Eating disorders impact more than 1.1 million people in Australia^[1], representing 4.5% of the population. These disorders include binge eating disorder, bulimia nervosa, and anorexia nervosa.

Meanwhile, more than 4.1 million people^[2] (18.9%) are affected by body dissatisfaction, a major risk factor^[3] for some types of eating disorders.

But what image comes to mind first when you think of someone with an eating disorder or body image concerns? Is it a teenage girl? If so, you’re definitely not alone. This is often the image we see in popular media.

Eating disorders and body image concerns are most common in teenage girls^[4], but their prevalence in adults, particularly in women, aged in their 30s, 40s and 50s, is actually close behind.

So what might be going on with girls and women in these particular age groups to create this heightened risk?

The 3 ‘P’s

We can consider women’s risk periods for body image issues and eating disorders as the three “P"s: puberty (teenagers), pregnancy (30s) and perimenopause and menopause (40s, 50s).

A recent report from The Butterfly Foundation showed the three highest prevalence groups^[5] for body image concerns are teenage girls aged 15–17 (39.9%), women aged 55–64 (35.7%) and women aged 35–44 (32.6%).

We acknowledge there’s a wide age range for when girls and women will go through these phases of life. For example, a small proportion of women will experience premature menopause^[6] before 40, and not all women will become pregnant.

Variations in the way eating disorder symptoms are measured across different studies can make it difficult to draw direct comparisons, but here’s a snapshot of what the evidence tells us.

Puberty

In a review of studies^[7] looking at children aged six to adolescents aged 18, 30% of girls in this age group reported disordered eating, compared to 17% of boys. Rates of disordered eating were higher as children got older.

Pregnancy

During pregnancy, eating disorder prevalence^[8] is estimated at 7.5%. Almost 70% of women are dissatisfied with their body weight^[9] and figure in the post-partum period.

Pregnancy can represent a major change in identity and self-perception. Pormezz/Shutterstock^[10]

Perimenopause

It’s estimated more than 73% of midlife women^[11] aged 42–52 are unsatisfied with their body weight. However, only a portion of these women would have been going through the menopause transition at the time of this study.

The prevalence of eating disorders is around 3.5% in women over 40^[12] and 1–2% in men at the same stage.

So what’s going on?

Although we’re not sure of the exact mechanisms underlying eating disorder and body dissatisfaction risk during the three "P"s, it’s likely a combination of factors are at play.

These life stages involve significant reproductive hormonal changes^[13] (for example, fluctuations in oestrogen and progesterone) which can lead to increases in appetite or binge eating^[14] and changes in body composition^[15]. These changes can result in concerns about body weight and shape.

These stages can also represent a major change in identity and self-perception. A girl going through puberty may be concerned about turning into an "adult woman” and changes in attitudes of those around her, such as unwanted sexual attention.

Pregnancy obviously comes with significant body size and shape changes. Pregnant women may also feel their body is no longer their own.

While social pressures to be thin can stop during pregnancy, social expectations arguably return after birth, demanding women “bounce back^[16]” to their pre-pregnancy shape and size quickly.

Women going through menopause commonly express concerns about a loss of identity. In combination with changes in body composition and a perception their appearance is departing from youthful beauty ideals, this can intensify body dissatisfaction^[17] and increase the risk of eating disorders.

These periods of life can each also be incredibly stressful, both physically and psychologically.

For example, a girl going through puberty may be facing more adult responsibilities and stress at school. A pregnant woman could be taking care of a family while balancing work and other demands. A woman going through menopause could potentially be taking care of multiple generations (teenage children, ageing parents) while navigating the complexities of mid-life.

Research has shown interpersonal problems and stressors can increase the risk^[18] of eating disorders.

Body image concerns and eating disorders are not limited to teenage girls. transly/Unsplash, CC BY^[19][20]

We need to do better

Unfortunately most of the policy and research attention currently seems to be focused on preventing and treating eating disorders in adolescents rather than adults^[21]. There also appears to be a lack of understanding among health professionals about these issues in older women.

In research I (Gemma) led with women who had experienced an eating disorder during menopause^[22], participants expressed frustration with the lack of services that catered to people facing an eating disorder during this life stage. Participants also commonly said health professionals lacked education and training about eating disorders during menopause.

We need to increase awareness^[23] among health professionals and the general public about the fact eating disorders and body image concerns can affect women of any age – not just teenage girls. This will hopefully empower more women to seek help without stigma, and enable better support and treatment.

Jaycee Fuller from Bond University contributed to this article.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. For concerns around eating disorders or body image visit the Butterfly Foundation website^[24] or call the national helpline on 1800 33 4673.

References

1. ^{^} 1.1 million people in Australia (butterfly.org.au)
2. ^{^} 4.1 million people (butterfly.org.au)
3. ^{^} major risk factor (www.tandfonline.com)
4. ^{^} teenage girls (butterfly.org.au)
5. ^{^} three highest prevalence groups (butterfly.org.au)
6. ^{^} premature menopause (www.menopause.org.au)
7. ^{^} review of studies (jamanetwork.com)
8. ^{^} eating disorder prevalence (onlinelibrary.wiley.com)
9. ^{^} dissatisfied with their body weight (www.mdpi.com)
10. ^{^} Pormezz/Shutterstock (www.shutterstock.com)
11. ^{^} 73% of midlife women (pmc.ncbi.nlm.nih.gov)
12. ^{^} 3.5% in women over 40 (journals.lww.com)
13. ^{^} significant reproductive hormonal changes (pmc.ncbi.nlm.nih.gov)
14. ^{^} increases in appetite or binge eating (www.sciencedirect.com)
15. ^{^} body composition (pmc.ncbi.nlm.nih.gov)
16. ^{^} bounce back (www.tandfonline.com)
17. ^{^} intensify body dissatisfaction (onlinelibrary.wiley.com)
18. ^{^} increase the risk (onlinelibrary.wiley.com)
19. ^{^} transly/Unsplash (unsplash.com)
20. ^{^} CC BY (creativecommons.org)
21. ^{^} rather than adults (jeatdisord.biomedcentral.com)
22. ^{^} eating disorder during menopause (jeatdisord.biomedcentral.com)
23. ^{^} increase awareness (learn.eatingdisorders.org.au)
24. ^{^} Butterfly Foundation website (butterfly.org.au)