Harvard Medical School Adviser by the Faculty of Harvard Medical School

Q:

I am a 55-year-old woman who struggled with an eating disorder (anorexia) during my teen years. As I get older, it's becoming harder and harder to keep excess weight off, and I'm afraid I may be slipping back into unhealthy old behaviors to lose weight. Are eating disorders common in older women? What can I do to avoid unhealthy habits?

A:

In a sense, it's good that you still take pride in your appearance. In fact, many baby boomers are experiencing a disconnect between how old they feel and their chronological age. In a 2009 Pew Research Center survey, half of people in their late 60s and early 70s said they felt at least 10 to 20 years younger than their actual age.

Feeling youthful inside is great, but a glance in the mirror may bring you up short. No matter how young you feel, you're likely to see some wrinkles, sags, tummy fat and less firm muscles, due to the weakening elastic tissue and natural muscle loss that come with aging.

At the same time, we're surrounded by many unrealistic images aimed squarely at mature women. Of course, you know that when you see a model or celebrity touted as looking "good for her age," it's the work of plastic surgeons, colorists, stylists and airbrushers -- but your unretouched body image can't help but suffer by comparison.

If you feel you should look as good as celebrities your own age, even though their public images may be artificial, your self-esteem can suffer. And this can, in turn, lead to extreme eating habits aimed at weight loss, without regard for your own well-being. Since you have a past history of eating disorders, you're more susceptible than most.

Here are some questions to help you assess whether body image and food concerns are crowding out other important parts of your life:

-- Do you worry about your body and your age more than your friends do? What efforts do you make to hide the effects of aging?

-- If you had the choice between living an extra five years and attaining your perfect weight, would you pick attaining your perfect weight?

-- Do you and your friends spend a lot of time discussing diets, weight, your looks, gym routines, etc.?

-- Does the number on the scale determine your mood for the day?

-- Do you spend an inordinate amount of time planning what to eat and not to eat and how to get enough exercise?

-- Do you gravitate toward health regimens that involve purging or restricting food -- for example, going gluten- or yeast-free, becoming a vegan, fasting, or doing colonics or cleanses?

If you answered yes to one or more of these questions, try to shift your conversations and mental energy away from food and body awareness. If this proves difficult, consider consulting a mental health professional.

Eating disorders are usually regarded as a problem of adolescents and young women; their prevalence among older women is less clear. Secrecy and shame often accompany these disorders, and women may not seek help -- particularly if they fear being forced to gain unwanted weight or stigmatized as having a "teenager's disease."

Despite the underdiagnosis of eating disorders in older people, health professionals are now reporting an upswing in requests for help from older women. For some of these women, the problem is new, while others have struggled with disordered eating for decades. In a 2010 study at the Oregon Health & Science University, women ages 65 to 80 were just as likely as young adult women to feel fat or concerned about their body shape.

This dissatisfaction matters. People with eating disorders are usually intensely unhappy about their body shape and size. A negative body image can suggest or prefigure a full-blown eating disorder -- or a "sub-clinical" problem in which a woman never becomes alarmingly thin but organizes her life around food and weight control.

First, you need a thorough medical examination. Certain medical conditions that cause rapid weight loss, interfere with appetite, or make eating difficult can be confused with an eating disorder.

Tell your doctor about any experiences with weight loss or gain, eating disorder behaviors or use of drugs to control weight. Your doctor also needs to know about any emotional problems you're confronting, including depression and anxiety. After taking a history and performing a physical, she or he may order certain tests, such as an electrocardiogram to check for arrhythmia, laboratory tests for metabolic imbalances, or a bone density scan). And if your doctor feels you could benefit from an expert in eating concerns, ask for a referral to a specialist.

A balanced diet is important for good health. With planning and perhaps some help, you can eat right and look good, too.

(Submit questions to harvard_adviser@hms.harvard.edu.)

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