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Eating disorders in women peak twice — midlife is the second wave

By Dr HB Lo, FACRRM 5 min read
Verdict Yes — worth knowing about

More than 1.1 million Australians are living with an eating disorder, and the most common form — binge eating disorder — is not just an adolescent illness. Research shows eating disorders have a second peak in women during their 40s and 50s, driven by hormonal shifts, life stress, and decades of diet culture.

Eating disorders are serious medical illnesses. They carry medical consequences — including cardiovascular effects, bone density loss, and menstrual disruption — and most are treatable with the right support. Your GP is the right first contact for assessment and care planning.

What just happened

A piece published today in Medical Republic puts GP screening for eating disorders across the female lifespan back in focus — and makes the case that women in midlife are among the most under-recognised groups when it comes to this diagnosis.

That framing matters. The public image of an eating disorder is still, stubbornly, a thin teenage girl. The clinical reality is considerably broader. More than 1.1 million Australians are currently living with an eating disorder — about 4% of the population. The most common form is not anorexia nervosa. It is binge eating disorder, which accounts for 47% of eating disorder diagnoses in Australia and affects people of all genders across a wide age range. The second most common form — 38% of diagnoses — is OSFED: Other Specified Feeding and Eating Disorders, a category that captures the many presentations that don’t fit neatly into a single diagnosis but carry the same level of clinical risk.

Anorexia and bulimia are the diagnoses most people recognise. They represent 3% and 12% of presentations respectively. The majority of people seeking help — including women in their 40s and beyond — are presenting with conditions the cultural template does not prepare us to see.

The both-and

Midlife is not a safe harbour

Eating disorders have two peak periods in women: adolescence and midlife. The perimenopause transition brings hormonal disruption, weight redistribution, disrupted sleep, and mood volatility that can destabilise relationships with food that appeared to be settled for years. For some women, patterns from earlier in life resurface. For others, binge eating disorder emerges for the first time.

The mechanism is not mysterious. Dieting is itself a significant risk factor for binge eating. The physiological hunger that follows restriction, and the guilt that follows breaking dietary rules, can trigger binge episodes that then generate further shame — a cycle that tightens over time. For women in their 40s navigating weight changes they feel pressure to manage, that cycle is a live clinical risk. Perimenopause-related sleep disruption compounds it: poor sleep raises ghrelin (the hunger hormone) and lowers leptin (the satiety signal), making self-regulation around food physiologically harder precisely when life stress is already high.

The medical consequences overlap with what midlife women are already tracking

The medical consequences of eating disorders are worth naming explicitly, because they intersect with the health concerns women in their 40s are often already managing. Binge eating disorder is associated with increased risk of cardiovascular disease, type 2 diabetes, and hypertension. Anorexia and OSFED carry risks of osteoporosis, menstrual disruption, and electrolyte imbalances — all of which are conditions a woman approaching perimenopause is likely already concerned about on other grounds.

Over 80% of adults with an eating disorder have at least one additional psychiatric diagnosis — most commonly mood disorders, anxiety, or PTSD. Eating disorder presentations in women in their 40s frequently sit alongside mental health conditions that are already under active management. What is often missed is that the eating behaviour is itself driving significant distress and medical risk, not just accompanying the psychiatric diagnosis.

Why diagnosis gaps persist

The same stereotypes that associate eating disorders with adolescent girls are the ones that cause clinicians and patients alike to not consider the diagnosis in midlife. A 47-year-old woman who eats secretly, feels acute shame after episodes, and has a difficult relationship with the scales may not connect her experience to the words “eating disorder” — and neither may her GP, unless the conversation is specifically opened.

The consequences of missed diagnosis are not benign. The National Eating Disorders Collaboration is explicit on this: “It is never advised to ‘watch and wait’. If you or someone you know may be experiencing an eating disorder, accessing support and treatment is important.” The watch-and-see response — more likely when the patient does not present as the culturally expected profile — delays access to treatment that meaningfully changes the course of the illness.

What effective treatment actually looks like

Most people with eating disorders recover through community-based care, not inpatient admission. The minimum effective treatment team, per the National Eating Disorders Collaboration, is a GP and a mental health professional. For binge eating disorder, the evidence base supports CBT-E (Cognitive Behaviour Therapy Enhanced), interpersonal therapy, and guided self-help programs. SSRIs have some supporting evidence alongside psychological treatment. For anorexia and OSFED, approaches vary by age and presentation, but GP involvement at the medical management layer is consistent across all of them.

Medicare supports GP mental health treatment plans that can open the referral pathway to psychological therapy. Accessing the right clinical pathway starts with the GP conversation.

My two cents

Eating disorders are underdiagnosed in women in their 40s because the cultural template is wrong. The clinical presentation in midlife — secretive eating, shame, distorted body image, episodes of eating that feel out of control — may not come with the visible weight loss that makes anorexia recognisable. Most eating disorder diagnoses in adult women sit in the BED or OSFED category, where weight may be average or above average, and where the suffering is almost entirely hidden.

If your relationship with food involves significant distress — episodes that feel driven rather than chosen, shame after eating, thinking about food in ways that feel consuming — that is worth naming to your GP. A particular body weight is not required to warrant investigation. Being “not sick enough” is not a reason to wait.

The conversation does not have to start with a diagnosis. It can start with: “I’ve been having a difficult time around food lately and I’m not sure what to make of it.” That is a complete and appropriate opening.

For anyone looking for support or information: the national eating disorder helpline is 1800 33 4673.

Verdict: yes — worth knowing about.

Sources cited

  1. Medical Republic — Eating disorders across the female lifespan: Practical screening and management (16 July 2026). https://medicalrepublic.com.au/eating-disorders-across-the-female-lifespan-practical-screening-and-management/127306
  2. National Eating Disorders Collaboration — Eating disorders in Australia. https://www.nedc.com.au/eating-disorders/eating-disorders-explained/eating-disorders-in-australia
  3. National Eating Disorders Collaboration — Binge eating disorder. https://www.nedc.com.au/eating-disorders/types/binge-eating-disorder
  4. National Eating Disorders Collaboration — Anorexia nervosa. https://www.nedc.com.au/eating-disorders/types/anorexia-nervosa

Frequently asked questions

  • Is it normal for eating patterns to change significantly in your 40s?

    Eating disorders, particularly binge eating disorder, can emerge or re-emerge in midlife. The perimenopause transition — with its hormonal shifts, disrupted sleep, and mood changes — can destabilise relationships with food that appeared to be stable for years. Weight redistribution driven by hormonal changes can also prompt restrictive dieting, which is itself a significant risk factor for binge episodes. If you notice significant distress around food, or episodes of eating that feel out of your control, this is worth raising with your GP. A formal assessment can identify whether what you are experiencing fits an eating disorder diagnosis and what kind of support is likely to help.

  • How do I know if what I'm experiencing is binge eating disorder and not just overeating?

    Binge eating disorder is characterised by recurrent episodes of eating a large amount of food in a short time with a distinct sense of lost control during the episode. It differs from occasional overeating in that the episodes occur regularly (at least weekly for three months to meet diagnostic criteria), they cause significant distress or shame, and the sense of being out of control is a consistent feature. Ordinary overeating at a celebration does not carry the same quality of compulsion or shame. If eating episodes feel driven rather than chosen, and leave you with significant guilt or self-disgust, that pattern is worth discussing with your GP regardless of your body weight.