Date Published: January 23, 2019
Publisher: Public Library of Science
Author(s): Marie Sigstad Lande, Jan H. Rosenvinge, Guri Skeie, Charlotta Rylander, Hajo Zeeb.
Disordered eating (DE) is extensively studied among adolescents and young women. However, there is growing evidence that DE as well as the clinical eating disorders may occur at any age from childhood to advanced years. This study aimed to determine the prevalence and correlates of DE in a representative sample of middle-aged women from Norway. The study included 90 592 women (median age: 55 years) from the Norwegian Women and Cancer study who responded to a questionnaire between the years 2002–2005. Correlates of self-reported DE were assessed by logistic regression analyses. The overall period prevalence of DE between 2002–2005 was 0.28 (95% confidence interval 0.25–0.31) %, and was highest among women ≥ 66 years: 0.65 (0.60–0.70) %. DE was strongly associated with depression (Odds ratio [OR] 3.34 [95% confidence interval 2.53–4.41]), being unemployed (OR 1.78 [1.32–2.40]) and single (OR 1.66 [1.25–2.20]). Women with DE were more likely to report low energy intake (OR 1.41 [1.08–1.86]) and were less likely to be moderately physically active (OR 0.67 [0.47–0.95]). Using the largest study sample in the literature, the present findings confirm smaller studies showing that DE do occur in women in mid-life and older age as well. Our results contribute to address a somewhat under-communicated community health problem that needs attention in terms of age-specific treatment and prevention.
Body dissatisfaction, weight preoccupation, and dysfunctional eating patterns represent the core features of disordered eating (DE). DE, as well as the diagnostic counterparts, anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) have been conceptualized as juvenile problems in terms of etiology (e.g., pre-pubertal risk factors and developmental age specific challenges) and peak prevalence [1, 2]. However, there is growing evidence that DE as well as the clinical eating disorders may occur at any age from childhood to advanced years. Since 1986, several reviews of late onset DE have shown that also developmental challenges related to life transition issues in midlife may elicit DE [3–6]. High prevalence of DE features among older women has also been reported: In a study of 536 women aged 50–64 years, 27% were concerned about being too fat  and among a random sample of 1000 women aged 60–70 years, 60% reported body dissatisfaction . Ng et al. reported a prevalence of 2.6% of DE among 2870 women above 50 years . Another study by Runfola et al. found that body dissatisfaction was highly prevalent (72–93%) among adult women aged 35 to 75 and above, and with no age difference . The latter study contrast other large (n = 1800–27 252) population studies [2, 11–13], which found an inverse relationship between age and prevalence of eating disorders/DE. For instance, a population-based study of about 25 000 Norwegians from mid-Norway reported an overall prevalence of 12% of DE among women above 30 years in 2006–2008 and a negative association with age . Previous studies have also suggested that the focus on thin female body ideals and concerns about being too fat seem to level off after the age of 60 [7, 14]. Thus, although DE is likely more prevalent among younger women, it is still a challenge for women in advanced years and often associated with serious comorbidities. DE in older adults has for instance been associated with higher BMI, and about six times increased risk of anxiety, mood disorders and alcohol dependence [7, 15–20].
Of the 90 592 women included in the present study, 253 reported DE by either selecting AN, BN or both in the questionnaires. This corresponds to an overall period prevalence of 0.28% (95% confidence interval 0.25–0.31%) during 2002–2005 among Norwegian women aged 46–76 years. The prevalence of DE in the oldest age group (≥ 66 years) was significantly higher (0.65% [95% confidence interval 0.60–0.70%]) than in the two younger age groups (Table 1).
In the present study of a representative sample of 90 592 women between 46 and 76 years of age from Norway, we estimated an overall period prevalence of 0.28 (95% confidence interval 0.25–0.31) % of DE during 2002–2005. This finding clearly supports the accumulating evidence that DE do occur also in women in mid-life and in older ages [7, 8, 28–32]. Along with previous studies , our finding that the oldest age group (66–76 years) had the highest prevalence of DE contradict the notion that DE and eating disorder symptoms decline throughout the life span [12, 14].