Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women

Unpacking eating disorder risk and resilience during menopause: a biopsychosocial perspective

OBJECTIVE

Midlife may represent a developmentally vulnerable period for eating disorders (ED) due to the biopsychosocial factors associated with menopause that influence risk and resilience.

METHODS

In this cross-sectional study, we utilized CloudResearch, a leading research participant sourcing platform to recruit, prescreen, and generate a diverse and nationally representative sample of women between the ages of 40 and 65 (n = 467), who voluntarily completed a fully online survey administered through Qualtrics, a web-based survey platform. We examined two conceptually driven, multifactorial models to determine the differential influences of biologic (ie, age, menopause stage, menopause symptoms), psychological (ie, body image, self-perceptions of aging and menopause) and social (ie, social support and strain) on healthy eating and eating pathology, and specific ED behaviors (ie, caloric restriction, binging, purging).

RESULTS

Two multivariate linear regression models were tested. We found that ED risk is elevated by higher body dissatisfaction and reduced by being in perimenopause or postmenopause as compared to premenopause. Resilience (ie, intuitive eating) was elevated by positive perceptions of aging and diminished by higher levels of body dissatisfaction, greater bothersomeness of menopause symptoms, and social support. Binging and purging were elevated by greater bothersomeness of menopause symptoms and greater body dissatisfaction. Dietary restraint was reduced by social relationship strains.

CONCLUSIONS

This study replicates previous research on the important role of menopause symptoms and body image for ED risk. This study is the first to examine factors related to resilient outcomes and specifically the role of self-perceptions of menopause, aging, and social support as mechanisms to affect adjustment to menopause and promote healthy aging.

Eating disorders of the perimenopause

Except for psychosis, women's mental health problems across the reproductive lifespan are common. There are periods in a woman's life, associated with significant sex hormone fluctuations, that render her particularly susceptible to mood disturbance and mental health illnesses, including eating disorders. Whilst eating disorders are usually conceptualized as diseases afflicting adolescence and young adults, there is increasing evidence to suggest the landscape for eating disorders has considerably changed and includes a peak in midlife, correlating with the perimenopause. Inpatient admissions and outpatient clinic attendances have increased amongst older women. It is likely this increasing trend is the result of numerous biopsychosocial factors. A diagnosis of an eating disorder in midlife may be more common in those women simultaneously navigating the perimenopause than in midlife women who remain pre-menopausal owing to the significant ovarian hormonal fluctuations encountered in the perimenopause. Eating disorders are serious illnesses associated with significant morbidity and mortality, which are exacerbated when present at older ages. Research is beginning to recognize the importance of including this typically under-represented cohort of middle-aged women in empirical studies, which is critical to a complete etiological understanding. Recognizing and treating these varied presentations and establishing effective treatments for chronic, recurrent and new-onset eating disorders in midlife women is crucial.

Systematic review of the epidemiology of eating disorders in the Arab world

PURPOSE OF REVIEW

The Arab world is dealing with modernization and sociocultural changes both associated with eating disorders. The present review provides an update of 'Eating disorders in the Arab world: a literature review', which was published in 2020.

RECENT FINDINGS

There are 22 recent epidemiological studies on eating disorders in five different countries in the Arab world. A large-scale national mental health survey reported a 12-month eating disorder prevalence of 3.2% and an eating disorder lifetime prevalence of 6.1%. Binge-eating disorder was the most common eating disorder (12-month prevalence = 2.1%, lifetime prevalence = 2.6%), 1.6% was at high risk for binge-eating disorder. Overall, between 23.8 and 34.8% was at high risk for any eating disorder. Body-shape dissatisfaction, a high BMI and separated/widowed/single marital status were associated with eating disorder pathology.

SUMMARY

Although there is still a lack of studies compared to the western world, the number of epidemiological studies on eating disorders in the Arab world is growing and there is an increase in studies using appropriate assessment-tools and norms. It is recommended to offer specialized treatment and to implement preventive programs.

Disordered eating behaviours during the menopausal transition: a systematic review

Disordered eating refers to a range of eating behaviours and attitudes towards weight and food that can negatively influence physical and psychosocial well-being. The menopausal transition could be a vulnerable period for disordered eating due to major hormonal fluctuations, menopausal symptoms, common body composition shifts, and an increased risk of psychological challenges. This systematic review aimed to summarize evidence on the associations between the menopausal transition and disordered eating. Records published before October 2023 were identified through MEDLINE, PsycINFO, Scopus, Embase, and CINAHL. Studies investigating associations between menopausal status, menopausal symptoms, or reproductive hormone levels, and disordered eating during the menopausal transition were sought. A total of 1301 non-duplicate records were screened, with 10 studies deemed eligible for inclusion. Most included studies used a cross-sectional design (n = 9). Findings include potentially higher levels of binge eating during the perimenopausal stage, whereas restrictive eating behaviours appeared more common during postmenopause compared to premenopause. Both studies investigating menopausal symptoms found strong positive associations with disordered eating. Nonetheless, findings are equivocal with contrasting results and limited methodological quality across studies. Further research is needed to verify these findings and better assist health professionals in supporting healthy eating behaviours in menopausal women during this complex transition. (PROSPERO ID: CRD42021290736).

Nutrition knowledge, attitudes, and perceptions of Greek menopausal women

OBJECTIVE

Nutritional guidelines for postmenopausal women differ. This study aimed to assess postmenopausal women's knowledge, beliefs, and practices regarding nutrition during menopause and their dietary habits.

METHODS

This cross-sectional study was conducted in a menopause clinic, and data from 105 women were analyzed. A nutrition knowledge, attitudes, and perceptions (KAP) questionnaire was designed, structured, and piloted before implementation, based on the Hellenic dietary guidelines. International Physical Activity Questionnaire-Greek version, MedDietScore, and Menopause-specific Quality of Life questionnaires were administered.

RESULTS

The mean ± SD age of the women was 56.9 ± 4.6 years. The mean ± SD KAP score was 12.2 ± 3.5. Those who lived in rural areas had lower KAP scores than those who lived in urban areas ( P = 0.004). Of all the women, 74.5% knew the Mediterranean diet pyramid, whereas 9.8% knew the Hellenic dietary guidelines. Women who had read the guidelines showed better knowledge of Mediterranean diet food groups (Pearson, 0.309; P = 0.039). Knowledge of dairy services was correlated with consumption of dairy products ( P = 0.002). Furthermore, 76.4% were willing to participate in nutrition education programs. The International Physical Activity Questionnaire score was positively correlated with years of smoking ( P = 0.002). Physical activity correlated with adherence to the Mediterranean diet ( P = 0.044).

CONCLUSIONS

The majority of postmenopausal Greek women in this study were unaware of the Hellenic dietary guidelines. In general, women's knowledge of nutrition during menopause was moderate. Greek postmenopausal women are willing to participate in nutrition education programs, which should raise awareness of healthy lifestyles through nutrition, exercise, and smoking cessation.

Menopause, weight, and metabolic health - considerations for a patient centered, multidisciplinary approach

PURPOSE OF REVIEW

To examine the complexity of weight and metabolic changes during the menopausal transition and propose a multidisciplinary care approach to support long-term metabolic health.

RECENT FINDINGS

Menopause, weight and metabolic health changes are influenced by many interplaying factors, and therefore, require a multipronged, multidisciplinary patient centered approach. This approach should start with a medical history and examination. Additional key components include: behavior change principles, mental health evaluation, gynecological care, nutrition, exercise recommendations and sleep care. In addition, when appropriate, weight loss pharmacotherapy and surgical options should be considered. Metabolic health is a long-term chronic process and improvement requires a chronic management approach.

SUMMARY

Applying the framework of chronic disease prevention and treatment to optimizing metabolic health and body weight in peri and postmenopausal women offers an approach that works with the dynamic nature of metabolism changes that occur during aging and the menopausal transition. Using patient-centered care and behavior change principles with this multidisciplinary approach can strengthen its long-term effect.

Binge Eating Risk During Midlife and the Menopausal Transition: Sensitivity to Ovarian Hormones as Potential Mechanisms of Risk

PURPOSE OF REVIEW

Recent research suggests that binge eating may be more prevalent among women in midlife than previously believed. The menopausal transition, an important developmental stage during midlife, is characterized by substantial fluctuations and eventual decreases in ovarian hormones that may contribute to increased risk. This narrative review summarizes findings from studies of binge eating during midlife and menopause and discusses the potential role of ovarian hormones in binge eating risk.

RECENT FINDINGS

Studies are few in number and findings are mixed, with only some studies showing increased binge eating during midlife and the menopausal transition. Sensitivity to ovarian hormones, potentially through gene x hormone interactions, may influence who experiences increased binge eating risk and could help explain mixed findings in the field. Future studies of hormone sensitivity and gene x hormone interactions are needed to further elucidate midlife and menopausal risk for binge eating in women.

Associations between menopause and body image: A systematic review

BACKGROUND

The menopausal transition involves multiple biological and psychosocial challenges that may render middle-aged women vulnerable to body image concerns.

OBJECTIVE

The aim of this study was to summarize evidence on the associations between menopause and body image perception in healthy middle-aged women.

DESIGN

This study is a systematic review of observational studies.

DATA SOURCES AND METHODS

Menopause-related exposure measures included menopausal stages, menopausal symptoms, and reproductive hormone levels during the menopausal transition. Studies investigating body image as an outcome, including through a positive (e.g. body self-esteem) or negative (e.g. body dissatisfaction) lens, were considered eligible. Articles published before March 2023 were identified through MEDLINE, PsycINFO, and Embase and underwent double screening, extraction, and quality assessment by two independent investigators. Characteristics and results were summarized using narrative synthesis.

RESULTS

A total of 820 non-duplicate records were identified, with 18 observational studies deemed eligible for inclusion after full-text screening. All studies investigating menopausal symptoms and body image (n = 6) found some significant association between them, with a higher frequency, intensity, or number of symptoms being associated with greater body image concern. Differences in body image perception between menopausal stages were inconsistent across studies (n = 12), while evidence of potential associations between reproductive hormones and body image was minimal (n = 2). Findings should be interpreted with caution as 17 of the included studies used a cross-sectional design, and not all studies adjusted their analyses for relevant confounders.

CONCLUSION

Overall, menopausal symptoms showed relatively consistent associations with a more negative body image perception. Additional research is required to understand the potential role of menopausal stages and reproductive hormone levels in the body image perception of middle-aged women and to confirm the direction of reported associations.

REGISTRATION

PROSPERO-CRD42021241637.