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Never too old for eating disorders or body dissatisfaction: A community study of elderly women

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The aim of the study is to examine eating behavior and body attitude in elderly women. A randomly selected nonclinical sample of 1,000 women, aged 60-70 years, was contacted for our questionnaire survey covering current eating behavior, weight history, weight control, body attitude, and disordered eating (DSM-IV). The 475 (48%) women included in our analyses had a mean BMI of 25.1 but desired a mean BMI of 23.3. More than 80% controlled their weight and over 60% stated body dissatisfaction. Eighteen women (3.8%; 95% confidence interval: 2.3-5.9%) met criteria for eating disorders (ED; N = 1 anorexia nervosa, N = 2 bulimia nervosa, and N = 15 EDNOS) and 21 (4.4%) reported single symptoms of an ED. Although EDs and body dissatisfaction are typical for young women, they do occur in female elderly and therefore should be included in the differential diagnosis of elderly presenting with weight loss, weight phobia, and/or vomiting.
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Never Too Old for Eating Disorders or Body
Dissatisfaction: A Community Study of Elderly Women
Barbara Mangweth-Matzek, PhD
1
*
Claudia Ines Rupp, PhD
1
Armand Hausmann, MD
1
Karin Assmayr, MA
2
Edith Mariacher, MA
2
Georg Kemmler, PhD
1
Alexandra B. Whitworth, MD
3
Wilfried Biebl, MD
1
ABSTRACT
Objective:
The aim of the study is to
examine eating behavior and body atti-
tude in elderly women.
Method:
A randomly selected nonclinical
sample of 1,000 women, aged 60–70 years,
was contacted for our questionnaire survey
covering current eating behavior, weight
history, weight control, body attitude, and
disordered eating (DSM-IV).
Results:
The 475 (48%) women included
in our analyses had a mean BMI of 25.1
but desired a mean BMI of 23.3. More
than 80% controlled their weight and over
60% stated body dissatisfaction. Eighteen
women (3.8%; 95% confidence interval:
2.3–5.9%) met criteria for eating disorders
(ED; N¼1 anorexia nervosa, N¼2 buli-
mia nervosa, and N¼15 EDNOS) and 21
(4.4%) reported single symptoms of an ED.
Conclusion:
Although EDs and body dis-
satisfaction are typical for young women,
they do occur in female elderly and there-
fore should be included in the differential
diagnosis of elderly presenting with weight
loss, weight phobia, and/or vomiting.
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2006 by Wiley Periodicals, Inc.
Keywords:
eating disorders; body dis-
satisfaction; elderly women
(Int J Eat Disord 2006; 39:583–586)
Introduction
Although clinical eating disorders (ED) and body
image distortions are typical for young female pop-
ulations aged 18–25 years, there is evidence that
EDs
1–12
and body image distortions
13–15
do occur in
women of midlife and beyond. Carrier and Dally
1,2
were the first to describe ‘‘tardive anorexia,’ a term
for anorexia nervosa (AN) with a first onset after
adolescence. Russell and Gilbert
3
supported the ex-
istence of ‘‘true tardive anorexia’’ as a distinct en-
tity. Mitchell et al.
4
described late onset bulimia
patients (>25 years) and found significantly more
comorbidity compared to early onset patients. Hsu
and Zimmer
6
showed that the clinical picture of
anorexia and bulimia nervosa (BN) in elderly
closely resembles that in younger patients. The fact
that literature on EDs occurring after menopause is
very sparse
8,12
might be due to the occurrence of
aged induced weight loss and other medical ill-
nesses that hamper the recognition of anorexia or
BN. All the existing literature shares that scientific
evidence is based on case reports and on small
clinical samples.
The few studies on body image in elderly showed
that body dissatisfaction remains stable across the
life span and does not diminish with age.
13–15
To
our knowledge, there are no epidemiological studies
on eating behavior and body image in elderly com-
munity women. Thus, we aimed to examine the
current (1) eating behavior, (2) body attitude and
body satisfaction, and (3) the prevalence of current
disordered eating in women aged 60–70 years.
Method
A random sample of 1,000 women was selected by the
local census bureau from the general population of Inns-
bruck. We chose the age cohort between 60 and 70 years
because this is the first decade of retirement in Austria. A
letter explaining the study was sent to ask for permission
to mail our self-report questionnaire. The enclosed ‘‘non-
participation card’’ was returned by 285 participants.
Thus, we mailed the questionnaire to the remaining 715
participants. From those we included 475 in our analysis
(48% of N¼1,000; 66% of N¼715). All attending partici-
pants signed the informed consent form that was
approved by the ethics-commission of the Innsbruck
University. Although we do not have specific information
1
Department of Psychiatry, Innsbruck Medical University,
Innsbruck, Austria
2
Department of Psychology, Innsbruck University, Innsbruck,
Austria
3
Department of Psychiatry, Paracelsus Medical University,
Salzburg, Austria
Accepted 26 May 2006
*Correspondence to: Barbara Mangweth-Matzek, Department of
Psychiatry, Innsbruck Medical University, Anichstr. 35, A-6020
Innsbruck, Austria. E-mail: barbara.mangweth@uibk.ac.at
Published online 22 August 2006 in Wiley InterScience
(www.interscience.wiley.com). DOI: 10.1002/eat.20327
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2006 Wiley Periodicals, Inc.
International Journal of Eating Disorders 39:7 583–586 2006—DOI 10.1002/eat
583
BRIEF REPORT
about the nonparticipants, we have data from the ‘‘Inns-
bruck Females Health Study,’’
16
showing a similar partici-
pation rate of 56% in the age >60 years. To increase par-
ticipation, we kept the questionnaire as short as possible
confining the questions to the present time.
The assessment of present eating behavior, weight his-
tory, weight control, and body attitude was based on
modified questions of the Diagnostic Survey For Eating
Disorders (DSED).
17
ED were examined using slightly
modified questions from the Structured Clinical Interview
for DSM-IV
18
for AN, BN, and eating disorders not other-
wise specified (EDNOS). Women who did not fulfill criteria
for ED but reported single symptoms of eating disorders
(SSED) like bingeing or various forms of purging were also
grouped together. The eating disorder inventory (EDI)
19
was used in addition to assess weight preoccupation and
clinical relevant characteristics in the sample divided into
different classifications of eating behavior (ED, SSED, and
healthy eating (HE)). We also added the Geriatric Depres-
sion Scale (GDS),
20,21
a basic screening measure for de-
pression in older adults with a score >5indicatingdepres-
sion, to compare the different groups. All women were
also openly asked for current physical illnesses by giving
examples such as hypotension, diabetes, cancer, etc.
Statistics
For the most part, the data were evaluated descrip-
tively. In addition, 95% confidence intervals (CI)
based on the binomial distribution were calculated
for categorical variables of special importance. Fish-
er’s exact test and the Mann–Whitney Utest were
used to compare body image as well as body atti-
tude in women with BMI <25 and women with BMI
25. To compare women with ED, SSED, and HE
regarding EDI, GDS, BMI, and self-evaluation of eat-
ing behavior the Kruskal–Wallis test and the
2
test
were used. Post hoc pairwise group comparisons
were performed using the Mann–Whitney Utest
and Fisher’s exact-test, respectively.
Results
We included 475 women in our analyses: They had
an average age of 63.8 (SD 62.7) years and were
mostly married (N¼281, 59%). The vast majority
(N¼400; 84%) had an average of 2.3 (61.1) chil-
dren. More than half of the women had an educa-
tional status lower than high school (N¼254; 54%).
Only 38 (8%) women graduated from college or uni-
versity. The majority of women described a Healthy
Eating pattern. More than two-thirds of the women
(73%) reported that they eat at least three times a
day. Asked for various troubles with eating 219
(47%) women specified ‘‘craving for sweets’’ as the
biggest problem, followed by ‘‘eating in society,’
‘boredom,’ ‘‘hunger attacks,’ and ‘‘stress.’’ More
TABLE
1. Body image and body attitude
N (%)
p-value (comparison
BMI <25 vs. BMI 25)Total Sample (N¼475) BMI <25
a
(N¼260) BMI 25
a
(N¼211)
‘‘How fat do you feel?’’
b
<.001
Very 61 (12.9) 5 (1.9) 53 (25.1)
Moderate 225 (47.5) 90 (34.7) 135 (64.0)
Not at all 188 (39.7) 164 (63.3) 23 (10.9)
Satisfaction with shape
b
<.001
High 170 (35.9) 142 (54.6) 27 (12.9)
Moderate 189 (39.8) 100 (38.5) 89 (42.6)
Low 114 (24.1) 18 (6.9) 93 (44.5)
Satisfaction with weight
b
<.001
High 178 (37.5) 153 (58.8) 24 (11.4)
Moderate 168 (35.4) 89 (34.2) 79 (37.4)
Low 129 (27.2) 18 (6.9) 108 (51.2)
Self-esteem depends on weight and shape
c
.032
Agree 213 (45.2) 128 (49.4) 82 (39.4)
Disagree 258 (54.8) 131 (50.6) 126 (60.6)
‘‘I really like my body’’
c
<.001
Agree 354 (74.8) 220 (84.6) 132 (63.2)
Disagree 119 (25.2) 40 (15.4) 77 (36.8)
Importance of appearance
b
n.s.
High 303 (63.8) 169 (65.2) 130 (61.6)
Moderate 169 (35.6) 89 (34) 80 (37.9)
Low 3 (0.6) 2 (0.8) 1 (0.5)
a
The number of the two categories is less than N¼475 because of 4 missings.
b
Mann–Whitney Utest.
c
Fisher’s exact-test.
584
International Journal of Eating Disorders 39:7 583–586 2006—DOI 10.1002/eat
MANGWETH-MATZEK ET AL.
than half of the sample (56%) stated that they restrict
their eating to prevent weight gain and 417 (88%)
evaluated their eating behavior as ‘‘normal and
healthy.’’ The majority of our sample (86%)
accounted weight control by various means: weight
check (71%), regular physical activity (69%), fasting
(10%), laxatives or diuretics (6%), and vomiting and
spitting out food (1%). With regard to weight history,
our women reported a mean current BMI of 25.1
(64.2), and desired a mean BMI of 23.3 (62.6). Their
mean lowest adult BMI of 20.7 (62.5) was at age 34.7
(612.8) and their mean highest BMI ever (exclusive
pregnancy) of 26.6 (64.4) was at age 52.7 (613.5).
Using weight categories 12 (3%) women were under-
weight (BMI 18.5), 248 (52%) were normal weight
(BMI: 18.5–24.9), and 208 (45%) had a BMI >25.
Table 1 demonstrates body image and body atti-
tude. Almost 90% of the total sample felt ‘‘very’’ or
‘‘moderately’’ fat and over 60% stated ‘‘moderate’’ or
‘‘low’’ satisfaction with weight and shape. Dividing
the sample into BMI </25, we found results as
expected: overweight and obese women felt signifi-
cantly fatter and showed significantly less satisfac-
tion with their body shape and weight than their
normal and underweight counterparts. However,
the proportions of ‘‘moderate’’ and ‘‘low’’ body sat-
isfaction and ‘‘moderate’’ and ‘‘much’’ feeling fat ex-
ceeded also more than one-third in the BMI <25
group.
As to disordered eating (Table 2), we revealed 18
women with ED in our cohort (3.8%, 95% CI: 2.3–
5.9%): 1 with AN, 2 with BN, and 15 with EDNOS. In
the case of the women with AN, the weight history
points to a late onset (after her fifties). Both women
with BN reported vomiting and use of laxatives. Par-
ticipants with EDNOS included five women with
Binge Eating Disorder. We also detected 21 women
(4.4%, 95% CI: 2.7–6.5%) who reported SSED, mostly
binge eating (33%), use of laxatives or diuretics
(62%), and vomiting (5%). The comparison between
women with ED, SSED, and HE on the EDI and the
GDS showed significantly higher scores in both
groups with disordered eating compared to women
with HE. Regarding body weight it is striking that
women with SSED had a significantly higher BMI
than both other groups. The participants’ self evalu-
ation of their eating behavior clearly confirmed our
diagnoses of ED, since significantly more women
with ED and SSED called their eating behavior
‘‘abnormal’’ compared to women with HE.
There was no significant difference in the three
groups on physical disorders except diabetes that
was three times more often reported by both
groups with disordered eating compared to those
with HE (p¼0.051).
Conclusion
We assessed eating behavior and body attitude in a
randomly selected community sample (N¼1000)
of 60–70 years old women in Innsbruck. The 475
women enclosed in our analyses described an over-
all Healthy Eating behavior and weight history that
goes along with the Innsbruck Females Health
Study
16
that found 59% of their women above 60
years normal or underweight and 2/3 physically
active. The weight history of our sample is consist-
ent with other study results describing a constant
TABLE
2. Comparison of females with eating disorders, single symptoms, and healthy eating on the EDI,
GDS, BMI, and self-evaluation
Scales
Eating Disorders
AN/BN/EDNOS
(Group 1)
[N¼18 (4%)]
Single
a
Symptoms
(Group 2)
[N¼21 (4%)]
Healthy
Eating
(Group 3)
[N¼436 (92%)]
p-value
Overall-Group
Comparison
b
Group 1 vs.
Group 3
c
Group 2 vs.
Group 3
d
Group 1 vs.
Group 2
e
EDI-total, mean (SD) 43.1 (29.4) 40.3 (16.5) 22.3 (13.4) <.001 .004 .001 n.s.
GDS-total, mean (SD) 4.9 (4.7) 4.6 (3.5) 2.2 (2.4) <.001 .016 .001 n.s.
BMI current,
mean (SD) 26.2 (5.9) 29.9 (4.0) 24.8 (4.0) <.001 n.s. .001 .002
Self-evaluation of
eating behavior,
N(%) <.001 .002 .059 n.s.
Normal 11 (61) 16 (76) 390 (90)
Abnormal 7 (39) 5 (24) 43 (10)
Notes: EDI, eating disorder inventory; GDS, geriatric depression scale; BMI, body mass index; AN, anorexia nervosa; BN, bulimia nervosa; EDNOS, eating
disorder not otherwise specified (DSM-IV).
a
Single symptoms of eating disorders.
b
For EDI, GDS, and BMI: Kruskal–Wallis-test,
2
¼24.3, 17.1, 27.5, respectively; for self-evaluation:
2
-test, df ¼2,
2
¼17.2.
c
Mann–Whitney Utest; Z¼2.87 for EDI, Z¼2.42 for GDS, and Z¼1.05 for BMI; Fisher’s exact-test for self-evaluation (no test statistic).
d
Mann–Whitney Utest; Z¼4.11 for EDI, Z¼3.46 for GDS, and Z¼5.17 for BMI; Fisher’s exact-test for self-evaluation (no test statistic).
e
Mann–Whitney Utest; Z¼0.52 for EDI, Z¼0.11 for GDS, and Z¼3.04 for BMI; Fisher’s exact-test for self-evaluation (no test statistic).
NEVER TOO OLD FOR EATING DISORDERS
International Journal of Eating Disorders 39:7 583–586 2006—DOI 10.1002/eat
585
weight gain during decades of life
13
and a subse-
quent biological determined weight decrease later
on.
22
The mean current BMI of 25.1 of our sample
lies between the lowest BMI at age 35 and the high-
est BMI at age 53.
Our outcome of body image and body attitude
reflects body dissatisfaction and ‘‘feeling fat’’ not
only in women with a BMI >25 but also in normal
and underweight women. This finding goes along
with other studies that describe a stability of body
dissatisfaction across life spans independent of ob-
jective weight
13
and agrees with our high numbers
of weight control (86%). Our rates of ED and SSED
(both 4%) in this age cohort were striking, given that
ED are typically associated with young age. The
high number of EDNOS goes along with Fairburn’s
findings describing this category as the most fre-
quent ED.
23
Our diagnoses are strengthened by the
high scores of the EDI and the GDS. Our prevalence
rate of disordered eating is in line with the findings
of Hay
24
who showed that problematic eating in el-
derly is more common than expected and the Inns-
bruck Study
16
that reported 4.1% of EDs in women
over 60 years, without further definition.
Several limitations should be recognized. First,
there was a high drop-out rate that limits the gener-
alizability of our findings. Second, given that par-
ticipants with EDs
25
are more often nonresponders
in prevalence studies than controls, our rates of EDs
may be underestimated. Third, the methodological
assessment using questionnaires is not as reliable as
clinical interviews, but should be seen as a first step
in a new field with the need of further studies.
In conclusion, the results of this study indicate
that the majority of women in Innsbruck aged 60–
70 display a Healthy Eating behavior and a normal
body weight. Nevertheless, the majority reported
dissatisfaction with weight and shape. Although
EDs are typical for young women, they do occur in
female elderly in various forms and a frequency that
should not be undervalued. Therefore EDs should
be included in the differential diagnosis of elderly
presenting with weight loss, weight phobia, and/or
vomiting.
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... This differs strongly from studies on women across ages [e.g. 38].The intensity of their training (almost 80% of all men exercised 4-7 times per week) could be one reason for the high proportion of positive body image, as well as the consequence of the high score of restraint eating (= high discipline in eating behavior including healthy and low caloric nutrition). ...
... We compared younger, middle-aged and older men and found disordered eating as defined by the EDE-Q and DSM-5 key symptoms (i.e., BMI < 18.5 and fat phobia, binge eating, purging behaviors, excessive exercise) in all groups. Our results showed that 10% of fitness-center attendees had symptoms of disordered eating and that the sport context may be involved with this [38]. ...
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Purpose To assess eating behavior and associated factors in male fitness-center attendees. Methods An anonymous questionnaire was administered to male fitness center members of Innsbruck (Austria), aged 18–80 years to assess socio-demographic features, weight history, sports activity, eating behavior including disordered eating based on the Eating Disorder Examination Questionnaire (EDE-Q) and DSM-5 key symptoms for eating disorders (anorexia nervosa, binge eating, bulimia nervosa, purging disorder) and body image. Three age groups (younger—middle-aged—older men) were compared regarding the variables described above. Results A total of 307 men included displayed high rates of disordered eating as described by EDE-Q cutoff scores (5–11%) as well as by DSM-5 eating disorder symptoms (10%). While EDE-Q cutoff scores did not differentiate between the groups, the prevalences of DSM-5 eating disorder symptoms yielded significant differences indicating a clear decrease with increasing age. Binge eating and bulimic symptoms with excessive exercising as the purging method were the most often reported symptoms. Conclusion Although described as typically female, disordered eating does occur in male fitness-gym attendees across all ages. The older the men, the less prevalent are the symptoms. Awareness of disordered eating and possible negative effects need to be addressed for attendees and trainers of the gym. Level of evidence V—descriptive survey study.
... Algunos estudios (Mangweth-Matzek et al., 2006;Vega et al., 2015) indican que la relación de la satisfacción corporal sobre la satisfacción vital podría mantenerse alta durante la madurez y la vejez, ya que la preocupación por la apariencia física no se reduce significativamente según se avanza en edad, e incluso se mantiene significativamente alta en personas de edad avanzada. En estos estudios se refleja cómo el sexo, la red social y la presencia de pareja tienen gran influencia sobre la satisfacción corporal y vital. ...
... Historically viewed as a problem of youth [2,3], BE remains relatively understudied in older adult populations. Yet, recent survey research indicates that 3.5-12% of women in midlife (age 50+; [4,5]) and older (age 60+; [6,7]) engage in recurrent BE; while 19% of women aged 65-90 reported subjective BE in the past month [7]. Additionally, 5.6% of women aged 65-94 reported at least one objective or subjective BE episode in the past month, with a mean frequency of 8 episodes/month for objective binge episodes, when evaluated by structured clinical interview [8]. ...
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Background: One type of overnutrition, binge eating (BE; eating an unusually large amount of food with loss of control), is prevalent among older adult women. Yet, little is known about the clinical significance of this eating disorder pathology in older adults, especially in relation to health outcomes used in geriatrics, while controlling for associations with body mass index (BMI). Method: Women (N = 227) aged 60-94 completed two measures of BE and health/wellness questionnaires online. We used multivariable analyses to compare women with Clinical-frequency BE (≥ weekly frequency), Subclinical-frequency BE (< weekly), and No BE on health/wellness outcomes controlling for BMI. We conducted partial correlations controlling for BMI to examine associations between BE severity and health indices. Results: Controlling for BMI, the Clinical-frequency BE group reported poorer health-related quality of life (physical function, role limitations due to both emotional and physical problems, vitality, emotional wellbeing, social function, and pain) and poorer psychological health (depression, body image) compared to both Subclinical-frequency BE and No BE. The Clinical-frequency BE group also reported poorer sleep, nutritious food consumption, general health, and positive affect compared to No BE. Associations between a separate measure of BE severity and health indices confirmed findings from group comparisons. Conclusion: Weekly BE may offer a promising screening benchmark for identifying one type of overnutrition in older women that is associated with numerous indicators of poorer health, independent of the effects of BMI. More research is needed to understand risks for and consequences of BE unique to older adult women. Binge eating (BE; eating an unusually large amount of food with loss of control), is prevalent among older adult women and is associated with health problems in younger populations. Yet, little is known about how BE is related to other health problems in older adults. We compared health behaviors, physical health, health-related quality of life, and psychological health between older adult women who reported weekly or more frequent BE (i.e., Clinical BE), those with low frequency BE (i.e., Subclinical BE), and those with no BE, while accounting for BMI. Older women in the Clinical BE group reported poorer health-related quality of life, more depression symptoms, and worse body image compared to the Subclinical BE and No BE groups. Compared to the No BE group, the Clinical BE group also reported poorer sleep, less frequent consumption of nutritious foods, worse health, and less frequent positive emotions. Using a separate measure of BE severity, we found similar associations with these health outcomes. Engaging in weekly BE may represent one type of overnutrition behavior in older women that is associated with numerous indicators of poorer health. More research is needed to understand risks for and consequences of BE unique to older adult women.
... Research on the body image and eating behaviors of older women is scarce (Tiggemann, 2004). This is an important gap in the literature, as contemporary older women grew up among pressure to pursue the thinideal and experience body image and eating concerns Mangweth-Matzek et al., 2006;Rodgers et al., 2016;Sabik, 2017). Compounding this, prior work examining body image and eating behaviors in older women has focused on body image concerns and patterns of disordered eating (e.g. ...
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Background Research on the body image and eating behaviors of older women is scarce. Moreover, the scant existing research has lacked a focus on positive dimensions, such as positive reappraisal and acceptance, body appreciation, appearance satisfaction, and intuitive eating among older women. Therefore, the aim of the present study was to examine a model of the relationships among these positive dimensions and psychological functioning in older women. Methods A sample of 171 women aged 60–75 years were recruited through social media to respond to a survey assessing body image, eating behaviors, and psychological wellbeing. Results The final model was a good fit to the data. In this model, positive reappraisal and acceptance of age-related appearance changes was associated with higher body appreciation, in turn associated with higher body image related quality of life, higher levels of intuitive eating, and lower levels of depressive symptoms. Conclusion Positive body image and positive reappraisal of aging-related changes in appearance are associated with psychological wellbeing among older women. Longitudinal data are needed to clarify the direction of these relationships and inform interventions. Body image remains an important dimension among older women and should be accounted for in broader health promotion efforts among this group.
... and onset is most common in adolescence or early adulthood (2,3). AN is not a Western-bound illness, nor is it constrained to those of a particular age, gender, culture or ethnicity (4)(5)(6)(7). ...
... Research, especially in women, demonstrates that body image concerns, especially weight concerns, tend to continue into adulthood rather than diminish across the lifespan (Kilpela, Becker, Wesley, & Stewart, 2015). For example, 60% of women aged 60-70 years report general dissatisfaction with their appearance (Kilpela et al., 2015;Mangweth-Matzek et al., 2006). Importantly, body dissatisfaction in adult years continues to predict elevated disordered eating symptoms and eating disorders (Slevec & Tiggemann, 2011). ...
Article
This study examined the temporal sequence of the relationship between social media use and body dissatisfaction in adults. A representative sample of adults (19–92 years old; M = 52.83, SD = 13.43; 62.02% women, 37.98% men) completed measures of social media use, body dissatisfaction, age, gender, BMI, and demographic variables in 2015, 2016, 2017, 2018 and 2019 (N = 6258) in the New Zealand Attitudes and Values Study. In the full sample, higher social media use was significantly associated with higher body dissatisfaction one year later, as was higher body dissatisfaction with higher social media use one year later after controlling for body dissatisfaction/social media use (T-1), gender, age, BMI, ethnicity, relationships status, and SES. Effects were small. The prospective pathway from social media use to body dissatisfaction was significant in all age groups but the reverse relationship was only significant in the middle aged and older groups. Both pathway directions were significant in women but only the pathway from body dissatisfaction to social media use was significant in men. The research has limitations and replication is required. However, findings suggest raising awareness about how to use social media positively across the broad community, not merely in adolescents, may be worthwhile.
... Recent studies show that 1.8-3.8% of community dwelling women over the age of 60 have indications of an eating disorder [13,14], suggesting that the risk of these disorders are life-long concerns. With the limited evidence available, what is known about eating disorders in the elderly population is that anorexia nervosa is the most common form, 60% of people have additional comorbid psychiatric conditions, and there is a very high mortality rate of 21% [1]. ...
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Background Historically, eating disorders were not identified in older populations and it is only in more recent times that there is greater recognition of the existence of eating disorders among the elderly. This is despite the high level of morbidity and mortality associated with these disorders. Current guidelines focus on treatment of eating disorders within the adolescent and general adult age groups, without apparent concessions made for the older age group. The aim of this study was to review existing literature on the demographics and treatment of eating disorders in older people. Methods/design A systematic review of the literature was conducted using CINAHL, MEDLINE, EMBASE, PsycInfo, Scopus, and Web of Science to identify publications focusing on treatment of eating disorders in people over the age of 65 years, age of diagnosis, gender distribution, treatment setting, and treatment outcomes. Results A total of 35 articles (reporting on 39 cases) were relevant to our study, with 33 of the 35 articles being either case studies or case series. The mean age of participants was 73.2 years (range 66–94 years) with the majority (84.6%) being female. Most cases (84.6%) were diagnosed with anorexia nervosa, and 56.4% of all cases were reported as late onset (i.e., after age 40 years). The vast majority (94.8%) received treatment, of which 51.5% was hospital-based treatment. In case descriptions where improvement was reported, the majority described a multidimensional approach that included a combination of hospital admission, therapy and pharmacotherapy. Overall, 79.5% of cases who underwent treatment for an eating disorder improved, while 20.5% relapsed or died as a result of the complications from their eating disorder. There were significant inconsistencies and omissions in the way cases were described, thereby impacting on the interpretation of the results and potential conclusions. Conclusions The information available on the treatment of eating disorders in people over the age of 65 years is limited. The quality of case reports to date makes it difficult to suggest specific assessment or treatment guidelines for this population.
... Research, especially in women, demonstrates that body image concerns, especially weight concerns, tend to continue into adulthood rather than diminish across the lifespan (Kilpela, Becker, Wesley, & Stewart, 2015). For example, 60% of women aged 60-70 years report general dissatisfaction with their appearance (Kilpela et al., 2015;Mangweth-Matzek et al., 2006). Importantly, body dissatisfaction in adult years continues to predict elevated disordered eating symptoms and eating disorders (Slevec & Tiggemann, 2011). ...
Preprint
This study examined the temporal sequence of the relationship between social media use and body dissatisfaction in adults. A representative sample of adults (19–92 years old; M = 52.83, SD = 13.43; 62.02% women, 37.98% men) completed measures of social media use, body dissatisfaction, age, gender, BMI, and demographic variables in 2015, 2016, 2017, 2018 and 2019 (N = 6,258) in the New Zealand Attitudes and Values Study. In the full sample, higher social media use was significantly associated with higher body dissatisfaction one year later, as was higher body dissatisfaction with higher social media use one year later after controlling for body dissatisfaction/social media use (T-1), gender, age, BMI, ethnicity, relationships status, and SES. Effects were small. The prospective pathway from social media use to body dissatisfaction was significant in all age groups but the reverse relationship was only significant in the middle aged and older groups. Both pathway directions were significant in women but only the pathway from body dissatisfaction to social media use was significant in men. The research has limitations and replication is required. However, findings suggest raising awareness about how to use social media positively across the broad community, not merely in adolescents, may be worthwhile.
Article
Purpose: This study examines body satisfaction, weight attitudes, dieting behaviours, and aging concerns of baby boomer women (BBW; born 1946–1965) from rural and urban Manitoba. Methods: Primary data collection occurred November 2015, and 1083 participants completed the Body Image and Food Choice Survey. Four strata of BBW were represented to examine differences between older and younger BBW and location of residence. Multinomial logistic regression models were fit to determine predictors of weight and appearance satisfaction. Odds ratios and 95% confidence intervals were considered significant at p ≤ 0.05. Results: Fifty-three percent of participants were satisfied with their appearance, whereas only 34% were satisfied with their weight. Ninety-one percent desired to lose weight (29.9 ± 29.3 lbs). Aging anxiety was evident for 46% of participants and associated with appearance satisfaction (χ ² = 27.46, df = 4, p < 0.001). Body work and dieting behaviours were used to mitigate body dissatisfaction, and media influence was associated with both appearance (χ ² = 76.17, df = 6, p < 0.001) and weight satisfaction (χ ² = 67.90, df = 6, p < 0.001). Desired weight change, appearance stress, appearance importance, and self-rated health predicted both weight and appearance satisfaction. Conclusions: There is a need for greater awareness of aging women’s body image concerns and the need for age-appropriate tools/resources to help dietitians support women achieve a healthy body image.
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A number of previous studies reported a link between body mass index (BMI) and body appreciation; however, many of these studies were conducted in Western countries and addressed younger samples. Older adults, especially in East Asia, remain insufficiently examined. Therefore, the objective of this study was to examine the relationship between BMI and body appreciation and to explore two potential mediators , body dissatisfaction and body image inflexibility, as proposed in a previous meta-analysis. A community based cross-sectional study was performed among 313 older Chinese men and women (M = 67.90, SD = 7.94). Mediation tests were conducted to examine the roles of body dissatisfaction and body image inflexibility in the relationship between BMI and body appreciation. BMI correlated significantly with body appreciation, body dissatisfaction, and body image inflexibility among older women but did not correlate with body appreciation among older men. Body dissatisfaction and body image inflexibility emerged as significant mediators in the relationship between BMI and body appreciation among older Chinese women. Reducing body dissatisfaction and body image inflexibility may be potential targets for helping older women with high BMI to promote their body appreciation.
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The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight sub-scales measuring: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness and 8) Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N = 113) are differentiated from female comparison (FC) subjects (N = 577) using a cross-validation procedure. Secondly, patient self-report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminate validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.
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Full-text available
The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight sub-scales measuring: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness and 8) Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N = 113) are differentiated from female comparison (FC) subjects (N = 577) using a cross-validation procedure. Secondly, patient self-report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminate validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.
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Objective To illustrate common psychogenic factors involved in undereating and undernutrition in the elderly Method Two cases are described. Results In the context of age‐related physical and social factors, obsessional, phobic, and hypochondriacal anxieties can lead to significant food restrictions and undernutrition. Discussion Psychogenic factors need to be considered in undernutrition of the elderly and the phenomena considered in the spectrum of eating disorders. © by John Wiley & Sons, Inc. Int J Eat Disord 25: 345–348, 1999.
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The study aims were to evaluate the prevalence and distribution of respective eating disorder behaviors (DSM-IV criteria) in a representative community-based sample. Method: Data were obtained from 3,001 interviews of a randomly selected sample of 4,200 individuals' (age >15 years) households in South Australia. Results: Ninety-six (3.2%) of respondents had regular current episodes of binge eating, 48 (1.6%) regularly fasted or used strict dieting, 24 (0.8%) purged. An estimated 8 (0.3%) had bulimia nervosa and 30 (1%) had binge eating disorder. Binge eating and dieting were most common in people who were in their early to mid thirties. Dieting and purging, but not regular binge eating, were more common in women than in men. Purging was most common in the 35–44 year age range. The only behavior significantly associated with (increased) weight was binge eating. Unmarried subjects were less likely to diet than married subjects. No significant differences in rates of these behaviors were found for household income. Discussion: Problematic eating disorder behaviors in older women and in men were more common than expected and merit further clinical and research attention. © 1998 John Wiley & Sons, Inc. Int J Eat Disord 23: 371–382, 1998.
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There are 5 women over the age of 55 with an eating disorder described. In view of a possible increase in the eating disorders among the elderly, the correct diagnosis and treatment of these disorders were emphasized.
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[discuss] the epidemiological research on binge eating and bulimia nervosa / review the findings of the research to date, taking particular account of methodological issues / consider ways in which epidemiological studies might answer broader questions than those simply concerning prevalence and incidence (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Two women with first onset of anorexia nervosa at ages 37 and 41 years presented with certain common clinical features. Both had presented a facade of social adjustment during their adult life, while mainta ning a very dependent and enmeshed relation with their parents. The development of some visible physical stigmata of aging, such as wrinkling and sagging skin, in association with a decline in their parents' health with aging caused their parents to encourage the patients to assume a more independent existence, as they realized that the patients would not remain “their little girls” forever. The patients, who had essentially postponed the adolescent task of separation-individuation for over 20 years, had a great deal of difficulty coping and developed intractable anorexia nervosa. They eventually transferred their dependency upon their spouse and/or grown-up children. Consideration of this factor could be very important in the management of some older eating-disordered patients.