How to Tell If Your Older Patients Are Binge Eating

Older women who binge eat may be at increased risk for metabolic disorders such as diabetes and high cholesterol, according to research presented at the 2022 annual meeting of the Gerontological Society of America (GSA 2022).

According to the National Institutes of Health, 1.6% of women in the United States have a binge eating disorder, which is defined as consuming large amounts of food while feeling loss of control. However, robust data on the prevalence of binge eating among older women are lacking. Some smaller, recent studies have found that the rates of binge eating in community samples of older women range from 12% to 26%.

Researchers from University of Texas Health Science Center at San Antonio aimed to define characteristics of women aged 65 and older who reported binge eating.

Participants in the study included 21 women aged 60 to 75 years who reported at least one episode of binge eating per week within the previous 3 months.

The researchers assessed the women's body composition, their resting metabolic rate, and findings from fasting blood tests. On the basis of body mass index, the majority of the women (90%) were considered overweight or obese.

Slightly over two thirds of the women had prediabetes or diabetes, almost half had high fasting blood sugar levels, and over three fourths had high low-density lipoprotein levels, the researchers found.

For all the participants, bone mineral density was in the healthy range, and a majority of the women had normal blood pressure, according to the researchers.

"Some of the women were on medication, but we're not sure what kind of medication, so it's possible they may have had high blood pressure but it was under control," said Savannah Hooper, BA, a research assistant at UT Health San Antonio's Research to Advance Community Health Center, who is the first author of the study.

The participants were not receiving any treatments specific to their eating disorder, Hooper noted.

"Some of the participants disclosed that this is the first time they told anyone about their binge eating, especially to a physician," she said.

Older women may be less likely to talk with their physician about their eating behavior because of the perceived stereotype that eating disorders primarily occur in teenage or young adult women, according to Jennifer Thomas, PhD, co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, Boston.

"A lot of times in our clinic, we'll be the first ones to hear about some of these disordered eating, even if it's been going on for years or even decades," Thomas, who was not involved with the study, told Medscape Medical News. "If you ask, they are much more likely to disclose it than spontaneously bringing it up."

The participants in the new study also underwent a short physical endurance test that included a 6-minute walk and a hand grip strength test. Over 90% scored below normal for their particular age and gender, according to the researchers.

To date, most studies on binge eating have focused on younger women, Hooper said. Emerging research on older women suggests the two populations' medical risks may be different, indicating a need for a different approach to treat the physical and metabolic problems that may present in older women.

The standard evidence-based treatment for binge eating, regardless of age, is cognitive-behavioral therapy. However, the circumstances that may trigger symptoms of binge eating may differ, depending on a person's stage in life, Thomas said.

"The baseline emotions may be similar, but maybe a young person is thinking about school, while an older person may be triggered because their family has moved away," Thomas said.

"This is really high for any disordered eating behavior in any age group," Hooper said.

Most of the women in the study reported that they started binge eating as early as age 40.

"A lot of women are starting their eating disorders later in life; eating disorders is not a young person's disorder," Hooper said.

"A baby step is to have physicians start to look for this and to ask about it," she said.

Thomas agreed, saying wider implementation of the SCOFF Questionnaire, a five-question screening tool designed to help identify an eating disorder, within primary care settings may help.

Future research should follow older women over time to better assess the prevalence of the disorder as well as older women's physical and metabolic risks, Hooper said.

Such studies may also help scientists better understand whether certain high-risk periods trigger the onset of binge eating, Thomas added.

"In older adults, there are things like menopause, being an empty nester, or having to be a caregiver to children and parents" that might trigger binge eating, Thomas said. "All of these should be investigated as possible stressors that trigger the onset of eating disorders."

GSA 2022: Abstract 35. Presented November 2, 2022.

Lara Salahi is a freelance journalist in the Boston area. In writing this article, she received support from a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations, and the Silver Century Foundation.

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Cite this: How to Tell If Your Older Patients Are Binge Eating - Medscape - Nov 18, 2022.