Women vulnerable to eating disorders and body image issues in midlife

That's how Sue Cody felt when seeking help for an eating disorder in her 50s.

Even after losing a significant amount of weight, Ms Cody said it was a constant struggle to have her symptoms taken seriously and get the help she needed.

A new analysis from Women’s Mental Health Australia and national eating disorder charity Butterfly Foundation suggests key life transitions, including perimenopause and menopause, can intensify body image concerns.

This is what happened to Ms Cody, who lived with bulimia until her late 20s when her daughter was born.

"My focus become more on becoming a mother, so the eating disorder was still there, it just sort of reared its head when life got stressful," she said.

But during perimenopause, Ms Cody's body changed, her self-esteem plummeted and her only child moved out of home.

This had a cumulative impact on her mental health and led to her developing anorexia.

Experts say there is a need for more awareness and support for older women experiencing body image concerns or living with an eating disorder.

Body confidence drops with age

The Butterfly Foundation estimates 1.1 million Australians live with an eating disorder, with recent research showing we have the highest rate of anorexia and bulimia in the world. 

While the most common age group is 15–19 years, older women are also vulnerable: 42 per cent of women living with an eating disorder are aged 35 and older, and 16 per cent are aged 50 and older.

Mel Wilton, head of communications and engagement at Butterfly Foundation, said middle-aged women typically faced a number of challenges, including menopause-related biological changes, relationship shifts and added caring responsibilities.

"As we get older, we go through different life stages: perimenopause, menopause, caring for aging parents, kids leaving home and older kids," she said.

"And all of the pressures are combined with society telling us that aging is an illness, that you need to avoid it at all costs."

A small survey from the Butterfly Foundation found that body confidence in women declined with age, with fewer than one in 10 baby boomers (61 to 80 years) reporting feeling confident about their own bodies, compared to one in five women under 45 years.

"The expectation is that as we get older, we become less concerned [about body image] but it's apparent that that's actually not true,"

she said.

Katrina Locandro, chief operating officer of Women's Mental Health Australia, said the figures on eating disorders in older women were likely an underestimation.

"One in four women experiencing menopause are also experiencing body image issues," she said.

"Body image doesn't have an expiry date, we need to stop treating it as a young woman's issue and start recognising it as a women's health issue across the life span."

Social media content contributing to problem

Social media can have a negative impact on how a person views their own body.

Karen Spielman, a Sydney-based GP and research associate at InsideOut Institute for Eating Disorders who did not contribute to the new analysis, said content in recent years had pivoted from body positivity to idolising skinny bodies.

"It's so upsetting," she said.

"It makes it harder to promote overall body positivity, to look at the whole person rather than just the number on the scale."

Dr Spielman said this change was, in part, driven by the rise in popularity of GLP-1 receptor agonists, sold under brands such as Ozempic, Wegovy and Mounjaro.

Trevor Steward, an associate professor at the University of Melbourne and director of the Brain and Mental Health Hub who did not contribute to the new analysis, was also concerned about content he saw online.

"You're creating this perfect storm, where a person is receiving these images on the one hand to say: 'I should look a certain way', and then receiving ads for an online pharmacy which say: 'GLP-1s delivered to my doorstep tomorrow,'" he said.

"This just really, in my opinion, is taking advantage of people who are in a very vulnerable position."

Experts have previously voiced concerns that injectable weight-loss drugs may put people living with or at risk of an eating disorder at further risk.

Screening tools for warning signs

Dr Spielman said a GP was typically the "first port of call" for many people living with an eating disorder seeking help.

But not all health professionals know the warning signs to look out for, or the best advice to give patients, she said.

To address this gap, Dr Spielman and her colleagues developed resources and screening tools for GPs to use.

"It's super important to take this seriously, it's not easy for patients to present for help," she said.

Ms Locandro wants all healthcare clinicians, not just GPs, to proactively ask patients questions about their mental health, instead of relying on patients' self-reporting.

"There is a level of shame that some women really place on having an eating disorder later in life or body image issues later in life," she said.

"A lot more [research] needs to be done to find out the real scope."

Ms Cody, still in recovery, wanted older women to know they were not alone.

After struggling to find help locally, Ms Cody found support online and said it had also been useful to connect with others of a similar age living with an eating disorder.

"At the end of the day, I don't want to look back on my life and remember what I weighed, I want to remember how much I lived,"