“No one expects a grown woman in her 40s to have an eating disorder. That’s for teenagers, right? Well, guess what – it happened to me.”

Alexa, a 44-year-old real estate agent, was telling me about her struggle with non-purging bulimia, which has come to control her life. We spoke in 2024 at a coffee shop as part of my ongoing research on eating disorders.

The names of my research subjects have been changed for this article to protect their identities.

“I didn’t understand what was happening for a long time,” Alexa said. “It didn’t even occur to me that it could be an eating disorder.”

She is not alone. A 2023 study estimated that over 9 million American women over 40 develop eating disorders. Some had eating disorders earlier in life and experience a resurgence at midlife. Others develop them for the first time in their 40s or older.

I am an anthropologist and licensed therapist who has researched and treated eating disorders for the past 30 years. I have also recovered from an eating disorder myself. I wrote a 2021 book about how contemporary clinical approaches to eating disorders can harm people and keep them sick. One of the things I uncovered in my research is that older women with eating disorders often fly completely under the radar, leading to increased health risks and even death.

My research leads me to conclude that this is due to health care providers’ misunderstanding of the cultural and existential factors affecting women in midlife, which can make this a time of increased risk of developing an eating disorder.

By the numbers

The numbers around eating disorders at midlife are sobering: Rates of eating disorders among middle-aged women have increased in recent years. As many as 13% of American women over 50 have eating disorder symptoms, slightly more than the percentage diagnosed with breast cancer.

One study found that 71% of women ages 30 to 74 wanted to be thinner, although 73% of them were at clinically normal weight for their height and age. Research shows that although anorexia, an eating disorder characterized by the severe restriction of calories, becomes less common after age 26, bulimia, where patients binge and then purge food from their bodies, doesn’t reach its peak until age 47. Binge eating disorder, or habitually eating excessive amounts in one sitting, can continue to plague women into their 70s.

Lack of treatment

Despite the prevalence of eating disorders in older women, they are often the least likely to get help.

In fact, flagrant symptoms of an eating disorder can be missed in these middle-aged people. At 52, Janelle, a schoolteacher, has struggled with anorexia for the past four years. Because she is petite, her slight frame hasn’t raised any alarms for medical professionals.

“My doctor told me I couldn’t possibly have an eating disorder because I’m too old,” Janelle told me. “I know I’m anorexic. I was anorexic as a teenager, so I know exactly what this is. My doctor just said I should consider myself lucky because a lot of women my age actually gain weight.”

This doctor’s response is emblematic of problems in eating disorder treatment more generally in the U.S. Though tools to assess patients for eating disorders are available, most physicians and even psychiatrists receive little, if any, training in their use. Learning to identify and respond to eating disorders requires that they go through additional – and costly – specialized training.

As a result, many hold erroneous popular stereotypes about these conditions, and so women with eating disorders aren’t getting the help they need.

Beyond stereotypes

In the popular imagination, eating disorders center on things young women supposedly care about; namely, being thin and attractive – specifically, attractive to men. This stereotype is a holdover from 19th- and 20th-century understandings of hysteria, which was thought to particularly afflict young women who craved but also feared male sexual attention.

According to this paradigm, middle-aged women are thought to be out of the sexual game, so to speak, so they ought to be immune to illnesses that focus on appearance.

This perception of eating disorders is not only wrong, but also dangerous because clinicians often don’t recognize these issues in women who don’t fit this stereotype.

In reality, eating disorders are deadly conditions that emerge from a convergence of genetic susceptibility, psychological factors, family environments, life events and cultural values. And they affect people of all genders, sexual orientations and races across the socioeconomic spectrum and the lifespan.

Although the drive for thinness often is the most obvious feature of these conditions, what I have found in my 30 years of research on this topic, including talking to over 200 patients with eating disorders, is that these illnesses are at heart about desperately trying to feel worthy of existing.

A concern with body shape, then, often reflects a much deeper existential crisis that can arise during times when a person’s identity is shifting as their body is changing. One of those times is adolescence. Another is middle age.

Seeking identity in middle age

Outwardly, eating disorders in middle age look a lot like eating disorders at any other age. But the body concerns and identity dilemmas associated with middle age are different from those that plague adolescence and young adulthood.

As women age, their metabolism slows down, their bodies don’t work the way they used to, and they visibly begin to wear their life experience. Questions of mortality and the meaning of life can come to the fore. It’s often a time of shifting dynamics within families. For those who have children, middle age is typically the time when those children are becoming more independent or leaving home. This is also a time when aging parents may require care.

At the same time, for women in particular, the pressures to remain fresh, fit and firm despite aging are monumental. The popularity of treatments like Botox, dermal fillers, Ozempic and the massive anti-aging industry have exploded as this over-40 market has been cultivated.

“We’re supposed to look 30 forever,” said Shelly, a 51-year-old marketing professional struggling with anorexia. “You’ve heard of the ‘middle-age spread’? There’s no way I’m going to let that happen to me.”

A woman’s worth

Progress in gender equality notwithstanding, women’s social worth in modern Western culture is still disproportionately determined by appearance and sexual and reproductive capacities.

It is not surprising, then, that looks and youth become the focus of existential distress for many women over 40. As older women struggle to secure a sense of value in a youth-obsessed world, food and eating can become a focus of attention that ultimately becomes destructive.

This doesn’t mean these women are vain or superficial. Rather, they have picked up on what their culture values, and they have internalized the message that thinness is a way to attain that.

“Our culture doesn’t value older women the way other cultures do,” observed Kaytlin, a 47-year-old office manager struggling with disordered eating. “The idea that older women should be revered for their wisdom and influence is foreign to us. Instead, we become invisible.”

My hope is that dispelling some of the erroneous assumptions that have driven both public perception and clinical practice about these illnesses will help women get the care they need.

Rebecca Lester does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.