to him about it? I want to help, but how?”

Answer from Jason Stone, M.D., psychiatrist, Providence Outpatient Eating Disorders Program and Providence Outpatient Behavioral Health Services, and Barbara Oyler, RN, MN, PMHNP, clinical team leader, Providence Behavioral Health Services:

People definitely can develop eating disorders in their 40s, 50s and beyond. Even though most of the patients in our Eating Disorders Program are teenagers and young adults, we are seeing a rise in the number of patients who are older.

Eating disorders tend to emerge when people are at significant transitions in their life, and in midlife, there are many: Parents make the transition into empty-nesters; many take on the care of their elderly parents; people begin to notice the effects of age on their bodies; and some simply feel a need to redefine their lives.

Dieting and exercising can be a healthy way to deal with these types of stressful changes, or to ward off the effects of a slowing metabolism. But for some people, these initially healthy behaviors can get out of control, going from positive to destructive. Not surprisingly, dieting is one of the most common pathways to an eating disorder.

Your friend’s obsessive dieting and pronounced weight loss could be signs of an eating disorder, but those signs alone are not enough to positively diagnose one. Have you noticed any other signs?

  • Have you ever heard your friend vomiting after eating, or have you noticed that he always goes to the bathroom immediately after eating?
  • Has he become more isolated, or started avoiding social situations where there’s food?
  • Does he exercise excessively, perhaps skipping lunches or get-togethers to make more time for workouts?

If your friend has developed an eating disorder, it could be brand new or, more commonly at his age, he could be experiencing a relapse of an old eating disorder that began in his youth. If it’s not an eating disorder, his symptoms still could indicate “disordered eating” — abnormal changes in eating that are unhealthy, but are not as imminently threatening as a diagnosed eating disorder. Or they could simply mean that your friend is adopting healthier habits and is still working out the right balance.

It would require a full evaluation to be able to tell where, on this spectrum of possibilities, your friend’s behavior lies. But because the possibility of an eating disorder is there, and because you are concerned, you should say something.

Eating disorders such as anorexia and bulimia can pose immediate, severe health risks and may be life threatening. If you suspect that your friend has an eating disorder, it’s important to encourage him to seek treatment for it.

How can you help?

We understand that it’s uncomfortable to broach this subject with a friend, but it’s important to take the risk anyway. He may already suspect that he has a problem, and your support may be just what he needs to work up the courage to take the next step and seek help. In our experience with hundreds of patients, no one has ever told us that they resented it when someone close to them expressed concern. Some patients recall that they may have reacted a little bit initially, but all appreciated it in the end.

People with eating disorders tend to be very self-critical, so approach your friend delicately, from the perspective of friendship and caring. You might say that you have noticed his continuing weight loss and that you are concerned. Ask him if he is OK, or if he is having trouble breaking out of his dieting habits. If he recognizes that he’s struggling or that he has a problem, let him know that it can be very difficult to turn things around without help. Encourage him to make an appointment to talk to a specialist in eating disorders. Offer to help him look up the phone number of a program, and to take him to the appointment if he wants you to.

Most importantly, let your friend know that he has your support, both now and as he moves forward with treatment. That support will be especially important during his recovery.

Good luck, and thank you for being a good friend.

April 2009